A STATISTICAL PROFILE ON THE HEALTH OF FIRST NATIONS IN CANADA:

A STATISTICAL PROFILE ON THE HEALTH OF FIRST NATIONS IN CANADA:
A STATISTICAL PROFILE
ON THE HEALTH OF FIRST
NATIONS IN CANADA:
DETERMINANTS OF HEALTH, 2006 TO 2010
Health Canada is the federal department responsible for helping the people of Canada maintain and improve their health.
We assess the safety of drugs and many consumer products, help improve the safety of food, and provide information to
Canadians to help them make healthy decisions. We provide health services to First Nations people and to Inuit communities.
We work with the provinces to ensure our health care system serves the needs of Canadians.
Également disponible en français sous le titre :
Profil statistique de la santé des Premières Nations au Canada :
Déterminants de la santé, de 2006 à 2010
To obtain additional information, please contact:
Health Canada
Address Locator 0900C2
Ottawa, ON K1A 0K9
Tel.: 613-957-2991
Toll free: 1-866-225-0709
Fax: 613-941-5366
TTY: 1-800-465-7735
E-mail: [email protected]
This publication can be made available in alternative formats upon request.
© Her Majesty the Queen in Right of Canada, as represented by the Minister of Health, 2014
Publication date: August 2014
This publication may be reproduced for personal or internal use only without permission provided the source is fully acknowledged.
Cat.: H34-193/1-2014E-PDF
ISBN: 978-1-100-24687-1
Pub.: 140130
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TABLE OF CONTENTS
1.HIGHLIGHTS.. . . .
2.INTRODUCTION.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Health Canada Activities. . . . . . . . . . . . . . . . . . . . . . . . . .
Aboriginal Affairs and Northern Development Canada Activities. .
Provincial and Territorial Activities. . . . . . . . . . . . . . . . . . . .
Background. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. DATA SOURCES AND METHODS.
4. RESULTS AND DISCUSSION.
Age and Sex Distribution. . . .
Community Wellness.. . . . . .
Education.. . . . . . . . . . . . .
Labour Force Characteristics. .
Income. . . . . . . . . . . . . . .
Personal Health Practices.. . .
Health Services. . . . . . . . . .
Social Support Networks. . . .
Social Exclusion—Racism. . . .
Culture. . . . . . . . . . . . . . .
Physical Environment. . . . . .
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Data Sources.. . . . . . . . . . . . . . . . . . . . . . . .
Comparisons with Previous Versions of this Report.
Statistical Significance. . . . . . . . . . . . . . . . . . .
Age Standardization. . . . . . . . . . . . . . . . . . . .
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5.ACKNOWLEDGEMENTS. .
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LIST OF FIGURES
FIGURE 1. Age Distribution, Population Registered Under the Indian Act in First Nations
Communities and Total Canadian Population, 2008. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
FIGURE 2. Highest Certificate, Diploma or Degree, First Nations People in First Nations
Communities and Total Canadian Population Aged 25 to 64 years, 2006. . . . . . . . . . . . . . . . . . . . 12
FIGURE 3. First Nations People Without a High School Diploma In and Outside First Nations
Communities by Age Group, 2006. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
FIGURE 4. Total Annual Income Groups, First Nations People in First Nations Communities and
Total Canadian Population, Aged 25 to 64 Years, 2005. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
FIGURE 5. Median Annual Income, First Nations People in First Nations Communities and Total
Canadian Population Aged 15 Years and Over, 2005. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
FIGURE 6. Smoking Status, First Nations People in First Nations Communities (2008/10) and Total
Canadian Population (2008), Aged 18 Years and Over. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
FIGURE 7. Consumed Alcohol in the Past 12 Months, First Nations People in First Nations
Communities (2008/10) and Total Canadian Population (2008) Aged 18 Years and Over. . . . . . . . . . . 25
FIGURE 8. Consumed Alcohol in the Past 12 Months, First Nations People in First Nations
Communities by Age Group, 2008/10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
FIGURE 9. Heavy Drinking on a Weekly Basis, First Nations People in First Nations Communities
(2008/10) and Total Canadian Population (2008), Aged 18 Years and Over. . . . . . . . . . . . . . . . . . . 26
FIGURE 10. Level of Physical Activity, First Nations People in First Nations Communities, Aged 18
Years and Over, 2008/10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
FIGURE 11. Time Spent Watching TV, Reading, Working at a Computer (outside of workday/schoolday)
etc., First Nations People in First Nations Communities, Aged 18 Years and Over, 2008/10. . . . . . . . . . 28
FIGURE 12. Number of Sexual Partners in the Past 12 Months, First Nations People in First Nations
Communities, Aged 18 Years and Over, 2008/10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
FIGURE 13. Frequency of Condom Use, First Nations People in First Nations Communities Aged 18
Years and Over, 2008/10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
FIGURE 14. Reported Level of Access to Health Services Available Compared to Canadians Generally,
First Nations People in First Nations Communities Aged 18 Years and Over, 2002/03 and 2008/10 . . . . 33
FIGURE 15. Selected Perceived Barriers to Receiving Health Services, First Nations People in First
Nations Communities Aged 18 Years and Over, 2008/10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
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FIGURE 16. When Last Saw a Traditional Healer, First Nations People in First Nations Communities
Aged 18 and Over, 2008/10.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
FIGURE 17. Women Ever Having a Mammogram, First Nations Women in First Nations Communities
(2008/10) and all Women in Canada (2008), Aged 40 Years and Over. . . . . . . . . . . . . . . . . . . . . . 35
FIGURE 18. Women Ever Having a Pap Test, First Nations Women in First Nations Communities
(2008/10) and all Women in Canada (2008), by Age Group. . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
FIGURE 19. First Nations Men in First Nations Communities who Reported Ever Having a Physical
Prostate Check or PSA test in their Lifetime, by Age Group, 2008/10. . . . . . . . . . . . . . . . . . . . . . 37
FIGURE 20. People Seen or Talked to in Past 12 Months about Emotional or Mental Health, First
Nations People in First Nations Communities, Aged 18 Years and Over, 2008/10. . . . . . . . . . . . . . . 40
FIGURE 21. Effect of Racism on Self-Esteem, First Nations People in First Nations Communities Aged
18 Years and Over, 2008/10.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
FIGURE 22. Languages Learned as Mother Tongue, First Nations People in First Nations Communities,
All Ages, 2006. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
FIGURE 23. Aboriginal Languages Learned as Mother Tongue, First Nations People in First Nations
Communities, All Ages, 2006. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
FIGURE 24. Frequency of Participation in Community’s Cultural Events, First Nations People in First
Nations Communities, Aged 18 Years and Over, 2008/10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
FIGURE 25. Aboriginal and non-Aboriginal Households Outside First Nations Communities and
Registered Indian Households in First Nations Communities Below CMHC Housing Standards, 2006. . . . 48
FIGURE 26. Water and Wastewater Treatment Capacities, First Nations Communities, 2009–2010
.. . . . 49
FIGURE 27. Fire Protection Services on AANDC-Administered First Nations Sites, 2009–2010. . . . . . . 50
FIGURE 28. First Nations Communities by Degree of Isolation, 2008. . . . . . . . . . . . . . . . . . . . . . 51
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LIST OF TABLES
TABLE 1. Census and Survey Data Sources.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
TABLE 2. Administrative Data Sources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
TABLE 3. Highest Certificate, Diploma or Degree, First Nations People in First Nations Communities
and Total Canadian Population Aged 25 to 64 Years by Sex, 2006. . . . . . . . . . . . . . . . . . . . . . . . 13
TABLE 4. Factors Contributing to Negative Impact on Health and Wellbeing of Residential School
Attendees, First Nations People in First Nations Communities Aged 18 Years and Over, 2008/10. . . . . . 15
TABLE 5. Labour Force Characteristics for First Nations People in First Nations Communities and
Total Canadian Population Aged 15 Years and Over, by Sex, 2006. . . . . . . . . . . . . . . . . . . . . . . . 17
TABLE 6. Labour Force Characteristics for First Nations People In and Outside First Nations
Communities, Aged 15 years and Over by Age Group, 2006. . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
TABLE 7. Smoking Status, First Nations People in First Nations Communities by Age Group, 2008/10. . . 24
TABLE 8. Reported Use of a Condom as a Means of Birth Control or Protection, First Nations People
in First Nations Communities by Age Group and Sex, 2008/10. . . . . . . . . . . . . . . . . . . . . . . . . . 30
TABLE 9. Selected Difficulties Accessing Dental Care, First Nations People in First Nations
Communities Aged 18 Years and Over, 2008/10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
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1. HIGHLIGHTS
CO M M U N I T Y W E L L N E SS
• When asked to identify the main strengths of their community, the most frequent response given
by First Nations adults in First Nations communities was family values (61.6%), Elders (41.7%) and
traditional ceremonial activities (37.7%).
E D U C AT I O N
• In 2006, 35% of First Nations adults living in First Nations communities aged 25 to 54 had a
post-secondary certificate, diploma or degree while in 1996, the percentage was lower (30%).
• In 2006, half (50.2%) of First Nations adults in First Nations communities had not graduated
from secondary school. This compares to 15.2% of the total Canadian population.
• Among First Nations people in First Nations communities who attended residential school, over
half (53.4%) stated the experience had a negative impact on their health and well-being.
L A B O U R FO R C E C H A RAC T E R I ST I C S A N D I N CO M E
• The 2006 unemployment rate for First Nations people living in First Nations communities was nearly
four times the total Canadian rate (25.0% vs. 6.4%).
• First Nations people living in First Nations communities have greater employment challenges than
First Nations people living elsewhere. The 2006 employment rate for those living in First Nations
communities was 39.0% compared to 52.8% for First Nations people living outside these communities.
• The 2005 median annual income for First Nations people in First Nations communities was less
than half that of the total Canadian population ($11,210 vs. $25,767).
P E R S O N A L H E A LT H P RAC T I C E S
• The daily smoking rate for First Nations adults in First Nations communities was higher than the
daily Canadian rate (43.2% versus 19.0%).
• The rate of reported alcohol consumption (at least one drink in the previous year) was lower for
First Nations adults than for those in the total Canadian population. While 64.7% of First Nations
adults living in First Nations communities reported drinking alcohol in the previous year, the figure
for the total Canadian population was 81.7%.
• The proportion of First Nations adults in First Nations communities who report heavy drinking on
a weekly basis (9.8%) was somewhat higher than that for the total Canadian population (8.0%).
• Daily consumption of vegetables and fruit (excluding juice) was reported by 63% and 57% of First
Nations adults in First Nations communities, and consumption of milk or milk products at least once
a day was reported by 58%.
• When asked to describe their routine in a typical day, 35.1% of First Nations men and 26.8% of
First Nations women said that they did at least 60 minutes of moderate activity per day.
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H E A LT H S E R V I C E S
• Almost four in 10 (38.6%) First Nations adults living in First Nations communities believed they
had less access to health services than Canadians generally.
• The most commonly reported barrier to receiving health care was lengthy waiting lists.
• A smaller percentage of First Nations women living in First Nations communities reported having
a mammogram at some point in their lives than women in the total Canadian population (65.4%
compared to 74.2% respectively).
• Similar percentages of First Nations women in First Nations communities and women in the total
Canadian population reported ever having a Pap test (90.3% and 87.0% respectively).
S O C I A L S U P P O RT N E T W O R KS
• When there is a need to talk about their emotional or mental health, First Nations adults living in
First Nations communities were most likely to speak to friends and family members. A very small
percentage spoke to professionals such as psychiatrists, psychologists or social workers.
C U LT U R E
• Just under half (45.9%) of First Nations people in First Nations communities reported having an
Aboriginal mother tongue compared to 13.3% of First Nations people living elsewhere.
P H YS I C A L E N V I R O N M E N T
• Over one-quarter (28%) of Registered Indian households in First Nations communities fell below the
standard for major repairs. This was more than 10 times the figure of 2% for non-Aboriginal households
outside of First Nations communities.
• Half of First Nations adults in First Nations communities reported the presence of mould or mildew
in their homes and this has increased over time.
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2. INTRODUCTION
The Statistical Profile on the Health of First Nations in Canada series, first published in 2003, was
developed to provide national-level information that contributes to the description of the health status
and conditions of First Nations people in Canada. Its intent is to help improve First Nations health by
increasing the information available to health professionals, researchers, community leaders, policy
makers and the public. The series aims to fill an important information gap by providing stakeholders
with a national picture of the health of First Nations, and inform evidence-based decision making.
