Smart Akwesasne
Communities lead the way
The Smart Cities Challenge is a competition open to all municipalities, local or regional governments, and Indigenous communities (First Nations, Inuit, and Métis) across Canada.
This Challenge will empower communities across the country to address local issues their residents face through new partnerships, using a smart cities approach.
A smart cities approach means achieving meaningful outcomes for residents through the use of data and connected technology. This approach can be adopted by any community, big or small.
Finalists will receive support to develop their smart cities proposals. Winning communities will be awarded with prize money to help implement them.
https://impact.canada.ca/en/challenges/smart-cities
Section I: Applicant information
Question 1: Please provide the following information on your community
- Name of community: Mohawk Council of Akwesasne
- Province/Territory: Ontario and Quebec
- Population: 12,315 people – Mohawk Council of Akwesasne, office of vital statistics
- Indigenous community: Yes
Question 2: Please select a prize category.
- $5 million (population under 30,000 residents)
Section II: Preliminary proposal
Question 3:
Decrease the rate of new cases of diabetes per year in Akwesasne to the Canadian average (0.5%; 5.9/1,000) by improving community wellness using traditional approaches encompassing holistic Indigenous practices, improved access to community services and health diagnostics.
Question 4:
Please describe the outcome (or outcomes) your proposal seeks to achieve by elaborating on your Challenge Statement.
Overweight, older and low income populations are at higher risk of Type 2 diabetes, as are those of Indigenous descent, whose situation is compounded by barriers to care. Diabetes Canada states the rate of diabetes for First Nations individuals living on a reserve is 3-5 times higher than other Canadians. The rate in Akwesasne is 30%, more than three times the national average of 9% and consistent with research on diabetes within First Nations populations. Beside the misery of diabetes itself, many complications arise with this preventable disease that can cause premature death, as well as increased risk of hospitalization due to cardiovascular disease, end-stage renal disease, and non-traumatic lower limb amputation.
According to the Mohawk Council of Akwesasne’s (MCA) Department of Health Diabetes Management Team, in 2017 there were over 100 people — an estimated 0.9% of the Akwesasne population — referred to them. These referrals were for:
- people not diagnosed but at risk for prediabetes and diabetes mellitus
- people diagnosed with prediabetes mellitus or diabetes mellitus in the past six months
- people who have been diagnosed with prediabetes mellitus or diabetes mellitus in a period more than six months ago.
High rates of diabetes are negatively impacting our community members’ quality of life. From a survey done in February 2018, Akwesasne residents rated health as the most important area of their lives. Health related comments included:
“Without good health, everything else is difficult to enjoy, or access”;
“If I am not healthy, I can not take care of my family”;
“My health is required to provide for my family”.
Twenty-five per cent (25%) of Canadians with diabetes indicated their treatment adherence was affected by cost. According to Diabetes Canada the majority of Canadians with diabetes pay more than 3% of their income or over $1,500 per year for needed medications, devices and supplies out of their own pocket.
New research from the University of Toronto’s Dalla Lana School of Public Health found that each person living with diabetes requires care costing the Canadian health-care system an average of $16,000 over eight years, compared to $6,000 in average health care costs for people without diabetes.
The main goal of this Smart Cities Challenge will be to reduce the number of new cases of diabetes per year moving forward in the community of Akwesasne. By implementing smart technologies, the MCA will reduce the number of people referred to the Diabetes Management Team to the national average of people diagnosed with diabetes per year. This will be accomplished by improving approaches to community wellness, use of traditional holistic Indigenous practices, improved access to community services, tracking of health diagnostics, and collaboration and data sharing using innovative digital applications.
Specific goals to support reduction in new diabetes cases in Akwesasne will break large goals into smaller ones. In each area of targeted change we will apply design strategy to identify uniquely appropriate approaches combining traditional ways with data sharing and mobile technology, all to prevent diabetes.
We will improve diets, increase regular physical activity, and create better access to healthcare and traditional healing practices for everyone in the Akwesasne communities to decrease risk factors. Clinical practice guidelines for diabetes will be embedded into the new processes for monitoring and managing all cases. The diabetes management team will use best practice guidelines and clinical reference tools as part of client centered approach to risk reduction. Risk reduction is a stronger approach as not all risk factors are modifiable.
Often caused by lifestyle factors, diabetes mellitus (type 2 diabetes) can be prevented. Smart technologies will be used to educate the community on diabetes, prediabetes and prevention of diabetes while incorporating holistic approaches embedded in our Indigenous traditions. Smart technologies will be used for collection and aggregation of totals to create transparent health result measures.
Two of the biggest prevention areas will be improving diet and increasing regular exercise. As part of the Smart Cities Challenge, the MCA will implement smart technologies to improve diets of the community and increase levels of physical activity.
Holistic Indigenous practices – Goodmindedness, Peacefulness and Strength
Holistic Indigenous practices refer to approaching health and wellbeing from more than just a clinical perspective. Akwesasne is part of Haudenosaunee nations and remains connected to those roots. Three principles that were introduced to the people as the Peacemaker traveled the land: Kankonhriio or Goodmindedness, Skennen or Peacefulness and Kasastensera or Strength. This became known as the Great Law of Peace. Essentially, what the Peacemaker taught throughout the territory was that the practice of Kanikonhriio or Goodmindedness would bring Peace or Skennenkowa to the people in the land. When the Peacefulness was pervasive through the territory, the people would gain a Strength or Kasastensera that could not be overcome by negative forces.
