Indigenous people with disabilities in Canada: First Nations people living off reserve, Métis and Inuit aged 15 years and older

by Tara Hahmann, Ph.D., Nadine Badets, and Jeffrey Hughes

Highlights

1. In 2017, 32% of First Nations people living off reserve, 30% of Métis and 19% of Inuit had one or more disabilities that limited them in their daily activities.
2. Rates of disability among First Nations people living off reserve and Métis were higher than for non-Indigenous people. This remained true after accounting for differences in age, geography and population centre size between the population groups. Rates of disability among Inuit were lower, largely because Inuit are younger.
3. Among First Nations people living off reserve, Métis and Inuit, disability rates were higher for women than for men. Disability rates increased with age for both men and women.
4. Of all severity levels, mild disabilities were most common among all three Indigenous groups and for both men and women.
5. Among all Indigenous groups, pain-related disabilities were most prevalent.
6. Differences in disability rates were observed by province and territory as well as by Inuit region in Inuit Nunangat. Among First Nations people living off reserve and Métis, disability prevalence was higher in Nova Scotia, New Brunswick, Ontario, British Columbia and Alberta while among Inuit it was higher in Nunatsiavut.

Discussion/Conclusion

Overall, roughly one in three First Nations people living off reserve and Métis had one or more disabilities, while among Inuit and non-Indigenous people the proportion was roughly one in five. The higher rates of disability among First Nations people living off reserve and Métis aligns with previous estimates of disability among Indigenous peoples (Burlock, 2017). The lower rates among Inuit largely reflects a younger age structure.

Consistent with findings on disability generally (Morris et al., 2018), prevalence increased with age among First Nations people living off reserve, Métis, and Inuit men and women. However, this increase began within younger age groups among off-reserve First Nations men and women, Métis men and Inuit women.

Among all three Indigenous groups, mild disabilities were the most common. Severe and very severe disabilities, however, were more frequent among older age groups.

There were key gender-related differences. Firstly, consistent with previous studies, among all groups, women were more likely to have a disability than men (Burlock, 2017; Morris et al., 2018). Secondly, women were more likely to have pain- and mental health-related disabilities than men across all Indigenous groups, as well as among non-Indigenous people. The high prevalence of chronic pain (Jimenez et al., 2011) and mental health conditions (Nelson & Wilson, 2017) among Indigenous peoples has been linked with social inequalities associated with the social determinants of health stemming from colonialism (King et al., 2009).

There were regional and population centre size differences in disability prevalence. Among First Nations people living off reserve and Métis, higher disability rates were found in Nova Scotia, New Brunswick, Ontario, British Columbia and Alberta. In addition, rates of disability were higher in urban areas within younger First Nations people living off reserve and Métis while they were lower in rural areas within older segments of these populations. For both Inuit men and women, disability prevalence was lower inside, rather than outside, Inuit Nunangat. A number of factors, including migration to access health care (Beulah Beatty & Berdahl, 2011), should be considered when interpreting differences in disability prevalence by region and population centre size.

Furthermore, disability among Indigenous peoples might be higher than the estimates provided here as for a number of reasons. Even within the social model of disability, any tendency to underreport chronic health conditions or impairments that may exist in a population could impact perceptions of limitation and disability. For example, certain health conditions may go under-reported due to cultural bias in diagnostic instruments as well as perceived bias, stereotyping, discrimination, and stigma (Lindblom, 2014). Cultural differences in health perceptions (McGrath, 2006) or experiences of colonization (Fenwick, 2006; Lindblom, 2014) and cultural, geographic, and socioeconomic barriers to health services access, including high quality care (Baron, Riva, & Fletcher, 2019; Gracey & King, 2009), among Indigenous peoples may also play a role in under-reporting and under-assessment (Gullemin, Bombardier, & Beaton, 1993; Hunt, Alonso, & Bucquet, 1991; Julien, Lacasse, Labra, & Asselin, 2018; Lindblom, 2014; Thurston et al., 2014).

These findings, especially higher prevalence rates of disability compared to the non-Indigenous population must be examined within the context of both the significant and complex environmental barriers faced by many Indigenous peoples as well as the larger literature on the social determinants of health which are tied to legislation and social policies that punished cultural preservation, practise and use among Indigenous peoples (Galabuzi, 2004). The International Symposium on the Social Determinants of Indigenous Health, a working group within the World Health Organization’s Commission on the Social Determinants of Health, recognized the destruction of Indigenous peoples’ ties to their land through colonization as an important determinant of health inequities (The Commission on Social the Social Determinants of Health, 2007). In this vein, The United Nations Declaration on the Rights of Indigenous Peoples has identified the need to address the impact of colonization to reduce health inequities (United Nations, 2007).

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https://www150.statcan.gc.ca/n1/pub/89-653-x/89-653-x2019005-eng.htm