Cancer

A Culturally-Relevant Perspective on This Issue

Introduction

Cancer is a class of diseases characterized by uncontrolled cell division and the ability of these cells to invade other tissues, either by direct growth into adjacent tissue (invasion) or by migration of cells to distant sites (metastasis) [1]. Tobacco use, dietary factors, infectious agents, reproductive and sexual factors, and occupation are just a few of the risk factors for various types of cancer. According to the Public Health Agency of Canada, cancer is not listed as one of the key health issues for Aboriginals, such as Diabetes or HIV/AIDS. As a result, there is minimal data on cancer in Aboriginal communities and even more limited information on cancer rates among Aboriginal women.

First Nations

Although the overall cancer rate is lower among the First Nations population, cervical cancer in women is prevalent [2]. Pap testing occurs both less frequently and more irregularly when it does occur among First Nations women in BC [3]. For example, cancer survival rates are low in Saskatchewan for the First Nations population and this is thought to be related to diagnosis occurring at later stages of cancer [2]. According to the Health Council of Canada, breast cancer was the leading cause of cancer-related deaths among First Nations women in 1999 [4].

Métis

Data on cancer prevalence in the Métis population is very scarce. Data from the 2006 Métis Nation British Columbia Provincial Survey reported that approximately 18% of Métis individuals report that at least one person in their household had cancer (compared to arthritis 54%) [3]. In the North West Territories, trachea, bronchus, and lung cancer account for 27% of all cancer-related deaths among Métis women [4].

Inuit

Approximately 2.8% of Inuit women suffer from some type of cancer compared to 1.5% of Inuit men. Historically, the Inuit population has experienced higher rates of cancers that are rare in the general population (nasopharyngeal, salivary gland, esophageal) possibly related to the use of smokeless tobacco products. However, cancers that are more common in the general population, such as lung, colon, cervix, and breast cancers are lower in the Inuit population [2]. The traditional Inuit diet has largely been replaced by store-bought food, which is high saturated fat and low in both Vitamin A and fibre content and may contribute to overall cancer incidence. In Nunavut, fewer women die from breast cancer (11.9/100,000) compared to the rest of Canadian women (25.2/100,000), but the lung cancer mortality rate for women was 5.3 times higher compared to the Canadian population [4].…

Cardiovascular Disease

A Culturally-Relevant Perspective on This Issue

Introduction

Cardiovascular disease (CVD) refers to conditions that affect the heart or blood vessels, including: arteriosclerosis, coronary artery disease, arrhythmia, heart failure, hypertension (high blood pressure), and cerebrovascular heart disease (stroke), to name a few [1]. CVD is 1.5 times higher among First Nations and Inuit Populations than in the general Canadian population [2]. Data on CVD in Aboriginal peoples, in particular the Métis population, are lacking.  Given the evidence that suggests high risk factors and prevalence of CVD among Aboriginal people, it is important to improve collection of CVD data, including CVD statistics among Aboriginal women.

First Nations

The CVD rate in First Nations adults is high (8%), and is more prevalent compared to the general Canadian adult population (6%).  The prevalence is particularly high among First Nations adults between 50-59 years of age (12%) [3].  The 2002/03 First Nations Regional Longitudinal Survey reported a higher CVD rate in First Nations women (8%), compared to men 7%, though this difference is not statistically significant. First Nations people have increased exposure to risk factors for CVD, such as cigarette smoking, diabetes, hypertension, and obesity [4,5]. These risk factors often cluster in First Nations people, further increasing their risk of developing CVD [5,6].

Métis

Data on CVD in the Métis population is limited. However, the high rate of diabetes, a risk factor for CVD, among Métis women and men [7], suggests the rate of CVD may also be high. Approximately 12% of the Métis population from British Columbia reported high blood pressure in the Aboriginal People’s Survey.

Inuit

In the past, Inuit people have demonstrated low rates of CVD, which is likely due to the protective effects of their traditional lifestyle and diet. Recent shifts away from traditional foods and lifestyle have increased the risk factors for CVD among Inuit people, such as high blood pressure, diabetes, and obesity. As such, the rate of CVD among Inuit people is also on the rise [8, 9]. Improved data collection on CVD among Inuit people is needed to assess potential changes in CVD among the population.…

Depression

A Culturally-Relevant Perspective on This Issue

Introduction

Depression is a mental disorder that presents with the following symptoms: feelings of sadness; loss of interest or pleasure; guilt, low self esteem; irregular sleep patterns; suicidal thoughts and attempts; loss of appetite, and poor concentration [1].

Aboriginal people are more likely than the general population to be affected by depression and are affected by a number of factors that can contribute to depression, including: the effects of residential schools, loss of cultural identity, poverty, high rates of substance abuse, alcoholism, and sexual abuse. [2]. These long term effects of colonization particularly affect Aboriginal women, in the form of inadequate housing and poor access to appropriate health care [3].  Aboriginal people have a  higher rate of depression and are more likely to seek help for this condition compared to the general Canadian population.

First Nations

The 2005 Regional Longitudinal Health Survey found that 30% of First Nations people felt sad or depressed for two or more weeks [4]. The rate of depression in First Nations living off-reserve was 12%, compared to 7% in the general population [5].  It is estimated that the rate of depression on reserve is even higher. Despite high rates of depression, First Nations people may be more likely to seek help than the general population. A study in Alberta found that First Nations were 2.5 times more likely than other residents to visit a doctor for depression [6].

Métis

There are very little data regarding depression among Métis communities. Since the Métis experienced similar long-term effects of colonization, such as residential schools, loss of cultural identity, and poverty, it is likely that the depression rate among Métis is similar to those among other Aboriginal peoples. A recent study among Métis in Northwestern Saskatchewan supports this; depression was identified as an important health issue in the community [7].