From a Haudenosaunee perspective Goodmindedness, Peacefulness and Strength are synonymous with mind, body and spirit a concept that has gained significant popularity in alternative healing practices.
In the Haudenosaunee Wellness Model, the ‘health’ of Haudenosaunee individuals, families, clans, communities, nations and overall confederacy can be measured using indicators strictly from our teachings and cultural mores. Likewise, an individual can receive guidance on a process to return to a state of ‘health’ using our traditional teachings and ceremonies.
The Haudenosaunee Environmental Task Force has proceeded with a project to develop an environmental protection process based on their indigenous world view and relationship with the natural world. Such a process enables individual nations and communities of the Haudenosaunee to protect and restore the natural world, while helping to preserve their unique relationship with it, as a sustainable society. The process devised criteria and indicators for health of the natural world, including people, which has a foundation in Haudenosaunee culture and traditions. These criteria and indicators will form part of our multi-level measuring.
Challenge: Geography and Accessibility
The geographical footprint of Akwesasne is unique and includes jurisdictions in Ontario and Quebec, and the state of New York. For many citizens, significant distances and travel times impact accessibility to services. This limits accessibility to fresh, healthy food. It limits access to facilities and infrastructure where physical health, fitness activities and training are provided.
Canadian healthcare is at best fragmented in our territory.
Straddling two provinces and a state, access to healthcare is complexly difficult for many. The Canadian domiciled Akwesasne population of 12,300 is evenly split between Ontario and Quebec. Those who live in the Ontario district are under the Ontario Health Insurance Program (OHIP), while those in the Quebec districts are under the Regie de l’Assurance Maladie program (RAMQ). The provincial health insurance programs have differing service levels. According to the Director of the Health Department for the MCA, these differences present challenges when trying to ensure follow up on diagnostic, secondary and tertiary services.
As an example, a disabilities and auditory appointment to follow up an initial diagnoses is much better if you’re in Ontario than in Quebec. The OHIP Akwesasne residents navigate the healthcare system faster, and services are centralized in one hospital center, either the Children’s Hospital of Eastern Ontario or the Ottawa Hospital for adults. Quebec RAMQ Akwesasne residents, on the other hand, have a harder time navigating this healthcare system. Referrals start at the Local Community Health Centre (CLSC) in Huntington. This is the entrance point of Quebec services. Residents are then screened at the Barrie Hospital for their next visit to another referring specialist. After that, they are screened to receive follow up at the Montreal General Hospital, if required. This is not a seamless process and involves three different locations for health services. The access to healthcare for all community members of Akwesasne needs to be improved.
Community Engagement
A Satisfaction and Experience Survey was conducted by the MCA Department of Health in 2017 and focused on what services community members had accessed in the past year. It asked about their satisfaction with the services offered, and what they considered the biggest health issue in the community. It asked what the Department of Health could do to create healthier generations in the Akwesasne community. Results suggest that a large portion of the respondents had accessed services for diabetes and nutrition education, Green Food Box (fresh produce at a discounted price) and fitness programming. At 32% the Akwesasne community believes the biggest health issue they are facing is related to diabetes, with 17% identifying obesity, and 12% the lack of physical activity. In regards to what the Department of Health could do to create healthier generations 44% suggested more education on health including information on diabetes, physical activity, drugs and nutrition, while 37% suggested improved diets, education on healthy foods, and better access and promotion of physical activity.
In February 2018, zu and MCA co-developed a survey that the MCA took to community members. The survey asked respondents to rank areas of life in importance to them. At 63% health was ranked the most important. The second most important factor was earning a good living, followed by safety, environment, and culture.
The survey also asked what service or program that could best benefit from better technology. Most responses were for health, followed by online services such as banking, applications/forms, voting, and education and schools. People within the Akwesasne community see health as the foundation for everything else. Health is required to earn a living, to be happy, and to care for and provide for their families.
Measuring Success
The chief measurable for this project is the number of new diabetes mellitus diagnoses throughout the Akwesasne community as tracked by the MCA’s Department of Health and Diabetes Management Team. Currently, the Team uses a paper form to track referrals, diagnoses of prediabetes mellitus and diabetes mellitus, and other information collected during that appointment.
Through the Smart Cities Challenge, we will update and digitize this form to track all appointments and information gathered at that time to better support the team. Ideally, information related to progress in the challenge can be used anonymously as a form of transparent and up-to-date feedback on where we are as a community.
Another measurement to track: of the number of people being diagnosed with prediabetes mellitus how many converted to a diabetes diagnosis vs. how many reverted to a healthy status. This and other information will be a basis for individual private health management. Using smart technologies, we plan to personalize engagement measures and cross reference them to key health measures. From there we can create plans for improvement in our focus areas of eating, exercise, and traditional health measures. We expect that a community achieving better levels of engagement in regards to healthy eating, activity levels and adoption of traditional mindsets would see positive results reflected in diabetes diagnoses numbers.