This is the second report in the 4th edition1 of the series. It presents a national description of the social
determinants of health among First Nations adults living in First Nations communities in Canada, including
community wellness, education, labour force characteristics, personal health practices, culture, social
support networks and the physical environment. These are in keeping with First Nations health
determinants models that encompass physical, social, emotional and spiritual domains.
Health Canada Activities
The First Nations and Inuit Health Branch (FNIHB) of Health Canada supports the delivery of public
health and health promotion services in First Nations and Inuit communities. FNIHB also provides primary
care services in First Nations and in remote and isolated areas, where there are no provincial services
readily available.
Further information on the past and present role of Health Canada in delivering services to First Nations
peoples, Inuit and their communities can be found on the FNIHB website at www.hc-sc.gc.ca/ahc-asc/
branch-dirgen/fnihb-dgspni/services_e.html.
Aboriginal Affairs and Northern Development Canada Activities
Aboriginal Affairs and Northern Development Canada (AANDC) supports First Nations peoples (in addition
to Inuit, Métis and Northerners) in many areas that contribute to health and well-being. The department
is responsible for safe water supplies in First Nations communities and funding a range of province-like
social programs to communities, including education, housing and income assistance, among others.a
Provincial and Territorial Activities
Health care in Canada is largely under provincial and territorial jurisdiction. As such, First Nations peoples
(and Inuit) obtain much of their care from the provincial and/or territorial health systems, including
hospitals or physicians in private practice, and these data are held in provincial/territorial databases.
Other health services (such as dental care, prescriptions and medical supplies) as well as allied health
services situated outside of hospitals (such as mental health services, community-based prevention and
home care) are generally not provided by provincial governments to First Nations people in First Nations
communities. The costs of these additional health services fall to the federal jurisdiction, under the policy
of Health Canada. For example, the federal government pays for health professionals such as dentists,
dental therapists and optometrists who provide services to remote and isolated communities on a visiting
basis, or for First Nations and Inuit travelling to larger centres for specialized/emergency treatments.
1
The first report in this series focuses on Vital Statistics while a Health Services Utilization report will be released at a later date.
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Background
S O C I A L D E T E R M I N A N T S O F H E A LT H
At every stage of life, health is determined by complex interactions between social and economic factors,
the physical environment and individual behaviour. These factors are frequently referred to as ‘determinants
of health’ and they do not exist in isolation from each other. It is the combined influence of the
determinants of health that helps determine overall health status.b
First Nations approaches to wellness are often wholistic, emphasizing interconnectedness between
individuals, their families, culture and community. While the physical health of the individual is important,
so too is the health of the mind, heart and spirit.c
In order to gain a more complete understanding of First Nations health and well-being, many determinants,
in addition to those provided in standard determinants of health frameworks are required. As such, various
frameworks have been examined for this report, including the Assembly of First Nation’s (AFN) First Nations
Wholistic Policy and Planning Modeld and the Public Health Agency of Canada’s (PHAC) framework.b
Many of the determinants of health outlined by PHAC are part of the AFN model. However, the AFN’s
wholistic approach also incorporates the four dimensions of the First Nations Medicine Wheel (spiritual,
physical, mental and emotional). Included too are components of social capital (relations within the
community, with other communities and with formal institutions). Self-government provides the base
for the model while the community is placed at its core.
A number of First Nations-specific determinants of health as proposed by the National Aboriginal Health
Organization were also examined.e These are:
• Colonization
• Access
• Globalization
• Territory
• Migration
• Poverty
• Cultural Continuity
• Self-determination
Data for some of these First Nations-specific determinants are available and are included in this report.
However, many of the indicators associated with these determinants are under development or have
yet to be developed. Their development can be challenging as there can be varying definitions of
wellness and it is difficult to adequately measure something as complex as wholistic wellness through
survey questions.
In this report, an effort has been made to use existing data to tell a balanced story of the health of
First Nations people. However, a comprehensive set of strengths-based, culturally appropriate and
meaningful indicators, covering the spectrum of wholistic wellness for First Nations people nationally,
has yet to be completely developed.
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REFERENCES
a. Aboriginal Affairs and Northern Development Canada. https://www.aadnc-aandc.gc.ca/eng/1100100035046/
1100100035050
b. Public Health Agency of Canada. “The Social Determinants of Health: An Overview of the Implications
for Policy and the Role of the Health Sector”. Public Health Agency of Canada 2005 November 23;
www.phac-aspc.gc.ca/ph-sp/oi-ar/01_overview-eng.php
c. First Nations Information Governance Centre. 2003. First Nations Regional Longitudinal Health Survey (RHS)
Cultural Framework. http://fnigc.ca/sites/default/files/ENpdf/RHS_General/developing-a-cultural-framework.pdf
d. Reading, J., A. Kmetic and V. Gideon, 2007. “First Nations Wholistic Policy and Planning Model”. Discussion
paper for the World Health Organization Commission on Social Determinants of Health. http://64.26.129.156/
cmslib/general/07-05-28_AFN_Paper_to_WHO_Commission_on_Social_Determinants_of_Health.pdf
e. National Aboriginal Health Organization, 2007: “How we see it! Broader determinants of health within
Aboriginal contexts”. www.naho.ca/documents/naho/english/publications/vaccho.pdf
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3. DATA SOURCES AND METHODS
Data Sources
The majority of data in this report comes from one of three sources: Statistics Canada’s 2006 Census of
Population and 2008 Canadian Community Health Survey along with the 2008/10 First Nations Regional
Health Survey (RHS)2, which is under the direction of the First Nations Information Governance Centre
(FNIGC). A summary of information on these sources, along with others used in the report, is provided in
Tables 1 and 2. Complete technical details for each of the following data sources are available through
these links:
a) 2006 Census: http://www12.statcan.ca/census-recensement/2006/ref/rp-guides/
rp/ap-pa_2/index-eng.cfm
b) 2008 Canadian Community Health Survey: www.statcan.gc.ca/imdb-bmdi/document/
3226_D7_T9_V5-eng.pdf
c) 2008/10 First Nations Regional Health Survey: www.fnigc.ca/sites/default/files/
First_Nations_Regional_Health_Survey_2008-10_National_Report.pdf
d) 2009/2010 First Nations Oral Health Survey: www.fnigc.ca/sites/default/files/
FNOHS%20Summary%20Report%2009-10_0.pdf
e) 2007–2009 Canadian Health Measures Survey, Oral Health Component:
www.fptdwg.ca/assets/PDF/CHMS/CHMS-E-tech.pdf
2
For additional information on the First Nations Regional Health Survey, including copies of the adult questionnaire, the RHS Cultural Framework
and the RHS Code of Research Ethics, see: www.fnigc.ca/resources.html
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TABLE 1. Census and Survey Data Sources
Data Source
Data Provided in Report
Methodology
1996 and
2006 Census
Data on education, income, labour
force and housing are for the
adult population. Mother tongue
data are for those of all ages.
In 1996 and 2006, in most First
Nations and Inuit communities,
all households were targeted to
receive the long form Census
questionnaire. Elsewhere, one in
five received the long form with
four in five receiving short form.
Figures are for those identifying
as First Nations people who are
registered under the Indian Act,
in addition to those for the total
Canadian population living
outside of First Nations
communities.
Limitations and
Additional Information
In 2006, 22 First Nations
communities did not take part
in the Census. The estimated
40,115 people living in these
communities are excluded from
census counts.
An additional 40,623 people
were missed in participating
First Nations communities
and are excluded from counts.
In 1996, 77 First Nations
communities did not take part
in the census. The estimated
44,000 people living in these
communities are excluded from
census counts. The number
of those missed living in
participating First Nations
communities is not available.
The census is the only data
source that can provide estimates
for the First Nations population,
living both inside and outside
First Nations communities and
the total Canadian population
living outside First Nations
communities.
Also excluded from First Nations
data for both years are First
Nations people in hospitals,
prisons, nursing homes along
with the homeless and those
living overseas and elsewhere.
2008/10 First
Nations Regional
Health Survey
(RHS)
Includes data for First Nations
adults aged 18 and over, most
of whom are registered under
the Indian Act who live in First
Nations communities across
Canada (on-reserve and in
northern First Nations
communities). Throughout this
report, this population is referred
to as “First Nations people living
in First Nations communities”.
RHS data are provided on
community wellness, smoking,
alcohol use, physical activity, diet,
sexual health, residential schools,
health care access, disease
screening, oral health, social
support, food consumption and
security, mould, cultural events
and racism.
Sampling is based on Aboriginal
Affairs and Northern Development
Canada’s (AANDC) Indian Register
counts of those living on-reserve
or on Crown Land.
The James Bay Cree of Northern
Quebec and the Innu of Labrador
did not participate. These
represent 10 out of 607 target
communities.
For the 2008/10 survey, 216 of
607 First Nations communities
participated and 11,043 adult
surveys were completed.
Also excluded are First Nations
people in hospitals, prisons,
nursing homes along with the
homeless and those living
overseas and elsewhere.
The final adult sample
represented 73.8% of the
intended target sample.
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Limitations and
Additional Information
Data Source
Data Provided in Report
Methodology
2008 Canadian
Community Health
Survey (CCHS)
The CCHS provides comparison
data for the total Canadian
population (excluding First
Nations communities).
In total, 71,922 individuals aged
12 and over were selected to
participate while 65,946
individuals took part.
Data provided in this report are
for adults (those aged 18 and
over) and focus on smoking,
alcohol use, disease screening
and food security.
The overall person-level response
rate was 91.7%.
Included are data for First
Nations adults aged 18 and over
(unless otherwise stated), who
live in First Nations communities
across Canada (on-reserve and
in northern First Nations
communities).
Sampling is based on the
AANDC Indian Register counts
of those living on-reserve or
on Crown Land.
2009–10 First
Nations Oral
Health Survey
Included are data on when First
Nations adults last saw a dental
professional, barriers to receiving
dental care, dental treatment
currently needed, flossing and
brushing frequency.
2007–2009
Canadian
Health Measures
Survey—Oral
Health Component
The survey provides oral health
data for the total Canadian
population (excluding First
Nations communities) aged 18 or
older (unless otherwise stated).
Data for decayed and missing
teeth, brushing and flossing
frequency are provided.
Excluded are individuals living
in First Nations communities
and on Crown Lands, institutional
residents, full-time members
of the Canadian Forces, and
residents of certain remote
regions.
Where possible, RHS estimates
have been compared with those
available from the CCHS. However,
this is not always possible as
comparable data may not exist.
Two communities (one urban/
rural and one remote/special
access) were chosen from each
of 4 regions across Canada for
a total of 8 participating
communities.
Only communities with a
population of 500 or more were
eligible for sample selection.
Data are not representative
of smaller First Nations
communities.
Confidence intervals cannot
be calculated because of
sample design.
The total sample is 1,188
(ages 3–79).
Data were collected from
approximately 5,600 people
aged 6 to 79 years.
The response rate was 69.6%.
Interviews/examinations were
carried out in 15 communities
across Canada.
Excluded are those living in
First Nations communities and
on Crown Lands, institutional
residents, full-time members
of the Canadian Forces, and
residents of certain remote
regions.
TABLE 2. Administrative Data Sources
Data Source
Data Provided
Limitations and Additional Information
2008 Indian Register (adjusted
counts), Aboriginal Affairs and
Northern Development Canada
Counts of those living in First
Nations communities registered
under the Indian Act are provided.
Adjusted data (2009 base year) are used in this report
to reduce impact of late reporting of births and deaths.
Area of residence information (on vs off reserve) can
be problematic as moves to and from reserve are
not always captured if a life event was not reported.
Included are some people who did not identify as
First Nations who are registered under the Indian Act.
Integrated Capital Management
System, Aboriginal Affairs and
Northern Development
Fire protection services data are
provided on AANDC-administered
First Nations sites.
Community Planning and
Management System, Health
Canada
The report includes data on the
degree of isolation of First Nations
communities based on the distance
from physician services and
accessibility to the community.
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Excluded are communities in the territories and
communities under the James Bay and Northern
Quebec Agreement.
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Comparisons with Previous Versions of this Report
Readers are advised to use caution when comparing data in this report with those provided in previous
versions of “A Statistical Profile on the Health of First Nations in Canada—Determinants of Health”.
Data may not be comparable due to changes in question wording; age groups of interest; concepts and;
target populations. Some comparisons over time have been provided in this report, where data permit.
Statistical Significance
In this report, unless otherwise stated, differences between percentages compared in the text are
statistically significant (the difference is not due to chance). In figures and tables based on survey
data, 95% confidence interval bars are provided to assist with significance determination. Estimates
are statistically significant if the ranges covered by the bars do not overlap.
