Diversity and Alberta Health Services

Diversity Resources

Health and Diverse Populations

Health and First Nations, Inuit and Metis Populations

Overview
Aboriginal Statistics
Aboriginals, Education and Literacy
Aboriginal Populations and Chronic Disease
    • Arthritis
    • Asthma and Chronic Obstructive Pulmonary Disease
    • Type 2 Diabetes
        First Nations
        Metis
        Inuit
    • Cardiovascular Disease
    • Obesity
    • Cancer
    • Oral Health
Aboriginal Populations and Infectious Disease
    • Tuberculosis
    • Pertussis
    • Hepatitis
    • Shigellosis
    • STD’s
    • HIV/AIDS
Injury
Suicide
Violence and Abuse in Aboriginal Populations
The Health of Aboriginal Children and Youth
The Health of Aboriginal Women
Reports, References and Websites

Overview

In 2001, Aboriginal peoples (including First Nations, Inuit and Métis) accounted for an estimated 3.3% of the total Canadian population (Statistics Canada, 2003). Aboriginal communities in Canada are very diverse and differ in their historical background, language and cultural traditions. However, regardless of their unique cultural and historical differences, Canadian Aboriginal populations as a whole are disproportionately effected by a number of social, economic and health related factors, which increase their susceptibility to various health conditions. Although improvements in the areas of infant mortality, life expectancy and overall health status have improved over the past few decades, more work is required to eliminate the health disparities that exist between Aboriginal and non-Aboriginal Canadians.

Enormous health disparities exist between Aboriginals and the rest of the Canadian population. Research shows that Aboriginal people are experiencing a higher incidence of suicide, injury, substance abuse, and chronic and infectious diseases compared to the general population. This trend is occurring among Aboriginal people across the country, which is indication that it is not just a problem of the individual. These problems are the result of a combination of historical, social and economic crisis among Aboriginal Canadians and they are occurring across the board. Colonization, residential schools, inadequate on-reserve services, racism, discrimination, poverty, unemployment and poor housing conditions are all underlying factors affecting the health of Aboriginal people today.

Aboriginal people have an overall life expectancy lower than that of the general population (Statistics Canada, 2003). Aboriginal people have a higher incidence of chronic disease such as diabetes, arthritis, heart disease, cancer, respiratory illness, obesity, and oral and mental health problems compared to the general population (Statistics Canada, 2003). In addition, data shows that Aboriginal disproportionate prevalence to a number of infectious diseases, such as HIV/AIDS, tuberculosis, pertussis, hepatitis, Shigellosis and sexually transmitted diseases (Health Canada, 2005; Minuk, & Uhanova, 2003; Health Canada, 1999). Poor lifestyle practices such as smoking, poor diet and lack of physical activity have been reported at high rates among the Aboriginal communities and may be contributing to the onset of chronic disease (First Nations and Inuit Health Survey, 1999). Substance abuse, family violence, suicide and injuries are all at high rates among the Canadian Aboriginal people and may be clear indicators of the social chaos present among this population.

Overcrowded and under serviced homes are very common living conditions among Aboriginal people. Aboriginal people are more likely live in houses 1) in need of major repair, 2) that have no piped water supply, 3) no bathroom facilities, 4) no flush toilet (Report on the Royal Commission of Aboriginal People, 1996). In addition, poor water quality and sewage problems are also a reality for many communities and thereby pose significant health risks.

It must be noted that differences are present with regards to the prevalence rates among and between different Aboriginal groups (First Nations, Métis, and Inuit). For example, the prevalence rates for diabetes are higher among the First Nations population compared to the Inuit population. In addition, HIV/AIDS are disproportionately higher among the First Nations people compared to the Métis, Inuit and the general population.

The term “Aboriginal” refers to the combination of three populations; First Nations, Métis and Inuit. It is important to note that the majority of research has occurred in First Nations communities. The term “Aboriginal” is used in this document when referring to all three Aboriginal subgroups. When the study has specific results for a particular subgroup, that specific term is used.

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Aboriginal Statistics

Population

According to the most recent Statistics Canada Census (2001), a total of 976,305 individuals identified themselves as one or more of the following Aboriginal groups, North American Indian, Métis or Inuit. This amounts to approximately 3.3% of the total Canadian population. 62% or 608,850 of the Aboriginal population were North American Indian, 30% or 292,310 were Métis, and 5% or 45,070 identified themselves as Inuit (Statistics Canada, 2003). These numbers should be looked at as an estimate, as they reflect only those individuals who reported to Statistics Canada.

Individuals of Aboriginal origin are distributed unequally across all provinces and territories. The majority of First Nations live in Ontario (22%), British Columbia (19%), Manitoba (15%), Alberta and Saskatchewan (14%). In 2001, only 47% of the First Nations people in Canada lived on a reserve. The majority of Métis people live in Alberta (23%), Manitoba (19%) and Ontario (17%). Approximately 50% of all Inuit people in Canada live in Nunavut, 21% live in Quebec, 10% in Newfoundland and Labrador and 9% in the Northwest Territories (Statistics Canada, 2003).

Approximately 70% of all Aboriginals live off-reserve; 46,000 Inuit, 295,000 Métis, and 358,000 First Nations (Aboriginal Peoples Survey, 2001).

Age Distribution

In 2001, the average age of the Aboriginal population was significantly younger than the general Canadian population. The median age of the Aboriginal population was 24.7 years, and at the same time, the median age of the non-Aboriginal population was 37.7 years, a difference of 13 years (Statistics Canada, 2003). In 2000, 61.1% of the First Nations populations were under 30 years of age; this is significantly higher than the 38.8% of the Canadian population under the age of 30 years in 2001.

Birth rate

According to the 2001 Canadian Census, the Aboriginal birth rate is approximately 1.5 times that of the non-Aboriginal Canadian population. The higher birth rate, is contributing to the high percentage of children 14 years and under. 32% of the overall Aboriginal population in Canada is 14 years of age or younger, compared to 19% of the non-aboriginal population.

Life Expectancy

The average life expectancy for Aboriginal people is lower than the general Canadian population. In 2000, the First Nations life expectancy for males was 68.9 years and for females it was 76.6 years, this is compared to the general population life expectancy of 77.0 and 82.1 years respectively (Indian and Northern Affairs Canada, 2001).

Infant Mortality Rates

Although infant mortality rates have been declining in the Canadian Aboriginal population over the past two decades, they still remain higher than the general population. The 2000 infant mortality data indicates that the infant mortality rate among First Nation Canadians was 6.4 per 1000 live births. The general Canadian infant mortality rates during the same period was 5.4 per 1000 live births, marking a 22% higher infant mortality rate in the First Nations population compared to the general Canadian population (Health Canada, 2005).