Healthy diets play a key role in healthy lifestyles and diabetes prevention. Healthy food choices are to be tracked via integrated online grocery ordering data from the Akwesasne areas. We will categorize food according to the Canada Food Guide and track the community’s consumption of healthy diets based on online orders, with goals compared to actual achievements in food ordering behaviour. Healthy traditional recipes and cooking videos will be available via the proposed websystem providing additional tools as well as behaviours to be measured.
Food security is another ongoing concern in Akwesasne. To address this and support healthier diets, a community smart greenhouse is part of our approach, providing opportunities for Akwesasne to grow healthy food independently. Gardening also revives a community tradition and builds engagement around new approaches to health.
Improving physical activity levels in Akwesasne is another measurable area for reducing diabetes risk. Data on physical activity will be collected through an online portal, or by offline processes were necessary. Enrolment in community physical activities and fitness facilities attendance will be recorded, as will usage of instructional videos made available through the websystem. Personalized training plans may be prescribed by health professionals based on each persons’ medical situation, age, and weight. The Smart Cities system may also facilitate inter member and ad hoc team challenges, so rival groups could compete to have higher activity levels and fitness measures, recognizing fun and friendly competition as good ingredients for fitness improvement.
Having a whole community make lifestyle changes along multiple parameters is a challenge. Having them adopt new reporting methods, technologies and learn new “apps”, no matter how straightforward, is an ambitious challenge. There is a reservoir of pride, however, to be tapped in Akwesasne; a latent sense of being powerful together that will help us activate our internal strength. Even if it necessitates giving up easy but harmful ways that are not from our own traditions.
Using the tools and approaches developed by the Smart City Challenge will enable us to coordinate and collaborate on the necessary changes we need to reverse this plague of diabetes. We bring our sense of community and friendly competition to the table to challenge one another to be our best.
The Smart Cities technology we are imagining will tie in actual results on the behaviours we seek to modify, showing us where to go to next, and transparently reveal whether we are elevating ourselves into a new era of health, or further deteriorating. Our traditional ways will give this new technological approach the heart it needs to be relevant to us. The outcome is admittedly ambitious, but it is achievable and so important to achieve.
The outcomes of the success of the implementation of our Smart Cities protocol are measurable first in the principle goal figure of reducing new cases of diabetes, and secondly, in the lifestyle measures that reduce the risk of diabetes. While specific measures need to be explored, we foresee 4-6 measures to track improvement in each of the action areas: health analytics, healthy eating, physical activity and adoption of traditional ways.
We foresee personal data collection but anonymous sharing. With Smart Cities we can develop and use technology to create a transparent sharing of our predicament and how to get out of it. We will share the challenge and improved wellness.
Avoidance of diabetes going forward would indicate a major overall improvement in health and well-being for this community, and provide a way forward for other communities that adopt the protocol we will model.
In combining the new digital tools and medical knowledge the modern world provides with our traditional approaches that protected our health and environment in the past, our community will build a modern foundation of health to move forward. With health, all things are possible.
Question 5:
Please describe how your community residents have shaped your Challenge Statement. Describe your plans for continuing to engage and involve them in your final proposal going forward.
The Mohawk Council of Akwesasne Department of Health conducted a Community Health Program Open House Survey in 2017. This survey was distributed throughout the community and 41 responses were received. The survey was made available online and promoted throughout the community using the Mohawk Council of Akwesasne’s Facebook page, radio announcements and e-newsletters distributed through email. The survey focused on which health services people had accessed in the past year, level of satisfaction with those services and in the respondents opinions, what are the biggest health issues in the community. The survey also asked the community what the Department of Health could do to create healthier generations.
The survey asked community members which services they had accessed in the past year. From the respondents, 19.5% said they had accessed diabetes education on an individual level and 9.8% had accessed at a group level. For nutrition education, 24.5% respondents had used the individual services and 7.3% had used the group services. The most accessed service from the survey was the Green Food Box, with 65.9% of the respondents using it in the past year. The Green Food Box is a service offered by the Department of Health that provides fresh fruit and vegetables to households at a low cost of $10 on a monthly basis. The survey also showed that 22% of respondents had accessed individual fitness programming and 19.5% had accessed group fitness programming.
The results from what the Akwesasne community believes to be the biggest health issue they are facing were related to diabetes (32%), obesity (17%) and the lack of physical activity (12%). Ideas for what the Department of Health could do to create healthier generations were more education on various aspects of health including diabetes, physical activity, drugs and nutrition (44%), improved diets and education on healthy foods (37%), and better access and promotion of physical activity.
In the summer of 2017, the Mohawk Council of Akwesasne Department of Health and Department of Community & Social Services conducted a strategic analysis of their departments. An environmental scan and a SWOT analysis was completed. These reviews identified areas to focus on to improve their services to meet the needs of Akwesasne. There were 14 objectives that came from this analysis that focus on increasing safety and promoting a healthier community and work environment between the Department of Health and the Department of Community & Social Service.
Mohawk Council of Akwesasne contracted a digital agency, zu.com communications from Saskatoon, to assist them in community engagement for the Smart Cities Challenge.
