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An Overview of Aboriginal Health in Canada

An Overview of Aboriginal Health in Canada

SETTING THE CONTEXT

An Overview of Aboriginal Health in

Significant health disparities exist between Aboriginal and non-Aboriginal . The factors that underlie these health disparities and hinder our ability to address them are multi-faceted. This fact sheet provides a general introduction to Aboriginal health in Canada and to the broad context in which Aboriginal communities, health practitioners, policy- makers and researchers seek to improve the health and well-being of Aboriginal peoples. Specifically, it provides an overview of Aboriginal peoples, the social determinants that impact their health, current health status indicators, and the jurisdictional framework for Aboriginal health policies and programs.

Who Are Aboriginal Peoples in Canada?

‘Aboriginal peoples’ collectively refers to the original inhabitants of Canada and their descendants, including , , and Métis peoples, as defined in Section 35(2) of theCanadian Constitution Act, 1982. According to ’s National Household Survey (NHS),1 in 2011 there were 1,400,685 people in Canada who self- identified as Aboriginal, representing 4.3% of Canada’s total population (Statistics Canada, 2013a).

First Nations First Nations peoples are original inhabitants of the area now known as

1 The 2011 National Household Survey (NHS) replaced the 2006 long-form census and has raised concerns for quality and comparability over time (Sheikh, 2013). Statistics Canada has identified potential limitations to the NHS data due to incomplete enumeration of 36 Indian reserves and low response rates among certain populations (Statistics Canada, 2013b). Due to the limited data available from the 2011 NHS, this fact sheet relies heavily on data obtained from the .

sharing knowledge · making a difference partager les connaissances · faire une différence Canada. Within this population there exist Métis Indian” according to the federal many distinct cultural groups or nations, In French, the word “Métis” translates as government are considered “non-status.” including 630 distinct communities “mixed.” There exists some debate over Based on the 2011 National Household (Assembly of First Nations, n.d.) and who is considered Métis, with some taking Survey, Statistics Canada reported approximately 60 different languages a broader definition than outlined by the that there were 213,900 First Nations (Statistics Canada, 2013a). Based on the Métis National Council (MNC). The people who were not Registered Indians 2011 National Household Survey, there are MNC defines Métis people as individuals in Canada, representing 25.1% of the an estimated 851,560 First Nations people who self-identify as Métis, are of historic total Aboriginal population (Statistics living in Canada. About 49% of First Métis origin (mixed First Nations and Canada, 2013a). Three-quarters of this Nations people reported living on-reserves, European heritage, descendants primarily population reside in urban areas, with while 51% live off-reserve. The majority of 18th century fur traders and First the largest numbers in metro , (approximately 75%) of First Nations Nations in the area known as the Métis , , -Gatineau people residing off-reserve live in urban Homeland), and are recognized by the and , respectively (Indian and areas (Statistics Canada, 2008). Métis Nation (Métis National Council, Northern Affairs, 2009). n.d.). Métis people have a distinct culture, Inuit traditions and language ( ) which The Daniels Decision Inuit peoples are original inhabitants contribute to their collective consciousness In early 2013, the Federal Court of Canada of the Arctic regions of the area now and nationhood (ibid). The 2011 National ruled in a decision known as the “Daniels known as Canada. The majority of the Household Survey reports that there are Decision” that Métis and non-status 59,445 Inuit people in Canada live in approximately 451,795 Métis people in Indian peoples be considered “Indians” their traditional territories in four regions Canada (Statistics Canada, 2013a). under section 91(24) of the Canadian collectively known as Constitution Act, 1867 (CBC News, (Statistics Canada, 2013a). These regions Non-Status and Urban Aboriginal Peoples 2013). Although the full implications of are: (Labrador), Many people who self-identify as the Daniels Decision are not yet clear, this (northern ), , and the Aboriginal are not registered under decision potentially doubles the number of Inuvialut Settlement Region in the Canada’s 1876 , which defines people considered status Indians under the (Inuit Tapiritt who is considered a “status Indian” and 1876 Indian Act. The federal government Kanatami, n.d.). Close to 70% of the thus eligible for a range of programs and appealed the decision and is unlikely to Inuit people speak , although services offered by federal and provincial implement it while the case is under appeal, the number of people reporting it as agencies. People who identify as First a process that could take several years. their is declining (Statistics Nations but who are not a “Registered Canada, 2008).