For more detailed statistics on the demographic profile of Aboriginal people in Canada, refer to the report “2001 Census: Analysis Series Aboriginal People of Canada: A Demographic Profile”. Link no longer available.

Indian and Northern Affairs Canada. (2004). Basic Departmental Data 2003. Available at http://www.ainc-inac.gc.ca

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Aboriginals, Education and Literacy

Aboriginal health status, education levels and literacy rates are considerably different than the overall Canadian population (Statistics Canada, 2003; Perrin, 1998). It is well published that the health of Aboriginal Canadians is significantly worse than the general population on a large number of health measures. The educational attainment and level of literacy skills are also significantly lower than the overall Canadian population. Interestingly, research has demonstrated the strong link between education and literacy skills, and overall health status (See the Health and Literacy Section). Therefore, education and literacy may be playing a considerable role in the overall health status among Aboriginal Canadians. Research specific to education, literacy and health status among the Canadian Aboriginal population is scarce and urgently needed.

According to the Aboriginal People Survey 2001, the percentage of Aboriginals with less than a high school education has declined in the past 5 years, meaning that more Aboriginal people are finishing secondary school. The percentage of First Nations with less than a high school education has remained the same at 52% between 1996 and 2001. However, the percentage of Inuit between the ages of 20-24 with a high school education has decreased from 66% in 1996, to 59% in 2001. The percentage Métis with less than a high school education of the same age group dropped from 47% in 1996 to 42% in 2001 (Statistics Canada, 2003).

Research shows that the Aboriginal postsecondary enrollment, retention and completion rates are significantly lower compared to the non-Aboriginal Canadian population (Malatest, 2002). A number of barriers have been identified with respect to Aboriginal participation in post secondary education. These include, 1) distrust among the Aboriginal community towards the education system as a result of residential school and other historical events, 2) lack of preparation at the elementary and secondary level, 3) feelings of social discrimination, isolation and loneliness when attending post secondary institutions, 4) financial barriers, 5) lack of knowledge of Aboriginal traditions and cultures at the post secondary level, and 6) family responsibilities that make attending school difficult (Malatest, 2002).

Academic preparation at the elementary and secondary level is essential in setting up success at the post-secondary level. Studies have shown that Aboriginal students are not on par with their expected grade level and are showing poor academic progress at the elementary school level (Minthorn-Biggs, 2004; Hull, Philips, Polyzoi, 1995).

Research into Canadian Aboriginal literacy levels is limited. The 2001 International Adult Literacy Skills Survey indicated that the literacy scores of Aboriginal adults are significantly lower than scores of the general Canadian population (Statistics Canada, 2003). This is of serious concern as research shows that the lower level of literacy an individual has the poorer their health status (Perrin, 1998).

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Aboriginal Canadians and Chronic Disease

Aboriginal Canadians have been disproportionately affected by certain chronic illness. According to the Aboriginal Peoples Survey (2001), nearly half (45%) of the Aboriginal population 15 years and older reported having one or more chronic condition. Further, the most commonly reported chronic conditions among Aboriginal Canadians 15 years of age and older are arthritis (19.3%), high blood pressure (12%), asthma (11.6%), stomach problems (10.2%), diabetes (7%) and cardiovascular disease (6.5%) (Statistics Canada, 2003). Many of these chronic diseases have significantly higher prevalence among the Aboriginal populations compared to the general Canadian population.

Statistics Canada. (2003). Aboriginal Peoples Survey 2001-initial findings: Well-being of the non-reserve Aboriginal population. Available at www.statcan.ca/english/freepub/89-589-XIE/free.htm

Arthritis

Arthritis is a highly prevalent chronic condition in Canada. Arthritis and its associated conditions are a major cause of disability, morbidity and increased health care utilization (Badley, & Wang, 1998). Essentially, arthritis is the inflammation of joints that can cause significant stiffness, swelling and pain. Statistics show that in general, more women are diagnosed with arthritis compared to men, 20.4% vs. 12.2% (Canadian Community Health Survey, 2000).

According to the Canadian Community Health Survey (2000), 16.4% of the total Canadian population 15 years of age and older reported having arthritis. The prevalence of arthritis among Aboriginal off-reserve people was reported at 19% (Canadian Community Health Survey, 2000).

For more information on Arthritis in Canada, refer to Arthritis in Canada. (2003). Available at http://www.phac-aspc.gc.ca/publicat/ac/pdf/ac_e.pdf

Asthma and Chronic Obstructive Pulmonary Disease

Asthma and Chronic Obstructive Pulmonary Disease (COPD) are common conditions among Aboriginal people. Smoking, or exposure to smoke, is a significant risk factor for the onset of asthma and/or COPD. Smoking rates have been reported at high levels. The First Nations and Inuit Regional Health Survey (1999) reported that 62% of First Nations and Inuit people of all ages across Canada reported to smoke regularly and 70% of survey respondents between the ages of 20-29 smoked (First Nations and Inuit Regional Health Surveys, 1999).

A study by Sin, Wells, Lawrence, Svenson, & Man (2006) investigated the rates of asthma and COPD emergency and doctor office visits among Aboriginals in Alberta and compare these rates to the rest of the population. An age standardized comparison of emergency room visits and office visits for asthma and COPD between Aboriginals and Non-aboriginals was conducted resulting in significantly higher rates among the Aboriginals. Aboriginals were found to be 2.1 times more likely to use emergency services for asthma and COPD, and 1.6 times more likely to have asthma or COPD-related office visit compared to the non-Aboriginal population. These results suggest significantly higher rates of asthma and COPD among Aboriginal populations. Aboriginals have a greater prevalence of smoking, inadequate housing, overcrowding, defective water and sewage systems, and poor nutrition compared to the general population; all of these factors can be contributing to the high rate of asthma and COPD suggested in this study.

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Type 2 Diabetes

Over the past 50 years, the prevalence of type 2 diabetes has increased dramatically and has become recognized as a significant public health issue in Canada, particularly among the Aboriginal population. According to the First Nations and Inuit Regional Longitudinal Health Survey (1997), an estimated 19.7% of First Nations adults in Canada have diabetes, of which 78.2% have type 2 diabetes, 9.9% have type 1, and 9.8% are in the pre-diabetes state.

Type 2 diabetes among Canada’s Aboriginal population is now considered an epidemic. Before 1940, diabetes was basically unknown in the Canadian Aboriginal population. The hunter-gatherer and substinence horticulture lifestyle of Canadian Aboriginals have slowly been replaced by sedentary lifestyles. They have become dependent on food derived from modern industrial practices rather than maintaining their traditional diet that was high in protein and low in carbohydrates. As a result, significant lifestyle and dietary changes have occurred in many indigenous communities. The change from a traditional hunter-gatherer lifestyle to a more “westernized” sedentary lifestyle together with genetics may be responsible for the high rates of obesity and type 2 diabetes existing in this population. The declined consumption of the traditional diet, coupled with lower levels of physical activity and a predisposition to store fat, has greatly contributed to the rise in obesity and in turn, the increased risk for diabetes (Gittelsohn, 1997; Hanley, 2000).

