Housing

A Culturally-Relevant Perspective on This Issue

Introduction

Housing accessibility and quality are an important determinant of health. Both poor quality and lack of accessible housing can affect physical and mental health through exposure to toxins, insects, rodents, structural problems, and social living conditions (housing tenure, satisfaction, overcrowding) [1]. Crowded living conditions can also result in health problems, such as increased transmission of infectious diseases, increased risk of injuries, mental health problems, family tension, and violence [2]. Aboriginal people are disproportionately affected by poor housing conditions, particularly on-reserve First Nations people and Inuit in the North.

Core housing need is particularly acute for Aboriginal women [3,4]. It has been estimated that the Aboriginal population is ten times more likely than the general population to be homeless [5]. Increased data collection on Aboriginal women’s housing needs is necessary to improve our understanding and address the housing problems apparent among Aboriginal communities.

First Nations

Housing problems include housing shortages, crowding, lack of plumbing and electricity, poor insulation, mould, and need for repairs [6]. According to the 2006 Census, 26% of First Nations on-reserve and 7% of First Nations off-reserve live in a crowded dwelling (more than one person per room per household) [7, 8]. As well, 44% of households reported mould or mildew in their homes [6]. Crowding and availability of household amenities (running water, electricity, stoves, refrigerators) in First Nations housing seems to be associated with low socioeconomic status and is especially high among large or isolated First Nations communities [6].  On-reserve housing is especially problematic as this housing is often poorly constructed, deteriorates quickly, poorly maintained, and crowded. These housing conditions elevate social and physical stress and give rise to physical and mental health problems [8, 9]

First Nations women report discrimination and are often refused apartments and homes, making decent housing even more difficult to acquire [10]. Also, First Nations On-Reserve women are not protected by provincial family laws and have no recourse to make claims on shared marital property and homes [11-13].

Métis

In general, Métis people enjoy better housing conditions compared to First Nations and Inuit people. According to the 2006 Census, 14% of Métis people live in homes in need of major repair compared to 7% in the Non-Aboriginal population. Three percent of the Métis population reported living in a crowded dwelling [14]. Métis living in rural areas are more likely to experience poor housing/crowding: 5% of rural Métis people versus 3% of urban Métis people reporting crowding. Approximately 18% of rural Métis versus 12% of urban Métis people reported living in homes in need of major repair [15].

Inuit

Inuit people are most likely to live in a crowded house, with 31% of the population reporting living in a crowded dwelling. Crowding is more prevalent among communities living in Inuit Nunaat, the northern regions of the Northwest Territories, Nunavut, Quebec and Labrador, with 38% of the people reporting living in a crowded dwelling. Furthermore, 28% of Inuit reported living in a dwelling of need of major repair. In Inuit Nunaat, 31% of Inuit live in home needing major repair [15,17]. 

Life of Expectancy

A Culturally-Relevant Perspective on This Issue

Introduction

Life expectancy is the average number of years a person is expected to live at birth (LEo) or at 65, based on average age-specific mortality rate for a period of time, usually a calendar year [1, 2]. Life expectancy is used as a basic measure of the health of a population. In general, Aboriginal people have a life expectancy that is much lower than the general population [3,4].

First Nations

The LEo for the First Nations population has slowly increased over time, but is still lower than that of the general Canadian population. The LEo for First Nations people in 2000 was 76 for females and 69 for males, compared to 82 years for females and 77 for males in the general population. [3]. Remote dwelling and access to health care facilities alone does not appear to account for the differences in life expectancy among the First Nations population and the general Canadian population. The interaction between poverty, oppression, and other health determinants may help explain this discrepancy [5].

Métis

The life expectancy data for Métis in Canada are unknown at this time [6].

Inuit

Life expectancy data for Inuit are not collected nationally, but instead have been collected for the Territories and Provinces separately over different periods of time [7].  A 2001 Statistics Canada study used a geography-based approach to estimate the life expectancy for the Inuit population. The LEo in 2001 was 77 years for the total population, 70 years for women and 64 years for men. This is more than ten years lower than the LEo of the general population for the same year (82 years for women, and 77 years for men)[4]. The LEo ranged significantly across Inuit regions, with Nunavik (the northern third of Quebec) having the lowest LEo of 63 years compared to Inuvialuit with a LEo of 70 years. Inuvialuit settlement region lies in the northern portion of the Northwest Territories extending from the Alaskan border to the western Canadian Arctic Islands. 