2 Data Limitations in Aboriginal Public Health

ublic health assessments and interventions, including those Ptargeting Aboriginal populations, depend on complete and accurate statistical information about the health and well-being of groups of people in order to be effective. Unfortunately, in Canada there exists a serious deficit in the availability of accurate, complete, and up- to-date statistical information about the health of certain sub-populations of First Nations, Inuit, and Métis peoples (Smylie, 2010). Many Aboriginal health data initiatives, for example, have not collected Aboriginal Health in Canada Determinants of Health data on non-registered First Nations Health is determined by many different people, or on Métis or Inuit people Prior to European contact, Indigenous factors affecting individuals, communities living in urban areas (Ibid.). Further, peoples of Canada had fully functional and populations. Health research focused inconsistencies in First Nations, Inuit, and systems of health knowledge that were on Aboriginal populations in Canada Métis ethnic identifiers in provincial health practiced within the contexts of their shows that “health disparities are directly data collected through vital registration specific ways of knowing and being. and indirectly associated with or related systems, hospital administrative datasets, However, the diseases and conflicts of to social, economic, cultural and political and acute and chronic disease surveillance colonization devastated Indigenous inequities; the end result of which is a systems means that these populations disproportionate burden of ill health populations and their systems of are often invisible in health statistics and social suffering on the Aboriginal Indigenous health knowledge. Although (Ibid.). Although work is underway to populations of Canada” (Adelson, 2005, the health of Aboriginal populations in improve data regarding the health of First Canada has been improving in recent years, p. S45). Nations, Inuit, and Métis populations, First Nations, Inuit, and Métis peoples these initiatives are isolated. The lack of continue to experience considerably lower The social, economic, cultural and political health outcomes than non-Aboriginal inequities that impact the health of statistical information in this fact sheet is Canadians. On many health indicators, individuals and communities are often a reflection of the limited availability of First Nations, Inuit, and Métis peoples referred to as “social determinants of complete, accurate, and up-to-date data on 2 continue to show a disproportionate health.” It is important to acknowledge Aboriginal health that is disaggregated by burden of disease or health disparities. there are differences in the socio-economic sub-population and geographical location. These disparities are often rooted in health circumstances and lived world experiences inequities, which are the “underlying of First Nations, Inuit, and Métis peoples, causes of the disparities, many if not most between status and non-status, on-reserve of which sit largely outside the typically and off-reserve, as well as urban and rural constituted domain of ‘health’” (Adelson, Aboriginal populations. Nevertheless, economic status and well-being between 2005, p. S45). These are referred to as several decades of census data and other Aboriginal and non-Aboriginal people in determinants of health. research show a persistent gap in socio- Canada (Reading & Wien, 2009).

2 For more information on how social determinants can impact health, please refer to the NCCAH’s Social Determinants of Health fact sheets, which can be found at www.nccah-ccnsa.ca/en/publications.aspx?sortcode=2.8.10&searchCat=2&searchType=0 and Wilkinson, R. and M. Marmot, eds. (1998). Social Determinants of Health: The Solid Facts. Copenhagen: World Health Organization.

An Overview of Aboriginal Health in Canada 3 Despite a modest improvement in the Household overcrowding and poor in Canada but also around the world socio-economic status of Aboriginal housing conditions (dwellings in need of (Gracey & King, 2009; King, Smith, & peoples in Canada over recent major repair) in Aboriginal communities Gracey, 2009). In Canada and elsewhere, decades, many of the underlying social are also improving, but regional statistics Indigenous peoples are affected by major determinants of poor health remain. show that they are still major problems in health problems at rates much higher Canada’s 2006 Census data shows that some areas. While the rates of household than non-Indigenous populations. These fewer Aboriginal people between the overcrowding remained steady in Canada’s health issues include high infant and young ages of 25 and 34 obtained high school non-Aboriginal population at 1.4% and child mortality; high maternal morbidity diplomas (68.1%) than non-Aboriginal have decreased in the total Aboriginal and mortality; heavy infectious disease people (90.0%) (Indian and Northern population from 7.6% in 1996 to 4.3% in burdens; malnutrition and stunted growth; Affairs Canada, 2009). The 2005 median 2006, overcrowding rates reached 23% in shortened life expectancy; diseases and income for Aboriginal people was Nunavut and 8% in (Indian death associated with cigarette smoking; almost $10,000 lower ($16,752) than and Northern Affairs Canada, 2009). social problems, illnesses and deaths for non-Aboriginal people ($25,955), Similarly, Aboriginal people were three linked to misuse of alcohol and other and despite a 10% increase in Aboriginal times as likely as non-Aboriginal people drugs; accidents, poisonings, interpersonal employment between 1996 and 2000 to live in houses in need of major repair, violence, homicide and suicide; obesity, (compared to a 4.1% increase in non- and over 22% of dwellings in Aboriginal diabetes, hypertension, cardiovascular, and Aboriginal employment during the same communities in 5 provinces and territories chronic renal disease (lifestyle diseases); time period), the rate (Saskatchewan, Northwest Territories, and diseases caused by environmental for Aboriginal people in 2006 was still , , and Nunavut) were in contamination (for example, heavy metals, more than twice that for non-Aboriginal need of major repair in 2006, compared industrial gases and effluent wastes) (ibid). people (13.0% compared to 5.2%) (Ibid.). with an average of 7.0% in non-Aboriginal The First Nations Regional Health communities in Canada (Ibid.). Although accurate, complete and current Survey (RHS) in 2008/10 showed no data on Aboriginal health status in improvements in household income from Aboriginal Health Status Canada is lacking, a general picture of 2002/03, and in fact observed an increase A common and Aboriginal health status is pieced together in low income levels for First Nations resulting economic, social and cultural in a document published in 2012 by communities (First Nations Information marginalization has had profound health the National Collaborating Centre for Governance Centre, 2011). impacts on Indigenous peoples not only Aboriginal Health (NCCAH) entitled

