1. Health Council of Canada. The health status of Canada’s First Nations, Metis and Inuit Peoples. First Nations Wholistic Policy and
Planning Model: Discussion paper for the WHO Commissi
Beating the Drum
on Health Inequalities
in Canadian Aboriginal People
Ingrid Giesinger, Priya Khemani, Rosemund Ogyaadu, Nisha Rajendran, Jin Zhu

2. Census of Canada 2001, Geography Division, Statistics Canada 2002
Historical Context:
a Distal Determinant of Health

3. Population Projections of Registered Indians, 2000-2021, Indian and Northern Affairs Canada, 2002; Statistics Canada, Canadian
Socio-economic Information Management System Table 051-0001
Demographics
• Younger age distribution among First Nations

4. Health Council of Canada. The health status of Canada’s First Nations, Metis and Inuit Peoples
Comparing Life Expectancy and Mortality
Life expectancy of Aboriginal and
Canadian populations (1980-2000)
Infant mortality (per 1000 live
births) of Aboriginal and Canadian
populations (1999) (1999, 2003)

5. A statistical profile on the health of First Nations in Canada: Self-rated Health and Selected Conditions, 2002 to 2005
Age-Standardized Prevalence of Selected Health Conditions, First
Nations On-Reserve (2002-2003) and General Canadian Population
(2003), Adults
n/a
n/a

6. Health Council of Canada. The health status of Canada’s First Nations, Metis and Inuit Peoples. Reading JL, Kmetic A, Gideon V.
First Nations Wholistic Policy and Planning Model: Discussion paper for the WHO Commission on Social Determinants of Health
Prevalence of Selected Health Behaviours Among
Adult Aboriginals and General Canadian Population
† Heavy drinking defined as consumption of five or more drinks on any single occasion.
*Antenatal alcohol use by pregnant women on Vancouver Island.

7. RHS 2002/03
Obesity Rate in First Nations (%)
Overweight (BMI 25-29.99); Obese (BMI>30)

8. NAHO 2004e
A Comparison of Diabetes Rate Ratio
Over all, diabetes rate for First Nations adults is more
than 3 times the Canadian rate (15.5% versus 4.7%)

9. Health Council Canada 2005
Prevalence of Diabetes Among First Nations
in Canada
• Diabetes is steadily rising in the First Nations and Inuit
population
• Age-standardized rate of diabetes in Métis
population is three times higher than
non-Aboriginal population
• Fifth most prevalent condition

10. Mental Health
Historical Determinants:
•Colonization
• Residential school trauma
• Loss of land, language and
livelihood
First Nations Suicide by Cultural Continuity Factors
Proxy measure of cultural continuity factors: land claims, self-government, education
services, police and fire services, health services, and cultural facilities.
Reprinted, with permission of the publisher, from Chandler & Lalonde (1998).

11. First Nations - Suicide and self inflicted injuries
•Aboriginal vs Non Aboriginal
Males 126 per 100,000 vs 24 per 100,000
Females 35 per 100,000 vs 5 per 100, 000
• Registered Indian youths (15-24 yrs old)
• Inuit youth suicide rate highest in the world
Overall, limited available data
University of Calgary: Suicide Rates by Age and Gender First Nations & All Canadians: 1990 - 1994

12. Reported Suicide
Suicide rates per 100,000 amongst Aboriginals
compared to mainstream Canadians (1996)
Potential life years lost due to suicide: comparing
Aboriginal to Mainstream Canadians (1999)
Health Council of Canada. The health status of Canada’s First Nations, Metis and Inuit Peoples

13. First Nations Regional Longitudinal Health
Survey 2002/3

14. AFN Discussion paper for WHO Commission on SDH, National Collaborating Centre for Aboriginal Health
Social Determinants: SES & Education
• Higher SES =
empowerment
• Low levels of
education: lower
perceptions of proper
nutrition, lower skills,
low paid jobs and
fewer employment
opportunities.

15. National Collaborating Centre for Aboriginal Health
Social Determinants: Self-Determination
Per cent who strongly agree that: Depressed Not
Depressed
I can solve the problems that I
have
32.4 38.5
No one pushes me around in life 33.8 41.0
I have control over things that
happen to me
28.0 31.1
I can do just about anything I set
my mind to
35.2 43.2
I often feel helpless in dealing
with the problems of life
7.4 4.1
What happens to me in the
future mostly depends on me
37.0 37.6
There’s little I can do to change
many of the important things in
my life
10.6 5.9
• WHO: aim to
equalise health
opportunity not
health status.
• Aboriginal people
do not participate
equally in political
decision-making;
control of land,
economies, social
and health services.

16. Social Determinants: Social Exclusion and
Racism
• Hierarchal
distribution of
resources and
power.
• Racism: hinders
Aboriginal
participation and
productivity in the
national economy.
• Stress of living in a
racist environment
may lead to
negative health
outcomes.
National Collaborating Centre for
Aboriginal Health

17. National Collaborating Centre for Aboriginal Health
Social Determinants: Culture and Language
• Rate of suicide varies
with “cultural
continuity” (Chandler &
Lalonde, 1998)
• Traditions, religion and
control of health
policies, social
programs, land rights,
education access, etc all
extremely important in
this context.

18. Goals of Policy Implementation
Social inclusion and the Community
• “Strength through numbers”
• Resources supporting community-based
solutions and activities
• Knowledge dissemination in the form
of family and community awareness
campaigns
• Decrease stigma through education,
ability to recognize risk factors of
illnesses
• Suicide prevention programs
• Outreach services
Health Canada

19. National Collaborating Centre for Aboriginal Health
Goals of Policy Implementation
• Empowerment
• Increased participation of First Nations in governance and
control of health and well being of their people. Ex. The BC
Tripartite First Nations Health Plan vision
• Cultural Integration and Sensitivity
• Cultural Health Index-tool to understand how Indigenous
people look at environmental change and how they assess
that change.
• Recognize the knowledge of First Nations people, to
observe their experiences and provide management
(Maori)
• Respect their health practices

20. Goals of Policy Implementation
• Implementing into school curriculum and to communities,
knowledge on the First Nations community and culture, in order to
decrease racism
• Renewed relationship with First Nations and Inuits, building social
capital and promoting inclusion
• Build social bridges with the rest of the country. Ex. Reverse
integration in schools, or exchange programs for youth.

21. References
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Browne AJ, Fiske J, Thomas G. First Nations women’s encounters with mainstream health care services and systems. British Columbia Center of Excellence for Women’s Health. 2000.
Chudley AD, Conry J, Cook JL, Loock C, Rosales T, LeBlanc N. Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. CMAJ. 2005; 172: S1-21.
Census of Canada 2001, Geography Division, Statistics Canada 2002 http://geodepot.statcan.ca/Diss/Maps/ThematicMaps/aboriginal/National/Cda_Aborig_TABP_Fc_f1.pdf
CSDH (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, World
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22. Questions