high death rates of Indian infants - nearly three times the national average - generally reflect postneonatal death related to infectious disease that develops before trained help can be obtained.2 Low income, poor housing, poor sanitation, unavailability of health care services and inadequate nutrition have been found to be significant factors in infant mortality.3 Indian health care auxiliaries have been recommended as the key factor in promoting health care education and providing early diagnosis and treatment of pediatric infectious disease to combat infant mortality.4 The high incidence of infectious disease, including otitis media and its complications, has been strongly linked with poverty, overcrowding, bottle-feeding, poor sanitation, poor nutrition and poor hygiene.'7 The high incidence of diabetes, hypertension, diseases of the gallbladder, dental disease and anemia in native people has been linked with poor nutrition; the use of native community health care workers to monitor diseases such as diabetes and hypertension, and to teach nutrition and health care education has been strongly advocated.8'2 The high incidence of violent death and alcoholism in native populations reflects the problems of poverty, unemployment, despair and cultural domination. Clearly it is only an integrated approach, under native leadership, that will have any impact on this health problem. The field personnel of the medical services branch have strongly recommended similar approaches, particularly that of strengthening the role of the native health care auxiliary in primary health care and health care education.13'14 I suspect that as long as the medical services branch is not responsive to the perceptions of its frontline personnel it will continue to make serious errors of judgement in planning and financing its health care services. As long as it is not responsive to the perceptions of the native people it serves it will fail to bring about improvements in health. Instead of just being sympathetic with native peoples' "demand for universal health care and the movement towards devolution of responsibility to the bands", per-

haps Dr. Black could reflect further on the Declaration of Alma-Ata; it affirmed that health care is a fundamental human right and stated that "existing gross inequality in the health status of the people. within countries is politically, socially, and economically unacceptable... [and that] people have a right and duty to participate individually and collectively in the planning and implementation of their health care . . in the spirit of self-reliance and self-determination."1 GRETCHEN ROEDDE, MD

Community physician Bear Island Lake Temagami, Ont. Health planning consultant Grand Council Treaty #Nine Timmins, Ont.

References 1. A hna-A ta 1978. Primary Health Care. Report of the International Conference on Primary Health Care, Alma-A ta, USSR, 6-12 Sept em ber, 1978, World Health Organization, 1978 2. GOLDTHORPE WG: Infant health in an outpost area. Can Fain Physician 21: 75, May 1975 3. BRENNER C, REISINGER KS, ROGERS

KD: Navajo infant mortality, 1970. Public Health Rep 89: 353, 1974 4. NUTTING PA, STROTZ CR, SHORR GI, et al: Reduction of gastroenter-

itis morbidity in high-risk infants. Pediatrics 55: 354, 1975 5. LUPIN AJ: Ear disease in western Canadian natives with a note on treatment by tympanoplasty. J Otolaryngol 5: 116, 1976 6. RATNESAR P: Chronic ear disease

along the coasts of Labrador and northern Newfoundland. Ibid, p 122

7. MANNING PJ, AVERY ME: The relationship between suboptimal nutrition and chronic otitis media in Inuit children in the eastern Arctic; commentaries on otitis media, in Circumpolar Health, SHEPHARD RJ, ITOH S (eds), U of Toronto Pr, Toronto, 1976, p 413 8. SIEvERS ML: Diabetes mellitus in

American Indians - standards for diagnosis and management. Diabetes 25: 528, 1976 9. SABRY ZI: Nutrition in Canada. Can J Public Health 65: 342, 1974 10. JOHNSTON JL, WILLIAMS CN, WEL-

DON KLM: Nutrient intake and meal patterns of Micmac Indian and Caucasian women in Shubenacadie, NS. Can Med Assoc 1 116: 1356, 1977 11. WILLIAMS CN, JOHNSTON JL, WEtDON KLM: Prevalence of gallstones

and gallbladder disease in Canadian Micmac Indian women. Can Med Assoc 1 117: 758, 1977

1346 GMA JOURNAL/NOVEMBER 17, 1979/VOL. 121

12. DESAT ID, LEE M: Nutritional status of Canadian Indians. I. Biochemical studies at Upper Liard and Ross River, the Yukon Territory. Can J Pub/ic Health 75: 369, 1974 13. CHAPMAN L, ROBERTS E: Point of contact. Can Nurse 74: 28, 1978 14. WooDs D: Community health symposium. Part I: a new togetherness and Indian care. Can Med Assoc J 113: 1095, 1975

Research in general practice To the editor: I read with interest Dr. William A. Falk's editorial entitled "Research in general practice" (Can Med Assoc J 120: 1198, 1979). Dr. Falk's comments are well taken, particularly those with respect to the deterrents to the general practitioner undertaking research. The Physicians' Services Incorporated Foundation, operated by the physicians of Ontario, has for several years attempted to encourage general practitioners to undertake research and apply to the foundation for funding. We recognize that lack of training in research skills is a deterrent to some general practitioners, and we are prepared to put those who are interested in contact with experts in the field of research design and methodology. In addition, the foundation is prepared to consider providing some compensation to physicians who lose income from their practice as a result of undertaking a foundation-funded research project. I encourage practising physicians in Ontario to apply for funding at the address below. I was pleased to note Dr. Falk's reference to the national influenza surveillance study carried out by the College of Family Physicians of Canada;1 funding for the Ontario portion was initially provided by the foundation. C.A. BOND Executive director The Physicians' Services Incorporated Foundation 4881 Yonge St., Ste. 304 Willowdale, Ont. M2N 5X3

Reference 1. Canadian Influenza Surveillance Working Party: First report: methods of the national recording system. Can Fain Physician 23: 64, Sept 1977