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    Select health indicators of First Nations people living off reserve, Métis and Inuit

    Statistics Canada Catalogue no. 82-624-X
    by Linda Gionet and Shirin Roshanafshar

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    Highlights

    • In 2007–2010, First Nations people living off reserve, Métis, and Inuit reported poorer health compared with non-Aboriginal people. First Nations people1 and Métis were more likely to report higher rates of chronic conditions compared with the non-Aboriginal population.
    • Smoking rates were over two times higher among the three Aboriginal groups than the non-Aboriginal population. Aboriginal people were also twice as likely to be exposed to second-hand smoke in the home.
    • Aboriginal adults had higher obesity rates:  First Nations people—26%; Inuit—26%; and Métis—22%; compared to 16% for non-Aboriginal adults.
    • All three Aboriginal groups were more likely to experience household food insecurity than the non-Aboriginal population. The rates were 27% of Inuit, 22% of First Nations people and 15% of Métis compared with 7% of non-Aboriginal people.
    • Métis and First Nations people were more active during leisure time than their non-Aboriginal counterparts. Inuit reported a stronger sense of belonging to their community and a high satisfaction with life.

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    The health of First Nations people, Métis and Inuit has been greatly affected by rapid societal changes in the last half century.2 They face the same health issues as the general population as well as their own challenges. Monitoring the health of Aboriginal groups, however, is limited by a lack of data.

    The Canadian Community Health Survey (CCHS) provides a wealth of information on many aspects of Canadians' health, and in recent years it included questions about Aboriginal identity for First Nations people, Métis and Inuit. The CCHS, however, was not designed for these specific populations. Furthermore, it does not include children under 12 years of age and its geographic coverage excludes reserves, as well as some northern and remote areas. Thus, the Health Statistics Division evaluated CCHS data to determine if it could be used to describe the health of Aboriginal peoples.3

    The evaluation compared CCHS questions with similar ones from the Aboriginal Peoples Survey, and found that both yielded similar results. The evaluation also explored the number of years of data that had to be combined to produce health indicators at more detailed levels—by age and sex. Four cycles, 2007 to 2010, were considered enough to yield reliable estimates for most indicators.4

    As a result, Statistics Canada combined the CCHS data collected from 2007 to 2010 to create two data tables (CANSIM tables: CANSIM table105-0512 and CANSIM table105-0513). The tables cover a range of health indicators for First Nations people, Métis, Inuit and the non-Aboriginal population; the indicators are broken down further by sex, three age groups, and by province and territory.

    This article presents selected findings from this CCHS dataset (2007 to 2010). Health data for First Nations people, Métis and Inuit are compared with the non-Aboriginal population on a variety of topics. A subset of the results is also featured in the List of Health Indicators.

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    Key demographics of the Aboriginal population: 2006 Census

    • There were 1,172,790 people who identified themselves as an Aboriginal person— that is, North American Indian (First Nations people), Métis and Inuit.5,6
    • Within the Aboriginal population, 60% were First Nations people, 33% were Métis, 4% were Inuit and 3% were of multiple or other Aboriginal identities.7
    • Among First Nations people, 43%8 of them lived on reserve9,10 while the rest lived off reserve.
    • Most Inuit, 78%, lived in Inuit Nunangat (an Inuktitut expression for 'Inuit homeland'), which consists of four Inuit regions across the Arctic. Ontario and the western provinces were home to 83% of First Nations people and 87% of Métis.8
    • From 1996 to 2006, the First Nations population, both on and off reserve, grew 29%; the Métis, 91% and Inuit, 26%.5 The growth of the Aboriginal population is partly because more people self-identified as an Aboriginal person in 2006 than in 1996. This is especially the case among Métis.11
    • Aboriginal people are younger than the non-Aboriginal population. The median age of First Nations people living off reserve was 26 years in 2006; of those on reserve, 25; Métis, 30; Inuit, 22; and non-Aboriginal people, 40.8

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    Overall health

    CCHS data revealed poorer self-reported health among First Nations people, Métis, and Inuit compared with non-Aboriginal people (Chart 1). This is consistent with findings from other surveys that focused on the Aboriginal population.