Age Standardization
Because the First Nations population living in First Nations communities is much younger than the total
population of Canada (Figure 1), survey percentages and confidence intervals are age standardized before
data are compared. In this report, data for the total Canadian population aged 18 and over (excluding
First Nations communities) from the Canadian Community Health Survey have been age standardized to
the First Nations Regional Health Survey adult age structure.
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4. RESULTS AND DISCUSSION
Age and Sex Distribution
In monitoring the health of First Nations people living in First Nations communities and making
comparisons to the total Canadian population, it is necessary to consider the differences in population
composition (Figure 1).
• The Registered Indian population3 living in First Nations communities is younger than the total
Canadian population.
• About 43% of those who are registered under the Indian Act living in First Nations communities
were under the age of 20, compared to 24% of those in the total Canadian population.
• While seniors (those aged 65 years and over) made up 5% of the Registered Indian population,
they made up a much larger share of the total Canadian population (14%).
Age Group
FIGURE 1. Age Distribution, Population Registered Under the Indian Act in First Nations Communities
and Total Canadian Population, 2008
Registered Population in
First Nations Communities
(n=459,271)
Total Canadian Population
(n=33,319,098)
85+
80–84
75–79
70–74
65–69
60–64
55–59
50–54
45–49
40–44
35–39
30–34
25–29
20–24
15–19
10–14
5–9
0–4
12
10
8
6
4
2
0
2
4
6
8
10
12
Percent Distribution
SOURCES: Aboriginal Affairs and Northern Development Canada, 2008 adjusted Indian Register data; Statistics Canada CANSIM
table 051–0001—Estimates of population, by age group and sex for July 1, Canada, provinces and territories, annual.
The gender split for the Registered Indian population living in First Nations communities was nearly equal,
consisting of 50.9% for males and 49.1% for females (data not shown).
3
The Registered Indian population includes those registered under the Indian Act. Excluded is a small number of First Nations people not
registered under the Act (ie: without status) who live in First Nations communities. Included is a small number of those who do not identify
as First Nations people who have status under the Indian Act.
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Community Wellness
First Nations health and wellbeing has been defined as “the total (First Nations) health of the total
(First Nations) person within the total (First Nations) environment”.a The wellness of the community is
one of the key components of a First Nations wholistic view of wellness.
Data from the 2008/10 First Nations Regional Health Survey provide some insights into how residents
perceive their communities. First Nations adults living in First Nations communities were asked to identify
the main strengths of their community. The most frequently reported strength was family values (61.6%),
followed by Elders (41.7%) and traditional ceremonial activities (37.7%).b
When First Nations adults were asked about challenges currently facing their communities, the most
common responses were alcohol and drug abuse (82.6%), housing (70.7%) and employment/number
of jobs (65.9%) (data not shown).b
D I S C U SS I O N
Many western models of wellness focus primarily on the health of the individual. However, as mentioned
previously, First Nations perspectives are often more wholistic and models of wellness often emphasize
the importance of the health of the community, in addition to that of the individual. For example, the
Assembly of First Nation’s Wholistic Policy and Planning model puts First Nations communities at its core.c
Community health is also a component of the First Nations Health Authority’s visual presentation of First
Nations wellness.d The interconnectedness of the health of First Nations community, families, culture
and individuals is emphasized in the First Nations Regional Health Survey’s Cultural Framework.a
This emphasis on community health speaks to the need for good quality data at this level. In response
to this need, the First Nations Information Governance Centre has developed a Community Survey, in
addition to individual level surveys. Combining data on individuals with those for their community can
provide insights into how community factors influence the health of their residents.e
REFERENCES
a. First Nations Information Governance Centre (FNIGC). 2003. RHS Cultural Framework.
http://fnigc.ca/sites/default/files/ENpdf/RHS_General/developing-a-cultural-framework.pdf
b. First Nations Information Governance Centre (FNIGC). 2012. “First Nations Regional Health Survey (RHS)
2008/10: National report on adults, youth and children living in First Nations communities”. Ottawa. FNIGC.
c. Reading, J., A. Kmetic and V. Gideon. 2007. “First Nations Wholistic Policy and Planning Model—Discussion
paper for the World Health Organization Commission on Social Determinants of Health”. http://64.26.129.156/
cmslib/general/07-05-28_AFN_Paper_to_WHO_Commission_on_Social_Determinants_of_Health.pdf
d. First Nations Health Authority, 2012. “First Nations Perspective of Wellness”. www.fnha.ca/wellness/
wellness-and-the-first-nations-health-authority/first-nations-perspective-on-wellness
e. First Nations Information Governance Centre. First Nations Regional Health Survey 2008/10—Community
Survey. http://fnigc.ca/sites/default/files/ENpdf/RHS_2008/RHS-Co2.pdf
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Education
For many First Nations people, learning and education ideally incorporate knowledge from both
indigenous and western traditions. Learning is a life-long endeavour, taking place in both formal and
informal settings such as at home, on the land, and in the classroom.a
Education is a catalyst for success in the labour market and plays a pivotal role in a person’s ability to
get a stable, well-paid job.b While many First Nations people emphasize the importance of traditional
teachings and the passing on of traditional knowledge, formal education is still considered essential
for full participation in the Canadian economy. Having an educated population can also help facilitate
economic opportunities in First Nations communities.
L E V E L O F E D U C AT I O N
• In 2006, half (50.2%) of First Nations people living in First Nations communities (aged 25 to 64)
had not graduated from high school.4 This was much higher than the figure for the total population
of Canada the same age (15.2%) (Figure 2).
FIGURE 2. Highest Certificate, Diploma or Degree, First Nations People in First Nations Communities
and Total Canadian Population1 Aged 25 to 64 Years, 2006
Highest Certificate, Diploma or Degree
First Nations Population in First Nations Communities
Total Canadian Population1
50.2
No Certificate, Diploma or Degree
15.2
High School Certificate
or Equivalent Only
14.8
24.0
Apprenticeship or Trades
Certificate or Diploma
12.8
12.4
College, CEGEP or
Other Non-university
14.0
20.4
University Certificate or
Diploma Below Bachelor Level
3.9
5.0
University Certificate, Diploma or
Degree at Bachelor’s Level or Above
4.3
23.1
0
10
20
30
40
50
Percent of Population
1
Total Canadian population living outside of First Nations communities.
NOTE: Percentages may not add up to 100% due to rounding.
SOURCE: Statistics Canada, 2006 Census custom tabulation.
4
Unless otherwise indicated, data in this section are from the 2006 Census. This source was used as it is able to provide comparable data for the
total population of Canada (living outside First Nations communities).
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E D U C AT I O N GA I N S O V E R T I M E
COMPARING CENSUS DATA OVER TIME
Before comparisons between 1996 and 2006 can be made, data for both years must be adjusted.
In 1996, 77 First Nations communities did not take part in the Census compared to 22 in 2006. To
facilitate the comparison, communities that did not take part in one or both years are removed from
these 1996 and 2006 data. When 2006 data are shown without a comparison to 1996, the 2006
data only exclude those living in the 22 First Nations communities.
First Nations adults have made gains in the formal education system in recent years. In 1996, 57%
of those registered under the Indian Act5 living in First Nations communities aged 25 to 546 had not
graduated from high school compared to 49% in 2006. At the post-secondary level in 1996, 30% had
a diploma, certificate or degree compared to 35% in 2006 (Data not shown).
DIFFERENCES BETWEEN MEN AND WOMEN
• A larger percentage of First Nations women in First Nations communities had a college certificate
(17.2%) or university diploma (6.0%) than their First Nations male counterparts (10.9% and 2.6%
respectively). The same was true for women and men in the total Canadian population (Table 3).
• 17.2% of First Nations men had an apprenticeship or trades certificate or diploma compared with
8.3% of First Nations women.
TABLE 3. Highest Certificate, Diploma or Degree, First Nations People in First Nations Communities and
Total Canadian Population1 Aged 25 to 64 Years by Sex, 2006
Highest Certificate, Diploma or Degree
1
First Nations People in
First Nations Communities
Both
Sexes
Males
Females
Total Canadian Population1
Both
Sexes
Males
Females
No Certificate, Diploma or Degree
50.2%
53.0%
47.3%
15.2%
16.1%
14.3%
High School Certificate or Equivalent Only
14.8%
13.5%
16.2%
24.0%
22.9%
25.0%
Apprenticeship or Trades Certificate or Diploma
12.8%
17.2%
8.3%
12.4%
16.0%
9.0%
College, CEGEP or Other Non-University
Certificate or Diploma
14.0%
10.9%
17.2%
20.4%
18.0%
22.7%
University Certificate or Diploma Below
Bachelor Level
3.9%
2.8%
4.9%
5.0%
4.4%
5.6%
University Certificate, Diploma or Degree
at Bachelor’s Level or Above
4.3%
2.6%
6.0%
23.1%
22.7%
23.4%
Total Canadian population living outside of First Nations communities.
NOTE: Percentages may not add up to 100% due to rounding.
SOURCE: Statistics Canada, 2006 Census custom tabulation.
5
1996 and 2006 data in this paragraph are for those registered under the Indian Act. While most of these people identify as First Nations,
included may be a small number of people who are registered who do not identify as First Nations.
6
Adjusted data for 1996 and 2006 are for a different age group than are unadjusted 2006 data, due to data availability.
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D I F F E R E N C E S BY AG E G R O U P A N D P L AC E O F R E S I D E N C E
• Among those living in First Nations communities aged 18 to 24 years, 65.7% had not completed high
school. The figure was lowest for those in the 30 to 44 year group (48.0%). This suggests that some First
Nations people may go back to complete their high school education when they are older (Figure 3).
FIGURE 3. First Nations People Without a High School Diploma In and Outside First Nations Communities
by Age Group, 2006
In First Nations Communities
Oustide First Nations Communities
90
Percent of First Nations Adults
80
70
60
65.7
65.1
55.9
52.9
50
40
81.6
51.9
48.0
46.3
36.0
31.0
30
34.7
28.3
20
10
0
All ages (18+)
18–24
25–29
30–44
45–64
65+
Age Group
NOTE: Percentages may not add up to 100% due to rounding.
SOURCE: Statistics Canada, 2006 Census custom tabulation.
• In 2006, while half (50.2%) of First Nations people in First Nations communities (aged 25 to 64) had not
completed high school, the comparable figure for First Nations people living outside these communities
was 31.1% (data not shown).
R E S I D E N T I A L S C H O O L AT T E N DA N C E A N D E X P E R I E N C E
Residential schools operated across Canada for over 100 years until the last closed in the mid 1990’s.
Approximately 70,000 to 80,000 First Nations people, Métis and Inuit who attended these schools are
alive today. While some students reported positive experiences at these schools, others experienced
emotional, physical and sexual abuse, a loss of language, separation from their families, communities and
cultures, among other things. The residential school system experience can leave an inter-generational
legacy as its impacts can be passed from one generation to the next.c
• At the time of the 2008/10 First Nations Regional Health Survey, 19.7% of First Nations people living
in First Nations communities aged 18 and over reported having attended residential school. The 65 and
over age group had the largest proportion of residential school attendees as 43.9% reported attending
(data not shown).
• Among those who reported attending, 13.7% said it had a positive impact on their health and
well-being and one-third (32.8%) said the experience had no impact. Over half (53.4%) said the
experience had a negative impact (data not shown).
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• Some of the most commonly stated negative impacts were isolation from family and verbal and
emotional abuse (Table 4).
TABLE 4. Factors Contributing to Negative Impact on Health and Wellbeing of Residential School
Attendees, First Nations People in First Nations Communities Aged 18 Years and Over, 2008/101
Negative Impact Reported
1
First Nations Adults in First Nations
Communities Who Attended Residential School
95% Confidence Interval
Lower
Upper
Isolation From Family
77.6%
73.1
81.5
Verbal or Emotional Abuse
73.1%
68.7
77.1
Separation From Community
69.7%
65.1
73.9
Harsh Discipline
69.3%
64.7
73.5
Loss of Cultural Identity
68.6%
64.8
72.2
Physical Abuse
66.9%
62.2
71.2
Language Loss
62.6%
58.5
66.6
Loss of Traditional Religion/Spirituality
62.0%
57.6
66.1
Bullying
61.3%
56.2
66.0
Poor Education
44.7%
40.3
49.2
Harsh Living Conditions
44.0%
39.5
48.5
Lack of Food
42.3%
38.1
46.7
Sexual Abuse
38.2%
34.2
42.4
Lack of Proper Clothing
37.6%
33.7
41.5
Data are for those who reported that their overall health and well-being was negatively impacted by their attendance at residential school.
