AN OVERVIEW OF ABORIGINAL HEALTH IN CANADA
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SETTING THE CONTEXT
An Overview of Aboriginal Health
in Canada
Significant health disparities exist
between Aboriginal and non-Aboriginal
Canadians. 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 First
Nations, Inuit, and Métis peoples, as
defined in Section 35(2) of the Canadian
Constitution Act, 1982. According to
Statistics Canada’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 2006 Canadian Census.
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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 Toronto,
(approximately 75%) of First Nations Nations in the area known as the Métis Vancouver, Montreal, Ottawa-Gatineau
people residing off-reserve live in urban Homeland), and are recognized by the and Edmonton, 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 (Michif ) 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 Inuit Nunangat Constitution Act, 1867 (CBC News,
(Statistics Canada, 2013a). These regions Non-Status and Urban Aboriginal Peoples 2013). Although the full implications of
are: Nunatsiavut (Labrador), Nunavik Many people who self-identify as the Daniels Decision are not yet clear, this
(northern Quebec), Nunavut, and the Aboriginal are not registered under decision potentially doubles the number of
Inuvialut Settlement Region in the Canada’s 1876 Indian Act, which defines people considered status Indians under the
Northwest Territories (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 Inuktitut, 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 first language is declining (Statistics Nations but who are not a “Registered
Canada, 2008).
2
Data Limitations in Aboriginal
Public Health
P
ublic health assessments and
interventions, including those
targeting 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
data on non-registered First Nations
Aboriginal Health in Canada Determinants of Health
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
populations and their systems of disproportionate burden of ill health
are often invisible in health statistics
Indigenous health knowledge. Although and social suffering on the Aboriginal
(Ibid.). Although work is underway to
the health of Aboriginal populations in populations of Canada” (Adelson, 2005,
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
continue to show a disproportionate health.”2 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 Saskatchewan (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 unemployment rate (Saskatchewan, Northwest Territories, and diseases caused by environmental for Aboriginal people in 2006 was still Manitoba, Yukon, 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 history of colonialism 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
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