Department Discussion Paper DDP1802 ISSN 1914-2838 FIRST PEOPLE LOST: DETERMINING THE STATE OF STATUS FIRST NATIONS MORTALITY IN CANADA USING ADMINISTRATIVE DATA Randall Akee Department of Public Policy, University of California, Los Angeles Los Angeles, California., United States 90095-1656 & Donna Feir Department of Economics, University of Victoria Victoria, B.C., Canada V8W 2Y2 February 2018 Abstract We present the most comprehensive set of estimates to date for Status First Nations mortality in Canada. We use administrative data from Indigenous and Northern Affairs Canada to establish a set of stylized facts regarding Status First Nations mortality rates from 1974 to 2013. Between 2010 to 2013, the mortality rates of Status First Nations men and boys are highest in nearly all age groups considered with the exception of Status girls between the ages of 10 to 14. On reserve, Status boys between the ages of 15 to 19 have mortality rates nearly four times that in the general population, while Status girls between the ages of 15 to 19 have mortality rates five times that in the general population. We demonstrate substantial regional variation in mortality rates which are correlated with economic factors. We document that there has been no improvement in mortality among Status women and girls living on-reserve in the last 30 years and relative mortality rates for all Status people on-reserve has not changed in 40 years. Mortality rates may be worsening among some age groups. Keywords: Mortality, First Nations, Native American, Status First Nation, gender bias JEL Classifications: J15, J16, I15, I14 Author Contact: Donna Feir, Dept. of Economics, University of Victoria, P.O. Box 1700, STN CSC, Victoria, B.C., Canada V8W 2Y2; E-mail: [email protected]; Voice: (250) 721-8533; FAX: (250) 721-6214 First People Lost: Determining the State of Status First Nations Mortality in Canada using Administrative Data Randall Akee Donna Feir Department of Public Policy Department of Economics University of California, Los Angeles University of Victoria [email protected] [email protected] February 14, 2018 Abstract We present the most comprehensive set of estimates to date for Status First Nations mortality in Canada. We use administrative data from Indigenous and Northern Affairs Canada to establish a set of stylized facts regarding Status First Nations mortality rates from 1974 to 2013. Between 2010 to 2013, the mortality rates of Status First Nations men and boys are highest in nearly all age groups considered with the exception of Status girls between the ages of 10 to 14. On reserve, Status boys between the ages of 15 to 19 have mortality rates nearly four times that in the general population, while Status girls between the ages of 15 to 19 have mortality rates five times that in the general population. We demonstrate substantial regional variation in mortality rates which are correlated with economic factors. We docu- ment that there has been no improvement in mortality among Status women and girls living on-reserve in the last 30 years and relative mortality rates for all Status people on-reserve has not changed in 40 years. Mortality rates may be worsening among some age groups. Keywords: Mortality, First Nations, Native American, Status First Nation, gender bias. JEL classification:J15, J16, I15, I14 Acknowledgments. We would like to thank two anonymous referees for invaluable feedback. We would also like to thank Siwan Anderson, Patrick Button, Pascal Courty, David Green, Robert L. A. Hancock, Stephen Hume, Anke Kessler, Eric McGregor, Kevin Milligan, David Scoones, Manisha Shah, Erin O'Sullivan, Steven Stillman, Jacqueline Quinless and all those who commented on this work along the way. We would also like to thank Statistics Canada's Research Data Centers Staff and Indigenous and Northern Affairs for the access they granted to the data. Any errors or omissions are ours alone. 1 Introduction Avoiding an early death is one of the greatest advantages of being born in a wealthy country (Deaton, 2013). However, this advantage is not shared equally. In Canada there is evidence of substantial health disparities between First Nations peoples and the general population, but existing statistics are at best sparse (Truth and Reconciliation Commis- sion of Canada (TRC), 2015, p 161). In this work we provide the most comprehensive analysis of the patterns and trends in mortality rates for the largest First Nation's pop- ulation in Canada { Status First Nations { to date.1 We do this by using administrative data from Indigenous and Northern Affairs Canada (INAC) from 1974 to 2013 which, to our knowledge, is the most complete and consistent source of First Nations vital statis- tics data available. Our goal in this work is to provide a benchmark set of stylized facts on Status First Nation's mortality in Canada that can be used for future academic and policy research. This work was conducted in response to the recent calls in Canada for reconciliation between Indigenous and non-Indigenous