If diabetes is cared for properly, individuals can lead a disability free life with limited diabetes-related complications. However, if blood glucose levels are not controlled properly, significant and irreversible damage can occur. Complications include kidney disease, heart disease, blindness, stroke, limb amputation, and reduced life expectancy (Diabetes in Canada, 1999). The Aboriginal population has significantly higher rates of diabetes related complications compared to the general population. Various factors present among the Aboriginal population may be causing these higher rates of complications and may include late detection and greater severity at diagnosis, increased prevalence of risk factors, and lack of assessable services.

According to the Aboriginal Peoples Survey completed in 2001, indicated that roughly 7 percent of the overall Aboriginal off-reserve population had diabetes compared to 4.3 % of the total Canadian population. However, diabetes prevalence statistics varied between First Nations, Métis and Inuit populations. Many results of the prevalence studies are based on self-reported data; therefore underestimation becomes an issue mainly because of the numerous undiagnosed cases of diabetes that exists (Diabetes in Canada, 1999). The prevalence of Non-insulin dependent diabetes in First Nations and Métis populations are suggested to be two to five times the national average (Adelson, 2005). Data shows that the Inuit people are the only Aboriginal group that has diabetes rates below the national average. However, risk factors are rising and it is feared that soon, the Inuit people will have diabetes rates similar to other Aboriginal groups.

Interestingly, a large percentage of Aboriginals with diabetes are older women. The 2001 Aboriginal Peoples Survey indicated that a higher proportion of women over the age of 65 years had diabetes compared to Aboriginal men over the age of 65 years. More specifically, one in every four women over the age of 65 years is diagnosed with diabetes, compared to one in every five men (Statistics Canada, 2003).

Diabetes in First Nations Populations

Numerous studies have indicated First Nations diabetes rates between 8-26%. Prevalence rates among First Nations tend to vary between communities. According to the Aboriginal People survey completed in 2001, approximately 8.3% of First Nations people had diabetes, compared to national average of 4.3% at the time of the survey. The 8.3% prevalence rate is from off-reserve First Nations. A number of prevalence studies conducted on people living on-reserve indicate even high diabetes prevalence rates.

A 1997 study in Sandy Lake, Ontario reported an age-adjusted diabetes prevalence rate of 26% among individual 10 years of age and older (Harris, 1997). A 1996 study in Haidii Gwaii, BC, reported that 17% of the population over the age of 35 years had type 2 diabetes (Gram, 1996). The Cree of James Bay reported a crude diabetes prevalence rate of 6.2% and an age-standardized rate of 13.1% (Maberley, 2000).

Diabetes in Métis Populations

According to the Aboriginal People survey completed in 2001, the prevalence of diabetes among the Métis population was approximately 6.0%.

A study by Bruce (2000) investigated the impact of Diabetes Mellitus among the Métis of Western Canada and determined the level of co-morbidity among Métis with diabetes. Data was collected using the Aboriginal People Survey. The crude diabetes prevalence rate among the sample in this study was 6.1%, a value that is twice the rate in the general population. The 6.1% prevalence rate was consistent with the findings from the Aboriginal People Survey conducted nationally in 1996. Métis individuals were more likely to report poor health status and more mobility and activity limitations than those without diabetes. Métis with diabetes across all age groups were twice as likely to report sight problems and three times more likely to have high blood pressure and heart disease compared to those without diabetes. This study confirmed the high diabetes prevalence rates and high levels of co-morbidity present among the Métis of Western Canada.

Aboriginal Diabetes Initiative. (2000). Métis, off-reserve Aboriginal and Urban Inuit Prevention and Promotion. http://www.hc-sc.gc.ca/dc-ma/alt_formats/fnihb-dgspni/moauipp-ppmahrimu-program_e.pdf

Diabetes in Inuit Populations

The Inuit population of Canada has been the only exception to the pattern of high diabetes prevalence rates. The prevalence of diabetes had not been an issue among the Inuit before the last decade. According to the Aboriginal People Survey completed in 2001, the prevalence of diabetes among the Inuit population in Canada was approximately 2.3%, significantly lower than the national average of 4.3% at the time of the survey, however, greater than the 1991 Inuit prevalence of 1.9%. Risk factors such as obesity and physical inactivity are increasing in the Inuit communities, thereby placing the Inuit people at risk of developing diabetes in the future (Orr, Martin, Patterson, & Moffatt, 1998). The Inuit population may be just a decade or so behind the epidemic.

http://www.inuitdiabetes.ca/about-risk-factors-aboriginal-canadians.html

The following are reports and websites that contain more comprehensive information regarding Diabetes among the Aboriginal population.

Diabetes in Canada: Diabetes and Aboriginal Peoples. (1999) Available at http://www.phac-aspc.gc.ca/publicat/dic-dac99/d12_e.html

For a better understanding of Diabetes, including the risks, diagnosis, complications and prevention, refer to the Health Canada. Diabetes. (2005) document available at http://www.hc-sc.gc.ca/fnih-spni/diseases-maladies/diabete/index_e.html

For information on the Aboriginal Diabetes Initiative and programs ongoing in your region, refer to the following website

http://www.hc-sc.gc.ca/fnih-spni/diseases-maladies/diabete/info_reg_e.html

Aboriginal Diabetes Initiative Program Framework is available at the following link
http://www.hc-sc.gc.ca/fnih-spni/alt_formats/fnihb-dgspni/pdf/pubs/diabete/2000_reserve-program_e.pdf

National Aboriginal Diabetes Association
http://www.nada.ca/

Diabetes and Aging in Aboriginal Communities. (1998).
http://www.niichro.com/Diabetes/Dia2.html

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Cardiovascular Disease

A study by Anand, Yusuf, Jacobs, Davis, Yi, & Gerstein (2001) investigated the prevalence of cardiovascular disease and associated risk factors in Aboriginal people in Southern Ontario. Their findings were surprising. The prevalence of cardiovascular disease among the Aboriginal population was significantly higher compared to the general population, 17% and 7% respectively. In addition, cardiovascular risk factors such as diabetes, smoking rates and obesity were significantly higher among the Aboriginal Canadians. 40% of the Aboriginal populations were regular smokers, compared to 15% of the general population. The prevalence of diabetes was greater among the Aboriginals (12%) compared to the general population (6%). 90% of Aboriginal men and 41% of Aboriginal women had a waist to hip ratio greater than 0.9, this is significantly greater than the general population at 74% and 8% respectively. This study revealed a serious concern for cardiovascular disease risk among the Aboriginal population. Cardiovascular disease risk reduction programs, including smoking cessation, weight reduction and lifestyle modification programs are essential to reduce this risk.

