An Introduction to Aboriginal Health:
What Determines Aboriginal Health in
Canada and Around the World?
Brown Bag Speaker Series on Aboriginal Health
October 14, 2010
Centre fro Aboriginal Health Research
Jeff Reading PhD
Professor and Director,
Centre for Aboriginal Health Research
School of Public Health and Social Policy
University of Victoria
Chronic Diseases
 In 2005 of the 58 million deaths worldwide approximately
60% were due to chronic diseases
 4 out of 5 deaths will be in low and middle income
countries
 In these countries people tend to develop diseases
younger, suffer longer, and die sooner
Chronic Diseases
 In Canada Aboriginal people face a similar situation
 Earn less than the non-Aboriginal population
 Suffer from higher rates of many chronic diseases and
associated risk factors
 Have a shorter life expectancy
 Internationally Canada ranks highly in health and well
being, while the Aboriginal population is much less
fortunate
Diabetes
 Historically of low prevalence in the Aboriginal population
 Changes in lifestyle and diet, adoption of Western habits
has resulted in an increase in diabetes
 Similar trajectory to Cardiovascular Disease and other
chronic conditions
Diabetes Risk factors
 Not all risk factors have been well studied in the Aboriginal
population
 Less is known about risk factors in the urban Aboriginal
population
Chronic Disease Risk Factors
 The most common risk factors for Chronic disease studied
among Aboriginals are:
 Impaired glucose tolerance (IGT);
 Type 2 diabetes;
 Obesity (over-eating and lack of exercise);
 Cigarette smoking.
Diabetes Risk Factors
 Diabetes prevalence is much higher in the Aboriginal
population than the non-Aboriginal population
 Diabetes occurs at a much younger age
 Incidence is increasing
Diabetes Prevalence Rates
Diabetes
First Nations and Labrador Inuit to the Canadian Population,
Age-gender-specific prevalence (%)
(Source: FNIRHS Steering Committee & Canadian data from the NPHS, 1994/95)
45
40
35
30
25
Can-M
Can-F
FN-M
FN-F
%
20
15
10
FN-F
5
FN-M
0
Can-F
25-34
35-44
Can-M
45-54
Age
55-64
65+
Diabetes Prevalence Rates
Diabetes
First Nations to the Canadian Population,
Age-gender-specific prevalence (%)
(Source: RHS 2002/03 & CCHS 2001)
45
40
35
30
25
Can-M
Can-F
FN-M
FN-F
%
20
15
10
FN-F
5
FN-M
0
Can-F
25-34
35-44
Can-M
45-54
Age
55-64
65+
Diabetes Prevalence Rates
Diabetes
First Nations to the Canadian Population,
Age-gender-specific Difference in Prevalence (%)
(Source: FNIRHS & NPHS, 1994/95 to RHS 2002/03 & CCHS 2001)
20
15
10
%
Can-M
Can-F
FN-M
FN-F
5
0
25-34
35-44
45-54
-5
Age
55-64
65+
Chronic Disease Risk Factors
 46% of First Nations people are daily smokers
 This rises to 54% in the 18-29 age group and if occasional
smokers are included rises to 70%
Chronic Disease Risk Factors
 In youth the rates are also very high
 Occasional and daily smokers 16 years of age
 44% male and 67% female
 Occasional and daily smokers 17 years of age
 56% male and 67% female
Chronic Disease Risk Factors
 From the 2002/03 Regional Health Survey
 42% of men and 31% of women are overweight
 29% of men and 34% of women are obese
 3% of men and 7% of women are morbidly obese
Chronic Disease Risk Factors
 According to the 2002/03 Regional Health Survey First
Nations peoples self reported rate of hypertension
 20.4% vs. 16.4% in the non-Aboriginal population
 In the 50-59 age group this rises to 30.5% vs. 22.4%
Adult Risk Factors
 Attempts to address problems of chronic diseases usually
focuses on changing patterns of adult risk factors
 Unfortunately this does not address the next generation
and prevention of chronic disease
Life Course Epidemiology
 Life course epidemiology has been defined as the study of
long-term effects of physical or social exposures during
gestation, childhood, adolescence, young adulthood, and
adult life on one’s developmental health and later disease
risk
Diabetes, Chronic Disease and Life Course
Epidemiology
 Life course epidemiology goes beyond traditional risk
factors and questions the importance of intrauterine
nutrition, birth weight, childhood obesity, smoking
initiation ages and rates, adolescent blood pressure, and
socioeconomic status across an individual and
community’s life course.