Inuit

Statistics Canada data from 2001 report that 3.1% of Inuit people suffered from depression and 6.4% were at high risk of depression, a rate well below the Canadian average [8]. These statistics are contrary to the high rates of suicide among Inuit regions, which are 6-11 times the national average [9]. This raises questions as to whether depression measures used for the population are applicable in the context of the Inuit culture. Other explanations include that depression, particularly in men, may present as alcohol problems, violence, or criminal activity and therefore may not be classified as depression [10,11]. Further research into depression rates among Inuit is needed to understand this discrepancy.…

Diabetes

A Culturally-Relevant Perspective on This Issue

Introduction

Diabetes is a chronic illness characterized by the body’s inability to produce insulin needed to break down sugar. Type 1 diabetes occurs when the body produces little or no insulin, and Type 2 diabetes occurs when the body cannot use insulin to break down sugar. The Public Health Agency of Canada has identified diabetes as a major health concern for the Aboriginal population. Aboriginal ancestry is a risk factor for the disease [1].  As well, Aboriginal populations experience earlier onset, greater severity at diagnosis, lack of accessible services, and greater complications from diabetes [2].  Aboriginal women are twice as likely than Aboriginal men to develop diabetes. Gestational diabetes can increase the risk for developing diabetes, birth complications, infant morbidity, and mortality [3,4]. Gestational diabetes can also increase the risk of obesity and diabetes in the offspring [5].

There is a lack of data about diabetes in First Nations, Métis, and Inuit populations and available survey data likely underestimates the true prevalence [6,7].  Further research using administrative and screening data is needed to better understand diabetes epidemiology among Aboriginal peoples, including Aboriginal women.

First Nations

The prevalence of diabetes in First Nations people is 20% and it is most prevalent among middle-aged men and older women. First Nations women make up two-thirds of First Nations people with diabetes [3,8]. Among the First Nations population, women aged 65+ have the highest rate of 40%, followed by 37% for women aged 55-64, both of which are higher than men’s rates of 36% and 30%, respectively. The diabetes prevalence is higher among those living in isolated communities and those that speak or understand a First Nations language [7]. Additionally, First Nations people are more likely to have Type 2 diabetes and are often develop it at a younger age than the general population [9].

Métis

According to the 2006 Aboriginal People’s survey, the rate of diabetes among Métis women and men in Canada is 7%.  Similar to First Nation people, the Métis population are also more likely to have Type 2 diabetes, and experience the disease at a younger age than the general population. Diabetes data in the Métis population, particularly in women, is limited [10].

Inuit

The prevalence of diabetes among Inuit people is 4%, which is comparatively lower than Métis and First Nations, however there is evidence that the rates are rising [11-14]. Currently, there is limited data on diabetes in the Inuit population, though research is ongoing. Due to recent changes in dietary, physical exercise and lifestyle practices, continual data collection about diabetes is needed to detect future increases in diabetes among the Inuit population [15].…

HIV / AIDS

A Culturally-Relevant Perspective on This Issue

Introduction

Acquired immune deficiency syndrome (AIDS) is caused by the human immunodeficiency virus HIV, which progressively weakens the immune system, leaving the body susceptible to infections and diseases. HIV/AIDS can be transmitted through unprotected sex, hypodermic needles, blood transfusions, pregnancy, childbirth, and breastfeeding. Among the Aboriginal population in Canada, injection drug use (IDU) is the primary mode of HIV transmission, with just over half of AIDS cases attributable to IDU [1].

Aboriginal people are disproportionately affected by HIV, making up to 12% of all new HIV infections in Canada, despite comprising only 3% of the population [2,3]. HIV/AIDS is affecting Aboriginal people at a younger age than the general population and is a significant burden among Aboriginal women, who represent 45% of positive HIV reports among the Aboriginal population [1]. Further, a disproportionate number of Aboriginal women engage in survival sex [4] and exchange sex for money, drugs, shelter, or other commodities, which increases their risk for HIV infection [5].

The surveillance data on Aboriginal HIV/AIDS rates are incomplete due to a lack of ethnicity reporting [1]. There is a need for improved HIV/AIDS epidemiology and HIV testing data among Aboriginal peoples to better prevent and control the spread of HIV/AIDS.

First Nations

Census data from 2001 report that 73% of Aboriginal AIDS cases occur among First Nations people. Females represent approximately one quarter of First Nations AIDS cases [1]. Economic and social problems that exist among many First Nations communities, such as poverty, violence, and both alcohol and drug use are often associated with higher rates of HIV infection [6].

Métis

The Public Health Agency of Canada 2004 report on Aboriginal AIDS cases states that 7% of Aboriginal AIDS cases occur among Métis community. Females are less likely to be affected, with 8% of Métis AIDS patients being female. AIDS is extremely prevalent among youth and accounts for 36% of Métis AIDS cases.

IDU is a key mode of transmission, with 29% of reported Métis AIDS cases attributed to IDU [1]. The high mobility of Métis people between urban and rural areas may increase the risk of HIV among remote rural communities, making HIV/AIDS prevention and control measures a priority among all Métis communities [7].

Inuit

Inuit people with AIDS make up 4% of the AIDS cases among Aboriginal people and roughly 21% of these cases are female. According to the Aboriginal AIDS Network, heterosexual transmission is the predominant mode of HIV transmission among the Inuit population [8]. However, IDU is also a major transmission mode, accounting for 30% of infections [8]. 

Awareness about HIV/AIDS among Inuit communities is lower than in other Aboriginal and non-Aboriginal populations making prevention and control efforts challenging. Urban Inuit are at greater risk of HIV infection compared to rural Inuit, due to a high prevalence of poverty, violence, and addictions (including IDU) [8].…