4 The State of Knowledge of Aboriginal considered to have reached “epidemic” 2010). Aboriginal peoples in Canada Health. This document draws together levels in First Nations communities, are also disproportionately affected by existing research focused on maternal, where adults are four times as likely to environmental contamination, particularly fetal and infant health; child health; suffer from Type 2 diabetes and are more in Arctic regions where the traditional communicable disease; non-communicable likely to experience health complications food sources of Inuit populations have disease; mental health and wellness; related to the disease than are non- accumulated environmental toxins, leading violence, abuse, injury and disability; Aboriginal Canadians (Thommasen, to a variety of health problems (Fontaine, environmental health; and food security Patenaude, Anderson, McArthur, & et al., 2008). and nutrition. Tildesley, 2004). In some First Nations communities, youth suicides occur at a Wellness and Resilience Despite variations between different rate 800 times the national average, while In spite of the considerable health issues First Nations, Inuit, and Métis groups, in others, suicides are virtually unheard and challenges outlined above, Aboriginal Aboriginal populations in Canada face of (Chandler and Lalonde, 1998). The peoples continue to demonstrate resilience many urgent health issues. Aboriginal suicide rate among Inuit communities and strive for wellness based in Indigenous people are over-represented in HIV in Arctic Canada is ten times that of the ways of knowing and being. Aboriginal infection rates. While they comprised general Canadian population (Kral, 2012). approaches to health are often rooted in a only 3.8% of the population in 2006, Violence against Aboriginal women is holistic conception of well-being involving they accounted for 8% of people living also considered to have reached epidemic a healthy balance of four elements or with HIV and 12.5% of new infections proportions in many parts of the country, aspects of wellness: physical, emotional, in 2008 (Monette, et al., 2011). They with Aboriginal women 3.5 times more mental and spiritual. These four elements also experience disproportionate rates likely to experience violence than other are sometimes represented in the image of tuberculosis at 26.4 times the rate of Canadian women (Native Women’s of the medicine wheel (King et al., 2009). Canadian-born non-Aboriginal people Association of Canada, 2009). As of Many Aboriginal people in Canada have (Public Health Agency of Canada, 2010, the Native Women’s Association suffered the loss of connections to their 2007). Although limited data exists of Canada had documented 582 cases of land, cultures, languages and traditional about rates of diabetes in Métis and Inuit missing or murdered Aboriginal women ways of life through colonial practices populations, Type 2 diabetes is now (Native Women’s Association of Canada, such as forced relocations, the Indian

