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Aboriginal people who live off-reserve in cities and towns are generally in poorer health than the non-Aboriginal population, according to a first-ever study using new data from the 2000/01 Canadian Community Health Survey.

Health of the off-reserve Aboriginal population 2000/01.

        Aboriginal people who live off-reserve in cities and towns are generally in poorer health than the non-Aboriginal population, according to a first-ever study using new data from the 2000/01 Canadian Community Health Survey (CCHS).

        The study found that inequalities in health persisted between Aboriginal people who lived off-reserve and other Canadians after socio-economic and health behaviour factors were taken into account.

        The study compared the off-reserve Aboriginal population with the non-Aboriginal population on the basis of four health status measures: self-perceived health, chronic conditions, long-term activity restriction and depression. Because the off-reserve Aboriginal population is much younger than the non-Aboriginal population, all data were age-standardized to the Canadian population.

        Except for chronic conditions, off-reserve Aboriginal people living in the provinces and those living in the territories reported similar levels of health status.

        As well as supplying data on health status and determinants, the CCHS captured information on use of the health care system.

        In 2000/01, 79% of the off-reserve Aboriginal population living in the provinces reported seeing a general practitioner at least once in the year before the survey, the same level as the provincial non-Aboriginal population. However, in the territories the off-reserve Aboriginal population was much less likely to have had contact with a doctor (59%) than the non-Aboriginal population living there (76%) and much more likely to have contacted a nurse (49% compared with 22%).

        In 2000/01, 20% of off-reserve Aboriginal people reported an unmet health care need, significantly higher than 13% for the non-Aboriginal population. This pattern prevailed across all areas examined.

Off-reserve Aboriginal people report higher levels of fair or poor health.

        Research has consistently shown that low socio-economic status is associated with poor health. However, when a broad range of socio-economic factors such as education, work status and household income were taken into account, the off-reserve Aboriginal population was still 1.5 times more likely than the non-Aboriginal population to report fair or poor health. This indicates that socio-economic factors alone do not fully explain why off-reserve Aboriginal people are more likely to report fair or poor health.

        Research has also shown that certain behaviours have an adverse impact on one's health. Once again, however, when a range of behaviours such as smoking, obesity and heavy drinking, more prevalent in the off-reserve Aboriginal population, were taken into account, off-reserve Aboriginal people were 1.3 times more likely than non-Aboriginal people to report fair or poor health.

        This indicates that both socio-economic and health behaviour factors, as measured in this analysis, did not fully explain the disparity between Aboriginal and non-Aboriginal people in reporting fair or poor health.

Note to readers

        This report is the third in a series of articles that examine various aspects of the health of Canadians using new data from the 2000/01 Canadian Community Health Survey (CCHS).

        This article focuses on the health status, health behaviours and health care utilization of the Aboriginal population living off-reserve in cities and towns across the country. Similar analysis on Aboriginal populations living on-reserve will be possible when data from the post-censal Aboriginal Peoples Survey are released in the fall of 2003.

        All data have been age-standardized and compared with findings for the non-Aboriginal population. Data are also adjusted for differences in socio-economic and health behaviour factors.

        According to the CCHS, an estimated 337,000 people aged 15 or older, or about 1.4% of the Canadian population, indicated that they belonged to an Aboriginal cultural or racial group, living off-reserve. The difference between this estimate and that of the 1996 Census (374,400) can be explained by different collection methods and the wording of the question that was used to define the Aboriginal population.

        For this analysis, 3,555 respondents indicated they were an Aboriginal person of North America. Within this group, 573 respondents (representing 88,000 people) reported a combination of Aboriginal and non-Aboriginal racial background.

        Respondents who answered the question on their cultural or racial background but did not indicate having an Aboriginal culture or race were considered non-Aboriginal.

        Adjusting for age only, 23% of Aboriginal people living off-reserve rated their health as either fair or poor in 2000/01, compared with 12% for the non-Aboriginal population. The percentage of off-reserve Aboriginal people reporting fair or poor health did not vary significantly across regions and the gap between off-reserve Aboriginal and non-Aboriginal people remained in all geographic regions.