    Chart 1 Very good or excellent perceived health by Aboriginal and non-Aboriginal populations, aged 12 and over, CanadaChart 1
    Very good or excellent perceived health by Aboriginal and non-Aboriginal populations, aged 12 and over, Canada

    Higher rates of chronic conditions partly explain the poorer self-reported health among First Nations people and Métis. Fifty six percent of First Nations people and 55% of Métis reported being diagnosed with one or more chronic conditions, compared with 48% of non-Aboriginal people.

    Inuit (43%) were the least likely to report having one or more diagnosed chronic conditions. However, this may be partly due to having less access to doctors who can diagnose their conditions. According to the 2007-2010 CCHS, 83% of non-Aboriginal people have a regular medical doctor, compared with 44% of Inuit. In fact, most Inuit communities are served by a nursing station only and accessing hospital services can require extensive travel.12

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    Less access to doctors in the North (2006 Aboriginal Peoples Survey)

    Inuit in Inuit Nunangat aged 15 years and older were more likely to have contact with a nurse (70%) than with a family doctor or general practitioner (46%). Inuit living in the rest of Canada were more likely to have contact with a family doctor or general practitioner (71%) than with a nurse (39%).13

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    Certain diagnosed chronic conditions, such as respiratory problems which are associated with smoking, were more common among the Aboriginal population than their non-Aboriginal counterparts.14,15

    All three groups had higher rates of asthma (13-14%15) compared with the non-Aboriginal population at 9%. Inuit, aged 25 to 44 years had a particularly high rate of asthma at 22%.15 Asthma is a chronic disease that renders breathing passages (airways) extra sensitive, making breathing difficult. Poor indoor air quality, ventilation and poor housing conditions contribute to high rates of asthma among Inuit.16

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    Housing conditions reported in the 2006 Census

    Inuit were ten times more likely (31%) than non-Aboriginal people (3%) to live in crowded homes—dwellings with more than one person per room—in Canada.

    While Inuit have traditionally lived in multi-family groupings, a number of reports have suggested that the high rate of families sharing a home may be due to the serious shortage of housing in many communities throughout Inuit Nunangat.16

    Inuit were four times more likely to live in homes in need of major repairs (28%) than non-Aboriginal people (7%). Major repairs include defective plumbing or electrical wiring, as well as structural repairs to walls, floors or ceilings.

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    First Nations people and Métis were also more likely to report that chronic conditions or health problems limited their ability to undertake some activities than the non-Aboriginal population.

    Health behaviours

    Higher rates of daily smoking and heavy drinking were reported by all three Aboriginal groups than by the non-Aboriginal population.

    Chart 2 Select health behaviours by Aboriginal and non-Aboriginal populations, aged 12 and over, CanadaChart 2
    Select health behaviours by Aboriginal and non-Aboriginal populations, aged 12 and over, Canada

    First Nations people's smoking rate was 32%; Métis, 30%; and Inuit, 39%, compared with 15% among non-Aboriginal people (Chart 2). Inuit youth aged 12 to 24 reported a rate of 33%, compared with 11% of non-Aboriginal youth.

    Inevitably, smoking also exposes non-smokers to carcinogens that can lead to cancer, and contributes to other diseases such as asthma, heart disease and emphysema.17 All three groups were more likely to be exposed to second-hand smoke in the home, compared with 7% of non-Aboriginal people. Métis youth, aged 12 to 24 years, experienced an especially high rate of exposure at 24%.