SOURCE: First Nations Information Governance Centre, First Nations Regional Health Survey (RHS) 2008/10.
D I S C U SS I O N
First Nations people living in First Nations communities have made gains in the formal education system
in recent years. However, significant education attainment gaps exist with the total Canadian population.
To narrow these gaps, First Nations organizations have developed strategies around greater incorporation
of First Nations values and languages in the classroom, increasing parental involvement, development of
culturally-relevant curricula and ensuring that schools are accessible, healthy, safe and well-resourced,
among others.d
Most of the indicators included in this section only measure success in the formal education system.
A more wholistic, comprehensive evaluation of First Nations education and lifelong learning would
incorporate a wide range of indicators covering the complete learning spectrum. National level data
of this type are not available for First Nations people.
REFERENCES
a. Canadian Council on Learning “The State of Aboriginal Learning in Canada: A holistic approach to measuring
success” www.cclcca.ca/CCL/Reports/StateofAboriginalLearning.html
b. Ciceri C. and Scott K. “The Determinants of Employment Among Aboriginal Peoples”. In: White JP, Wingert S,
Beavon D, Maxim P, editors. Aboriginal Policy Research: moving forward, making a difference. Toronto:
Thompson Education Publishing; 2006. p. 3–32
c. Library of Parliament, 2011. “Addressing the Legacy of Residential Schools” publication no. 2011-76-E
www.parl.gc.ca/Content/LOP/ResearchPublications/2011-76-e.pdf
d. Assembly of First Nations. 2009. “First Nations Control of First Nations Education: It’s Our Vision, It’s Our Time”
http://64.26.129.156/calltoaction/Documents/FNCFNE.pdf
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Labour Force Characteristics
Employment status and the type of job a person has can have an effect on their overall physical and
mental health. A better paying job can have positive effects on a person’s overall quality of life, though
certain jobs may also pose health risks (e.g. higher rates of injury, exposure to toxins).
EMPLOYMENT INDICATOR DEFINITIONS AND LIMITATIONS
Unemployed people are those who, during the week before the Census, were without paid work
or without self-employment and were available for work and either:
• had actively looked for paid work in the past four weeks; or
• were on temporary lay-off and expected to return to their job; or
• had definite arrangements to start a new job in four weeks or less
The labour force is made up of people who were either employed or unemployed in the week
before the Census.
Three indicators of employment are provided here. Each helps better understand the health of the
economy and society more generally:
Unemployment rate: The percentage of people aged 15 years and over who are currently
unemployed and looking for work. Excluded from this rate are those who are not working and not
looking for work.
Labour force participation rate: The percentage of people aged 15 years and over, who are either
employed or currently looking for work. It excludes those not looking for work, such as full-time
students, retired persons or discouraged workers.
Employment rate: The percentage of people aged 15 years and over who are working for pay or
in self-employment.
Comparing employment indicators for the First Nation population to those for the total Canadian
population has some limitations. In many First Nations communities, much of the available work is
seasonal. In addition, much unpaid work is done that is not reflected in these rates. Many people
take part in activities that contribute to the local economy such as hunting, fishing, sewing, child
care and so on. Rates may therefore exaggerate the gaps between First Nations people and the
total Canadian population.
Included in standard measures of unemployment are those who are not working but who are looking
for work. In some small First Nations communities, there may be less need to look for work as it is
known throughout the community that there are few employment possibilities. Those without work
may then be considered “discouraged workers” (not working and not looking for work) and are
excluded from the unemployment rate.
Excluded from Census data are those living in 22 First Nations communities that did not take part
in the 2006 Census.
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• In 2006, the unemployment rate for First Nations people in First Nations communities (aged 15 and
over) was nearly four times the rate for the total Canadian population (25.0% versus 6.4% respectively)
(Table 5).7
• For First Nations people, the employment rate was 39.0% compared to 62.6% for the total
Canadian population.
TABLE 5. Labour Force Characteristics for First Nations People in First Nations Communities and Total
Canadian Population1 Aged 15 Years and Over, by Sex, 2006
First Nations People in
First Nations Communities
1
Total Canadian Population1
Both Sexes
Males
Females
Both Sexes
Males
Females
Unemployment Rate
25.0%
28.7%
20.6%
6.4%
6.4%
6.5%
Employment Rate
39.0%
39.6%
38.3%
62.6%
67.9%
57.7%
Labour Force Participation Rate
51.9%
55.6%
48.3%
66.9%
72.5%
61.7%
Total Canadian population living outside First Nations communities.
SOURCE: Statistics Canada, 2006 Census custom tabulation.
DIFFERENCES BETWEEN MEN AND WOMEN
• The employment rate for First Nations men living in First Nations communities was almost the same
as that for First Nations women (39.6% and 38.3% respectively). However, the unemployment rate
for men was higher than that for women (28.7% versus 20.6%) (Table 5).
D I F F E R E N C E S BY AG E G R O U P A N D P L AC E O F R E S I D E N C E
• First Nations people living in First Nations communities have greater employment challenges than
those living elsewhere. In 2006, the unemployment rate was higher for those in First Nations
communities, while the overall participation and employment rates were lower (Table 6).
TABLE 6. Labour Force Characteristics for First Nations People In and Outside First Nations Communities,
Aged 15 years and Over by Age Group, 2006
Participation Rate
Age Group
All Ages (15+)
Employment Rate
Unemployment Rate
First Nations
Communities
Outside
First Nations
Communities
First Nations
Communities
Outside
First Nations
Communities
First Nations
Communities
Outside
First Nations
Communities
51.9%
62.4%
39.0%
52.8%
25.0%
15.4%
15–24
33.1%
50.0%
20.4%
38.6%
38.3%
22.7%
25–44
66.6%
74.6%
50.0%
63.7%
24.9%
14.6%
45–64
61.7%
65.6%
50.9%
58.0%
17.4%
11.6%
65+
12.4%
11.0%
10.6%
9.9%
14.7%
10.2%
SOURCE: Statistics Canada, 2006 Census custom tabulation.
7
Unless otherwise indicated, data in this section are from the 2006 Census. This source was used as it is able to provide comparable data for the
total population of Canada (living outside First Nations communities).
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• Gaining employment is especially challenging for young First Nations people living in First Nations
communities. For those aged 15 to 24, the employment rate was 20.4%, compared to 38.6% for those
the same age living outside First Nations communities. For young people the same age in the total
population (excluding First Nations communities), the employment rate was 57.7% (data not shown).
• The employment rates for young First Nations men (21.4%) and women (19.4%) aged 15 to 24 living
in First Nations communities were very similar (data not shown).
D I S C U SS I O N
First Nations people living in First Nations communities face many employment challenges. The
unemployment rate is almost four times that of the total Canadian population and the unemployment
rate for young First Nations people is especially high. Reducing these gaps could contribute to better
health outcomes for First Nations people.
There are many factors contributing to the employment gap between First Nations people in First Nations
communities and others. Some of these include lower levels of formal education, lack of secure housing,
difficulties accessing child care and transportation, racism and the legacy of colonialism, among others.a
REFERENCE
a. Ciceri, C. and K. Scott, 2006. “The Determinants of Employment Among Aboriginal Peoples” in J. White, S.
Wingert, D. Beavon and P. Maxim “Aboriginal Policy Research: Moving Forward, Making a Difference” Vol. III.
Toronto: Thompson Educational Publishing Inc.
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Income
”Poverty and ill-health are inextricably linked… the lower an individual’s socio-economic status, the worse
their health”.a Income, one key dimension of poverty, influences living conditions, quality of housing, and
the ability to afford sufficient good food, all of which affect health status.
INCOME INDICATOR DEFINITIONS AND LIMITATIONS
In this report, data for two related but different income concepts are provided—total annual individual
income and median income.
Total annual individual income includes money received from all sources (employment, pensions,
government transfers etc.).
The median income marks the middle point where exactly half of the population has more income
and half has less. The median, rather than the average, is the preferred statistic when describing the
income since average income is sensitive to extreme values.
Excluded from Census data are those living in 22 First Nations communities that did not take part
in the 2006 Census.
TOTA L A N N UA L I N CO M E
• In 2005, about one-quarter (25.9%) of First Nations adults in First Nations communities aged
25 to 64 had a total annual income of less than $5,000, compared to 9.9% of those in the total
Canadian population8 (Figure 4).
• A larger proportion of the total Canadian population is found at the higher end of the income spectrum.
While 19.2% of those in the total Canadian population had a total annual income of $60,000 or more,
3.6% of First Nations people living in First Nations communities were in this category.
8
Unless otherwise indicated, data in this section are from the 2006 Census. This source was used as it is able to provide comparable data for the
total population of Canada (living outside First Nations communities).
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FIGURE 4. Total Annual Income Groups, First Nations People in First Nations Communities and Total
Canadian Population1, Aged 25 to 64 Years, 2005
30
First Nations People in First Nations Communities
Total Canadian Population1
25.9
25
Percent of Population
22.3
19.2
20
10
14.8
14.5
15
15.1 14.5
14.6
8.1
7.6
5.2
5
0
11.3
10.6
9.9
2.7
Under $5,000
(Including
No Income)
$5,000—
$9,999
$10,000—
$19,999
$20,000—
$29,999
$30,000—
$39,999
$40,000—
$49,999
$50,000—
$59,999
3.6
$60,000+
Total Annual Income Groups
1
Total Canadian population living outside First Nations communities.
NOTE: Percentages may not add up to 100% due to rounding.
SOURCE: Statistics Canada, 2006 Census custom tabulation.
M E D I A N I N CO M E
• The median income of First Nations people in First Nations communities is less than half that of the
total Canadian population. In 2005, the median income of First Nations adults was $11,210 compared
to $25,767 for the total population (Figure 5). For First Nations people living outside First Nations
communities, the figure was $16,771 (data not shown).
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A S TAT I S T I C A L P R O F I L E O N T H E H E A LT H O F F I R S T N AT I O N S I N C A N A D A :
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FIGURE 5. Median Annual Income, First Nations People in First Nations Communities and Total Canadian
Population1 Aged 15 Years and Over, 2005
$35,000
First Nations People in First Nations Communities
Total Canadian Population1
$32,434
Median Annual Income
$30,000
$25,767
$25,000
$20,535
$20,000
$15,000
$10,000
$12,469
$9,953
$11,210
$5,000
$0
Males
Females
Both sexes
Sex
1
Total Canadian population living outside First Nations communities.
SOURCE: Statistics Canada, 2006 Census custom tabulation.
• For First Nations men living in First Nations communities, the median income was $9,953, much less
than that of men in the total Canadian population ($32,434). The gap between First Nations women
in First Nations communities and women in the total Canadian population was smaller than that for
men but the median income of First Nations women was still much lower. The median income for First
Nations women in First Nations communities was $12,469 compared to $20,535 for women in the
total population—a difference of over $8,000.
• First Nations men had a lower median income than First Nations women while the reverse was true in
the total Canadian population.
D I S C U SS I O N
Incomes of First Nations adults living in First Nations communities are much lower than those of people
in the total Canadian population. The factors contributing to this gap are numerous and complex and are
only in part related to higher rates of unemployment and educational disparities. b The Royal Commission
on Aboriginal Peoples (RCAP) has stated that, “Redistributing lands and resources will greatly improve
their (Aboriginal Peoples’) chances for jobs and a reasonable income. After that, the tools most urgently
needed are capital for investment in business and industry and enhanced technical, management and
professional skills to realize new opportunities”.c
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REFERENCES
a. National Collaborating Centre for Aboriginal Health, 2009. Fact sheet—“Poverty as a Social Determinant of
First Nations, Inuit and Métis Health”. www.nccah-ccnsa.ca/Publications/Lists/Publications/Attachments/
21/Poverty%20(English).pdf
b. Wilson, D. and D. MacDonald 2010. “The Income Gap Between Aboriginal Peoples and the rest of Canada”
Ottawa: Canadian Centre for Policy Alternatives. www.policyalternatives.ca/sites/default/files/uploads/
publications/reports/docs/Aboriginal%20Income%20Gap.pdf
c. Royal Commission on Aboriginal Peoples. 1996 “Highlights from the Report of the Royal Commission on
Aboriginal Peoples—People to People, Nation to Nation”. www.aadnc-aandc.gc.ca/eng/1100100014597
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Personal Health Practices
Personal health practices, sometimes known as behavioural risk factors, are the many choices throughout
a person’s life such as smoking, alcohol use or physical activity that can have both positive and negative
effects on an individual’s health.a
SMOKING
While tobacco was traditionally used for ceremonial purposes among many First Nations peoplesb,
non-ceremonial use can present health risks. Some of these include coronary heart disease, lung cancer,
emphysema and other illnesses.c
• Data from the 2008/10 First Nations Regional Health Survey (RHS) show that First Nations adults living
in First Nations communities were more than twice as likely to smoke every day as people in the total
Canadian population. Over four in 10 (43.2%) First Nations adults smoked on a daily basis compared to
19.0% of the total population (Figure 6).