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Obesity

Obesity and excess weight gain is a major public health issue in Canada. The prevalence of obesity among Canada’s First Nations, Métis and Inuit populations have been reported to be significantly greater than that of the general non-Aboriginal population.

One particular study by Self, Birmingham Elliot, Zhang, & Thommasen (2005), investigated the prevalence of overweight and obesity in adults living in Bella Coola Valley, BC. Results of the study indicated that 50% of the adult population in Bella Coola valley were overweight, with a BMI greater than 27. Further, significantly more overweight individuals were of Aboriginal origin (65% vs. 47%). Interestingly, a correlation was found between increased weight and increased prevalence of diabetes, hypertension, hypercholesterolemia, gastroesophageal reflux, asthma, depression, coronary artery disease and alcohol issues (Self, Birmingham Elliot, Zhang, & Thommasen, 2005).

The prevalence of diabetes and obesity among Inuit people has been somewhat lower than the general population. However, recent studies indicate that this trend is changing. An increase in obesity has been reported among the Inuit people (Orr, Martin, Patterson, & Moffatt, 1998).

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Cancer

The incidence of cancer among Aboriginal Canadians has historically been very low. However, over the past few decades, research indicates that the incidence among the Aboriginal population is increasing (Marrett, Jones, Wishart, 2004). The incidence of cancer has been shown to vary among Aboriginal populations across Canada.

The Aboriginal Cancer Care unit at Cancer Care Ontario investigated the incidence of cancer among First Nations in Ontario (Marrett, 2003). Between 1992-2001, the age-standardized cancer incidence among First Nations in Ontario was significantly lower than the general population. First Nations females had significantly lower incidence of breast, lung, colorectal, and ovary cancer compared to the general population. The incidence of cervical cancer however, was comparable to non-First Nations women. First Nations men had significantly lower incidence of lung and prostate cancer compared to men in the general population. However, colorectal, kidney and mouth and throat cancer rates were comparable to the general male population. Of concern is the trend indicating an increase in cancer among the Aboriginal people of Ontario. The rates are increasing for all cancers (Marrett, 2003).

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Cervical Cancer

Cervical cancer is the third most common cancer in Canadian women between the ages of 20-49 years (Health Canada, 2001). The introduction of the Pap test has significantly decline the mortality rate from cervical cancer over the past 25 years. Numerous cases of cervical cancer have been prevented or detected early enough that death from the disease has been avoided. However, regardless of the effectiveness of cervical cancer prevention measures, an estimated 1400 women in Canada will be diagnosed with cervical cancer each year; of these women, approximately 400 women will die of the disease (Health Canada, 2002).

The rate of cervical cancer among Aboriginal Canadians has been reported at high rates over the past decade. Cervical cancer rates have been investigated among the Inuit in the Arctic. Findings indicate that approximately 15% of cancers among women are cervical cancer and the age standardized rate has been reported at roughly three times that of the general Canadian population (Nielson, Storm, Gaudette, Lanier, 1996; Inuit Tapiriit Kanatami, 2005). A study by Young, Kliewer, Blanchard, & Mayer (2000) investigated cervical cancer testing among Aboriginal and non-Aboriginal women in Manitoba, Canada. Findings indicated that Aboriginal women had 1.8-3.6 times the age-standardized incidence rate of cervical cancer compared to the general population. Further, Aboriginal women were less likely to report a Pap test in the past three years compared to non-Aboriginal women. To review the full article, refer to the following link http://www.cancercare.mb.ca/

For more information on Cervical Cancer in Canada review the following documents:

Cervical Cancer Screening in Canada: 1998 Surveillance report
http://www.phac-aspc.gc.ca/publicat/ccsic-dccuac/pdf/cervical-e3.pdf

Health Canada. Women and Cancer.
http://www.hc-sc.gc.ca/hl-vs/alt_formats/hpb-dgps/pdf/facts_cancer.pdf

Cervical Cancer: Epidemiology, Prevention and the role of human papillomavirus infection. http://www.cmaj.ca/cgi/reprint/164/7/1017

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Oral Health

Research has indicated that Canada’s First Nations and Inuit population is experiencing from a high incidence of oral and dental disease, with oral health profiles that appear to mirror those in developing nations (Canadian Dental Association, 2001; First Nations and Inuit Health Branch, 2003). The poor oral health of the Canadian Aboriginal population is particularly alarming due to the high population growth and increasing evidence of a link between oral disease and other serious health conditions such as cardiovascular disease, respiratory disease and diabetes.

The oral health care for First Nations and Inuit people of Canada is covered to a certain extent under the Non-Insured Health Benefits Program. Despite this oral care coverage, in 1997, the First Nations and Inuit Regional Health Survey found that 25% of Aboriginal children experience from toothaches or bleeding gums and 91% of children experience tooth decay (First Nations and Inuit Regional Health Survey, 1999). The non-insured health benefits program is in serious need of improvements and this has been recognized by the Canadian government (Non-Insured Health Benefits Program, 2003).

Before European contact, the dental health of Canadian Aboriginals was quite good. Estimates show that dental caries were present among less than 1% of the population (Waldram, Herring, & Young, 2000). The introduction of high levels of dietary carbohydrates appears to be one of the main causes of the degradation of the oral health of the Aboriginal population. Participation in daily brushing and flossing is effective in preventing dental caries and gum disease (WHO, 2003); however, dental hygiene practices were not practiced concomitantly with the increased carbohydrate consumption.

Schuller, Thompson, Taerum (1998), investigated the awareness and understanding of periodontal disease in Aboriginal and non-Aboriginal children aged 10-15 years living in Northern Canada. The median age of the participants was 12.5 years. Their findings revealed that 43.8% of the Non-Aboriginal children and 63.8% of the Aboriginal children in their study associated bleeding gums with tooth brushing. 50% of the Aboriginal children associated gum disease with the symptoms of pains, as compared to 43.8% of non-Aboriginal children.

Leake (1992) conducted an oral health survey of Aboriginal children ages 6 and 12 years. His findings indicated that 15% of the 6 year olds and 11% of the 12 year olds were dental carie free. Decayed, missing or filled teeth (DMFT) values for Ontario’s Aboriginal children were 6.5 for children aged 6 years and 3.9 for children aged 12 years. These values can be compared to the 1994 Ontario dental health survey that found DMFT values of 1.2 and 1.4 respectively. Six-year old Aboriginal children have more than five times the DMFT, as compared to the non-Aboriginal population (6.9 vs. 1.2).

