The most recent census in 2016 counted 1.67 million Indigenous people in Canada, or 4.9% of the total population. Almost half (44%) of the Indigenous population—representing 731,480 First Nations, Métis and Inuit people —lived in one of 49 urban areas large enough to be divided into neighbourhoods (or census tracts):
- 51% identified as First Nations (373,055)
- 45% as Métis (329,166)
- 1% as Inuit (7,315)
For example, the top ten are:
Our Health Counts
The Ontario Federation of Indian Friendship Centres (OFIFC), Métis Nation of Ontario (MNO), Ontario Native Women’s Association (ONWA), and Tungasuvvingat Inuit (TI) have been working with a health research team led by Dr. Janet Smylie based at the Centre for Research on Inner City Health (CRICH), Saint Michael’s Hospital, on the Our Health Counts Urban Aboriginal Health Database project.
We do know from the Canadian Census that First Nations, Inuit, and Métis populations experience ongoing disparities in social determinants of health such as income security, employment, education, and adequate housing compared to non-Aboriginal Canadians and that these disparities persist with urban residence. From a population and public health perspective, this near absence of population based health assessment data is extremely concerning, particularly given the known disparities in social determinants of health. This situation is unacceptable in a developed country such as Canada.
According to “Our Health Counts“, the largest urban indigenous population health study ever conducted in Canada, the urban Indigenous population is significantly larger than that indicated by StatsCan. The study was based on Toronto’s indigenous population that – based on preliminary findings – is approximately 2-4Xs larger that what Statistics Canada reported (2011 NHS).
Why the difference?
Many indigenous people move frequently or are homeless and the study did not require a fixed address (unlike the National Household Survey (NHS) that uses mailing addresses from a voting registrar. Other “Our Health Counts” studies in Ottawa and Hamilton reached a similar conclusion”. In addition, a number of Indigenous people do not participate in the census.
|Our Health Counts |
|Toronto (2018)||23,065||65,832||14% – 2011|
|Hamilton (2011)||13,735||Six Nations – largest First Nation – did not participate in census||2006|
|Ottawa Inuit (2017)||1,280||4 x larger (eg. 3,361 Tungasuvvingat Inuit clients)||18% – 2006|
The following overriding conclusions of the studies in Toronto, Hamilton and Ottawa (with London, Thunder Bay and Kenora in the works) can be extrapolated to other urban contexts throughout the county:
- Striking levels of poverty
- 70% of the First Nations population in Hamilton lives in the lowest income quartile neighbourhoods vs 25% of the general Hamilton population.
- 69% of Inuit adults in Ottawa/Gatineau report an annual income less than $20,000
- 87% of Indigenous adults living in Toronto fell below the before tax Low-Income Cut-Off (LICO)
- Living in crowded conditions
- 73.7% of First Nations persons in Hamilton vs. 3% general Canadian population
- 20% of Inuit in Ottawa/Gatineau vs 2.5% of general population
- 14% of Indigenous adults living in Toronto vs 4% of general population
- Food Insecurity
- 22% of the First Nations in Hamilton experienced food insecurity
- 55% of Inuit in Ottawa/Gatineau vs 7.4% of general population
- 26% of Indigenous population in Toronto vs 9.5% in general population
All of the above contribute to the underlying social determinants of health that continue to make Indigenous peoples one of the most at-risk groups in the country to poor health outcomes . The following data compares chronic illnesses (high blood pressure, diabetes, respiratory (asthma, COPD/ Bronchitis) identified as the underlying health conditions posing the highest risk for those exposed to COVID-19 to be infected? Heart disease data was incomplete.
The high incidence of chronic health conditions has been linked to a disproportionate burden of poverty, adverse living conditions and racism. Culturally based health care and health promotion initiatives have the potential to increase treatment uptake and health literacy, thus improving overall health and wellbeing of Indigenous people experiencing chronic health conditions. Among urban Indigenous adults, rates of chronic health conditions have been demonstrated to be between 2 to 10 times higher than the general population in Canada. (Our Health Counts)
Consider, Indigenous experiences of access to health in the three survey communities are as follows:
- Hamilton: 40% rated their experience as either fair or poor
- Ottawa: 43% rated their experience as either fair or poor
- Toronto: 66% rated their experience as poorer
What’s the Problem?
The ongoing failure to act on specific recommendations to improve the health outcomes of Indigenous people goes back to the Hawthorne Report from 1963 (and even earlier) that concluded that “Aboriginal peoples were Canada’s most disadvantaged and marginalized population”. Fifty-seven years later and even after the Royal Commission on Aboriginal Peoples in 1996, the Kelowna Accord in 2005 and the Truth and Reconciliation Commission (TRC) in 2015 each made specific recommendations or Calls to Action, the same chronic health issues persist For example, the health related recommendations identified by the Royal Commission in 1996 were replicated by the subsequent Kelowna Accord and TRC to take just three examples from the last 24 years:
|Royal Commission of Aboriginal People Theme||Kelowna Accord||TRC|
|Federal-Provincial-Territory Aboriginal partnership and cooperation||✔||✔|
|Partnerships in design, development and delivery||✔||✔|
|Restructuring of federal institutions||✔||✔|
|Data Collection and exchange||✔||✔|
|Reducing administrative burden for Métis and off-reserve groups||✔||✔|
|Supporting Strong Communities, People and Economies||✔||✔|
|Improving Health and Public Safety||✔||✔|
|Improving community infrastructure||✔||✔|
|Creating healthy communities||✔||✔|
On May 10, the Assembly of First Nations National Chief Perry Bellegarde stated: “Unfortunately, largely due to gaps in co-ordination and information sharing with the federal government and the provinces and territories, First Nations do not have access to reliable sources of information that tracks infections among First Nations…Indigenous Services Canada does not report recovered cases or the names of affected First Nations, saying it’s a privacy issue, or include numbers of cases among First Nations people living off-reserve.
As “Our Health Counts” emphasizes over and over again in each of their reports “this near absence of population based health assessment data is extremely concerning, particularly given the known disparities in social determinants of health. This situation is unacceptable in a developed country such as Canada.“
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