Alcohol Use

A Culturally-Relevant Perspective on This Issue

Introduction

Alcohol use has been identified as a problem among Aboriginal communities and can lead to violence, sexual and physical abuse, accidents, self-inflicted injury, and death [1]. However, data on the extent and impact of alcohol use on Aboriginal communities are lacking. A number of risk factors have been linked to alcohol use in Aboriginal populations such as poverty, depression, and history of attendance at residential/boarding schools, childhood abuse, and being a victim of physical or sexual violence and/or a history of family violence [2,3].

First Nations

The rate of alcohol use is lower among First Nations communities (66%) compared to the general population (79%). However, alcohol misuse is a growing concern among First Nations communities who do use alcohol.  Alcohol-related deaths among First Nations people are six times higher compared to the general population [4]. First Nations men are more likely (69%) to drink alcohol than women (62%).  However, the proportion of heavy drinkers among First Nations people is more than double compared to the general population (16% versus 6%), with First Nations men being more than twice as likely to be heavy drinkers compared to women (21% versus 10%) [5].

Métis

Alcohol abuse is also considered a problem among Métis communities [6], however there is a lack of data available regarding alcohol use among the Métis. Improved data collection on alcohol use among Métis people is needed.

Inuit

The Pauktuutit Inuit Women’s Association identified alcohol misuse to be among the Inuit communities’ prominent health problems [7]. For example, there has been a 14% increase in alcohol use in Nunavik since 1992. Although the drinking prevalence in Inuit communities is low compared to the rest of Canada, binge drinking is the most prevalent pattern among those who drink, leading to increases social and health problems such as violence, abuse, accidents, and death in Inuit communities [1,8]. In Nunavik (the northern third of Quebec), 90% of drinkers reported having drunk heavily within the previous year, a rate which is double that of the general population [8]. More data is needed to understand alcohol use/abuse in Inuit communities. Also, culturally appropriate measures need to be developed to address the growing problem of alcohol abuse among Inuit communities.…

Body Mass Index

A Culturally-Relevant Perspective on This Issue

Introduction

Body Mass Index (BMI) is the most common measurement of body weight and is calculated by dividing a person’s height, squared (kg/m2). In Canada, body weight classes are categorized by BMI values (obese: BMI = 30, overweight: BMI = 25.0-29.9, underweight: BMI < 18.5, normal weight: BMI = 19.0-24.9). The Aboriginal population is 2.5 times more likely to be obese or overweight compared to their non-Aboriginal counterparts, making obesity a major health concern among Aboriginal communities [1]. Health risks are associated with weight classes higher and lower than the normal weight class [2]. This poses serious health issues such as increased risk of chronic health problems as diabetes, hypertension, gall bladder disease, arthritis, risk of cardiovascular disease, and other health problems. High rates of both overweight and obesity among Aboriginal peoples may reflect socioeconomic differences, eating habits, physical activity levels, as well as rapid changes in lifestyle and diet [2-4].

First Nations

The First Nations population in general has a higher BMI compared to the general population; the obesity rate for the First Nations population is twice the Canadian obesity rate [5]. For example, among the age group 18-34 years, 35% of First Nations were overweight compared to 25% in the general population. Similarly, in the age group 34-54 years, 44% of First Nations people were found to be obese compared to 19% of 34-54 years olds in the general population [6]. Among First Nations people, the majority of overweight individuals are men (42% versus 32% in women). However, First Nations females are more likely than their male counterparts to be obese (40% versus 32%). [7]. Childhood obesity is also a growing problem among First Nations communities [8].

Métis

Data on body weight of Métis is limited, however numerous studies have identified obesity among the Métis population as a major risk factor for chronic disease, such as diabetes and cardiovascular diseases [9-11].

Inuit

The Inuit population has undergone rapid lifestyle changes, including changes to their diet and physical activity levels. This has lead to a steady increase in BMI, which is comparable or greater than that of the general population [12]. A 2007 study found that rates of overweight were 33% for women and 37% for men, while rates of obesity were 26% for women and 16% for men. Obesity in children has also recently been identified as a major health problem among Inuit communities [8].

Obesity and a tendency to store weight around the abdomen are especially high among Inuit women [13]. However, in the Inuit population, high BMIs are less likely to be associated with metabolic consequences (such as high blood lipids and blood pressure) and disease risk compared to the general Canadian population [14]. Several possible reasons for this could be genetic differences and dietary differences [13].

Due to differences in body shape and composition of Inuit peoples compared to the general population, there is debate surrounding the applicability of the BMI measurement as an indicator for obesity. Ethno-specific obesity criteria may be necessary to assess body weight among the Inuit population [14]. Nationally collected data on body weight among the Inuit is currently unavailable and is needed to understand and address the body weight and associated health issues among the Inuit population.…

Education

A Culturally-Relevant Perspective on This Issue

Introduction

Education is the gradual acquisition of knowledge, skills, and values through formal instruction or other informal teachings, such as hands-on experience [1]. Educational attainment refers to the highest level of schooling a person has attained in elementary and secondary school, or post-secondary education completed (e.g., trades, college, university), as well as certificates or diplomas obtained [2]. Education is an important determinant of health because it fosters an understanding of health, access, and use of health services. Education also influences health as it may affect employment opportunities and income. 

The educational attainment of Aboriginal women is improving, but still lags significantly behind that for women in the general population. Among Aboriginal women, pregnancy is a significant barrier to completing high school: 25% of Aboriginal women cited pregnancy and childcare as a reason for quitting school [3]. However, among Aboriginal peoples, women are more likely than men to attain higher levels of education.

Aboriginal people’s education is influenced by the legacy of colonization and residential schooling and a long history of conflict between Aboriginal and non-Aboriginal cultures, which has led to distrust and resentment of a system primarily run by non-Aboriginal, middle-class people [3]. Data specific to Aboriginal women’s education and its relationship to health are lacking.

First Nations

Educational attainment among First Nations people in Canada is low. Data from the 2006 census show that 42% of First Nations People (aged 25-64 years) had completed postsecondary education.  For on-reserve First Nations residents, 60% of those aged 20-24 had not completed high school or an alternative diploma or certificate program [4]. 

An estimated 12% of off-reserve First Nations had a trades certificate, 17% a college degree, and 7% of First Nations people had a university degree. Off-reserve First Nations people were more likely to have university and college degrees. First Nations women both on- and off-reserve (aged 25-64) were more likely than men to have completed a postsecondary education (44% compared to 39%) [4].

Métis

Among the population identifying as Métis between the ages of 25 and 64 years, half had obtained postsecondary qualifications, 24% had completed high school or a high school equivalent, and 26% had not completed high school or the equivalent. The most common postsecondary qualification was a college diploma (21%), followed by trades certificates (16%) [5].

Inuit

According to the 2006 census, 49% of the adult Inuit population had completed high school and 36% held a postsecondary certificate, diploma or degree. A greater proportion of Inuit high school graduates are female [6]. The most popular field of post secondary study among Inuit people was construction trades, with 22% attaining qualifications in that area. The number of Inuit with a university degree increased from 2% in 2001 to 4% in 2006 [5].…

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.…