An Overview of Aboriginal Health in Canada 5 reservation system and the residential environment and jurisdictional confusions care, prescription drugs, medical supplies schooling system, which removed several have created barriers to equitable access to and equipment, transportation and other generations of children from their families health care and services (ibid). services (FNIHB, 2008). and communities. In this context, the revitalization and recovery of Aboriginal For the majority of Canadians, including The provision of health care services cultures, traditions and ways of knowing Métis, off-reserve status and non-status to Aboriginal peoples in Canada is can have profound restorative impacts Indians, health services are financed in a constant state of flux. In recent on health and well-being at both the through the national health insurance years, FNIHB has been working with individual and the community levels plan and administered at the provincial communities to transfer responsibility (Kirmayer, Simpson, & Cargo, 2003). or territorial level. For on-reserve First for provision of on-reserve health care Nations and Inuit communities, the federal services to communities and tribal government finances and administers councils. Under the Health Transfer Policy Aboriginal Health Policy health services through the First Nations initiated in 1989, individual communities and Programs and Inuit Health Branch (FNIHB). have negotiated with FNIHB to transfer FNIHB administers several programs, varying levels of health care responsibility Aboriginal health policy in Canada is including community-based programming to the community or council level (Health made up of a complicated “patchwork” of for health promotion and disease Canada, 2005). Legislation regarding policies, legislation and agreements that prevention; primary health care centres provision of health services also exists in delegate responsibility between federal, and nursing stations in about 200 remote varying degrees at the provincial/territorial provincial, municipal and Aboriginal communities; public health programs level, and this is largely focused on defining governments in different ways in different focused on prevention of communicable areas of jurisdiction and setting parameters parts of the country (NCCAH, 2011). disease, safe drinking water, and other for agreements regarding delivery of Although in some cases, the administration public health issues; and non-insured services between provincial, federal and of Aboriginal health services is adequate, health benefits, which covers expenses Aboriginal government entities. However, in other cases the gaps and ambiguities not typically covered by provincial health most provinces have transferred authority created by a complicated policy care plans, including dental and vision for health service planning and delivery

6 to regional health authorities, and several provinces also have Aboriginal-specific policies to address gaps and coordinate cross-jurisdiction service provision. In short, multiple levels of authority and responsibility are involved in the provision of services to Aboriginal communities, with a general tendency towards delegating responsibility to local levels (NCCAH, 2011). In the absence of a clear national Aboriginal health policy, jurisdictional gaps and inconsistent levels of funding continue to create barriers for many Aboriginal communities (Lavoie, Forget, & O’Neil, 2007).

Conclusion

This fact sheet has provided a general introduction to Aboriginal health and an overview of the broad context within which First Nations, Inuit, and Métis communities, along with health practitioners, policy-makers and researchers, seek to improve the health and well-being of Aboriginal populations in Canada. Although the challenges faced by Aboriginal communities are References First Nations Information Governance Centre. (2011). RHS Phase 2 (2008/10) Preliminary Results. complex and varied, there is increasing Ottawa, ON: Author. Retrieved on May 14, 2013 Adelson, N. (2005). The embodiment of inequity: recognition that First Nations, Inuit, and from http://www.rhs-ers.ca/sites/default/files/ Health disparities in Aboriginal Canada. Canadian Métis peoples possess the knowledge, ENpdf/RHSPreliminaryReport31May2011.pdf Journal of Public Health, 96(2): S45-S61. determination and resilience rooted in Fontaine, J. Dewailly, E. Benedetti, J.L., Pereg, D., their varied traditions and cultures to Assembly of First Nations. (n.d.). Description of the Ayotte, P., & Déry, S. (2008). Re-evaluation of blood meet those challenges, particularly if they AFN. Ottawa, ON: Author. Retrieved March 5, 2013 mercury, lead and cadmium concentrations in the from http://www.afn.ca/index.php/en/about-afn/ are aided by culturally-appropriate care Inuit population of Nunavik (Québec): A cross- description-of-the-afn in the maintenance and enhancement of sectional study. Environmental Health, 7: 25. their health and well-being. Canadian Broadcasting Corporation [CBC]. (2013). Gracey, M., & King, M. (2009). Indigenous health Federal Court grants rights to Métis, non-status part 1: Determinants and disease patterns. The Indians. CBC News, January 8. Retrieved March For more Information Lancet, 374: 65-75. 4, 2013 from http://www.cbc.ca/news/politics/ story/2013/01/08/pol-cp-metis-indians-federal- Health Canada. (2005). Ten years of health transfer · Assembly of First Nations court-challenge.html First Nation and Inuit control. Ottawa, ON: Author. www.afn.ca/index.php/en/policy-areas/ Retrieved March 4, 2013 from http://www.hc-sc. Chandler, M.J., & Lalonde, C. (1998). Cultural health-and-social-secretariat gc.ca/fniah-spnia/pubs/finance/_agree-accord/10_ continuity as a hedge against suicide in Canada’s First · Inuit Tapiriit Kanatami years_ans_trans/index-eng.php www.itk.ca Nations. Transcultural Psychiatry, 35: 191-219. Indian and Northern Affairs Canada. (2009). · Métis National Council First Nations and Inuit Health Branch [FNIHB]. A demographic and socio-economic portrait of www.metisnation.ca (2008). Fact sheet – First Nations and Inuit Health Aboriginal populations in Canada. Ottawa, ON: Branch. Ottawa, ON: Author. Retrieved March 3, · National Collaborating Center Author. Retrieved March 5, 2013 from http:// 2013 from http://www.hc-sc.gc.ca/ahc-asc/branch- for Aboriginal Health publications.gc.ca/collections/collection_2010/ainc- dirgen/fnihb-dgspni/fact-fiche-eng.php www.nccah-ccnsa.ca inac/R3-109-2009-eng.pdf