Studies have investigated the oral health status of the Aboriginal population and revealed that the oral health of Aboriginal people is significantly worse than the general population. A number of factors are contributing to this and include but are not limited to the following:

Lack of fluoridated water in many rural and remote communities
Limited access to dental care in rural and remote communities
Poor oral hygiene practice,
Poor nutrition
Lack of dental public health program.

Studies have not investigated the differences between the oral health status among First Nations, Métis and Inuit Canadians. More research in this field is required.

Children’s Oral Health Initiative.http://www.hc-sc.gc.ca/ahc-asc/activit/
strateg/fnih-spni/cohi-isbde_e.html

First Nations and Inuit Oral Health. (2003).
http://www.cdha.ca/content/newsroom/pdf/aboriginal_peoples.pdf

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Aboriginals and Infectious Diseases

Tuberculosis (TB)

Tuberculosis is a major public health issue for many Canadian Aboriginal people.
In 1999, the age standardized rate of Tuberculosis among Aboriginal Canadians was 34 per 100,000 population (Health Canada, 1999). The age-standardized TB rate of the general population around the same time was 5.9 per 100,000 (Health Canada, 1999). Of the new active cases of TB in Canada between 1991 and 1999, 17% occurred among Canadian Aboriginals.

For more information about the Tuberculosis in Canadian-Born Aboriginal People, visit the following link http://www.phac-aspc.gc.ca/publicat/tbcbap-tbpac
/special_report_e.html#fig2

Tuberculosis in Canada. (1999). Available at http://www.phac-aspc.gc.ca/publicat/tbc99/pdf/tbincanada99_e.pdf

Pertussis

Pertussis, also known as whooping cough, is a highly contagious respiratory illness that results in chronic coughing and vomiting. It is the most frequently reported vaccine-preventable disease in Canada. Majority of sufferers are children and infants, particularly among non-immunized or partially immunized children. According to Health Canada (2000), the prevalence rates of pertussis among First Nations people were reported 2.2 times greater than the prevalence among the general population. One contributing factor to this higher prevalence may be the lower level of immunization rates evident among the First Nations population in Canada (Health Canada, 2000).

For more information about Pertussis, refer to the Health Canada document at the following link http://www.hc-sc.gc.ca/iyh-vsv/alt_formats/cmcd-dcmc/pdf/whooping_cough_e.pdf

or the Canadian Communicable Disease Report: Prevention of pertussis in Adolescents and Adults available at http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/03pdf/acs-dcc-29-5-6.pdf

Hepatitis

Hepatitis surveillance data indicates that the prevalence of acute Hepatitis B and Hepatitis C among the Canadian Aboriginal population is between 4 to 7 times higher than the general Canadian population. Injection drug use and unprotected sexual activity were the main risk factors in accounting for the new cases (Health Canada, 2000). Another study investigated the prevalence of Hepatitis B among the Inuit people and concluded that the rates are significantly higher among the Canadian Inuit population compared to the general population. The prevalence of Hepatitis B in Canada is approximately 0.5% (Zhang, Zou, & Giulivi, 2001). The prevalence of Hepatitis B among the Canadian Inuit was reported at 5%, a value approximately 10 times the Canadian prevalence (Minuk, & Uhanova, 2003).

Shigellosis

Shigellosis is an acute, bacterial disease that causes diarrhea, fever and nausea. Individuals become infected when they consume food or water that is infected with Shigella Bacteria, or by person to person contact through oral-fecal transmission. The condition typically last 4-7 days. First Nations communities are disproportionately affected by Shigellosis. In 1999, the reported incidence rate among First Nations communities was 74.1 per 100,000, which was 26 times higher than the Canadian national incidence rate of 2.8 per 100,000 (Health Canada, 2005).

Research has reported important links between Shigellosis and various environmental factors such as sewage disposal, water treatment quality, and crowded housing conditions. All of these environmental factors have been reported in First Nations communities.

To read more about Shigellosis in First Nations communities, visit the Health Canada – Shigellosis and First Nations Communities at the following link.
http://www.hc-sc.gc.ca

STD’s

In 2000, prevalence statistics for genital Chlamydia among First Nations populations was seriously high. Chlamydia in First Nations communities was six times higher than the Canadian rate, 1,071.5 per 100,000 and 178.9 per 100,000 respectively (Health Canada, 2000).

HIV/AIDS

HIV and AIDS among Canada’s Aboriginal people are of an ongoing concern as a high rate of HIV and AIDS has been documented in Aboriginal populations. The number of HIV and AIDS cases has risen dramatically among Aboriginal people over the past decade. For example, in 1992, 1.3% of Aboriginal Canadians were affected by AIDS. By 2000, this number shot up to 7.2% (Public Health Agency of Canada, 2004). Further, of 638 positive HIV cases across Canada in 1998, 119 of them were individuals of Aboriginal origin, representing 18.8% of all cases during that period. In 2002, the Aboriginal HIV proportion increased to 23.8%. Therefore, considering the Aboriginal population contributes to approximately 3.3% of the population, they are beginning to over-represent the HIV and AIDS epidemic in Canada.

According to the most recent AIDS statistics, Aboriginal people represent approximately 3.1% of the reported AIDS cases in Canada. The number of AIDS cases reported in 2003 disproportionately affected different Aboriginal groups. Out of the 508 Aboriginal AIDS cases reported in 2003, 72.3% were First Nations, 8.3% were Métis and 4.1% were Inuit (Public Health Agency of Canada, 2004).

The high risk of HIV and AIDS for Canadian Aboriginals is related to a number of prominent cofactors; such as substance abuse, injection drug use, sexual transmitted diseases, poverty, low self-esteem, power inequity within relationships and limited access to health services. Injection drug use has been found to be the most common mode of HIV transmission among all Aboriginal people. 61.1% of Aboriginal people reported exposure to drug injection as the contributing factor to their contraction (Public Health Agency of Canada, 2003).

Injection drug use continues to serve as a major route of HIV/AIDS transmission for Aboriginal people. The percentage of HIV/AIDS cases that have occurred due to exposure through injection drug use is significantly greater among Aboriginal People compared to non-Aboriginal people (Public Health Agency of Canada, 2005).

Aboriginal women are beginning to feel the impact of HIV/AIDS. The prevalence of HIV/AIDS among Aboriginal women has increased dramatically over the past couple decades. This is of concern due to the transmission of HIV/AIDS that can occur between mother and baby during birth. Data from before 1993 indicates that Aboriginal females represented approximately 11% of all Aboriginal AIDS cases in Canada. In 2003, this figure increased to 44.6% of the Aboriginal AIDS case representation were Aboriginal women (Public Health Agency of Canada, 2005).

