Excess Mortality, Institutionalization and Homelessness Among Status Indians in Canada

DISCUSSION PAPER SERIES IZA DP No. 10416 Excess Mortality, Institutionalization and Homelessness Among Status Indians in Canada Randall Akee Donna Feir DECEMBER 2016 DISCUSSION PAPER SERIES IZA DP No. 10416 Excess Mortality, Institutionalization and Homelessness Among Status Indians in Canada Randall Akee University of California, Los Angeles and IZA Donna Feir University of Victoria DECEMBER 2016 Any opinions expressed in this paper are those of the author(s) and not those of IZA. Research published in this series may include views on policy, but IZA takes no institutional policy positions. The IZA research network is committed to the IZA Guiding Principles of Research Integrity. The IZA Institute of Labor Economics is an independent economic research institute that conducts research in labor economics and offers evidence-based policy advice on labor market issues. 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IZA – Institute of Labor Economics Schaumburg-Lippe-Straße 5–9 Phone: +49-228-3894-0 53113 Bonn, Germany Email: [email protected] www.iza.org IZA DP No. 10416 DECEMBER 2016 ABSTRACT Excess Mortality, Institutionalization and Homelessness Among Status Indians in Canada* In this paper we use confidential-use Census and administrative data to produce the first national estimates of excess mortality, institutionalization and homelessness for the largest Indigenous population in Canada from the ages of 5 to 64. We identify mortality rates at least twice the Canadian average and find exceptionally high mortality rates for young Indigenous women and girls – up to four times the Canadian average at certain ages. We show mortality rates are even higher on reserve – up to five times the Canadian average. These relative mortality rates are higher than the relative mortality rates of African Americans and the Native Americans to non-Hispanics in the United States. We also estimate very high rates of institutionalization and homelessness, especially among men and as a result there are stark gender ratio imbalances among this population. We speculate that this gender imbalance may play a role in excess female mortality in addition to several other socioeconomic factors. JEL Classification: J10, J15, J16, 015, I15, I14, I32 Keywords: mortality, First Nations, Native American, Status Indian, homelessness, institutionalization, gender bias Corresponding author: Randall Akee Department of Public Policy University of California, Los Angeles 3250 Public Policy Building Los Angeles, CA 90095 USA Email: [email protected] * We would like to thank Anke Kessler, Pascal Courty, David Green, Kevin Milligan, Robert L. A. Hancock, David Scoones, Manisha Shah, Erin O’Sullivan, Steven Stillman, Eric McGregor, Jacqueline Quinless and all those that commented on this work along the way. We would also like to thank Indigenous and Northern Affairs for the access they granted to the data and Statistics Canada’s Research Data Centers Staff. Any errors or omissions are ours alone. 1 Introduction Indigenous peoples have faced numerous dimensions of marginalization since colonization (United Nations, 2009). In Canada, Australia, the United States, and elsewhere dif- ferences in measurable conditions between Indigenous peoples and their non-Indigenous counterparts are well documented.1 However, to our knowledge, no one has examined the extent to which excess mortality, institutionalization and homelessness have a↵ected Indigenous peoples by age and gender. While a lack of available data makes these sorts of estimates impossible in many contexts, we demonstrate that the unique institutional structure in Canada makes them feasible for the largest Indigenous group in the country; Status Indians.2 In this paper we provide the first Canada-wide estimates of the degree of institutionalization, homelessness, and excess mortality by gender and age. The results of this exercise are striking. The first result is that, relative to their non-Indigenous counterparts, Status Indian females face exceedingly high rates of mortality. Using the “Indian Register” data set, maintained by the Indigenous and Northern A↵airs Canada (INAC), we find that young Status Indian females have mortality rates that are 3 to 4 times the female non-Indigenous mortality rate and this di↵erence begins as early as the age of 5. These relative mortality rates are statistically higher than the relative mortality rates for Status males which are themselves 2 to 3 times that of the non-Indigenous average. While previous researchers have found that there were higher rates of excess mortality for Status Indians women in Canada in general, no one has identified the disproportionately large burden of avoidable mortality borne by Status Indian women and girls at such young ages and at the national level (Tjepkema et al., 2009; Park et al., 2015; Health Canada, 2010).3 We also are 1See Feir and Hancock (2016) for a list of citations documenting this for Canada. For the American case see Greenfeld, Lawrence, and Smith (1999), Jones (2006), and Akee and Taylor (2014). For Australia, see Pink and Allbon (2008). Schulhofer-Wohl and Todd (2015) identify counties in the US that have mortality rates for American Indians that exceed national averages. 