A survey was created, SMART Akwesasne, and was available online and promoted throughout the community using the Mohawk Council of Akwesasne’s Facebook page, radio announcements and e-newsletters distributed through email. There were 61 people that respond to the survey. The age range of respondents was 18 to over 65. Over half of the respondents were between age 35 and 50 (55%). Of the remaining respondents, 21% were between the ages of 18 and 35 and 23% were over the age of 50.
Respondents were asked to rank the areas of life in importance to them. Health was the most important with 63% of the respondents choosing it. People within the Akwesasne community see health as the foundation for everything else. Health is required to earn a living, be happy, care for and provide for their families.
Community members also ranked the relative importance of transportation, safety, earning a good living, health, community, food, culture and environment. The second most important factor identified after health was earning a good living. This was followed by safety, environment, and culture.
The survey queried community members about how they see technology being used in Akwesasne and what would be the most obvious service or program that could benefit from better technology. Technology was named as a tactic to improve online services like banking, applications/forms, voting, education and schools.
The results of this survey were consolidated by zu and presented to the Mohawk Council of Akwesasne at a workshop in February 2018. There were facilitated group discussions about the results of the survey. The group used design strategy approaches to explore how the group could utilize the Smart Cities Challenge to address the largest concerns in Akwesasne. From the design thinking activities the group effectively collaborated in creating Challenge Statements addressing the community’s needs most pressing needs.
On April 2018 zu facilitated a second design thinking workshop with stakeholders from Mohawk Council of Akwesasne. In this workshop the group rolled up their sleeves to further narrow the focus of the challenge project. Additionally, they envisioned supporting activities and projects. From these structured sessions and workshops, and from referencing survey data, a Challenge Statement was developed that best reflected a foundational challenge in Akwesasne.
The development of the Challenge Statement resulted from examining health statistics, surveys, undertaking community engagement, by determining what factors are most important and most troubling to community members and by using design strategy approaches to mobilize the collaborative power of Akwesasne leadership. With this data and tools we succeeded in identifying key challenges and possible solutions. From a focus on health we identified preventing diabetes as a key risk factor, associated with many other medical issues. Access to health care, access to suitable food, access to physical fitness resources and facilities, and access to educational materials are all exacerbating factors leading to higher rates of diabetes diagnosis. To improve the diabetes situation we will start with improving these contributing factors.
The design thinking methodology provided by zu is not just for generating initial direction; it is for the continuous testing of progress as the development and implementation of the Smart Cities program comes to life. This approach encompasses the ideas of user-centered design that focus on getting whatever is built –whether software, physical product or new process– right for the end user. If what comes from the challenge does not fit what Akwesasne members need and are comfortable using, all will be for nought.
zu’s design strategy begins with an evaluative process, its touchpoints and systems. It encompasses the entire ecosystem of the community, its services, and people. Their business blueprint is built on design strategy methodology and putting users first. By placing user needs at the heart of this ecosystem, it allows them to focus investment towards making changes that matter. For Akwesasne, we are looking to create an informed argument for the requirements which should be created or developed further to create value for the community.
zu’s strategic process is iterative–progressing in many small steps as opposed to a few large leaps. Strategy is never siloed away from development; it’s interconnected and plays a big role in informing development to create more accurate and valuable features.
The first step in the approach is discovery. zu will lead strategic thinking sessions throughout the organization, bringing in various stakeholders to help create vision and focus. Through a combination of interviews and exercises, zu takes an in-depth view at the intricacies of the entire community.
zu trusts the emotional impact of workshops. Bringing together stakeholders in a relaxed and spirited setting creates buy-in and unearths major opportunities and roadblocks providing the roadmap for a successful project. Initial activities are not limited to a specific set of exercises they are tailored for the group or individual in order to:
- Envision future states and new features
- Uncover deepest hopes and fears
- Align strategic thinking
- Create focus
- Define value
- Establish experience principles
- Storyboard experiences
- Set KPIs
Surveys will continue to be used to gain feedback as new initiatives are introduced. Existing survey results will be used as baseline data for comparison to future results and to track successes through development and implementation of our Smart Cities tactics. A forum will be included in the websystem that will harvest ongoing feedback on our progress, on the newly implemented services to the community, and on our future plans. Ongoing feedback from our Akwesasne end users is key to staying on track. Involvement of those we are innovating for is crucial to ending up with programs and services that are accepted and utilized.
Sub-section 2 – Preliminary proposal details
Question 6:
Please describe your preliminary proposal and its activities or projects.
The Health Optimizing Framework we are planning to design will combine personal record keeping, public data aggregation and reporting, educational information, and a myriad of smaller applications to facilitate all the associated work our program is designed to make happen. Depending on the initiatives we hope to complete in initial phases mobile app-lets will facilitate scheduling, sharing, tracking, educating, as well as containing motivational elements to engage and personalize the community wide initiatives.
The integration of applications and resources will have a home base in an Internet accessible application, but will live in mobile versions carried by everyone with a cellphone in the community. At this point in our preliminary planning we are adding as many suitable ideas to the possibility list as we can, understanding that a smaller list of priorities will be undertaken in the first phase. Other ideas will be saved for a future phase backlog.