FIGURE 6. Smoking Status, First Nations People in First Nations Communities (2008/10) and Total
Canadian Population1 (2008), Aged 18 Years and Over
100
First Nations People in First Nations Communities
Total Canadian Population1
75.6
Percent of Population
80
60
43.1
43.2
40
19.0
20
13.8
5.4
0
Non Smoker
Daily Smoker
Occasional Smoker
Smoking Status
1
Total Canadian population living outside First Nations communities.
NOTES: Percentages may not add up to 100% due to rounding. CCHS data have been age standardized to the RHS age structure.
SOURCES: First Nations Information Governance Centre (FNIGC), First Nations Regional Health Survey (RHS) 2008/10, custom tabulation;
Statistics Canada, Canadian Community Health Survey 2008.
• The daily smoking rate among First Nations people in First Nations communities has not changed in
recent years. The percentage from the 2002/03 RHS (data not shown) was about the same as that
from the 2008/10 survey.
• The 2008/10 RHS shows that there was no difference between the daily smoking rates for First Nations
men and women (data not shown).
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A S TAT I S T I C A L P R O F I L E O N T H E H E A LT H O F F I R S T N AT I O N S I N C A N A D A :
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• The daily smoking rate was highest for young First Nations adults aged 18 to 29 (51.5%) and lowest
for those aged 60 and over (25.4%) (Table 7).
TABLE 7. Smoking Status, First Nations People in First Nations Communities by Age Group, 2008/10
Smoking Status
Age Group
All Ages (18+)
18–29
30–39
40–49
50–59
60+
43.1%
33.1%
37.3%
40.1%
52.1%
69.1%
Non-Smoker
Percent
Lower 95% C.I.
41.3%
30.3%
34.2%
36.7%
48.9%
66.6%
Upper 95% C.I.
44.9%
36.0%
40.6%
43.6%
55.2%
71.4%
43.2%
51.5%
44.2%
44.8%
38.5%
25.4%
Daily Smoker
Percent
Lower 95% C.I.
41.6%
48.6%
40.9%
41.6%
35.5%
23.1%
Upper 95% C.I.
44.8%
54.4%
47.6%
48.2%
41.6%
28.0%
13.8%
15.4%
18.4%
15.0%
9.5%
5.5%
Occasional Smoker
Percent
Lower 95% C.I.
12.7%
13.7%
15.1%
13.3%
7.8%
4.4%
Upper 95% C.I.
14.9%
17.2%
22.3%
17.0%
11.4%
6.8%
NOTE: Percentages may not add up to 100% due to rounding.
SOURCE: First Nations Information Governance Centre (FNIGC), First Nations Regional Health Survey (RHS) 2008/10.
A LCO H O L U S E
Excessive use of alcohol can have a number of negative effects, both in terms of physical health and the
social and cultural impacts of alcoholism.
• According to the 2008/10 First Nations Regional Health Survey, First Nations adults in First Nations
communities are less likely to report drinking alcohol than those in the total Canadian population.
Among First Nations adults, 64.7% had at least one drink of alcohol in the past 12 months prior to
the survey, compared to 81.7% of adults in the total population (Figure 7). Conversely, 35.3% of First
Nations adults abstained from alcohol in the previous 12 months, compared to 18.3% of adults in
the total population.
• Among First Nations men, 68.3% consumed alcohol in the previous year while the figure for First
Nations women was 61.0%.
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A S TAT I S T I C A L P R O F I L E O N T H E H E A LT H O F F I R S T N AT I O N S I N C A N A D A :
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FIGURE 7. Consumed Alcohol in the Past 12 Months, First Nations People in First Nations Communities
(2008/10) and Total Canadian Population1 (2008) Aged 18 Years and Over
First Nations People in First Nations Communities
Total Canadian Population1
100
85.6
Percent of Population
81.7
77.8
80
68.3
64.7
61.0
60
40
20
0
Males
Females
Both Sexes
Sex
1
Total Canadian population living outside First Nations communities.
NOTE: CCHS data have been age standardized to the RHS age structure.
SOURCES: First Nations Information Governance Centre (FNIGC), First Nations Regional Health Survey (RHS) 2008/10; Statistics Canada,
Canadian Community Health Survey 2008.
• Of all First Nations adults, those aged 18 to 29 years were the most likely to report drinking alcohol
(81.4%). The proportion fell with increasing age to 34.9% among those aged 60 and over (Figure 8).
FIGURE 8. Consumed Alcohol in the Past 12 Months, First Nations People in First Nations Communities
by Age Group, 2008/10
Percent of First Nations Adults
100
81.4
80
74.2
63.7
64.7
60
46.5
34.9
40
20
0
18–29
30–39
40–49
50–59
60+
Age Group
SOURCE: First Nations Information Governance Centre (FNIGC), First Nations Regional Health Survey (RHS) 2008/10.
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All ages
(18+)
A S TAT I S T I C A L P R O F I L E O N T H E H E A LT H O F F I R S T N AT I O N S I N C A N A D A :
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• Heavy or “binge” drinking is defined here as having five or more drinks on one occasion. A larger
percentage of First Nations people aged 18 and over in First Nations communities reported heavy drinking
on a weekly basis compared to those in the total Canadian population—9.8% versus 8.0% (Figure 9).
• Men in the total Canadian population were as likely as First Nations men to drink heavily on a weekly
basis (12.4% in both cases). However, a larger percentage of First Nations women (7.1%) had five or
more drinks on one occasion compared to women in the total population (3.7%).
FIGURE 9. Heavy Drinking1 on a Weekly Basis, First Nations People in First Nations Communities
(2008/10) and Total Canadian Population2 (2008), Aged 18 Years and Over
16
Percent of Population
14
First Nations People in First Nations Communities
Total Canadian Population2
12.4
12.4
12
9.8
10
8.0
7.1
8
6
3.7
4
2
0
Males
Females
Both sexes
Sex
1
Heavy drinking is defined here as having five or more drinks on one occasion at least once a week.
2
Total Canadian population living outside First Nations communities.
NOTES: The denominator includes those who did and did not consume alcohol in the past year. CCHS data have been age standardized
to the RHS age structure.
SOURCES: First Nations Information Governance Centre (FNIGC), First Nations Regional Health Survey (RHS) 2008/10; Statistics Canada,
Canadian Community Health Survey 2008.
FO O D CO N S U M P T I O N
A healthy eating pattern helps infants, children, teens and adults get the nutrients needed to grow,
be healthy, prevent illness and to have a healthy weight.
• Data from the 2008/10 First Nations Regional Health Survey show that 42% of First Nations adults
living in First Nations communities report that they do not consume milk or milk products daily while
10% report never or hardly ever consuming milk or milk products.d Canada’s Food Guide recommends
at least two servings (cups) of milk per day for adults.e
• Nearly four in 10 (37%) state that they do not consume vegetables at least once a day, and 43%
report not consuming fruit (excluding juice), at least once per day.d
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• The percentage of First Nations adults in First Nations communities reporting they often consumed
traditional meats varied widely by location: urban (30%), rural (37%), remote (58%), and no road access
(51%). Traditional fruit and vegetable consumption varied little: 18% for both urban and rural areas,
25% for remote regions and 22% for areas with no road access.d Studies show that consumption of
traditional foods leads to improved intake of several nutrients.f
FO O D S EC U R I T Y 9
Having enough healthy food to eat is essential to good health. As described in Canada’s Action Plan on
Food Security, food security “exists when all people, at all times, have physical and economic access to
sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and
healthy life”.g For many First Nations people, food security includes both traditional and market foods.
It can be measured at individual, household and/ or community levels.
Food security is recognized as a socio-economic determinant of health.h Several factors undermine First
Nations food security including poverty, unemployment, environmental changes affecting traditional food
practices and the unreliable supply, quality and high prices of market food in remote and isolated First
Nations communities.i
First Nations eating patterns may reflect, in part, food insecurity, which is found to a much greater degree
generally among Aboriginal populations than non-Aboriginal populations in Canada. Adults and
adolescents in food insecure households in Canada have been found to have lower intakes of milk
products, fruits and vegetables, and to be at an increased risk of inadequate nutrient intake.j
• Over half (54.2%) of First Nations adults in First Nations communities lived in food insecure households,
according to the 2008/10 First Nations Regional Health Survey.d Although not directly comparable due
to differences in methodology and survey weighting (individual vs. household), this is much higher than
the 7.7% from the 2007-08 Canadian Community Health Survey for all Canadian households, excluding
those in First Nations communities (data not shown).
P H YS I C A L AC T I V I T Y
Regular physical activity has numerous benefits including improving overall well-being and quality of
life, reducing the risks of many diseases and improving mental wellness. It also contributes to maintaining
a healthy weight, an important consideration given that 39.8% of First Nations adults in First Nations
communities are obese, compared to 16% of all adults in Canada.10 A recent study has shown that
active First Nations adults are more likely to have fewer health conditions, feel more balanced spiritually,
emotionally, mentally and physically and are more likely to express feelings of control over their own
lives than are those who are less active.d
• When asked to describe their routine in a typical day, 35.1% of First Nations men and 26.8% of
First Nations women say that they did at least 60 minutes of moderate activity per day (Figure 10).
9
While most data in this section are related to personal health practices, some additional data are provided on food security because of its
relationship to food and nutrient intake.
10
First Nations data are from the First Nations Regional Health Survey, 2008/10 while data for the total Canadian population (excluding reserves)
are from the 2008 Canadian Community Health Survey. CCHS data have been age standardized to the RHS age structure.
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FIGURE 10. Level of Physical Activity, First Nations People in First Nations Communities,
Aged 18 Years and Over, 2008/10
Males
40
Percent of First Nations Adults
35
31.3
29.0
28.3
30
25
26.8
21.6
20
15
Females
35.1
15.9
11.9
10
5
0
Rarely Active
At Least 30 Minutes of Physical
Activity at Least Once a Week
Moderate Activities
35–59 Minutes/Day
Moderate Activities at
Least 60 Minutes/Day
Level of Activity
NOTE: Percentages may not add up to 100% due to rounding.
SOURCE: First Nations Information Governance Centre (FNIGC), First Nations Regional Health Survey (RHS) 2008/10.
• Over four in 10 (44.1%) First Nations adults in First Nations communities spent more than 1.5 hours a
day doing sedentary activities such as watching TV, reading, playing bingo or video games (Figure 11).
Differences between men and women were not statistically significant (data not shown).
FIGURE 11. Time Spent Watching TV, Reading, Working at a Computer (outside of workday/schoolday)
etc., First Nations People in First Nations Communities, Aged 18 Years and Over, 2008/10
50
44.1
Percent of First Nations Adults
45
40
35
27.1
30
25
17.6
20
15
11.2
10
5
0
Less Than 30 Minutes
30 Minutes–1 Hour
1 Hour–1.5 Hours
More Than 1.5 Hours
Time spent in average day watching TV, reading, playing bingo/video games or working at computer
NOTE: Percentages may not add up to 100% due to rounding.
SOURCE: First Nations Information Governance Centre (FNIGC) First Nations Regional Health Survey (RHS) 2008/10.
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S E XUA L H E A LT H
Sexual health contributes to overall health and well-being throughout the life course. Data from
the First Nations Regional Health Survey (2008/10) can provide some insights into the sexual health
of First Nations people.
• 72.1% of First Nations adults aged 18 and over stated that they were sexually active
(77.4% of men and 66.7% of women—data not shown).
• Among those that had intercourse in the previous year, 89.0% of First Nations adults living
in First Nations communities had one or two partners (Figure 12).
• A larger percentage of First Nations men than women reported having had 3 or more partners
during the year—14.5% and 7.0% respectively.
FIGURE 12. Number of Sexual Partners in the Past 12 Months, First Nations People in First Nations
Communities, Aged 18 Years and Over, 2008/10
90
Percent of First Nations Adults
80
82.6
76.6
Males
Females
Both Sexes
79.4
70
60
50
40
30
20
10.4
9.0
10
14.5
9.6
11.0
7.0
0
1 Partner
2 Partners
3 or More Partners
Number of Sexual Partners
NOTES: Data are for those that had sexual intercourse in the last 12 months. Percentages may not add up to 100% due to rounding.
