Thank you, and good morning.
I would like to extend greetings to the chair and members of the committee, as well as to the other guests of the committee with us today.
I would also like to convey the regrets of the chief executive officer for the National Aboriginal Health Organization, Dr. Paulette Tremblay, because she is unable to attend today.
Thank you for inviting NAHO to participate in this hearing. It is a privilege to have been invited to provide an overview of the health and well-being of aboriginal peoples in Canada.
My name is Mark Buell, and I am the director of communications and research at NAHO, an organization that was founded in 2000 to influence and advance the health and well-being of aboriginal peoples and communities by carrying out knowledge-based strategies.
In Canada, section 35 of the Constitution recognizes the three original peoples in Canada: first nations, Inuit, and Métis. Each of these population groups is distinct from the others and has a unique history. Within each group there is also considerable diversity. There are over 600 individual first nations in Canada.
Recent demographics paint a clear picture of the first nations, Inuit, and Métis populations. According to Statistics Canada's 2006 census, there are almost 1.2 million aboriginal people in Canada, accounting for about 4% of Canada's total population. Of these populations, first nations account for 60%, Inuit for 7%, and Métis for about one-third.
The aboriginal population is the fastest-growing segment of the population, growing nearly six times faster than the non-aboriginal population. The Métis population is growing more than 11 times faster than the non-aboriginal population, and the first nations and Inuit populations are both growing three times as fast as the non-aboriginal population.
Fifty-four percent of aboriginal people live in urban areas, and 48% of the aboriginal population consists of children and youth under the age of 24, compared with 31% for the non-aboriginal population. What this means is that the first nations, Inuit, and Métis populations are young, with half of the Inuit population at 22 years and younger, half of the first nations population at 25 years and younger, and half of the Métis population at 30 years and younger. The median age for the general Canadian population is 40.
Like many of their international indigenous counterparts, aboriginal peoples in Canada suffer from a greater burden of illness than non-aboriginal people. For the first nations population, the following are some examples I've taken from Health Canada's report called “A Statistical Profile of First Nations in Canada”.
In 2000, life expectancy at birth for the first nations population was estimated at almost 69 years for males and just under 77 years for females. This reflects differences of seven and a half years and five years, respectively, from the Canadian population.
The infant mortality rate for first nations in 1999 was eight per 1,000 live births, compared to the Canadian rate of five and a half per 1,000 live births.
For Inuit, the situation is similar. According to a 2003 Health Canada report, life expectancy of Inuit living in the northern territory of Nunavut in 1999 was 67.7 years for men and 70.2 years for women. According to a 2006 Statistics Canada report, the hospital admission rate for lower respiratory tract infections for Inuit children is the highest in the world. Furthermore, the infant mortality rate in Inuit-inhabited regions is four times higher than in the rest of Canada.
Suicide is among the leading causes of death for first nations and Inuit. For Inuit living in Nunavut, this means that the suicide rate for men in 1999 was almost nine times the Canadian rate. As Ms. Langlois indicated, rates for most diseases, including HIV infection, diabetes, measles, and tuberculosis, are much greater than those for the general Canadian population.
Although there is limited information available on the health and well-being of the Métis population in Canada, what we do know paints a similar picture. We do not, however, know the life expectancy for Métis in Canada, nor can I report on the infant mortality rate for Métis.
The health statistics I've reported to you are interesting, but they certainly don't tell us the entire story about indigenous health in Canada. In fact, as many of you are aware, an aboriginal concept of health encompasses much more than these statistics can tell you. Interestingly, though, the World Health Organization's definition of health encompasses a holistic wellness approach that is similar to an indigenous concept of health and well-being: “an integrated approach linking together all the factors related to human well-being, including physical and social surroundings conducive to good health”--in other words, the broader determinants of health, or the causes of the causes.
Health Canada recognizes 12 broader determinants, including such things as housing, income, social supports, and access to services such as health care and education. These broader determinants of health really elucidate the disparities between indigenous peoples in Canada and non-indigenous peoples.
First nations rate lower than the general Canadian population on all educational attainment indicators, including secondary school completion rates, post-secondary education admissions, and completion of university.
Among Inuit children under the age of 15, 40% live in crowded homes, compared to only 7% among all children in Canada. From the 2006 aboriginal peoples survey, we know that 22% of Métis children under the age of six had mothers between the ages of 15 and 24. This is compared to 8% for the non-aboriginal population. And 30% of the Métis children in Canada live in lone-parent households, compared to 13% of their non-aboriginal counterparts.
I won't speak at length about the broader determinants—Ms. Langlois mentioned a few—but it's well known that first nations, Inuit, and Métis score lower on almost every indicator in this regard. In fact the socio-economic conditions of aboriginal peoples are often compared to those of the developing world, but that isn't the case. There are numerous examples of things that work. We also know quite a bit about what doesn't work, and I'd like to bring some of those examples to your attention.
With regard to the prevention of suicide, in a 1998 groundbreaking study by Chandler and Lalonde on suicide in British Columbia first nations communities, they argued that—and I quote from the Policy Research Initiatives journal called Horizons:
...cultural continuity forms a critical backstop to the routine foibles of identity formation; in the absence of a sense of personal and cultural continuity, studies show that life is easily cheapened, and the possibility of suicide becomes a live option.
It is clear to us that bridging traditional cultures with the mainstream is the key. We would also argue that culture and ethnicity are among the key determinants of health for first nations, Inuit, and Métis in Canada. For example, once western medicine was imposed on Inuit communities, beginning in the 1950s, women were flown out of their home communities to give birth. At a time that should be a great celebration with family, these women would often be alone in southern medical centres. In recent years, however, there's been a resurgence in traditional midwifery in Inuit communities. The Inuulitsivik Health Centre has been operating since 1986 in northern Quebec, and other midwifery centres have followed. Care is provided to women by hybrid teams—Inuit midwives and western medical practitioners. The perinatal outcomes of the Inuulitsivik centre are equivalent to those in obstetric wards in southern Canada.
It is also well known that a top-down approach to the delivery of health care programs and services generally does not work. As I mentioned, there's great diversity among aboriginal peoples. Therefore only a community-driven approach ensures the built-in flexibility to accommodate the diversity of first nations, Inuit, and Métis populations in Canada. Community-based initiatives and control appear to be effective. We have found that community control over resources actually has an amplifying effect on results. When programs and decisions are under the control of an appropriate community authority, outcomes are improved compared to similarly resourced but externally controlled and applied processes.
There is significant research to support the connection between self-determination and health.
In 1988 the Government of Canada approved the health transfer policy framework for transferring resources for health programs to first nations living south of the 60th parallel. By 2005, 78% of communities that were eligible for transfer had done so. The following has been attributed to transferring control over resources for these services to first nations communities: an increased awareness of health issues; the development of services better suited to the unique needs of first nations; improved integration and coordination of health services; and in fact a decline in the use of medical services.
With regard to Métis, NAHO is currently wrapping up a project to evaluate culturally specific health promotion messaging. Mainstream media messages are generally not effective for aboriginal people. We've conducted focus groups across the country with Métis people. Once complete, the information gathered will be used to inform the development of programs and services to address the needs of the Métis population.
I encourage you to visit our site, NAHO.ca, where many resources are available on the health and well-being of first nations, Inuit, and Métis individuals, families, and communities.
Thank you.
I look forward to answering any questions you may have.