    Heavy drinking is also linked to a host of health problems.18 All three groups were more likely to drink heavily than non-Aboriginal people. Focusing on heaving drinking, however, masks a more complex reality. Among these groups, for instance, there were high rates of people who did not drink. That is, 34% of Inuit and 29% of First Nations people did not consume alcohol in the past year compared with 24% of non-Aboriginal people.

    Non-Aboriginal people were less physically active than Métis and First Nations people.19 In 2007–2010, 46% of non-Aboriginal people were inactive during leisure time, compared with 44% of First Nations people and 39% of Métis.

    Obesity

    Obesity is recognized as a major public health problem in Canada20 and the rates are high among Aboriginal people.21 For adults aged 18 years and older,22 self-reported height and weight were used to compute body mass index (BMI) to explore obesity. The obesity rate for First Nations people was 26%. It was 22% for Métis, 26% for Inuit and 16% for non-Aboriginal people (Chart 3). However, all groups had similar rates for the overweight category. Although BMI is commonly used to assess a person's weight, there is debate as to whether the same cut-offs are appropriate for Inuit.23,24,25

    Chart 3 Percentage of population who are overweight or obese by Aboriginal and non-Aboriginal populations, aged 18 and over, CanadaChart 3
    Percentage of population who are overweight or obese by Aboriginal and non-Aboriginal populations, aged 18 and over, Canada

    Childhood and youth weight problems are a particular challenge for Aboriginal people, whose population is younger than the non-Aboriginal population (see Key demographics). Métis (28%) and First Nations (26%) youth aged 12 to 17 were more likely to be overweight or obese than their non-Aboriginal counterparts (19%).

    Diabetes is one of many health issues related to obesity.26 According to the Canadian Diabetes Association, most people with diabetes are overweight or obese, and Aboriginal people face a high risk of developing the disease.27 Although diabetes was rare among the Aboriginal population in North America prior to 1940, it has now reached epidemic levels in some communities.28,29 First Nations people, in particular, were more likely to report being diagnosed with diabetes than non-Aboriginal people. This difference was most pronounced for those 45 years and older, where 19% of First Nations and 11% of the non-Aboriginal population were diabetic.30

    Household food insecurity

    Food security is commonly understood to exist in a household when all people, at all times, have access to adequate, safe and nutritious food.31 Conversely, food insecurity occurs when food quality and/or quantity are compromised; this is typically associated with limited financial resources.32

    Low-income families face many obstacles to consuming a nutritious diet, including limited access to fresh produce. Moreover, there tend to be fewer grocery stores or farmers' markets in low-income neighbourhoods.33 These findings are relevant for First Nations people, Métis and Inuit, who had lower median incomes than the non-Aboriginal population according to the 2006 Census.34,35

    Health complications associated with food insecurity can range from malnutrition to obesity. Although it may seem contradictory, people who experience food insecurity are more likely to be obese. One possible reason is that people with lower incomes may have less access to affordable healthy food. Instead, they consume low-cost, high calorie foods.36,37

    Chart 4 Moderate or severe household food insecurity by Aboriginal and non-Aboriginal populations and by sex, aged 12 and over, CanadaChart 4
    Moderate or severe household food insecurity by Aboriginal and non-Aboriginal populations and by sex, aged 12 and over, Canada

    Among First Nations people 12 and older, 22% lived in households that experienced food insecurity, three times the proportion of non-Aboriginal people at 7% (Chart 4). Fifteen percent of Métis, and 27% of Inuit also lived in food-insecure households. Food insecurity was a problem for a larger percentage of First Nations females (26%), than First Nations males (16%). One contributing factor may be that lone-parent families are more likely to be headed by females and the percentages are higher among the Aboriginal population.38

    The high cost of food in the North contributes to food insecurity. In most isolated communities, it may cost $360 to $450 a week to provide a nutritious diet for a family of four, compared with about $200 to $250 in the South.39

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    Life expectancy in Inuit Nunangat

    Life expectancy in the Inuit regions (Inuit Nunangat) is 70.8 years. This is about 10 years lower than in the rest of Canada where it is 80.6 years.40 Smoking-related causes of death contribute significantly to the years of life lost—lung cancer and respiratory diseases account for 21% of all deaths in Inuit Nunangat.41,42

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    Amidst the harsh conditions of living in the North, Inuit maintain a strong sense of community. Specifically, 81% of Inuit reported a strong sense of belonging to their local community compared with 65% of non-Aboriginal people. The majority of Inuit (92%) also reported they were satisfied with life, similar to the rate for non-Aboriginal people (93%), while First Nations people (89%) and Métis (90%) reported lower rates.

