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

    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).

Data Limitations in Aboriginal
                                                                                                                 Public Health

                                                                                                                         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).

    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 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

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

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).

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.
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                                                         3333 University Way, Prince George, BC V2N 4Z9            

© 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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