peoples by the Truth and Reconciliation Com- mission of Canada: the commission called for all Canadians to contribute to the process of reconciliation and called for the establishment of comprehensive measures of well-being for Indigenous peoples (TRC, 2015, p 161). The commission also called for cooperation between the federal government and Indigenous groups to establish measurable goals to identify and close the gaps in health outcomes between Indigenous and non-Indigenous communities and to publish annual progress reports and assess long-term trends (TRC, 2015, p 322). It is our hope that this work helps to establish a foundation for the dialogue and that it takes a step towards establishing comprehensive measures of well-being for Indigenous peoples. Using administrative data on births and deaths for Status First Nations people that 1\Status First Nations" are individuals who are governed explicitly under the Indian Act as \Indians". \Indian Status" is determined through genetic relation to the first peoples classified by the federal government as \Indians." 1 includes information on the gender, age, band of membership, and whether an individual resides on or off reserve, allows us to create measures of mortality rates at the national level and by location on and off reserves. We also link patterns in mortality over time, and at the regional level, with data available from the 1991-2006 Canadian Census and 2011 National Household Survey.2 With this data we make three main contributions: 1) we provide the first national and regional level estimates of mortality among Status youth; 2) we provide the first modern estimates of how Status mortality rates differ by reserve residence and province and the correlation with province-level economic factors; and 3) we provide the first description of how Status mortality rates have changed since the 1970s and how this is correlated with economic changes and to changes in Status First Nations definitions. Despite the relative simplicity of our analysis, we find striking and unsettling results. We begin by confirming the findings of earlier, less comprehensive studies using our data: age-standardized mortality is higher for Status males than Status females, and Sta- tus First Nations age-standardized mortality are always higher than for the general popu- lation. Using the most recent data available, 2010 to 2013, we find that age-standardized mortality rates are close to twice that of the general population. However these aggre- gate statistics mask significant differences by age: Status women and girls have mortality rates that are three to four times that of the general female mortality rates between the ages of 10 and 44. These relative mortality rates are statistically higher than the rel- ative mortality rates for Status males, which are themselves two to two and half times that of the general population. While previous researchers have found higher rates of relative mortality for Status women, to our knowledge no one has identified the dispro- portionately high mortality rates borne by Status women and girls at such young ages at the national level (Health Canada, 2008, 2014; Mao et al., 1992; Park et al., 2015; Tjepkema et al., 2009). We also demonstrate that the proportional difference in mor- 2Unfortunately, the data does not provide information on cause of death or detailed individual socio- economic characteristics and we do not report on these causes in the current analysis. 2 tality between Status peoples and the general Canadian population is larger than the proportional difference in mortality between Native Americans and non-Hispanic Whites and the difference between African Americans and non-Hispanic Whites in the United States. We also demonstrate that the gender bias in relative mortality rates for Status First Nations women and girls is not present among either Native Americans or African Americans relative to non-Hispanic American Whites.3 Next, we examine the patterns in mortality by place of residence. We show mortality rates are higher on-reserve relative to off-reserve: between the ages of 15 and 19 in 2010 and 2013, the mortality rate of Status First Nations girls was five times the rate for girls in the general population. The mortality rates of boys on-reserve was also notably higher, nearly four times that of boys in the general population. We also show that absolute and relative mortality vary significantly by province and age. While First Nations mortality rates are highest in Alberta, Manitoba and Saskatchewan, we find that Alberta and Ontario exhibit the highest relative mortality rates. We provide evidence that this regional variation is associated with economic differences between Status peoples and the general population. Finally, we examine trends in mortality rates from 1974 to 2013 (the years for which we have data). We find that here has been no improvement in relative, age standardized mortality rates between Status peoples on-reserve and the general population in the past 40 years.