Mortality rates for First Nations young women and girls living on reserve have not improved in 30 years and may have actually worsened, according to new research.
First Nations teenagers living on reserve face much greater risk of an early death than their peers in the general population, according to the new study, published this month in the Canadian Journal of Economics. Girls aged 15-19 living on reserve have mortality rates nearly five times higher, while for boys, it’s four times higher, the study found.
“The patterns are so dramatic, I was taken aback,” said lead author Donna Feir, an economist from the University of Victoria currently working at the Centre for Indian Country Development in Minnesota.
“Part of the privilege we have living in a wealthy country is we can avoid an early death, and our children can [also]. That same privilege has not been extended to First Nations people,” Dr. Feir said.
Dr. Feir and co-author Randall Akee, an economist at UCLA, examined administrative data from the Indian Register, the official list of status First Nations people kept by the government of Canada from 1974 to 2013. The data provides the most complete picture to date of First Nations mortality, Dr. Feir said, but it is not perfect. For example, it does not include important details such as cause of death, and likely underreports infant mortality and deaths of those older than 65.
Inspired in part by the calls to action of the Truth and Reconciliation Commission, Dr. Feir said she and Prof. Akee sought to tackle the lack of mortality data for First Nations people. What they found lays bare a major difference in health outcomes, one that hasn’t improved much over the past several decades: First Nations people die younger and at rates that exceed those in the general population. Both men and women living on reserve have seen no improvement in age standardized relative mortality over the past 40 years, the study found.
“I would have anticipated seeing improvement, because we tend to see improvement in the population more generally,” Dr. Feir said. “The age standardized mortality rates for [First Nations] women under the age of 40 haven’t changed in the last 30 years and they have even increased in some age groups. In addition, there has been no improvement in relative mortality on reserve in the past 40 years.”
There are approximately 750,000 status First Nations people in Canada, about 45 per cent of whom live on reserve, according to the 2016 census. Those living off-reserve have fared relatively better in recent generations, according to this data. There has been some convergence between mortality rates for First Nations people who don’t live on a reserve and those in the general population.
Evan Adams, chief medical officer of the First Nations Health Authority in British Columbia, who was not involved in the research, said it’s clear that the health of First Nations people is significantly different from that of the general population. The reasons for those differences have historical roots, he said.
“Colonization for original peoples meant being moved almost literally to the margins to make way for waves of immigration, which changed the trajectory of their health and well-being,” Dr. Adams said.
“Indigenous people have the worst health and are the poorest of any ethnic group in the country and that is no accident. That is a direct result of their history.”
In general, wealth, education and opportunity are crucial social determinants of health, Dr. Adams said. First Nations people, in addition to living with relatively lower incomes, have higher rates of injury and motor-vehicle death, suicide and chronic disease, he added.
The proportional differences in mortality between the general population and First Nations in Canada are larger than those between whites and African Americans and whites and Hispanics in the United States, the study found.
Typically, men and boys have higher rates of mortality than their female peers. But this data revealed one significant exception: First Nations girls between the ages of 10 and 14 on reserve have mortality rates higher than that of the boys.
According to Statistics Canada, projected life expectancy at birth for First Nations men was 73 in 2017, six years less than for the male population in general. For First Nations women, projected life expectancy was 78, five years less than for the female population in general,