SOURCE: First Nations Information Governance Centre (FNIGC), First Nations Regional Health Survey (RHS) 2008/10.
• Among First Nations adults aged 18 and over, young First Nations men were the most likely to have
3 or more partners. Among First Nations men aged 18 to 29 who reported being sexually active, 25.3%
had 3 or more partners during the previous year compared to 13.9% of young First Nations women
(data not shown).
• When asked which birth control or protective methods were used, nearly four in 10 (38.3%) First Nations
adults reported that they and/or their partner used a condom (data not shown).
• When asked how often they used a condom, 21.2% of First Nations adults stated they always did, and
16.3% reported they did most of the time. An additional 14.9% said they occasionally used a condom
while nearly half (47.6%) stated they never did (Figure 13).
• The main reason given for not always using a condom was being with a steady partner (60.0%)
(data not shown).
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FIGURE 13. Frequency of Condom Use, First Nations People in First Nations Communities Aged 18 Years
and Over, 2008/10
Percent of First Nations Adults
60
47.6
50
40
30
21.2
20
16.3
14.9
Most of the time
Occassionally
10
0
Always
Never
How Often Condoms Used
NOTES: Data are based on responses to the following question asked of sexually active adults: “Which of the following birth control or protective
methods do you and/or your partner(s) use… condoms?”. Respondents were not asked to specify frequency of use. Percentages may not add up to
100% due to rounding. Data are for those who reported having sexual intercourse in the past 12 months.
SOURCE: First Nations Information Governance Centre (FNIGC), First Nations Regional Health Survey (RHS) 2008/10.
• Young men (aged 18 to 29) were the most likely group to report using condoms (67.8%) while older
adults were the least likely to report using them (Table 8).
TABLE 8. Reported Use of a Condom as a Means of Birth Control or Protection, First Nations People in
First Nations Communities by Age Group and Sex, 2008/10
Age group
Males
Females
Percent
Lower 95% C.I.
Upper 95% C.I.
Percent
Lower 95% C.I.
Upper 95% C.I.
18–29
67.8%
63.3%
72.0%
55.2%
51.2%
59.1%
30–39
41.8%
37.0%
46.8%
30.4%
24.3%
37.2%
40–49
23.9%
19.9%
28.3%
17.6%
13.0%
23.5%
50–59
17.9%
14.2%
22.3%
7.7%
4.6%
12.6%
60+
11.8%
7.5%
17.9%
*
*
*
All ages (18+)
41.9%
39.3%
44.4%
34.1%
31.2%
37.1%
E
NOTES: Data are based on responses to the following question asked of sexually active adults: “Which of the following birth control or protective
methods do you and/or your partner(s) use… condoms?”. Respondents were not asked to specify frequency of use. Data are for those who reported
having sexual intercourse in the past 12 months. C.I. = confidence interval.
SOURCE: First Nations Information Governance Centre (FNIGC), First Nations Regional Health Survey (RHS) 2008/10.
E
use with caution.
* data not shown for confidentiality/data quality reasons.
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O RA L H E A LT H P RAC T I C E S
Daily brushing and flossing help maintain good oral health.k
• 54.5% of First Nations adults aged 20 to 79 (with at least one natural tooth) living in First Nations
communities reported brushing their teeth at least twice a day.l For people in the total Canadian
population the same age, the figure was 73.4%.m
• Among First Nations adults, 27.0%l reported flossing at least five times per week, about the same
as the 28.9% for the total Canadian population.m
• Among First Nations adults aged 20 and over who had at least one natural tooth, more than half
(56.6%) had at least one tooth with untreated decay.l By comparison, the figure for those in the
total Canadian population was 19.3%.m
D I S C U SS I O N
Data on personal health practices of those living in First Nations communities suggest the presence of
some risk factors that could have health and social consequences. For example, the daily smoking rate
among First Nations peoples is more than double that of the total Canadian population.
Personal health practices might be considered lifestyle choices; however, a variety of factors can affect
an individual’s choice such as income; the amount of free time available; access to recreational facilities,
information and resources; availability of traditional foods, and availability and cost of healthy store foods;
child and health care, among others. In addition, the displacement of First Nations people from their
traditional lands, residential school attendance, racism and a host of other factors all work together
to impact the physical, mental and spiritual health of First Nations people.n
REFERENCES
a. Public Health Agency of Canada, 2013. “What makes Canadians Healthy or Unhealthy?” www.phac-aspc.gc.ca/
ph-sp/determinants/determinants-eng.php#personalhealth
b. Reading, J. 1999 Chapter 4: The Tobacco Report in “First Nations and Inuit Regional Health Survey Final Report”.
Ottawa: First Nations and Inuit Regional Health Survey National Steering Committee. www.rhs-ers.ca/sites/
default/files/ENpdf/RHS_1997/rhs_1997_final_report.pdf
c. Health Canada. 2007. “An Overview of Health Risks of Smoking”. Ottawa www.hc-sc.gc.ca/hc-ps/tobac-tabac/
res/news-nouvelles/risks-risques-eng.php
d. First Nations Information Governance Centre (FNIGC) (2012). “First Nations Regional Health Survey (RHS)
2008/10: National report on adults, youth and children living in First Nations communities”. Ottawa: FNIGC.
www.fnigc.ca/sites/default/files/First%20Nations%20Regional%20Health%20Survey%20%28RHS%29%20
2008-10%20-%20National%20Report.pdf
e. Health Canada, 2007. “Canada’s Food Guide”. www.hc-sc.gc.ca/fn-an/food-guide-aliment/basics-base/
quantit-eng.php
f. Receveur, O., Boulay, M., and H. Kuhnlein. 1997. “Decreasing Traditional Food Use Affects Diet Quality for Adult
Dene/Métis in 16 Communities of the Canadian Northwest”. Journal of Nutrition, Vol. 127, #11: 2179–2186.
g. Agriculture and Agri-Food Canada. “Canada’s Action Plan for Food Security: A Response to the World Food
Summit”. Ottawa: Agriculture and Agri-Food Canada, 1998. www.agr.gc.ca/misb/fsec-seca/pdf/action_e.pdf.
h. Chief Public Health Officer. “The Chief Public Health Officer’s Report on the State of Public Health in Canada
2008: Addressing Health Inequalities”. Ottawa: Public Health Agency of Canada, 2008
i. Power, E. 2007. “Food Security For First Nations and Inuit”, Background Paper. Unpublished. Prepared for First
Nations and Inuit Health Branch, Health Canada.
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j. Kirkpatrick S, Tarasuk V. 2008, “Food Insecurity Is Associated with Nutrient Inadequacies among Canadian
Adults and Adolescents”. Journal of Nutrition. V138: 604–612.
k. Canadian Dental Association. www.cda-adc.ca/en/oral_health/cfyt/dental_care/flossing_brushing.asp
l. First Nations Information Governance Centre, 2011. “First Nations Oral Health Survey (FNOHS) 2009–2010
Summary Report”, First Nations Information Governance Centre.
m.Statistics Canada, 2007–2009 Canadian Health Measures Survey, custom tabulations.
n. Adelson, N. 2005. “The Embodiment of Inequity—Health Disparities in Aboriginal Canada”. Canadian Journal
of Public Health: March–April.
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Health Services11
Health services can be divided into preventive services (which are designed to maintain health), diagnostic
services (which are designed to identify illness and potential illness as early as possible), and therapeutic
services (which are designed to treat ill health). This section focuses on access to general health services
as well as diagnostic services.
ACC E SS TO H E A LT H S E R V I C E S
• When asked how they would rate their level of access to health services compared to Canadians
generally, 12.4% of First Nations adults living in First Nations communities stated they had better
access, 49.0% stated their access was the same while 38.6% stated they had less access to health
services (Figure 14).
• For the 2002/03 period, a larger percentage (23.6%) stated they had better access than in 2008/10.
FIGURE 14. Reported Level of Access to Health Services Available Compared to Canadians Generally,
First Nations People in First Nations Communities Aged 18 Years and Over, 2002/03 and 2008/10
60
2002/03
2008/10
Percent of First Nations Adults
49.0
50
40
35.6
40.8
38.6
30
23.6
20
12.4
10
0
Less Access
Same Level of Access
Better Access
Reported Level of Health Service Access
NOTE: Percentages may not add up to 100% due to rounding.
SOURCES: First Nations Information Governance Centre (FNIGC), First Nations Regional Health Survey (RHS) 2002/03 and 2008/10.
• When asked if they have experienced any barriers to receiving health care in the past 12 months, the
top response provided by First Nations adults in First Nations communities was that the waiting list
was too long (37.6%) (Figure 15).
11
Unless otherwise stated, in this section, data for First Nations adults are from the First Nations Regional Health Survey (2008/10) while data for
the comparison population are from the Canadian Community Health Survey (2008).
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FIGURE 15. Selected Perceived Barriers to Receiving Health Services, First Nations People in First Nations
Communities Aged 18 Years and Over, 2008/10
Waiting List Too Long
37.6
Doctor or Nurse not Available in my Area
22.6
Not Covered by NIHB*
20.6
Felt Health Care Provided was Inadequate
19.8
Unable to Arrange Transportation
17.6
Could Not Afford Direct Cost of Care, Service
16.6
Could Not Afford Transportation Costs
16.6
Service was not Available in my Area
16.1
Approval for Services Under NIHB* was Denied
15.5
Felt Service was not Culturally Appropriate
15.4
0
10
20
30
40
Percent of First Nations Adults
SOURCE: First Nations Information Governance Centre (FNIGC), First Nations Regional Health Survey (RHS) 2008/10.
* NIHB = non-insured health benefits
CO N TAC T W I T H T RA D I T I O N A L H E A L E R S
• Over half (57.8%) of First Nations people living in a First Nations community had never seen a
traditional healer, while 19.3% had seen one in the past 12 months (Figure 16).
FIGURE 16. When Last Saw a Traditional Healer, First Nations People in First Nations Communities
Aged 18 and Over, 2008/10
Percent of First Nations Adults
70
60
57.8
50
40
30
19.3
20
10
6.4
8.2
8.3
Over 2 Years Ago
Don’t Remember
0
Never
Within the Last 12 Months
1–2 Years Ago
When Last Saw Traditional Healer
NOTE: Percentages may not add up to 100% due to rounding.
SOURCE: First Nations Information Governance Centre (FNIGC), First Nations Regional Health Survey (RHS) 2008/10.
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• Nearly four in 10 (39.6%) First Nations adults in First Nations communities reported using traditional
medicines (data not shown).
M A M M O G RA P H Y
Disease screening is an important part of the health care system, as the early detection of many
conditions can have a major effect on the treatment and prognosis of patients.
Breast cancer is the most common type of cancer among women in Canada and the second leading
cause of cancer death. Early detection through mammograms can contribute to reducing breast
cancer-related deaths.a, 12
• Among women aged 40 and over, a larger percentage of those in the total Canadian population
reported having had a mammogram in their lifetime (74.2% compared to 65.4% for their First Nations
counterparts) (Figure 17).
• The largest gap existed among women aged 50 to 59 where 74.4% of First Nations women living in
First Nations Communities reported having at least one mammogram, compared to 86.6% of women
in the total Canadian population.
FIGURE 17. Women Ever Having a Mammogram, First Nations Women in First Nations Communities
(2008/10) and all Women in Canada1 (2008), Aged 40 Years and Over
First Nations Women in
First Nations Communities
Canada1
100
86.6
90
88.5
74.4
80
Percent of Population
82.4
74.2
65.4
70
60
50
55.2
47.4
40
30
20
10
0
40–49
50–59
60+
All ages (40+)
Age Group
1
Total population living outside First Nations communities.
NOTES: Percentages may not add up to 100% due to rounding. CCHS data have been age standardized to the RHS age structure.
SOURCES: First Nations Information Governance Centre (FNIGC), First Nations Regional Health Survey (RHS) 2008/10. Statistics Canada,
Canadian Community Health Survey 2008.
12
As approximately half of all new cases of breast cancer among women occur to those aged 50 to 69, most provinces and territories offer breast
screening services to women in this age group. Less targeted screening is offered to women of other ages in some provinces and territories.a
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PA PA N I CO L AO U ( PA P ) T E ST
In the general population, cervical cancer incidence and mortality rates have significantly decreased since
the introduction of the Pap test.b
• A slightly larger percentage of First Nations women aged 18 and over living in First Nations
communities reported ever having a Pap test compared to women in the total population of
Canada (90.3% and 87.0% respectively) (Figure 18).