A core aspect of this project will be to create a mobile websystem that improves access to information and services. This lack of access has been identified as impediments to good health in our findings and is believed to be a contributor to the number of new diabetes cases. The websystem will allow for community members to create an account personalized to their health data and needs. Here they will access educational resources, coordinate use of public transport to access the needed essential services, and utilize a delivery system for food. The websystem will track their activities and allow interaction with other people in the community.
From a healthcare perspective, each person’s account will provide them with education on diabetes prevention and management of the disease. Through the application they will communicate with health professionals who can work with high risk patients to identify risk factors, manage risk factors and have the ability to diagnose prediabetes as well as an early diagnosis of diabetes. Professional healthcare support will include nutritionists, traditional healers, doctors and pharmacists.
The websystem will provide improved access to traditional healers and information about therapies based on holistic indigenous practices. We envisage the shared system containing a database of traditional healing methods and guidelines for applying traditional therapies. The websystem will also assist with the delivery of alternative healing practices via online registration, schedules and assistance with transportation arrangements.
Community members will also track their own health diagnostic measures to better understand and manage their health. District wide kiosks for self-monitoring of key health measures like blood pressure, weight and other low maintenance monitoring will also help people understand and manage their health. Personal tracking this information could then be entered into people’s digital account to assist with tracking their personal data. Collection of this data and comparison to healthy ranges would identify those at risk of the disease or from complications from diabetes and prediabetes. For people with concerns or questions about their results the system will provide an option to book an appointment with a healthcare professional.
Access to healthcare and health information is a current challenge in Akwesasne. As part of the Smart Cities Challenge, Akwesasne would like to introduce a transport system integrated into various services. With the purchase of two electric delivery type vans, these vehicles will be used for the transport of people between jurisdictions to necessary services. Simultaneously, the vehicles will provide a delivery service of food, medicine and other groceries. A digital tracking system with GPS and a scheduling application will be needed for people to use the delivery system as well as to request a trip between jurisdictions. This system can be incorporated with the websystem and can be accessed in each personal account.
To reduce the number of new diabetes cases we know that increased levels of physical activity are a key part of our Smart Cities Challenge program. The promotion and education of physical activity will be included in the websystem and be part of the customization for each person. There will be the ability to track each person’s level of physical activity. This activity information, as well as other information in personal accounts, can then be aggregated into the community information with the goal of transparent but anonymous sharing of status and results. Dashboard summaries held in the websystem will engage interest and encourage shared responsibility for progress.
Services such as fitness centre and fitness class schedules would be posted, with personal reminders if someone were to sign up for a class or activity. Community events such as a community run/walk could also be communicated through the websystem. Online fitness videos such as traditional dance classes could also be provided to allow for physical activities to be done at a convenient time and place for people.
Managing a healthy diet also plays a key role in diabetes and prevention. Through the websystem, self reporting one’s diet can be done to track if they are eating healthy. The personal tracking of nutritional performance will be used with the goal of transparent but anonymous sharing of information with the whole community in dashboard summaries. This can also be shared with health professionals who can then provide personalized coaching at in-person appointments or through online interactions. Education on healthy diets, food storage and reducing food waste can be done through online resources. Healthy traditional food fact sheets, and culturally appropriate, healthy recipes could be included on the websystem. Creation of cooking videos with Mohawk chefs using local foods and traditional recipes would also be available via the websystem.
To address the food security concerns reported throughout Akwesasne, an online grocery ordering and delivery system will be developed. Recipes available on the websystem could link to a digital grocery list connected to the online grocery ordering system. This system would best be integrated into local grocery store inventory systems. Further integration would include connection to the delivery vehicles, scheduling system and geolocation of van and shopper. This information flow will provide us with various data points to track and monitor participants’ diets, system difficulties and identify new opportunities for propagation of a healthier lifestyle, and a reduction in new diabetes diagnoses.
Beyond the online grocery ordering and delivery system, an online pharmacy for order and delivery of medicines could be developed to expand the service offering.
Introducing a community smart greenhouse is another key initiative that will be done to not only provide healthy, fresh food to the Akwesasne communities, but will also help address the food security issues that are present due to the geographical challenges. A smart greenhouse will provide an opportunity to educate community members on all aspects of food production and healthy food options. It will also be another source of healthy food for the community.
Smart greenhouse controls vary from manual to fully automated. Automation can include temperature control, the amount of light saturation, humidity levels, soil moisture as well as other factors. Smart greenhouses can be controlled remotely over the cloud through an app, eliminating the need for a person to be present for most operational needs. By using IoT, sensors and actuators, factors such as temperature and humidity can be monitored remotely, and changed based on needs to create the most viable growing environment for the products. (https://emeraldkingdomgreenhouse.com/blog/the-smarter-greenhouse/)
A digital websystem with the ability to track each community members’ health and activity levels will be a key tool in our goal of creating initiatives planned to reduce the diagnosis of diabetes. Key health measurements, physical activity levels and diet will be tracked using self and automated reporting. Views of educational resources and videos are also trackable and measurable data, reflecting engagement. The use of the new electric vans to increase access to healthcare, for delivery of more nutritious food whether from stores or our own smart greenhouse also provides additional data on lifestyle changes.