        The gap between reported health for Aboriginal and for non-Aboriginal people persisted at all income levels as well: 33% of off-reserve Aboriginal people in low-income households reported fair or poor health compared with 25% for non-Aboriginals; for middle-income households, the proportion was 26% for off-reserve Aboriginal people versus 16% for non-Aboriginal, and for high-income households it was 13% versus 8%.

Chronic conditions prevalent

        After socio-economic factors were taken into account, the off-reserve Aboriginal population was 1.5 times more likely than the non-Aboriginal population to report at least one chronic condition such as diabetes, high blood pressure or arthritis. When health behaviours were also controlled, the increased odds of reporting a chronic condition persisted but were reduced to 1.3 times.

        Adjusting for age only, 60% of the off-reserve Aboriginal population reported at least one chronic condition in 2000/01, compared with only 49% of the non-Aboriginal population. By geographic region, off-reserve Aboriginal people living in the territories reported a lower prevalence of chronic conditions (45%) than those living in either rural (60%) or urban areas (63%) in the provinces. This may be because of the reduced opportunity for those in the north to see a doctor in order to be diagnosed with such a condition.

        By household income level, 65% of off-reserve Aboriginal people living in low- and middle-income households and 52% of those living in high-income households reported a chronic condition. The gap between Aboriginal off-reserve and non-Aboriginal people was significant among low- and middle-income households, but not among high-income households.

Long-term activity restrictions more common

        When socio-economic factors were taken into account, the off-reserve Aboriginal population was 1.4 times more likely than the non-Aboriginal population to report a long-term activity restriction than the non-Aboriginal population. This difference was eliminated, however, once health behaviour factors were also taken into account.

        Adjusting for age only, 16% of the off-reserve Aboriginal population across all regions reported a long-term activity restriction in 2000/01, compared with 10% for the non-Aboriginal population. However, this difference was only significant in the provinces; in the territories, the percentage reporting an activity restriction did not differ significantly between Aboriginal and non-Aboriginal people.

        By household income level, 21% of off-reserve Aboriginal people in low-income households reported a long-term activity restriction, compared with 17% of those living in middle-income households and 9% of those living in high-income households. The gap between off-reserve Aboriginal and non-Aboriginal people was only significant among middle-income households; the difference was not significant for low- or high-income households.

Prevalence of depression significantly higher

        When socio-economic factors were taken into account, the off-reserve Aboriginal population was 1.5 times more likely than the non-Aboriginal population to experience a major depressive episode in the year before the survey. When health behaviour factors were accounted for, the odds were reduced to 1.3 times.

        Adjusting for age only, about 13% of the off-reserve Aboriginal population had experienced a major depressive episode in the year before the survey, compared with 7% for the non-Aboriginal population. By geographic region, 14% of off-reserve Aboriginal people living in provincial urban areas, and 13% of those living in provincial rural areas, had a major depressive episode; each of these proportions is significantly higher than the one for the non-Aboriginal population in the corresponding region. In the territories, the difference between the proportion reported by the off-reserve Aboriginal population (9%) and the non-Aboriginal population was not significant.

        By household income level, 21% of off-reserve Aboriginal people in low-income households had a major depressive episode, compared with 13% of those living in middle-income households and 8% of those living in high-income households. The gap between off-reserve Aboriginal and non-Aboriginal people was significant in low- and middle-income households, but not among high-income households.

The article The health of the off-reserve Aboriginal pupulation (82-003-SIE, free) is now available on Statistics Canada's web site (http://www.statcan.ca). From the Our products and services page, choose Free publications, then Health.

For more information, or to enquire about the concepts, methods or data quality of this release, contact Michael Tjepkema, by phone: 416-952-4620; or by e-mail: michael.tjepkema@statcan.ca, Health Statistics Division.