    Summary

    The CCHS data reaffirmed that the health profiles for Métis, Inuit and First Nations people differs from the general population.43 Aboriginal people were more likely to report having respiratory problems and other chronic conditions. All three Aboriginal groups were also more likely to report unhealthy behaviours, namely smoking and heavy drinking compared to the non-Aboriginal population.

    Métis, Inuit and First Nations people had high rates of obesity and household food insecurity. Among specific groups, First Nations people's diabetes rates were particularly high for those aged 45 and over. Inuit had the highest rates of smoking and household food insecurity; and Métis youth were more likely to be exposed to second-hand smoke at home.

    Linda Gionet and Shirin Roshanafshar are analysts with the Health Statistics Division.

    The authors wish to acknowledge Teresa Janz, Brenda Wannell and Lawson Greenberg for their contributions.

    Appendix 1 List of Health Indicators by Aboriginal and non-Aboriginal populationsAppendix 1
    List of Health Indicators by Aboriginal and non-Aboriginal populations

    References

    1. For the remainder of the article, the term "First Nations people" refers to the First Nations population living off reserve.
    2. Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a public health perspective. Ottawa: Public Health Agency of Canada; 2011.
    3. Roshanafshar S. Evaluating the Canadian Community Health Survey data for Aboriginal populations. Paper presented at: Health Data Users Conference; September 10-11, 2012; Ottawa.
    4. Even combining four survey cycles yielded very limited data for Inuit because of the small population size.
    5. 'Aboriginal identity' refers to those persons who reported identifying with at least one Aboriginal group: North American Indian, Métis or Inuit, and/or those who reported being a Treaty Indian or a Registered Indian, as defined by the Indian Act of Canada, and/or those who reported being members of an Indian Band or First Nation. Source: Statistics Canada. Aboriginal Statistics at a Glance, 2010. Available at: http://www.statcan.gc.ca/pub/89-645-x/89-645-x2010001-eng.htm. Accessed November 27, 2012.
    6. More recent Aboriginal data from the 2011 National Household Survey will be released in 2013.
    7. Statistics Canada. Aboriginal identity population, 2006 counts, percentage distribution, percentage change, 2006 counts for both sexes, for Canada, provinces and territories - 20% sample data. Aboriginal Peoples Highlight Tables, 2006 Census. 2009. Available at:
      http://www12.statcan.ca/census-recensement/2006/dp-pd/hlt/97-558/pages/page.cfm?Lang=E&Geo=PR&Code=01&Table=3&Data=Count&Sex=1&
      StartRec=1&Sort=2&Display=Page. Accessed December 19, 2012.
    8. Statistics Canada. 2006 Census: Aboriginal Peoples in Canada in 2006: Inuit, Métis and First Nations, 2006 Census: Findings. 2006 Census: Analysis Series. 2009. Available at: http://www12.statcan.ca/census-recensement/2006/as-sa/97-558/index-eng.cfm. Accessed November 27, 2012.
    9. The 'on-reserve' population is defined according to criteria established by Aboriginal Affairs and Northern Development (AANDC). For a detailed definition, see the 2006 Census Dictionary: Statistics Canada. More information on Census subdivision (CSD). 2011. Available at: http://www12.statcan.gc.ca/census-recensement/2006/ref/dict/geo012a-eng.cfm. Accessed November 27, 2012.
    10. Some Indian reserves and settlements did not participate in the census as enumeration was not permitted, or it was interrupted before completion.