• Across age groups, percentages for First Nations women and their counterparts in the total population
were similar. The only significant difference was for those in the 18 to 29 age group. A higher
percentage of young First Nations women living in First Nations communities had a Pap test than
young women in the total Canadian population (85.0% and 75.9% respectively).
FIGURE 18. Women Ever Having a Pap Test, First Nations Women in First Nations Communities (2008/10)
and all Women in Canada1 (2008), by Age Group
First Nations Women in
First Nations Communities
Canada
95.6
100
92.2
94.3 92.8
91.6 93.2
85.0
Percent of Population
80
84.3 85.9
90.3
87.0
75.9
60
40
20
0
18–29
30–39
40–49
50–59
60+
All Ages (18+)
Age Group
1
Total population living outside First Nations communities.
NOTE: CCHS data have been age standardized to the RHS age structure.
SOURCES: First Nations Information Governance Centre (FNIGC), First Nations Regional Health Survey (RHS) 2008/10; Statistics Canada, Canadian
Community Health Survey 2008.
• In 2008, 18.9% of women aged 18 and over in the total Canadian population who reported not
having a Pap test in the past three years had not done so due to a hysterectomy. No comparable
data are available for First Nations women. This must be kept in mind when comparing rates for
these two groups.
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P R O STAT E C H EC KS
Prostate cancer is the most commonly diagnosed cancer among men in Canada and the third leading
cause of male cancer death.c The prostate-specific antigen (PSA) blood test and a digital rectal exam
(DRE) are the two main prostate cancer screening tests.
• Overall, 23.4% of First Nations men aged 18 and over living in a First Nations community reported
having had a PSA test or physical prostate check (rectal exam) in their lifetime (Figure 19).
• Over half (52.8%) of First Nations men aged 60 and over reported having had at least one PSA or DRE.
FIGURE 19. First Nations Men in First Nations Communities who Reported Ever Having a Physical Prostate
Check or PSA test in their Lifetime, by Age Group, 2008/10
Percent of First Nations Men
70
52.8
60
44.1
50
40
26.2
30
23.4
20
10
11.7
7.1
0
18–29
30–39
40–49
50–59
60+
All Ages (18+)
Age Group
SOURCE: First Nations Information Governance Centre (FNIGC), First Nations Regional Health Survey (RHS) 2008/10.
D E N TA L S E R V I C E S
Good oral health is essential to overall health and well-being and can reduce premature mortality. Poor
oral health can lead to considerable pain and function impairment.d
• Over half (56.5%) of First Nations adults in First Nations communities reported having received dental
care within the past year. About one-fifth (20.2%) stated they received treatment one to two years ago
while 23.3% reported receiving dental care more than two years ago or never (data not shown).
• When asked if they had experienced any difficulties accessing dental care, about one quarter (24.1%) of
all First Nations adults stated waiting lists were too long, 18.0% reported that dental services were not
available in their area and 17.4% stated that services were not covered by non-insured health benefits
(NIHB) (Table 9).
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TABLE 9. Selected Difficulties Accessing Dental Care, First Nations People in First Nations Communities
Aged 18 Years and Over, 2008/10
Barriers to Access Dental Care
Yes (%)
95% Confidence Interval
Lower
Upper
Waiting List Too Long
24.1
22.3
26.1
Dental Services Not Available in My Area
18.0
16.6
19.5
Service Not Covered by NIHB*
17.4
15.7
19.2
Felt Dental Services Were Inadequate
15.5
14.2
16.9
Prior Approval for Services Under NIHB* Was Denied
14.7
13.2
16.3
Direct Cost of Care
14.1
12.6
15.7
Transportation Costs
13.0
11.8
14.2
Other Cost
4.9
4.2
5.6
Childcare Costs
4.4
3.8
5.1
SOURCE: First Nations Information Governance Centre (FNIGC), First Nations Regional Health Survey (RHS) 2008/10.
* NIHB = non-insured health benefits
• Data from clinical examinations carried out for the First Nations Oral Health Survey provide evidence of
unmet need for dental care among First Nations adults living in First Nations communities. For example,
8.2% were in urgent of treatment. Over eight in ten (83.1%) had some type of dental treatment need—
70.3% were in need of fillings, 87.2% required preventative care, over one-quarter (26.3%) were in need
of surgery while 24.1% required gum treatment and 6.8% needed root canal treatment.e
D I S C U SS I O N
First Nations people are in a unique position in terms of health care in Canada. As with all Canadians, they
are entitled to universal health care administered through the provincial health care systems. In addition,
those with status also receive non-insured health benefits coverage from the Federal Government for
certain medically necessary services not normally covered by the universal health care system, such as
prescription drug coverage, dental and vision care, as well as coverage for emergency transport.
A concern of the many First Nations who live in remote communities is access to health services. In
many remote communities, primary care is provided mainly by nurse practitioners, while patients with
emergencies are transported to facilities in larger centres.
Disease screening is a fundamental aspect of the health care system, as the early detection of many
conditions can have a major effect on the treatment and prognosis of patients. Fewer First Nations
women report having mammograms than other Canadian women, perhaps in part because of difficulty
in accessing screening services, including availability of services, transportation barriers, economic barriers
and cultural appropriateness of these services.f By comparison, First Nations women have similar rates
of Pap tests as other Canadian women.
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REFERENCES
a. Public Health Agency of Canada, 2011. “Organized Breast Cancer Screening Programs in Canada—Report
on Performance in 2005 and 2006.” www.phac-aspc.gc.ca/cd-mc/publications/cancer/obcsp-podcs05/pdf/
breast-cancer-report-eng.pdf
b. Public Health Agency of Canada, 2009. “Performance Monitoring for Cervical Cancer Screening Programs
in Canada”. www.phac-aspc.gc.ca/cd-mc/cancer/pmccspc-srpdccuc/pdf/cervical-eng.pdf
c. Canadian Cancer Society. “More about prostate cancer testing” www.cancer.ca/Canada-wide/Prevention/
Getting%20checked/More%20about%20prostate%20cancer%20testing.aspx?sc_lang=en.
d. World Health Organization, 2003. “The World Oral Health Report”. www.who.int/oral_health/media/en/
orh_report03_en.pdf
e. First Nations Information Governance Centre (FNIGC), “First Nations Oral Health Survey (FNOHS) 2009–2010
Summary Report, 2011” www.jcda.ca/uploads/c143/FNOHS-NationalReport.pdf
f. First Nations Information Governance Centre (FNIGC), “First Nations Regional Longitudinal Health Survey (RHS)
2002–2003; Results for adults, youth and children living in First Nations communities”. Assembly of First
Nations; 2005 November; www.rhs-ers.ca/sites/default/files/ENpdf/RHS_2002/rhs2002-03-technical_report.pdf
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Social Support Networks
S O C I A L S U P P O RT N E T W O R KS
Support from family, friends and others can contribute to good overall health. Strong social relationships
can help protect against a number of health problems.a
• Data from the First Nations Regional Health Survey show that First Nations people living in First Nations
communities were most likely to seek out friends and family if they needed to talk about their emotional
or mental health. Just over six in 10 First Nations adults reported seeing or talking to immediate family
(63.1%) or friends (62.6%) about their emotional or mental health in the past 12 months (Figure 20).
• Professionals such as psychiatrists (5.4%), psychologists (6.2%) and social workers (8.7%) were seen
or talked to much less often.
FIGURE 20. People Seen or Talked to in Past 12 Months about Emotional or Mental Health, First Nations
People in First Nations Communities, Aged 18 Years and Over, 2008/10
Percent of First Nations Adults
70
63.1
62.6
60
54.2
50
40
27.7
30
20
10
2.8
5.4
6.2
8.7
14.3
11.4
17.3
18.2
m
e
Fa dia
m te
ily
nd
Im
Fr
ie
F
Do am
ct ily
(N
or
ot
Im
m Fa
ed m
ia ily
te
)
rs
e
Tr
ad
it
He ion
al al
er
se
un
Co
Nu
llo
r
R
CH
W Soc
or ia
ke l
r
Cr
isi
W sL
or ine
ke
r
Ps
yc
hi
at
ris
t
Ps
yc
ho
lo
gi
st
0
Person Seen or Talked on Phone to About Emotional or Mental Health in Past 12 Months
SOURCE: First Nations Information Governance Centre (FNIGC), First Nations Regional Health Survey (RHS) 2008/10.
D I S C U SS I O N
Many studies point to the relationship between good physical, mental and emotional health and strong
ties to family, friends and community. However, it has also been argued that for some First Nations people
living in small, socially interconnected communities, social support relationships can negatively impact
health because of “conformity pressures and social obligations that promote health-damaging behaviours
such as domestic violence and smoking”.b
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In addition to existing questions on sources of social support, a more thorough understanding of First
Nations adults’ support networks would be gained through the development of survey questions on
unmet support needs.
REFERENCES
a. Public Health Agency of Canada 2003. “What Makes Canadians Healthy or Unhealthy?”
www.phac-aspc.gc.ca/ph-sp/determinants/determinants-eng.php
b. Richmond, C., N. Ross, 2008. “Social Support, material circumstance and health behaviour: Influences on health
in First Nations and Inuit communities of Canada”. Social Science and Medicine. Vol. 67 #9. pp. 1423–1433.
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Social Exclusion—Racism
While racism is not one of the determinants of health in the Public Health Agency of Canada’s framework,
it is a form of social exclusion and can impact socio-economic status, which the World Health Organization
considers to be a structural determinant of health.a It has been stated that, “the colonial system created
social stratification along ethnic lines, with a consequent hierarchical distribution of resources, power,
freedom of control, all of which ultimately influenced Aboriginal health”.b
• According to the 2008/10 First Nations Regional Health Survey, about one third (32.6%) of First Nations
people in First Nations communities had personally experienced racism in the past 12 months (data
not shown).
• Among those that had experienced racism, 42.1% reported it had no effect on their self-esteem,
46.9% said it had little or some effect and 10.9% said it had a strong or very strong effect on their
self-esteem (Figure 21).
FIGURE 21. Effect of Racism on Self-Esteem, First Nations People in First Nations Communities Aged 18
Years and Over, 2008/10
Percent of First Nations Adults
60
50
46.9
42.1
40
30
20
10.9
10
0
No Effect
Little or Some Effect
Strong or Very Strong Effect
Effect of Racism on Self-esteem
SOURCE: First Nations Information Governance Centre (FNIGC), First Nations Regional Health Survey (RHS) 2008/10.
NOTE: Data are for those that reported personally experiencing racism in the past 12 months.
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D I S C U SS I O N
First Nations peoples have experienced racism in a variety of forms over a long period of history. Racism
and the resulting feelings of social exclusion stemming from the impacts of colonialism can impact the
mental health of First Nations peoples and their social support networks and create barriers to health
care access, education and employment.c Data from the First Nations Regional Health Survey show that
one third (32.6%) of First Nations adults living in first Nations communities experienced racism in the
12 months before the survey. Among those that had experienced racism, over one-half stated that it
had some impact on their self-esteem.
REFERENCES
a. World Health Organisation, 2007. “A Conceptual Framework for Action on the Social Determinants of Health”.
Discussion paper for the Commission on Social Determinants of Health. Geneva.
b. Loppie, C. and F. Wein, 2009. “Health Inequalities and Social Determinants of Aboriginal People’s Health” pg. 22.
National Collaborating Centre for Aboriginal Health.
c. Reading, J., A. Kmetic and V. Gideon, 2007. “First Nations Wholistic Policy and Planning Model—Discussion
Paper for the World Health Organization Commission on Social Determinants of Health”. Ottawa: Assembly
of First Nations. http://ahrnets.ca/files/2011/02/AFN_Paper_2007.pdf
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Culture
Culture and tradition are integral components of a First Nations wholistic approach to health and
well-being. Although it is difficult to measure something as complex and multifaceted as culture, two
indicators used here are the use of a First Nations language and participation in cultural events.
M OT H E R TO N G U E
• Mother tongue is the first language learned in childhood and still understood. According to the 2006
Census, just under half (45.9%) of all First Nations people living in First Nations communities13 had an
Aboriginal language as their mother tongue (either alone or in combination with English or French)
(Figure 22).
FIGURE 22. Languages Learned as Mother Tongue, First Nations People in First Nations Communities,
All Ages, 2006
1.0%
45.9%
Aboriginal Language Only or With English and/or French
English Only
French Only
53.0%
SOURCE: Statistics Canada, 2006 Census, custom tabulation.