Life Course Intervention
The Goal:
To optimize the developmental trajectory over entire life
course
Life Course Intervention
What matters:
Address the complex interaction of health determinants, in
particular Aboriginal contexts, over entire life course
Life Course Risk Factors
 Birth weight
 Low birth weight has been associated with an increased risk
of heart disease and hypertension
 Low or high birth weight has been associated with increased
risk for diabetes
 First Nations babies are twice as likely to be high birth
weight babies
Life Course Risk Factors
 Maternal Diabetes
 Gestational diabetes rates are higher in Aboriginal women
 Children born to diabetic mothers are at increased risk for
impaired glucose tolerance, childhood obesity, and diabetes
Life Course Risk Factors
 Childhood and adolescent obesity
 Increases the risk for adult obesity
 Aboriginal children are lacking in sports and recreation
facilities in their communities
Social Determinants of Health
That population level factors which determine health and
well-being for any collectivity have their origins in
upstream historic, cultural, social, economic and political
forces affecting the lives of Indigenous peoples, has been
articulated for almost a decade.
* Young, 1988; Young, 1994; INAC, 1996.
Many determinants of health are beyond the
scope of the health care system:
 Changing diets from traditional to non-traditional foods
 Food insecurity
 Stress due to economic factors
 Pollution
 Global capitalism etc...
A word about Words
 Social Exclusion
 Marginalization
 Inequality
 Risk
 Vulnerability
Social Determinants of Health
The social determinants are often referred to as the “causes
of the causes”
Affect rates of individual level risk factors such as smoking,
obesity, substance abuse
Social determinants require social remedies
END POVERTY NOW!!
Poverty eradication as the most important determination of
health, because it is through income that other
determinants of health are purchased, such as adequate
housing, access to health services and education, potable
water and nutritious food etc.
% Experiencing Major depressive Episode by household Low
income level and off-reserve health status*
* Charlotte Loppie Reading and Fred Wein, Health Inequities and Social
Determinants of Aboriginal peoples Health. NCCAD, PHAC, 2009
% Experiencing Major depressive Episode by household Low
and High income level and off-reserve health status*
Low
Medium
High
* Charlotte Loppie Reading and Fred Wein, Health Inequities and Social
Determinants of Aboriginal peoples Health. NCCAD, PHAC, 2009
Social Determinants of Health
 Many studies have demonstrated a connection between
socioeconomic status and health
 Aboriginal population has lower levels of education,
income, and employment
 These conditions are associated with increased rates of
obesity, chronic conditions and diabetes
Social Determinants of Health
 Can observe a health gradient within the Aboriginal
population - poorer health associated with lower SES
 Effects of colonialism
 Effects of residential school system
Demographic Trends
 Aboriginal population is much younger than the rest of
Canada
 Risk factors are more prevalent and increasing and
occurring in ever younger Aboriginal people
 As the youthful Aboriginal population ages increased rates
and numbers of people with diabetes and chronic
conditions disease can be expected
Actions
 Seek commitment to a multi-year dialogue to explore common issues
and agendas for action in Aboriginal health and well being.
 Facilitate and accelerate the dissemination, transfer and translation of
knowledge into potential applications and benefits through policies,
interventions, services and products.
 Encourage multi-lateral collaborative ventures among communities
and institutions concerned with improving the health and well being
of Indigenous peoples. Promote multi-disciplinary, multi-institutional,
and multi-sectored collaborations and to build upon existing networks
of policy-makers and researchers to further develop capacities on
Indigenous peoples’ health in areas of mutually shared priorities.
Conclusion
 A plethora of health indicators demonstrate that
Aboriginal Peoples’ in Canada endure a profound public
health and socioeconomic burden when compared to
mainstream populations.
 Such a pattern is observed globally as Aboriginal
populations are the poorest of the poor and
correspondingly vulnerable to high rates of preventable
disability, disease and premature death.
How to Contact Us
 If you would like to visit our website and sign up for our
mailing list please visit: http://cahr.uvic.ca
 Recordings of the entire “Brown Bag Aboriginal Health
Speaker Series” will be posted online on our website
 (for our online viewers if you would like to fill out a
feedback form and be entered in our draw please email
Bianka at bsaravan@uvic.ca)