    11. This phenomenon is akin to 'ethnic mobility', where there are "changes over time in the ethnic identity that individuals report." Source: Guimond, É. Ethnic mobility and the demographic growth of Canada's Aboriginal populations from 1986 to 1996. Report on the Demographic Situation in Canada. Statistics Canada Catalogue no. 91-209-X. Issue 1998 and 1999, 195-209.
    12. Pauktuutit-Inuit Women of Canada. Health. 2012. Available at: http://pauktuutit.ca/health/. Accessed November 27, 2012.
    13. Statistics Canada. 2006 Profile of Aboriginal Children, Youth and Adults: Key indicators from the 2006 Aboriginal Children's Survey and the 2006 Aboriginal Peoples Survey. 2009. Available at: http://www12.statcan.gc.ca/census-recensement/2006/dp-pd/89-635/index.cfm?LANG=eng&fpv=10000. Accessed December 20, 2012.
    14. Within the CCHS, respiratory problems include asthma, chronic bronchitis, emphysema and chronic obstructive pulmonary disease.
    15. The Inuit statistic should be used with caution.
    16. Knotsch C, Kinnon D. If not now.when? Addressing the ongoing Inuit housing crisis in Canada. Ottawa: National Aboriginal Health Organization; 2011.
    17. Health Canada. Second-hand Smoke. Health Concerns. 2009. Available at: http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/second/index-eng.php. Accessed November 28, 2012.
    18. Health Canada. Responsible Drinking. Healthy Living. 2012. Available at: http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/life-vie/drink-boire-eng.php. Accessed November 28, 2012.
    19. Respondents' leisure-time physical activity was based on a list of common activities. This list, however, was designed for the total Canadian population and may not include activities that are more relevant to the Aboriginal population. For instance, the Aboriginal Peoples Survey includes the following activities that are not listed in the CCHS, namely: hunting/trapping, canoeing or berry picking.
    20. Public Health Agency of Canada and the Canadian Institute for Health Information. Obesity in Canada. Ottawa: Government of Canada; 2011.
    21. According to Willows, "The ominous chronic disease profile among Aboriginal people in Canada highlights an urgent need for effective, culturally appropriate obesity prevention strategies." Source: Willows ND, Hanley AJ, Delormier T. A socioecological framework to understand weight-related issues in Aboriginal children in Canada. Appl Physiol Nutr Metab. 2012;37(1):1-13.
    22. Age groupings for obesity differ from the other health indicators in the article.
    23. Charbonneau-Roberts G, Saudny-Unterberger H, Kuhnlein HV, et al. Body mass index may overestimate the prevalence of overweight and obesity among the Inuit. Int J Circumpolar Health. 2005;64(2):163-9.
    24. Young TK, Bjerregaard P, Dewailly E, et al. Prevalence of obesity and its metabolic correlates among circumpolar Inuit in 3 countries. Am J Public Health. 2007;97(4):691-5
    25. Lear SA, Humphries KH, Frohlich JJ, et al. Appropriateness of current thresholds for obesity-related measures among Aboriginal people. Can Med Assoc J.  2007;177(12):1499-1505.
    26. Monash University. Critical link between obesity and diabetes discovered. Science Daily. 2009. Available at:  http://www.sciencedaily.com/releases/2009/07/090708090917.htm. Accessed on November 27, 2012.
    27. Canadian Diabetes Association. Research. Diabetes in special populations. 2012. Available at: http://www.diabetes.ca/research/specialpopulations/. Accessed November 29, 2012.
    28. Young TK, Reading J, Elias B, et al. Type 2 diabetes mellitus in Canada's First Nations: status of an epidemic in progress. Can Med Assoc J. 2000;163(5):561-566.
    29. Bruce S. Prevalence and determinants of diabetes mellitus among Métis of western Canada. Amer J Hum Biol. 2000;12(4):542-551.