• Only a few First Nations languages have an adequate population of speakers needed to maintain the
transfer of the language to future generations. In First Nations communities that took part in the 2006
Census, the five most common Aboriginal mother tongues reported were (Figure 23):
• Cree (42.6%)
• Ojibway (13.2%)
• Oji-Cree (8.0%)
• Montagnais-Naskapi (6.5%)
• Mi’kmaq (5.2%)
13
While other data in this report are for adults, figures for language are for First Nations people of all ages
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FIGURE 23. Aboriginal Languages Learned as Mother Tongue, First Nations People in First Nations
Communities, All Ages, 2006
The remaining 11% speak over
20 different Aboriginal languages.
2%
3%
43%
4%
5%
5%
6%
Cree
Ojibway
Oji-Cree
Montagnais-Naskapi
Mi’kmaq
Dene
Siouan languages (Dakota/Sioux)
Atikamekw
Blackfoot
8%
13%
SOURCE: Statistics Canada, 2006 Census, custom tabulation.
NOTE: Those that reported more than one Aboriginal mother tongue are excluded from this figure.
LIMITATIONS OF CENSUS LANGUAGE DATA
In 2006, approximately 80,000 people living in First Nations communities were not counted by the
Census. These people are excluded from the language data. Some language families (i.e.: Iroquoian)
are more affected by this exclusion than others.
• First Nations people living in First Nations communities were more likely to speak an Aboriginal
language as their mother tongue than are those living outside these communities (45.9% and 13.3%
respectively—data not shown).
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PA RT I C I PAT I O N I N C U LT U RA L E V E N T S
• When respondents to the First Nations Regional Health Survey were asked how often they took part in
their local community’s cultural events, 20.7% of First Nations adults living in First Nations communities
responded “always” or “almost always”. An additional 46.4% reported sometimes (Figure 24).
FIGURE 24. Frequency of Participation in Community’s Cultural Events, First Nations People in First
Nations Communities, Aged 18 Years and Over, 2008/10
Percent of First Nations Adults
60
50
46.4
40
30
20.4
20.7
20
12.5
10
0
Always/Almost Always
Sometimes
Rarely
Never
Frequency of Participation in Community’s Cultural Events
SOURCE: First Nations Information Governance Centre (FNIGC), First Nations Regional Health Survey (RHS) 2008/10.
D I S C U SS I O N
Nearly half of all First Nations people living in First Nations communities speak an Aboriginal language
as their mother tongue. Some of these languages have many speakers, while others have only a few.
Strengthening First Nations languages is important as they “reflect distinctive histories, cultures and
identities linked to family, community, the land and traditional knowledge”.a
A lack of cultural connection is frequently cited as a primary cause of many of the social problems
facing First Nations people. For example, research has shown that suicide rates are lower in First Nations
communities where efforts have been made to preserve and strengthen components of culture.b A recent
study showed that First Nations adults who took part in cultural events were “less likely to be depressed,
more likely to perceive control over their lives, more likely to perceive greater social support and less likely
to use licit and illicit substances than those who infrequently participated in community cultural events”.c
Something as complex as culture cannot be adequately described or measured through the small number
of indicators provided in this report. Similarly, while this section has focused on some indicators of culture
for First Nations people in First Nations communities, there is not one but many diverse First Nations
cultures across the country. The indicators provided here are designed to provide a general national-level
overview of a few components of culture.
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D E T E R M I N A N T S O F H E A LT H , 2 0 0 6 T O 2 0 1 0
REFERENCES
a. Norris, M.J. 2007, “Aboriginal Languages in Canada: Emerging Trends and Perspectives on Second Language
Acquisition” Canadian Social Trends, May.
b. Chandler, M. and C. Lalonde, 1998, “Cultural Continuity as a Hedge Against Suicide in Canada’s First Nations”
Journal of Transcultural Psychiatry 35(2):191–219.
c. The First Nations Information Governance Centre, “First Nations Regional Health Survey (RHS) Phase 2
(2008/10) National Report on Adults, Youth and Children Living in First Nations Communities”: pp. 230 (Ottawa:
The First Nations Information Governance Centre, June 2012).
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Physical Environment
The physical environment encompasses a number of things, including housing quality, clean air and water,
sanitation services and the security of community infrastructure. In addition to impacting physical health,
it can also significantly influence psychosocial well-being, as is the case with housing quality, for example.
HOUSING
Poor housing quality can affect the quality of the indoor air, or allow the growth of mould or the
manifestation of other harmful agents. Overcrowding can contribute to a host of physical ailments
(such as communicable diseases like tuberculosis) as well as psychological effects, such as stress
between household members.
• Census data show that over one-quarter (28%) of Registered Indian households in First Nations
communities fell below the adequacy standard—they were considered by their residents as requiring
major repairs (Figure 25). This was more than 10 times the percentage for non-Aboriginal households
outside of First Nations communities.
• In addition, 12% of Registered Indian households fell below the suitability standard—their homes did
not have enough bedrooms for the size and make up of those living in the home.
FIGURE 25. Aboriginal and non-Aboriginal Households Outside First Nations Communities and Registered
Indian Households in First Nations Communities Below CMHC Housing Standards, 2006
Non-Aboriginal Households Outside First Nations Communities
Aboriginal Households Outside First Nations Communities
Registered Indian Households in First Nations Communities
Percent of Households Below Standard
40
34
35
30
28
25
20
20
16
15
10
12
11
6
5
12
5
2
2
0
Below Affordability
Standard
Below Adequacy
Standard
Below Suitability
Standard
Below One or
More Standard
Housing Standards
SOURCE: Canada Mortgage and Housing Corporation based on 2006 Census data.
NOTE: The affordability standard cannot be calculated for Status Indian on-reserve households, since many homes on-reserve are paid for through
Band housing arrangements.
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• Data from the Regional Health Survey show that for the 2008/10 period, 50.9% of First Nations adults
in First Nations communities reported that there had been mould or mildew growing in their home in
the past 12 months. This was up from 44.0% in 2002/03 (data not shown).
• A separate survey showed that 50% of First Nations people living in First Nations communities that
reported having mould in their home believed that their own health or the health of others in their
household had been affected by the presence of mould. Respiratory-related problems such as asthma,
shortness of breath, bronchitis and allergies were often reported.a
• For the 2008/10 period, some First Nations people living in First Nations communities reported not
having hot running water (3.4%), cold running water (2.1%) or flush toilets (2.7%) in their home. There
has been no significant change in these numbers since 2002/03.b
WAT E R SYST E M S
• In First Nations communities, 1,880 homes (or 1.5%) were reported to have had no water service
(no plumbing in the house), in the 2009-2011 National Assessment of First Nations Water and
Wastewater Systems.c
• The same assessment found that 13.1% of water treatment systems were operating beyond estimated
capacity as they could not meet present needs. Another 3.6% was operating at capacity (current needs
were being met) (Figure 26).c
FIGURE 26. Water and Wastewater Treatment Capacities, First Nations Communities, 2009–2010
Over Capacity
At Capacity
Available Capacity
Not Enough Data
100
13.1
90
18.0
3.6
3.2
80
Percent
70
60
58.5
50
80.8
40
30
20
10
20.3
2.5
0
Water Treatment Capacity
Wastewater Treatment Capacity
N = 807 for water treatment; N = 532 for wastewater treatment
NOTES: Existing systems that are unable to meet current needs are considered to be over capacity. Those at capacity can meet current needs.
Available capacity suggests that the existing system has the capacity to meet more than current needs. For more details, please see the source
cited below.
SOURCE: Adapted from Department of Indian and Northern Affairs Canada, 2011. “National Assessment of First Nations Water and Wastewater
Systems—National Roll-Up Report. www.aadnc-aandc.gc.ca/eng/1313770257504/1313770328745
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• In First Nations communities, 314 or 39% of water systems inspected were categorized as high risk—
they had major deficiencies that could lead to environmental or health and safety concerns and posed
a high water quality risk. Of these, 192 did not meet a health parameter laid out in the Guidelines for
Canadian Drinking Water Quality (GCDWQ). The majority of these were determined to be high risk
because they exceeded the bacteriological parameter. c
WA ST E WAT E R SYST E M S
• Among First Nations individuals living in First Nations communities, 2% of homes were reported to
have no wastewater service.c
• 18.0% of wastewater treatment systems were operating beyond capacity and 3.2% were operating
at capacity (Figure 26).c
FIRE SERVICES
• 43% of sites under the jurisdiction of Aboriginal Affairs and Northern Development Canada (AANDC) had
no fire service (26%) or inadequate fire service (17%). Over half (57%) had adequate service (Figure 27).
FIGURE 27. Fire Protection Services on AANDC-Administered First Nations Sites1, 2009–2010
26%
No Service
Inadequate service
Adequate service*
17%
57%
N = 973 sites
1
“Site” refers to a First Nations settlement. A First Nation or Band may include more than one location or site with different community services.
Each of these sites would be counted separately.
* Adequate service means fire protection services are verified by a site survey conducted by a Fire Protection Specialist. Inadequate means service
has not been verified or does not meet the Level of Service Standard.
NOTE: Excludes communities in the territories, the Inuit communities of Nunavik (northern Quebec) and the communities under the James Bay
and Northern Quebec Agreement.
SOURCE: AANDC 2010, Integrated Capital Management System.
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CO M M U N I T Y I S O L AT I O N
• The majority (65%) of First Nation communities were non-isolated. They were accessible by road
and were less than 90 kilometres from physician services (Figure 28).
• 16% were semi-isolated communities that had road access, but the nearest physician services were
farther than 90 kilometres away.
• Another 15% were isolated in that they had scheduled flights and good telephone service, but no
year round road access.
• Less than 4% of First Nations communities were remote isolated. These had no scheduled flights
or road access, and minimal telephone and radio service.
FIGURE 28. First Nations Communities by Degree of Isolation, 2008
4%
15%
Non-isolated
Semi-isolated
Isolated
Remote-isolated
16%
65%
N = 627
NOTE: The number of communities is as of December 31, 2008.
SOURCE: Health Canada, First Nations and Inuit Health Branch, Community Planning and Management System.
D I S C U SS I O N
Concerns in the physical environment can range from a simple lack of sanitation to contaminants in the
air, water, food or soil that can cause a variety of adverse health effects, including cancers, birth defects,
respiratory illness and gastro-intestinal ailments.d,e,f In addition, the physical environment, such as the
house one lives in, can significantly influence psychosocial well-being.
Data provided in this section have shown some First Nations people in First Nations communities may
face challenges from their physical environment. Homes are more likely to be crowded and half are
reported to contain mould. Many communities do not have fire protection services and the water and
wastewater systems in some communities are operating at or beyond capacity.
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D E T E R M I N A N T S O F H E A LT H , 2 0 0 6 T O 2 0 1 0
REFERENCES
a. Health Canada, 2007. “Quantitative Research on Indoor Air Quality and Mould in First Nations Households”.
http://epe.lac-bac.gc.ca/100/200/301/pwgsc-tpsgc/por-ef/health/2007/503-06/summary.pdf
b. First Nations Information Governance Centre (FNIGC) 2012. “First Nations Regional Health Survey (RHS)
2008/10: National report on adults, youth and children living in First Nations communities”. Ottawa. FNIGC. Pg.
50 www.fnigc.ca/sites/default/files/First%20Nations%20Regional%20Health%20Survey%20(RHS)%20200810%20-%20National%20Report.pdf
c. Department of Indian Affairs and Northern Development 2011. “National Assessment of First Nations Water and
Wastewater Systems—National Roll-Up Report”. www.aadnc-aandc.gc.ca/eng/1313770257504/13137703287
d. Dales R., R. Burnett, H. Zwanenburg, 1991. “Adverse health effects among adults exposed to home dampness
and molds”. American Review of Respiratory Disease 143: 505–9
e. Dolk H., M. Vrijheid, 2003. “The impact of environmental pollution on congential abnormalities”. British Medical
Bulletin 68: 25–45.
f. Lévesque B., P. Ayotte, R. Tardif, L. Ferron, S. Gingras, S. Schlouch et al, 2002. “Cancer risk associated with
household exposure to chloroform”. Journal of Toxicology and Environmental Health A 65(7): 489–502.
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5. ACKNOWLEDGEMENTS
The publication of this report would not be possible without the contribution of the Health Data Technical
Working Group (HDTWG). Their hard work and dedication is gratefully acknowledged. In addition, thanks are
expressed to the organizations that provided data for this report—the First Nations Information Governance
Centre (FNIGC), Statistics Canada, and Aboriginal Affairs and Northern Development Canada (AANDC).
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