Each identified area for improvement is planned to contribute information to the system. Using smart technologies these specific measures, once identified, can be collected individually, anonymized for privacy, and then aggregated into scores for the community as a whole. This data can be used in many ways to transparently make the community aware of their combined condition, and whether they can share the pride connected to turning the situation around, or the disappointment in being unable to create healthy change. The combination of parameters can be used to give individual scores for each of the measures, as well as an overall score predicting movement away or towards disease.
In even more ambitious approaches, individual plans and targets touching all measurement areas could be created for each participant to further engage community members in their own health outcomes. Using digital technology, systems of alerts and polling could be created to facilitate compliance by essentially coaching people, and allowing “pokes” from team mates or other community members. It is not impossible to envisage system participants using this technology to form teams or teams based on geographic regions to compete as groups in regards to activity levels, dietary changes or even health diagnostics, such as the combined average BMI of a whole neighbourhood.
There are many ideas to contribute to the Smart Cities Challenge of reducing the number of new diabetes diagnoses. By using design thinking, community engagement, and prototyping we will be able to identify the exact projects that will have the most impact on the community and reducing new cases of diabetes. Projects that aren’t developed and integrated in the next phase of the Smart Cities Challenge can be considered in future phases.
The websystem that we are planning to develop is scalable, replicable and non-proprietary. The system is undoubtedly focussed on creating community wide lifestyle changes for the prevention of diabetes in Aboriginal communities. But this challenge is not one only faced by Aboriginal people. In targeting the prevention of diabetes, a worldwide epidemic, it will be an initiative of interest to many jurisdictions. Information flowing from additional other community users will increase the evolution of the system, perhaps expanding its interactions to wider populations and their experiences. With its integrated digital approach to practical lifestyle changes, this system can continue to evolve based on use of new available technologies and better understanding of human health. In integrating holistic traditional practices it respects the importance of reverence for one’s environment, one’s own health and the understanding that right practices leads to internal strength.
Question 7:
Please describe the ways in which your preliminary proposal supports your community’s medium and long-term goals, strategies, and plans.
To supplement your response, please provide any relevant documents and make clear linkages and references.
The Mohawk Council of Akwesasne developed a Comprehensive Community Plan that is a community owned and community driven document. It covers goals and objectives in subject areas that are most relevant to community members. The eleventh goal of the plan is to “improve our health and well-being” and is based on feedback from community members rating health and well-being of the community to be average to below average. Member-identified areas in need of improvement include having adequate and accessible health programs and services, reducing the level of drug and alcohol abuse in our community, and reducing pollution of air and water.
In addition to the expansion of medical clinics, specialized medical care and hospitalization services, ambulance services and traditional medicine, many members indicated the need to establish a hospital or clinic in Tsi Snaihne. Also identified is the need to expand health services tailored to community members with special needs and disabilities including in-home care, in-home therapy, and transportation.
Of the twenty different objectives supporting the goal of improving health and well-being in Akwesasne, eight of the objectives will be touched on with this Smart Cities Challenge aiming to reduce the number of new diabetes diagnoses. These eight supported objectives are:
- Promote use of traditional medicines (train community members and health staff on how to identify, gather, prepare and use traditional medicines).
- Recruit more health navigators to facilitate communication between our community members and the correct health personnel within the health facility.
- Encourage collaboration across health departments, facilities and jurisdictions.
- Incorporate mental health services and prevention programs within our community health programs and services.
- Promote the use of telehealth services.
- Establish a healing lodge in our community for traditional healing practices.
- Incorporate holistic healing principles and culture into medical services.
- Provide training to health staff around cultural competency and public interactions.
The Mohawk Council of Akwesasne developed a Strategic Plan in early 2016. Within the document, key priorities are listed that also relate and support this Smart Cities Challenge. The second priority is well-being and the fourth is modernization with supporting strategies to promote a healthier and stronger community. Education, information technology and communications as well as community gatherings are important pieces linked in this document to the Smart Cities Challenge.
The Smart Cities Challenge proposed in this application not only greatly reflects a need in the Akwesasne community, it corresponds to the planned blueprint for change in the community. The Comprehensive Community Plan is guiding the Mohawk Council of Akwesasne to implement impactful change by using openness and collaboration throughout the community for community members. By integrating a smart cities approach, the Mohawk Council of Akwesasne will be able to accelerate positive change using data and connected technology, and provide tools for other communities to follow.
Question 8:
Please describe your community’s readiness and ability to successfully implement your proposal.
This section should include:
- Experience with implementing complex projects (i.e. multi-stakeholder, multi-dimensional) that span multiple business lines and functional units.
- Structures, processes, and practices in place or planned for managing and implementing complex projects that span multiple business lines and functional units.
- Organizational strengths and potential weaknesses for managing and implementing a smart city proposal, and plans to address weaknesses to ensure successful proposal management and implementation.
Akwesasne is ready and able to successfully implement our proposal to reduce the number of new people being diagnosed with diabetes mellitus. This confidence is based on our attitude, skills, knowledge, and experience with implementing complex projects in the past that resulted in meaningful, positive outcomes for our community.