An Overview of Aboriginal Health in Canada 7 Inuit Tapiriit Kanatami. (n.d.). About Inuit. Ottawa, Native Women’s Association of Canada. (2009). May 14 from http://www.theglobeandmail.com/ ON: Author. Retrieved March 5, 2013 from https:// Violence against Aboriginal women in Canada commentary/canada-has-lost-its-census-anchor/ www.itk.ca/about-inuit (backgrounder). Ottawa, ON: Author. article11795465/

King, M., Smith, A., & Gracey, M. (2009). Native Women’s Association of Canada. (2010). Smylie, J. (2010). Achieving strength through Indigenous health part 2: The underlying causes of the What their stories tell us: Research findings from numbers: First Nations, Inuit, and Métis health health gap. The Lancet, 374(9683): 76-85. the Sisters in Spirit initiative. Ottawa, ON: Author. information. Prince George: National Collaborating Retrieved on May 14, 2013 from http://www.nwac. Centre for Aboriginal Health. Kirmayer, L., Simpson, C., & Cargo, M. (2003). ca/sites/default/files/reports/2010_NWAC_SIS_ Healing traditions: Culture, community and mental Report_EN.pdf Statistics Canada. (2008). Aboriginal Peoples in health promotion with Canadian Aboriginal peoples. Canada in 2006: Inuit, Métis and First Nations, Australasian Psychiatry, 11(s1): S15-S23. National Collaborating Centre for Aboriginal 2006 Census. Ottawa, ON: Author. Retrieved Health [NCCAH]. (2012). The state of knowledge March 7, 2013 from http://www12.statcan.ca/ Kral, M.J. (2012). Postcolonial Suicide among Inuit of Aboriginal health: A review of Aboriginal public census-recensement/2006/as-sa/97-558/pdf/97-558- in Arctic Canada. Culture, Medicine, and Psychiatry. health in Canada. Prince George, BC: Author. XIE2006001.pdf 36(2): 306-325. National Collaborating Centre for Aboriginal Health Statistics Canada. (2013a). Aboriginal Peoples in Lavoie, J.G., Forget, E., O’Neil, J.D. (2007). Why [NCCAH]. (2011). Looking for Aboriginal health Canada: First Nations People, Métis and Inuit, equity in financing First Nations on-reserve health in legislation and policies, 1970 to 2008: A policy National Household Survey, 2011. Ottawa, ON: services matters: Findings from the 2005 National synthesis project. Prince George, BC: Author. Author. Retrieved on May 8, 2013 from http:// Evaluation of the Health Transfer Policy. Healthcare www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-011- Policy, 2(4):79-96. Public Health Agency of Canada. (2007). Special x/99-011-x2011001-eng.pdf report of the Canadian Tuberculosis Committee: Métis National Council. (n.d.). The Métis Nation. Tuberculosis among Aboriginal peoples of Canada, Statistics Canada. (2013b). Aboriginal Peoples Ottawa, ON: Author. Retrieved March 6, 2013 2000-2004. Ottawa, ON: Author. Reference Guide: National Household Survey, 2011. from http://www.metisnation.ca/index.php/who- Ottawa, ON: Author. Retrieved on May 14, 2013 are-the-metis Reading, C., & Wien, F. (2009). Health inequalities from http://www12.statcan.gc.ca/nhs-enm/2011/ and social determinants of Aboriginal Peoples’ health. ref/guides/99-011-x/99-011-x2011006-eng.pdf Monette, L.E., Rourke, S.B., Gibson, K., Bekele, T.M., Prince George, BC: National Collaborating Centre Tucker, R., Greene, S., et al. (2011). Inequalities for Aboriginal Health. Thommasen, H.V., Patenaude, J., Anderson, N., in determinants of health among Aboriginal and McArthur, A., & Tildesley, H. (2004). Difference Caucasian persons living with HIV/AIDS in Sheikh, M. (2013). Canada has lost its census anchor. in diabetic co-morbidity between Aboriginal and : Results from the Positive Spaces, Healthy , May 9, 2013. Retrieved on non-Aboriginal people living in Bella Coola, Canada. Places study. Canadian Journal of Public Health, Rural and Remote Health, 4: 319. 102(3): 215-19. IONDESIGN.CA

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© 2013 National Collaborating Centre for Aboriginal Health. This publication was funded by the NCCAH and made possible through a financial contribution from the Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.

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