First Nations Comparable Health Indicators

January 2005

The February 2003 First Ministers' Accord on Health Care Renewal directed health ministers to further develop health indicators to supplement previous work on comparable indicator reporting.

This has resulted in a suite of 70 indicators which address a number of themes and priority areas identified in the Accord. These indicators were developed by an inter-jurisdictional Performance Reporting Technical Working Group (PRTWG) with assistance from the Canadian Institute for Health Information (CIHI) and Statistics Canada.

The Federal Comparable Indicators Report (Healthy Canadians: A Federal Report on Comparable Health Indicators 2006) concentrates on the reporting of a featured set of 18 health indicators out of a total list of 70. First Nations and Inuit Health Branch (FNIHB) has reported on 10 indicators in this report.

The following information presents First Nations data for health indicators not included in the report. First Nations data for these indicators was obtained from a variety of sources, and details of data sources and limitations are included with each indicator.

Those wishing to compare the data presented here with the national figures for Canada may do so at Comparable Health and Health System Performance Indicators for Canada, the Provinces and Territories. Please note that in some cases the First Nations data is not identical to the definition as set by the Technical Working Group. In these cases, a direct comparison between the data presented here and the data reported in the Comparable Health Indicators report is not possible.

Primary Health Care

• Proportion of population that reports having a regular family doctor
• Proportion of female population aged 18-69 with at least one PAP test in the past three years
• Proportion of women aged 50-69 obtaining mammography in the past two years
• Life Expectancy at Birth for overall population

Vital Statistics

• Low birth weight
• Mortality rate for:
  • Lung cancer
  • Prostate cancer
  • Breast cancer
  • Colorectal cancer
  • Acute myocardial infarction (AMI)
  • Stroke
• Potential years of life lost due to suicide and unintentional injury

Reportable Communicable Diseases

• Incidence rate for measles
• Incidence rate for Haemophilus influenzae b (invasive) (Hib)
• Incidence rate for Verotoxigenic E. coli
• Incidence rate for tuberculosis
• Incidence rate for Chlamydia
• Rate of newly reported HIV cases

Primary Health Care

Proportion of population that reports having a regular family doctor

In 2002, 76% of First Nations on-reserve reported having a regular medical doctor.

Source: National Aboriginal Health Organization, What First Nations Think About Their Health and Health Care, 2004. This data comes from a telephone poll commissioned by the National Aboriginal Health Organization (NAHO), and the question is worded differently than similar questions from Statistics Canada. The question may not match the Performance Reporting Technical Working Group specifications, but does address similar issues. See the National Aboriginal Health Organization (NAHO) for more information on the poll.

Proportion of female population aged 18-69 with at least one PAP test in the past three years

In 2002, 50% of First Nations females on-reserve reported having undergone a PAP smear in the past 12 months.

Source: National Aboriginal Health Organization, What First Nations Think About Their Health and Health Care, 2004. The question may not match the Performance Reporting Technical Working Group specifications, but does address similar issues. See the National Aboriginal Health Organization (NAHO) for more information on the poll.

Proportion of women aged 50-69 obtaining mammography in the past two years

In 2002, 22% of First Nations females on-reserve reported having obtained mammography in the past 12 months.

Source: National Aboriginal Health Organization, What First Nations Think About Their Health and Health Care, 2004. The question may not match the Performance Reporting Technical Working Group specifications, but does address similar issues. See the National Aboriginal Health Organization (NAHO) for more information on the poll.

Life Expectancy at Birth for overall population

In 2000, life expectancy at birth for the Registered Indian population was estimated at 68.9 years for males and 76.6 years for females. This reflects differences of 8.1 years and 5.5 years, respectively, from the 2001 Canadian population's life expectancies.

Life Expectancy for First Nations is calculated by Indian and Northern Affairs Canada, using data from the Indian Register.

Source: Indian and Northern Affairs Canada, 2001, Basic Departmental Data 2001, Catalogue no. R12-7/2000E

Vital Statistics

Vital statistics are derived from birth and death certificates sent to the provincial or territorial vital statistics registrars. First Nation and Inuit Health Branch regional offices obtain this information from the vital statistics registrars in the four Western provinces. Data from British Columbia and Alberta include on and off reserve populations. Data for Manitoba and Saskatchewan include only the on reserve population.