The Akwesasne Territory includes portions in Ontario, Quebec, and New York State. No other First Nation in Canada has these jurisdiction and geographic challenges. The Mohawk Council of Akwesasne (MCA) exercises jurisdiction and delivers programs and services to those community members who reside in the portions of the Akwesasne Territory situated within Canada.
As a result of our geography, we’ve taken the opportunity to build relationships with the Federal Government of Canada and the Provincial Governments of Ontario and Quebec. We routinely meet with all three to develop partnerships for assistance. As you can imagine, implementing projects is a complex experience due to our location and jurisdictional boundaries, but it’s an experience we’ve become accustomed to, and even excel at.
SAFE WATER
A key project implemented by MCA years ago now provides safe and healthy water and wastewater services to the community. This began over 20 years ago as a project with 6 small basic water treatment pump houses servicing approximately 10% of the buildings in Akwesasne. Major growth and improvements have continued over the years. And by optimizing two main water plants classified by Ontario as Class 3 Design, we now have a Water and Wastewater Program servicing approximately 97% of our homes.
The plant located in the Quebec portion of our Territory serves two Districts with 27 kilometers of water main and approximately 950 service connections. The plant in the Ontario portion serves one District with over 9 kilometers of water main and approximately 450 service connections. Our Program utilizes Ontario’s stringent regulations and certification process as “best practices” to deliver potable water to the community and to discharge safe wastewater to the environment. We currently have 8 technicians cross-trained in water and wastewater, with certifications ranging from Basic Operator in Training to a Class 3 Water Distribution Certification (with Class 4 being the top Ontario certification).
What started as a project over the years has grown into a program. The progress our community made was only possible through the relationships and partnerships formed with Federal and Provincial governments and First Nation organizations.
HOUSING
Another important service provided to community members is ensuring equal access to affordable and quality housing. There are a number of housing projects we have implemented to do just that. In the late 1990s, 20 units (1 & 2 bedrooms) were built in Kanatakon for Elders to independently reside. During the same general time period, 34 units (3 bedrooms) were built on Kawehnoke geared toward low-income families. During the past 3 years, a total of 14 units were built in Tsi Snaihne. For low income, single mothers, living in overcrowded homes we built 6 units (3 bedrooms) and an additional 8 units (2 bedrooms) were provided non-specifically to all community members. These projects were made possible through funding provided by Federal partners. All of the units mentioned are consistently 100% occupied.
AKWESASNE NON-INSURED HEALTH BENEFITS
Back in 1995, we initiated discussions with the Medical Services Branch (MSB) of Health Canada to assume administration of the Non Insured Health Benefits for our community members. As a pilot project, we were given 6 weeks to set up computers, hire employees, and develop programs to incorporate fields specific to MSB programs. Every 3-6 months we were given another program to administer as we had exceeded the expectations of the MSB. Within a year, we had full administration of the Dental, Pharmacy, Medical Supplies & Equipment, Medical Co-Pay and Vision programs. Our policies were created using a framework provided by MSB and tailored to suit the specific needs of our community members. The Medical Co-Pay Program we currently have is exclusive to Akwesasne and is due to the fact that we have the Ontario/Quebec border running through our community. It allows our Quebec residents to be seen in Ontario for medical services. These advancements made since 1995 were possible because of our relationship and partnership with Health Canada.
EMERGENCY MEASURES
MCA has implemented an Emergency Measures Program to provide a controlled and coordinated response to emergencies that occur within the Territory of Akwesasne. The Akwesasne Joint Emergency Operations Plan was created through collaboration of the three (3) governing bodies within the Territory of Akwesasne: the Mohawk Council of Akwesasne, Saint Regis Mohawk Tribe, and the Mohawk Nation Council of Chiefs. The Plan includes technical response supports from over 100 internal and external partners and stakeholders on both sides of the Canada/US border. Some of our partners include: Canadian/US Border Services, Canadian/US Coast Guard, Ontario Provincial Police, New York State Troopers, Ontario Power Generation, New York Power Authority, Hydro Quebec, Cornwall Electric, and National Grid.
The Akwesasne & Local Emergency Planning Committee was established in 1990 to ensure that all training, testing, and exercises are planned, coordinated, and shared with partners/stakeholders to avoid duplication and better manage finances. Any one of our Emergency Operations Centers can be activated to oversee, manage, and coordinate an emergency and assist first responders and emergency personnel if the need arises.
STRUCTURES, PROCESSES, and PRACTICES
MCA, as an organization, consists of 9 departments and 61 programs administered by 12 Directors and 22 Managers. Specifically related to implementing this proposal, the MCA has a Finance Policy in place that covers operating plans, budgetary controls, financial reporting, authority limits, expenditures, asset management, tendering/contracts, and capital tendering. In addition, we have capital project management procedures and an agreement processing administrative directive in place.
ADDRESSING ORGANIZATIONAL WEAKNESSES
A recent organizational review was undertaken to identify and address organizational weaknesses. In response to the results of this review, we have taken steps to participate in a results based management pilot project with the goal to encourage enhanced reporting on measurements that matter to the community.