2Status Indians are individuals who are governed under the Indian Act. We discuss this in more detail in the next section. Generally the term First Nations person rather than Indian is preferred. However, to be consistent with legislation, we use the term Indian throughout. 3These findings are in line with Park et al. (2015) who find that mortality rates for all First Nations 1 the first researchers to calculate excess Status Indian mortality rates on and o↵reserve in Canada. We find that excess mortality rates are extremely high for the on-reserve population of Status females, almost five times the comparable non-Indigenous Canadian average. However, o↵-reserve, we see higher mortality rates for the youngest age groups we study. The Status Indian relative mortality rates are higher than for the Native American and African American population relative to non-Hispanics in the United States.4 The second result is that there is a large percentage of Status Indian men who are homeless and institutionalized which has a direct e↵ect on the male to female Status Indian gender ratio. Using a novel method to estimate institutionalization and homelessness that combines Census and administrative data, we show that as much as 13 percent of the Status male population falls into one of these categories. These high rates of institutionalization and homelessness create a large imbalance in the gender ratio at ages where individuals would typically start families. By our calculations, between the ages of 20 to 55 there are approximately 8.5 Status Indian men to every 10 Status Indian women. Similar gender imbalances have been observed in the African American population in the United States (Wolfers, Leonhardt and Quealy, 2015) and have been shown to have significant e↵ects on family formation and female well-being (Angrist, 2002; Chi- appori, Fortin and Lacrouix, 2002; Charles and Luoh, 2010; Mechoulan, 2011). Based on prior literature, we suggest that this gender ratio imbalance could play a role in the high mortality rates of Status Indian women and girls and provide suggestive evidence consistent with this hypothesis. The simultaneous finding of high rates of excess female mortality and gender ratios that are skewed in favor of women makes an important and general contribution to the peoples was at least twice the Canadian average and found slightly higher mortality rates for all First Nations women. Tjepkema et al. (2009) shows higher rates of mortality for Status Indian women and has closer estimates to our own but their findings are limited to women above the age of 25. In addition, our results extend over a greater time period than both these works. Health Canada (2011) presents mortality statistics by age group for 2001/2002 for a select geographical region. 4This is not simply due to relatively higher average non-Hispanic, non-minority American mortality rates. 2 literature on “missing women.”5 Since the seminal work of Sen (1992) nearly 30 years ago, high male to female gender ratios in the developing world have been associated with excess female mortality (Sen, 1992; Klasen and Wink, 2002; Jha et. al., 2006; Das Gupta, 2005; Das Gupta, 2006; Erwin, Heerink, and Zhang, 2011; Duflo, 2012; Rosen- blum, 2013).6 However in our context, we see low male to female gender ratios in survey data, but very high rates of excess female mortality. This excess female mortality would go unnoticed if one looked at gender ratios alone; the extremely high rates of institutionalization and homelessness among the male population obscures excess female mortality when examining only gender ratios. This is a similar result as found by Anderson and Ray (2010) who identify excess mortality among women in developing countries with relatively balanced gender ratios; our results are novel in that we identify excess female mortality in a wealthy, developed country with gender ratio imbalances in favor of women (Anderson and Ray, 2010). Our findings make three important contributions in the Canadian context. First, our findings may have implications for the recently called Canadian National Inquiry into Missing and Murdered Indigenous Women and Girls (The Economist, 2014; Amnesty International, 2015; Government of Canada, 2015; Levin, New York Times, 2016). The inquiry was called to investigate circumstances that have given rise to the extremely high rates of disappearance and homicide experienced by Indigenous women and girls.

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