For more information on HIV and AIDS surveillance in Canada, refer to the following Health Canada document http://www.phac-aspc.gc.ca/publicat/epiu-aepi/epi_update_may_04/pdf/epi_may_2004_e.pdf

Understanding the HIV/AIDS epidemic among Aboriginal people in Canada: the community at a glance. (2005). http://www.phac-aspc.gc.ca/publicat/epiu-aepi/epi-note/

HIV in Aboriginal Communities.
http://www.cpa-apc.org

HIV/AIDS and Aboriginal Women, Children and Families. Available at
http://www.caan.ca/english/grfx/resources/publications/Women_and_HIV.pdf

Aboriginal Roundtable on Sexual and Reproductive Health http://www.hc-sc.gc.ca/fnih-spni/pubs/develop/1999_health-sante-sex-int-conf/index_e.html

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Injury

Injuries are a major public health problem across Canada. Depending on the injury at hand, they have the potential to result in a wide range of health problems, including disability, death, mental health problems, substance abuse, HIV/AIDS and sexually transmitted disease. Aboriginal people of Canada are disproportionately affected by injuries. Injuries are one of the top leading causes of death among First Nations people in Canada (First Nations and Inuit Regional Longitudinal Health Survey, 2005).

Aboriginal people of Canada are at greater risk of certain injuries than the general population in Canada due to their increased exposure to various risk factors. Their physical environment, especially in the remote north, exposes individuals to extreme cold climates of the north, putting individuals at risk of hypothermia and frost bite. Aboriginal people living in the north, typically have to travel for long distances via vehicle (snow machine, ATV, automobile) to access certain good and services, putting them at risk of accident during travel. The over crowdedness often evident in Aboriginal homes places individuals at risk of injury; in addition, over crowdedness may increase the stress level, which could contribute to increased family violence. The hunting and fishing lifestyle of Aboriginal people increases the risk of firearm injury and boating/ice fishing injuries.

Motor vehicle accidents, drowning, fire-related injury, accidental poisoning, accidental falls, are the common unintentional injuries among Aboriginal communities. Common intentional injuries include suicide, injury related to family violence, homicide and assault.

Unintentional and Intentional Injury Profile for Aboriginal People in Canada. http://www.hc-sc.gc.ca/fnih-spni/alt_formats/fnihb-dgspni/pdf/pubs/injury-bless/2001_trauma_e.pdf

Suicide

Aboriginal people have significantly higher rates of suicide compared to the general population. In 1999, data indicates that 38% of deaths among Aboriginal youth between ages 10-19 years were a result of suicide. Further, 23% of all death among Aboriginals between 20-44 years were a result of suicide. The 1999 suicide rate among First Nations Canadians was 27.9 per 100,000, a rate that is more than twice the Canadian suicide rate (First Nations and Inuit Health Branch, 2003).

Each suicide that occurs among the Aboriginal Canadians reinforces the need for effective intervention strategies. The high suicide rates among this population are a clear indicator of the social trouble present in Aboriginal communities across Canada.

Suicide among Aboriginal People. Website link no longer available.

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Violence and Abuse in Aboriginal Populations

Family Violence is a major public health issue in Canada as well as in many other countries around the world. Family violence occurs at all income and education levels, in both genders and in all religious, racial and cultural groups. Family violence and abuse has a devastating replicating effect, where children who are victims of abuse or witness abuse often repeat the abusive behaviours and become perpetrators of abuse themselves. The primary victims of abuse are women, children, disabled individuals and the elderly, those who are the most vulnerable and dependent on others (Health Canada, 2002)

It is difficult to determine the exact prevalence of family violence in Canada, because in many cases, the abuse and violence remains hidden. The violence may carry on over a long period of time before help and support is sought after. Individuals who are abused or witnessing the abuse may not report the violence for a number of reasons. These include:

Feelings of shame, denial or powerlessness
Stage of development or age- individuals may be unable to communicate what happened to them.
Fear of the abuser
Emotional attachment or economic dependency on the abuser
Geographic or social isolation- lack access to information, resources, supports and services
Not knowledgeable how to report the abuse
Frightened about what happens when a report is made i.e. removal from home, don’t think anyone can help them.

While men can be the victim to family violence, more often it is women and children that are victims. The Report of the Royal Commission of Aboriginal People (1996) indicated that 39.2% of Aboriginal people reported Family violence to be a major social problem in their communities.

Women

According to Greaves et al, (1995), almost 250,000 women are battered or sexually assaulted in Canada each year. According to a report by the Canadian Centre for Justice Statistics (2002), approximately 40% of women in violent relationships report some kind of physical injury and 15% of these cases require medical attention. This statistic can be compared to 13 % of men.

A study by the Ontario Native Women’s Association (1989) reported that 8 out of 10 Aboriginal women in Ontario have personally experienced family violence. Of those women experiencing family violence, 87 % had been physically injured and 57 % had been sexually abused.

A 1991 study by Dumont-Smith and Sioui-Labelle investigated the prevalence of family violence in Northern Aboriginal Communities across Canada. The study reported that approximate 75-90 % of women living in Northern Aboriginal communities are battered.

In Canada, approximately 75% of Aboriginal girls under the age of 18 have been sexually abused (McIvor and Nahanee, 1998).

Children

In 1998, an estimated 135,573 child maltreatment investigations were carried out in Canada. 31 percent of child investigations involved alleged physical abuse, 10 percent were sexual abuse investigations, 40 percent were neglect, and 19 percent were emotional abuse (Health Canada, 2001). In 44 percent of these investigations, a child functioning issue was reported by the investigator. The most common child functioning issues were behaviour (24%), depression (11%), negative peer involvement (10%), irregular school attendance (9%), and developmental delay (8%).

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Aboriginal Child and Youth Health

Children and youth 14 years of age and under, represent approximately 32% of the entire Canadian Aboriginal Population. The high birth rate among the Aboriginal population is approximately twice that of the general Canadian population (Statistics Canada, 2006). Therefore, Aboriginal children and youth make up a significant proportion of the Canadian population, making their health needs extremely important. Ear infections, tooth decay, injury, suicide, diabetes are common among Aboriginal children and youth, with some rates that exceed those of their non-Aboriginal counterparts (Canadian Pediatric Society, 2004).

The Aboriginal Peoples Survey indicated that the most common chronic conditions reported among off-reserve Aboriginal children were allergies (15.5%), asthma (12.1%) and ear infections (9.8%) (Statistics Canada, 2001).

Otitis Media, also known as an ear infection are highly prevalent among Aboriginal children and youth living in Northern Canada. Some communities have had prevalence rates as high as 40 times the rates found in the south (Bowd, 2005). Of concern is that Otitis Media has the potential to cause temporary and permanent hearing impairment among the children and youth affected; potentially leading to speech and language problems and poor academic performance. Immunity as well as environmental factors such as exposure to cigarette smoke has been linked to Otitis Media susceptibility.