Question 9:
Describe your plan for using the $250,000 grant, should you be selected as a finalist. Provide a high-level breakdown of spending categories and an accompanying rationale.
The $250k grant will accelerate the planning and prototyping needed to complete the Smart Cities project. We will produce a minimum viable prototype of the websystem, and identify costs, options and deployment plans for the non-digital proposal components.
Design Thinking and User Experience
Design Thinking is planned to be used for collaborative creation through both the $250,000 assessment stage, and the $5 million dollar development phase.
In the first phase we plan to produce working prototypes of certain functionality, but will concentrate on developing the plan for the complete system.
Identification of Measurable
These basic branches of information are:
- Diabetes Health Analytics
- Accessing Health Care support
- Healthy Eating
- Physical Activity Levels
- Adoption of Indigenous Holistic Practices.
Impactful but practical sub-measures will need to be preliminarily identified in each of these to frame the systems preliminary scoreboard.
Creation of A Community Member Account Profile
Here we rough in design for individual account data receptacle which holds lifestyle measures and administrative data. Privacy measures preserving data anonymity and sharing will be scoped into the planning process.
Modelling of Websystem Data Warehouse
Here we consider the development of databases forming the hub of the system and its administration. All functionality will occur between distributed individual mobile and desktop applications and this central point.
Additional Data Collection
Once measurables associated with desired outcomes are potentially identified, we scope budgets and resources to gather information via surveys and interviews to delineate the current state.
Modeling of Prototype from Illustrated to Functional
As our Design Thinking exercises produce direction and priorities, we will begin to model selected functionality allowing some user testing. The build phase will include multiple rounds for full system development.
Modelling of Community Dashboard
While considering the planning of the final data repository for health and lifestyle measurements, we will use Design Strategy to model how our transparent reporting system dashboard will meet the needs of users.
Estimation of Smart Greenhouse System
Concurrently, we will develop a business plan for the Smart Greenhouse System. This will involve research to work-up set-up and operational costs, training and staffing.
Estimation and Logistics Investigations for Electric Vans
The electric van delivery and transportation system will also be examined as a cost center. This initiative requires development of a software application to optimize scheduling for health services access and for deliveries. Planning and cost estimations for algorithm development based on geographic information, location of grocery outlets and medical services and actual community member needs will be scoped.
Holistic Indigenous Practice Curriculum Development
With the eventual goal of creating a curriculum for on and offline delivery an assessment of resources for traditional approaches to health will be planned.
Change management and Human Resources
Overlying all the other assessment and planning work will be addressing the need communicating and engaging the community in these ideas and their development. Additionally, we will identify new responsibilities and jobs associated with sustaining the proposed system and its ability to deliver positive health outcomes.
Question 10:
Describe the partners that are or will be involved in your proposal. Where partners are not yet determined, describe the process for selecting them.
The Mohawk Council of Akwesasne plans to bring on zu who is a digital products and services firm in Saskatoon as their digital partner. They use design strategy to drive innovation within organizations. zu works with clients committed to building modern solutions for mature industry problems.
The team at zu find success through collaboration, execution and long-term adaptation. They help clients form ideas, build digital products and services, and adapt for what’s next.
Innovate
True innovation is a product of collaboration and will. And it doesn’t have to be painful. Together we will define problems, build buy-in around a single direction and rapidly deploy solutions informed by users. Through the innovation services, zu offers design strategy, digital products and service design as well as software prototyping.
Build
Building the right solution is important. It begins by asking the right questions and solving the right problems. It results in quality products that stand the test of time. In a project build, zu will lead clients through a project assessment, design, development and project management.
Adapt
Implementing a forward thinking software development lifecycle improves long-term cost avoidance and maximizes the value from your investment. We are here to support, optimize and adapt your business-critical assets. Because good software is nurtured software. Ongoing support, optimization and adaptation are services provided to clients once a project is completed.
zu has partnered with the Mohawk Council of Akwesasne over the last year working on design thinking and potential digital projects. The Mohawk Council of Akwesasne and zu have worked together on community engagement and designing an approach for the Smart Cities Challenge. zu supported the direction of the application from a digital design perspective and will continue to do so as these projects move forward. Together, zu and the Mohawk Council of Akwesasne will develop smart projects that will support the decrease of new cases of diabetes mellitus throughout the Akwesasne communities while continuing to engage the community throughout the process.
zu has years of success in working with communities on major digital projects including large community engagement efforts, both with the City of Saskatoon and the City of Regina.
An example of an educational application developed by our partner zu, is The Help Me Tell My Story application assessment uses a holistic approach to assessment that measures oral language, development for Prekindergarten and Kindergarten children. In order to provide a holistic view of each child’s learning, the assessment collects data from the children, their caregivers, their teachers and Elders in their community. It provides immediate access to results for educators and caregivers through easy-to- use web-based tools. The overall purpose of this assessment is to help create real and measurable change in the oral language development of children across Saskatchewan.
Other experts may be involved in future phases of the project as consulting experts. These may include fitness consultants, Diabetes Canada, agrologists specializing in greenhouse food production and other relevant experts. The process for choosing these experts could be completed through a request for information.