Self-Rated Health

A Culturally-Relevant Perspective on This Issue

Introduction

Self-rated health is a measure of a person’s perception of his or her own health, measured on a five point scale of excellent, very good, good, fair, or poor [1]. Self-rated health includes a range of aspects of people’s health such as incipient disease, disease severity, pain and discomfort, social, mental and physical function, physiological, and psychological resources [2]. Self-rated health is an important indicator of a population’s overall health and wellbeing. The self-rated health of Aboriginal people is lower than that of the general population [2] and may reflect the poor socio-economic and health conditions present in some Aboriginal communities. There is a lack of socio-economic and health data, as well as data on how they relate and affect self-rated health, particularly for the Métis and Inuit populations [3]. This data would be useful to better understand and improve the health (and self-rated health) of all Aboriginal peoples in Canada.

First Nations

A 2003 poll by the National Aboriginal Health Organization (NAHO) found that 73% of First Nations people interviewed reported themselves to be in good to excellent health, 13% rated themselves as excellent, 27% very good, 33% as good, and 27% as fair or poor [4]. Though the majority of First Nations people rate their health positively, the self-rated health measure is lower than that of the general Canadian population [4]. First Nations males reported a slightly higher level (76%) of self-rated health compared to women (70%). As in the general population, a positive health rating was found to correlate with level of income and education. For example, 50% of First Nations respondents making $30,000 or more reported their health to be excellent, compared to only 35% of respondents who earned less than $30,000 per year. Of the respondents classifying themselves as healthy, exercise (48%) and a balanced diet (43%) were cited as being the most important contributor to their good health [4].

Métis

The 2006 Aboriginal Peoples Survey found that 58% of adult Métis respondents rated their health as excellent or very good, similar to rates reported in 2001. The self-rated health measures were reportedly similar among Métis men and women [5]. The self-rated health varies by age group, with 75% of Métis people between 15 and 19 reporting excellent or very good health, which is higher than the Canadian average for the same age range (67%).  For the age group 25-34, 70% report excellent to good health, which is the same as the general population. The proportion of Métis rating their health as excellent or very good for ages 35 years and older declines steadily and is lower than the general population [5].

Inuit

The self-rated health for Inuit people is also low, with only 50% rating their health as excellent or very good. More Inuit men (52%) compared to Inuit women (48%) rated their health as excellent or very good, though this difference is not statistically significant. The proportion of respondents who rated their health as excellent or very good decreased with increased age. Among males, those aged 15-24 were most likely to rate their health as excellent to very good (59%), whereas for females, those aged 25-34 were most likely to rate their health highly (59%) [6].  The low self-rated health for Inuit people can be partly explained by the high prevalence of health and social problems, as well as a lack of access to health care services, particularly among those who live in rural and remote regions such as Inuit Nunaat (the northern regions of the Northwest Territories, Nunavut, Quebec, and Labrador) [7]. 

Suicide

A Culturally-Relevant Perspective on This Issue

Introduction

The suicide rate refers to the number of suicide deaths per 100,000 population, (age adjusted) [1]. Suicidal behaviours extend beyond suicide deaths to include suicide ideation (thoughts of suicide), as well as suicide attempts (suicidal behaviour not resulting in death). Suicide is a major problem among Aboriginal communities and is the leading cause of potential years of life lost (PYLL) among First Nations and Inuit populations. In British Columbia between 2005 and 2007, 20% of youth suicides were among Aboriginal youth, with one quarter of those Aboriginal youth suicides being among girls [2]. There are a number of factors contributing to the high suicide rates among First Nation, Inuit, and Métis peoples, including: loss and/or changes in language and culture; poverty; low levels of education; limited employment opportunities; inadequate living conditions; historical legacy of residential schools including family life disruption; physical, sexual and abuse [3]; and high levels of alcohol and drug misuse [4].