Child death from Sudden Infant Death Syndrome (SIDS) has been reported to be three times that of the general population (Public Health Agency of Canada, 1999; Canadian Pediatric Society, 1996). In 1996, the Canadian SIDS rate was 0.5 per 1000 live births. For more statistics on the SIDS deaths in Canada refer to the Public Health Agency of Canada (1999) document Sudden Infant Death Syndrome at the following link http://www.phac-aspc.gc.ca

FASD is the leading cause of developmental disability among Canadian children (Public Health Agency of Canada, 2005). It is a 100% preventable life-long disability. An estimated 9 in every 1000 live births in Canada have FASD. Fetal Alcohol Spectrum Disorder is a problem throughout Canada and among the Aboriginal population. For more information on FASD in First Nations and Inuit Communities, refer to the following link http://www.hc-sc.gc.ca/fnih-spni/famil/preg-gros/intro_e.html

Rates of Pneumoccocal infection, especially meningitis and pneumonia have been reported among Aboriginal children in Canada. Detailed information on Pneumoccocal infection among Aboriginal Children can be found at the following link http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/03vol29/dr2905ea.html

Injuries in Aboriginal Children. (2004).
http://www.pulsus.com/Paeds/09_05/Pdf/sayl_ed.pdf

The Well-being of Canada’s Young Children: Government of Canada Report 2002. Available at http://socialunion.gc.ca/ecd/2003/report2_e/index.html

Emerging Priorities for the Health of First Nations and Inuit Children and Youth. (1999). Available at http://www.hc-sc.gc.ca/fnih-spni/pubs/develop/1999_priorit-child-enfant/index_e.html

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The Health of Aboriginal Women

Significant disparities exist between the health of Aboriginal women and women from the rest of Canada. First of all, life expectancy is lower among Aboriginal women compared to the general population. In 1999, the life expectancy for Aboriginal women was 76.2 years, compared to 81 years for non-Aboriginal Canadians. The incidence of HIV/AIDS among Canada’s Aboriginal women is increasing (Public Health Agency of Canada, 2005). This is of increasing concern due to the possibility of transmission from mother to child. Diabetes is significantly higher among the Aboriginal population compared to the general population and reports have indicated that Aboriginal women have higher prevalence compared to Aboriginal men (Health Canada, 1999). Cervical cancer is higher among Aboriginal women compared to the general population (Young, Kliewer, Blanchard, Mayer, 2000; Healey, Aronson, Mao, Schlecht, Mery, Ferenczy, & Franco, 2001). Rates of cervical cancer have been reported to be more than 3 times the rates in the general population. In addition, women are often the victims of domestic violence. The mortality rate due to violence among Aboriginal women is approximately three times that of women in the general population (Health Canada, 1999).

For more information on the health of Aboriginal women refer to the Health Canada document available at the following link http://www.hc-sc.gc.ca

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Reports, References and Websites:

1. Anand, S., Yusuf, S., Jacobs, R., Davis, A., Yi, Q., Gerstein, H. (2001). Risk factors, atherosclerosis and cardiovascular disease among Aboriginal people in Canada: the study of health assessment and risk evaluation in Aboriginal people.; Lancet, 358, 1147-1153.

2. Indian and Northern Affairs Canada. (2001). Basic Departmental Data 2001, Catalogue no. R12-7/2000E

3. Health Canada. (2001). Tuberculosis in First Nations Communities, 1999, Ottawa.

4. Health Canada (2005. First Nations comparable health indicators. Available at
http://www.hc-sc.gc.ca/fnih-spni/pubs/gen/2005-01_health-sante_indicat/index_e.html

5. Badley, E., Wang, P. (1998). Arthritis and the aging population: projections of arthritis prevalence in Canada 1991 to 2031. Journal of Rheumatology ;25:138-44.

6. Gittelsohn, J. (1997). Specific patterns of food consumption and preparation are associated with diabetes and obesity in Native Canadian Community, Journal of Nutrition, 128, 541-547.

7. Grams, G. (1996). Haida perspectives on living with non-insulin dependent diabetes. Canadian Medical Association Journal, 155, 1563-1568.

8. Hanley, A. (2000). Overweight among children and adolescents in a native Canadian community: prevalence and associated factors, American Journal of Nutrition, 71, 693-700.

9. Harris, S. (1997). The prevalence of non insulin dependent diabetes mellitus and associated risk factors in Native Canadians, Diabetes Care, 20(1), 185-187

10. Maberley, D. (2000). The prevalence of diabetes in the Cree of Western James Bay. Chronic diseases in Canada, 21(4), 128-132.

11. Health Canada. (2002). A report on mental illness in Canada. Health Canada Editorial Board Mental Illnesses in Canada; Ottawa.

12. Health Canada (2003). Fetal Alcohol Spectrum Disorder (FASD). Ottawa.

13. Greaves, L. (1995). Selected estimates of the costs of violence against women.

14. Ontario Native Women’s Association. (1989). Breaking free: a proposal for change to Aboriginal Family Violence. P.18-19.

15. Dumont-Smith, C., Sioui-Labelle, P. (1991). National Family violence strategy: phase I.

16. McIvor, Sharon D. and Teressa A. Nahanee. "Aboriginal Women: Invisible Victims of Violence." In Unsettling Truths: Battered Women, Policy, Politics, and Contemporary Research in Canada, ed. Kevin Bonnycastle and George S. Rigakos, 63-69. Vancouver, BC: Collective Press, 1998.

17. Bowd, A. (2005). Otitis media: health and social consequences for Aboriginal youth in Canada’s north. International Journal of Circumpolar Health, 64(1), 2-3.

18. Self, R., Birmingham, C., Elliott, R., Zhang, W., Thommaser, H. (2005). The prevalence of overweight adults living in a rural and remote community. The Bella Coola Valley. Eating and Weight Disorder Journal, 10(2), 133-138.

19. Orr, P., Marin, B., Patterson, K., & Moffatt, M. (1998). Prevalence of diabetes mellitus and obesity in the Keewatin District of the Canadian Arctic. International Journal of Circumpolar health, 57 suppl1, 340-347.