    30. Inuit rate of diabetes for this age group is not statistically different from the rate among non-Aboriginal people.
    31. Food and Agricultural Organization. Rome Declaration on World Food Security and World Food Summit Action Plan. 1996. Available at:  http://www.fao.org/docrep/003/w3613e/w3613e00.htm. Accessed November 29, 2012.
    32. Tarasuk V. Health Implications of Food Insecurity. Social Determinants of Health: Canadian Perspectives. Second Edition. Toronto: Canadian Scholar's Press; 2009, Chapter 14.
    33. Milway J, Chan K, Stapleton, J. et al.The poor still pay more: Challenges low income families face in consuming a nutritious diet. Toronto: Insitute for Competitiveness and Prosperity: Open Policy Toronto; 2010.
    34. According to the 2006 Census, the median total incomes were $27,728 for Métis, $24,782 for Inuit and $19,114 for First Nations people (both on and off reserve) compared with $33,394 among non-Aboriginal people. Source: Statistics Canada, Aboriginal Statistics at a Glance. See reference in note no. 5.
    35. Median total income includes earnings from all sources including employment income as well as government transfers. The median income is the middle value where half of the specified population earns more and half the population earns less.
    36. Willows ND, Hanley AJG, Delormier T. A socioecological framework to understand weight-related issues in Aboriginal children in Canada. See reference in note no. 21.
    37. Blackwell Publishing Ltd. Lower-income Neighbourhoods Associated with Higher Obesity Rates. Science Daily. 2008. Available at: http://www.sciencedaily.com/releases/2008/02/080207163807.htm. Accessed November 29, 2012.
    38. In the 2006 Census, 35% of First Nations children living off reserve (aged 14 and under) were in a family with a lone-parent female compared with 6% who were headed by a lone-parent male. Among the non-Aboriginal population, 14% of non-Aboriginal children were raised by lone-parent females compared with 3% raised by lone-parent males. Source: Statistics Canada. 2006 Census: Aboriginal Peoples in Canada in 2006: Inuit, Métis and First Nations, 2006 Census: Findings. See reference in note no. 8.
    39. Aboriginal Affairs and Northern Development Canada. Revised Northern Food Basket - Highlights of Price Survey Results for 2006,2007 and 2008. Food Cost. December 19, 2008. Available at: http://www.aadnc-aandc.gc.ca/eng/1100100035941/1100100035942. Accessed November 29, 2012
    40. Statistics Canada. Table 102-0406: Life expectancy, at birth and at age 65, by sex, five-year average, Canada and Inuit regions. CANSIM. 2012. Available at: http://www5.statcan.gc.ca/cansim/pick-choisir?lang=eng&p2=33&id=1020706. Accessed December 10, 2012.
    41. Data on life expectancy, cancer and respiratory problems in the Inuit regions, include both Inuit and non-Inuit.
    42. From 2004 to 2008, there were 1,210 deaths in the Inuit regions. Of those, 123 were caused by lung cancer and 136 by respiratory diseases. Source: Statistics Canada. Table 102-0407: Mortality, by selected causes of death (ICD-10) and sex, five-year average, Canada and Inuit regions.CANSIM. 2010. Available at: http://www5.statcan.gc.ca/cansim/a26?lang=eng&retrLang=eng&id=1020704&paSer=&pattern=&stByVal=1&p1=1&p2=-1&tabMode=dataTable&csid=. Accessed December 10, 2012.
    43. Garner R, Carrière G, Sanmartin C, et al.The Health of First Nations Living Off-Reserve, Inuit and Métis Adults in Canada: The Impact of Socio-economic Status on Inequalities in Health. Health Research Working Paper Series. Statistics Canada Catalogue no. 82-622-X–No. 004. Ottawa: Statistics Canada; 2010.
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