First Nations

The First Nations suicide rate is exceptionally high at 24 per 100,000 in 2000. First Nations women are more likely to have thought about committing suicide than men (33% versus 29%) and are much more likely to have attempted suicide (19% versus 13%).Youth suicides are also very prevalent in First Nations populations. On-reserve First Nations youth are 5-7 times more likely to die from suicide compared to the Canadian youth in the general population [5]. Gender differences in suicide ideation and attempts are apparent in youth suicide as well. For example, 21% of girls aged 15-17 reported attempting suicide, a rate that is three times that of boys in the same age group.  This pattern is apparent between males and females of all age groups [6].

Métis

Nationally collected suicide data for Métis people are currently unavailable. Suicide has, however been identified as a major concern among Métis communities [7, 8]. According to Women of the Métis Nation report, about 16% of Métis women reported contemplating suicide and 8% reported attempting suicide. Although Métis men are more likely to complete suicide, 14% of Métis women reported having attempted suicide compared to 4% of men. The number of Métis women who have considered attempting suicide (14%) is higher compared to women in the Canadian population (3.8%) [8, 9].

Inuit

The Inuit Tapiriit Kanatami identified suicide prevention as the number one health concern among the Inuit population.  According to 2001 Census data, the suicide rate of all Inuit regions was 135 per 100,000, which is more than 10 times the Canadian rate [10]. In 2002, the suicide rate for the Inuit population as a whole was 79/100,000. The suicide rate is higher among Inuit men; 15% of suicides occurring among women [11]. The rate of youth suicide among Inuit youth is among the highest in the world and is 11 times the national average [12].  The suicide rate is highest in Nunavik ( 82 per 100,000)  followed by Nunatsiavut (80 per 100,000) and Nunavut (77 per 100,000).  Inuvialuit had the lowest suicide rate of the Inuit regions (18/ 100,000) [13]. 

Tobacco Use

A Culturally-Relevant Perspective on This Issue

Introduction

Tobacco has traditionally been used in many First Nations ceremonies, rituals, and medicines [1]. The traditional uses of tobacco are not problematic, however recreational use and misuse of tobacco is addictive, harmful, and has been associated with numerous health issues, such as lung cancer, heart diseases, and strokes [2]. Smoking is very prevalent among the Aboriginal population, with the smoking rate in many Aboriginal communities almost double the Canadian rate. Smoking during pregnancy has harmful health effects on the mother as well as on the baby, including preterm birth, low birth weight, impaired physical and intellectual development, behavioural changes, asthma, and other respiratory infections [3-9]. Data on maternal smoking among Aboriginal people are lacking, however, a recent study in Manitoba found that significantly more Aboriginal mothers reported smoking during pregnancy compared to non-Aboriginal mothers (61% versus 26%) [10].

First Nations

The smoking rates of First Nations people seem to be decreasing, however, the smoking rate is about three times that of the Canadian rate [11]. Recent statistics show that approximately 60% of the First Nations adults (aged 18-34) interviewed reported smoking. Teenage smoking is also a major health problem, with approximately 50% of First Nations people having started smoking between the ages of 13 and 16 years [1].

Métis

The smoking rate among the Métis has been declining over the years and the current prevalence of daily smokers is 31%. This rate has decreased by 6% since 2001 [12]. Data from 2001 indicate a decrease in smoking prevalence in older Métis populations: 42% of 25-44 year olds were daily smokers compared to 34% of 45-64 year oldss and 24% of seniors (65 years and older). 

Inuit

The Inuit people have the highest smoking rate among Aboriginal groups, with a smoking prevalence of 72% [1]. In Labrador, the smoking prevalence among Inuit is 65% for both sexes (67% for women and 63% for men) [13]. The prevalence of teenage (aged 12-19) smoking is also exceptionally high among Inuit people, with almost half (46%) of teens initiating smoking at age 14 or younger. In Nunavut, the teenage smoking rate in is 2.5 times the Canadian rate: 51% of Inuit teenage girls smoke compared to 10% of teenage girls in the general population [14].