Content warning: this article contains mention of suicide.

For its fourth consecutive year, Canada has been ranked as number one in the world for quality of life, according to the U.S. News & World Report. A factor that drove the ranking was Canada’s advanced health care system.

But when it comes to access to health care and health outcomes, the glaring disparities that separate Canada’s Indigenous and non-Indigenous populations cast an ugly shadow on the ranking.

A June 2019 Statistics Canada report indicated that, between 2011–2016, First Nations people experienced a suicide rate that is three times higher than that of the non-Indigenous population. How can such a disparity exist in a country ranked at the top spot for quality of life?

How Indigenous people face worse health outcomes

Suicide rates among Inuit youth in particular are one of the highest in the world, and 11 times greater than the national average. In some First Nations communities, the suicide rate among youth under the age of 15 is almost 50 times greater than the rate among non-Indigenous youth.

Lower life expectancy and the prevalence of chronic conditions — such as hypertension, obesity, diabetes, and arthritis — also disproportionately burden the Indigenous population. Tuberculosis, a disease that is both curable and preventable, is reported at a rate that is more than 40 times higher among Indigenous people living on-reserve than among non-Indigenous people.

In 2016, a U of T-affiliated comparative study compared racial health inequalities between the US and Canada. Though Canada’s population fared relatively better in the margin of inequalities seen across racial minorities, according to the study’s findings, the health inequality between the Indigenous and white population in Canada was greater than in the US.

Furthermore, the observed health disparity held when adjusted for demographic, socioeconomic, and behavioural factors in Canada. In the US, some of the differences could be accounted for by socioeconomic factors.

So what’s the reason for this inequity, and why is it especially prevalent in Canada?

The factors that drive the disparity

Paul Kim, a U of T medical student, recently published a paper in Health Equity about the social determinants of health disparities that affect Indigenous people in Canada.

He discussed his findings with The Varsity, highlighting the need for Canadians, especially those in health care, to understand the historical context that underpins the health outcomes for Indigenous people seen today.

Kim’s research discussed how distal determinants of health, such as colonialism and racism, can worsen individualized factors, such as health behaviours and socio-economic status.

“The reason why we still see health inequity over time, even though the residential school system doesn’t exist anymore, is because of longitudinal policies that influenced parenting habits, influenced diet habits, [and] influenced lifestyle habits,” he noted.

“And [it’s] not just one generation of impact — [it’s a] multi-generational impact between parents and children, and their children’s children.”

A vicious cycle of health injustice among Indigenous people was set off by the cultural deprivation and systemic isolation of Indigenous people created by residential schools and colonial practices.

Forced assimilation following the Indian Act of 1876 — operationalized through the residential school system, the ‘60s Scoop, and legislation banning Indigenous languages from being spoken, as well as forbidding the practice of traditional ceremonies and rituals, created a deep rift between culture and personal identity within Canada’s Indigenous population.

In his paper, Kim elucidated how the trauma endured by children in the residential school system has continued to manifest in poorer mental health outcomes and cognitive dysfunction decades later.

He explained how these outcomes stemmed from the oppressive environment created by the residential schools, abusive teachers, the psychological stress of being taken from their families and communities, and the fact that this all happened during a critical period of cognitive development and identity formation: childhood.

“As a kid, in particular, emotional stress influences mental health as an adult because the brain is still developing,” he noted.

“And that’s important to remember,” he continued, “because the residential school system targeted children. It’s during this critical developmental stage that they learn to make rational judgements, form goals, and develop skills for later in life.”

Research has shown that enduring abuse in childhood leads to an increased number of hospitalizations, physical and mental illnesses, and poorer overall self-rated health later in life. Likewise, family separation in childhood is a significant long-term predictor of depression.

Kim also noted the significance of education as an influence on health status later in life. A good education fosters academic and social development, which is necessary to develop strong interpersonal relationships as well as health literacy.

Conversely, negative educational experiences, most notably the abuse experienced by Indigenous children in schools, not only fail to prepare children with the skills they need to thrive, but effectively turn them away from the prospect of academic success and ambition.

Bridging the gap

When asked how we can begin to resolve this issue, Kim expressed optimism, but highlighted the importance of being aware of the connection between Canada’s colonial past and the health inequities we see today.

“I think the way that we’re headed currently with trauma-informed practice, with the government recognizing what’s happened, is a step toward the right direction.”

Trauma-informed care is an approach that aims to provide health care services in a manner that is sensitive to the experiences and needs of people that have dealt with trauma. This is especially important given that people who have experienced trauma can be re-traumatized in health care and service settings, and therefore may be less likely to access these services.

Kim believes that several aspects of trauma-informed care are especially important for care providers to keep in mind. Best practices include practising non-judgement when people discuss their trauma, as well as empathy with how one’s trauma may relate to an inability to seek help or heal.

He also emphasized using a patient’s knowledge of their trauma to facilitate strengths-based skill-building. “Trauma is a negative thing,” he said, “but people are resilient.”

At a systems-level, Kim believes overcoming Canada’s health inequities requires implementing policies that specifically address social determinants of health, particularly on reserves and rural areas. This includes access to clean water, fresh food, job opportunities, and mental health support systems.

“The next time you’re on a reserve, think about where the closest hospital is, or where the closest tertiary hospital is, as well as where the closest grocery store is where you can get fresh food.”

The Truth and Reconciliation Commission of Canada’s Final Report is a good start, said Kim, but policy recommendations need to be “granular and specific” in order to be effective.

“I wouldn’t say it’s redemption,” reflected Kim. “I would say it’s the right thing to do. I would say it’s a moral obligation.”

Editor’s note (February 28, 2021): This article’s headline has been updated to avoid relating Indigenous people to Canada in a possessive manner. 

If you or someone you know is in distress, you can call:

  • Canada Suicide Prevention Service phone available 24/7 at 1-833-456-4566
  • Good 2 Talk Student Helpline at 1-866-925-5454
  • Ontario Mental Health Helpline at 1-866-531-2600
  • Gerstein Centre Crisis Line at 416-929-5200
  • U of T Health & Wellness Centre at 416-978-8030.

Warning signs of suicide include:

  • Talking about wanting to die
  • Looking for a way to kill oneself
  • Talking about feeling hopeless or having no purpose
  • Talking about feeling trapped or being in unbearable pain
  • Talking about being a burden to others
  • Increasing use of alcohol or drugs
  • Acting anxious, agitated, or recklessly
  • Sleeping too little or too much
  • Withdrawing or feeling isolated
  • Showing rage or talking about seeking revenge
  • Displaying extreme mood swings

The more of these signs a person shows, the greater the risk. If you suspect someone you know may be contemplating suicide, you should talk to them, according to the Canadian Association for Suicide Prevention.