20. Sin, D., Wells, H., Svenson, L., Man, P. (2005). Asthma and COPD Among Aboriginals in Alberta, Canada. Chest the cardiopulmonary and critical care journal. Available at http://www.chestjournal.org/cgi/content/full/121/6/1841

21. Health Canada. (2005). Shigellosis and First Nations Communities. Available at http://www.hc-sc.gc.ca

22. Public Health Agency of Canada. (2005). Understanding the HIV/AIDS epidemic among Aboriginal people in Canada: the community at a glance.
http://www.phac-aspc.gc.ca/publicat/epiu-aepi/epi-note/

23. First Nations and Inuit Regional Longitudinal Health Survey. (2005). Available at http://www.naho.ca/english/:

24. Health Canada. (2000). Incidence of Acute Hepatitis B and Hepatitis C in the Canadian Aboriginal population, 1999-2000. http://www.phac-aspc.gc.ca/hcai-iamss/bbp-pts/pdf/hepbc_ab_e.pdf

25. Zhang, J., Zou, S., Giulivi, A. (2001). Epidemiology of Hepatitis B in Canada. The Canadian Journal of Infectious Diseases and Medical Microbiology, 12(6), 345-350.

26. Minuk, G., & Uhanova, J. (2003). Viral Hepatitis in the Canadian Inuit and First Nation population. Canadian Journal of Infectious Diseases and Medical Microbiology, 17(12), 707-712.

27. Bruce, S. (2000). The impact of Diabetes Mellitus Among the Métis of Western Canada. Ethnicity and Health, 5(1), 47-57.

28. Non-Insured Health Benefits Program. (2003). Annual Report 2002/2003. Available at http://www.hc-sc.gc.ca

29. Leake, J. (1992). Report on the oral health survey of Canada’s Aboriginal Children aged 6 and 12. Department of Community Dentistry and Nation School of Dental Therapy. Faculty of Dentistry, University of Toronto.

30. Schuller, P., Thompson, G., Taerum, T. (1998). Awareness of periodontal disease in a group of Northern Canadian Children. International journal of circumpolar health, 57(Sup.1), 163-168.

31. World Health Organization. (2003). The world Oral Health report 2003. Available at http://www.who.int/topics/en/

32. First Nations and Inuit Health Branch. (2003). A statistical profile on the health of first Nations in Canada. Ottawa: Health Canada.

33. Adelson, N. (2005). The embodiment of Inequity: Health disparities in Aboriginal Canada. Canadian Journal of Public Health, 96, S45-S61.

34. Orr, P., Martin, B., Patterson, K., & Moffatt, M. (1998). Prevalence of diabetes mellitus and obesity in the Keewatin District of the Canadian Arctic. International Journal of Circumpolar Health, 57(supp1), 340-347.

35. Young, T., Kliewer, E., Blanchard, J., & Mayer, T. (2000). Monitoring Disease burden and preventive behaviour with data linkage: Cervical cancer among Aboriginal People in Manitoba, Canada. American Journal of Public Health.

36. Healey, S., Aronson, K., Mao, Y., Schlecht, N., Mery, L., Ferenczy, A, & Franco, E. (2001). Oncogenic human papillomavirus infection and cervical lesions in Aboriginal women of Nunavut, Canada. Sexually Transmitted Diseases, 28(12), 694-700.

37. Canadian Pediatric Society. (2004). Aboriginal Child Health. Available at
http://www.cps.ca

38. Hull, J., Phillips, R., Polysoi, E. (1995). Indian control and delivery of special education services to students in band-operated schools in Manitoba. Alberta Journal of Educational Research, 41(1).

39. Statistics Canada. (2006). Birth and Birth rates by province and territory. www.statcan.ca/english/Pgdb/demo04b.htm

40. Minthorn-Biggs, M. (2004). Results of the Saving our Children project. Chiefs of Ontario. Unpublished.

41. Perrin, R. (1998). How does literacy affect the health of Canadians? A profile Paper. Ottawa: health Promotion and Programs Branch, Health Canada. Available at http://www.phac-aspc.gc.ca/ph-sp/phdd/literacy/literacy.html

42. Statistics Canada. (2003). 2001 Aboriginal Peoples Survey.
http://www.statcan.ca/english/freepub/89-589-XIE/article.htm

43. Health Canada. 2001. Cancer Division

44. Nielsen, N., Storm, H., Gaudette, L., Lanier, A. (1996). Cancer in circumpolar Inuit 1969-1988. A summary. Acta Oncol ;35(5):621-8.

45. Inuit Tapiriit Kanatami, 2005. Cancer Incidence. Available at http://www.itk.ca/health/cancer-registry-graph05.php

46. Young, T., Kliewer, E., Blanchard, J., Mayer, T. (2000). Monitoring disease
burden and preventive behavior with data linkage: cervical cancer among aboriginal people in Manitoba, Canada. Am J Public Health ;90(9):1466-8.

47. Marrett, L., Jones, C., & Wishart, K. (2004). First Nations Cancer Research and Surveillance priorities for Canada. Available at http://www.cancercare.on.ca/documents/ACSFirstNationsWorkshopReport.pdf

48. Marrett, L. (2003). Cancer in Ontario First Nations. Available at http://www.cancercare.on.ca/documents/Day1_1_Marrett_OntarioFNCancer.pdf

49. Canadian Pediatric Society. (1996). Reducing the risk of sudden infant Death. Journal of Pediatrics and Child Health. 1(1), 63-67.

50. Public Health Agency of Canada. (2005). Fetal Alcohol Spectrum Disorder. Available at http://www.publichealth.gc.ca/fasd

Reports

Report on the Royal Commission of Aboriginal People. (1996).
http://www.ainc-inac.gc.ca

The Health and Well-Being of Aboriginal People in British Columbia. (2001).
http://www.healthservices.gov.bc.ca/pho/pdf/phoannual2001.pdf

First Nations and Inuit Regional Health Survey. (1999).
http://www.naho.ca

First Nations regional Longitudinal Health Survey. 2002/2003.
http://www.naho.ca

The Health of Manitoba’s Métis Population and their Utilization of Medical Services: A Pilot Study. (2002).http://www.gov.mb.ca/health/publichealth/epiunit/docs/metis.pdf

Aboriginal Women’s Health Research. Final Report. 2001. Available at
http://www.bccewh.bc.ca

Aboriginal Peoples Survey (2001).
http://www.statcan.ca/english/freepub/89-589-XIE/89-589-XIE2003001.pdf

Royal Commission on Aboriginal People - Website link no longer available.

Websites:

City of Calgary – Aboriginal Resources

Aboriginal Youth Info-net
http://infonet.nextsteps.ca/abmove.html

Métis Calgary Family Services
http://www.mcfs.ca/

Calgary Aboriginal Services Directory
http://www.informalberta.ca/public/
directory/initialize_directorySummaryList.
do;jsessionid=F056037E85D21EA0589D3B5530B300C6?miniDirTaxonomyId=4223

Calgary Health Region – Aboriginal Health Program
http://www.calgaryhealthregion.ca/programs/aboriginal/index.htm

Aboriginal Health Resources
http://members.shaw.ca/womens-centre/abhealth.html

Health Canada - First Nations and Inuit Health Branch
http://www.hc-sc.gc.ca/fnih-spni/index_e.html

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