In the Atlantic, Ontario and Quebec regions, no arrangements currently exist with provincial vital statistics registrars and so this information is obtained by First Nation and Inuit Health Branch regional offices directly from the communities. Most often, it is the community health nurses who provide reports to the regional offices.

The estimated coverage of communities varies from 90% in the Atlantic Region to just under 50% in the Quebec Region. Nunavut is in the process of developing its vital statistics system and was unable to submit Inuit-specific data at this time.

The Yukon and the Northwest Territories report their vital statistics through Statistics Canada on each territory as a whole and so are unable to supply data on First Nations and Inuit-specific data at this time.

Low birth weight

Low birth weight is defined here as the proportion of all live births under 2,500 grams, including those under 500 grams.

Of all reported First Nations births in 2000, 4.7% were classified as low birth weight. This compares favourably with the 2001 Canadian rate of 5.5%. Previous First Nations and Inuit Health Branch data (1989 to 1993) on low birth weight have shown variable rates (from 3% to 5%, approximately), with some indication of an increasing trend towards heavier babies in recent years.

Source: Health Canada, First Nations and Inuit Health Branch in-house statistics.

Mortality rate for lung cancer, prostate cancer, breast cancer, colorectal cancer, acute myocardial infarction (AMI) and stroke (Age-standardized to the 1991 Canadian population)

The number of deaths where the underlying cause of death is one of those specified, per 100,000 population, that would be observed in the population if it had the same age composition as the reference or "standard" population.

Except for male prostate cancer, First Nations cancer mortality rates are lower than those for the overall Canadian population. Acute myocardial infarction (AMI) rates among First Nations are about 20% higher than the Canadian rate, and stroke rates among First Nations are almost twice as high as the comparable Canadian figure.

All rates are age-standardized to the 1991 Canadian population.

Source: Health Canada, First Nations and Inuit Health Branch in-house statistics; Statistics Canada, Canadian Vital Statistics, Birth and Death Databases, and Demography Division.

Note: The First Nations rates include the off reserve population for British Columbia and Alberta.

Potential years of life lost due to suicide and unintentional injury

Potential years of life lost (PYLL) is the number of years of life "lost", when a person dies "prematurely" - defined as dying before age 75.For example, a suicide at age 25 results in 50 potential years of life lost.

In 2000, suicide accounted for approximately 1,079.91 potential
years of life lost (PYLL) per 100,000 population in First Nations.
This is nearly three times the 2001 Canadian rate.

At 2571.7 PYLL per 100,000 population, unintentional injuries are one of the largest contributors to premature mortality among First Nations. This figure is almost four and a half times higher than the 2001 Canadian rate. For both unintentional injuries and suicide, males suffer a greater proportion of premature mortality than females.

The First Nations rates include the off-reserve populations for British Columbia and Alberta.

Source: Health Canada, First Nations and Inuit Health Branch in-house statistics.

Note: The First Nations rates include the off reserve population for British Columbia and Alberta.

Potential Years of Life Lost (PYLL) for Unintentional Injury and Suicide, First Nations On-reserve, by Sex and Combined, 2000 rates per 100,000 population

	Unintentional Injury	Suicide
Total population	2571.7	1096.2
Males	3376.2	1517.9
Females	1688.7	633.3

Source: Health Canada, First Nations and Inuit Health Branch in-house statistics.

Reportable Communicable Diseases

Reportable diseases are those diseases that must, by Federal and/or Provincial law, be reported by medical practitioners to public health authorities. A variety of mechanisms are used by the regional offices to obtain reportable disease information. In all regions except Manitoba, reports are sent to the regional offices by the community health nurses.

• In Manitoba, where the provincial health department is the primary source of reportable disease information on First Nations, the Manitoba Department of Health contacts the regional office when follow-up of an individual is required. Some of the reportable disease cases in First Nations communities are not received by the regional office.
• Ontario and Alberta regional offices also send reportable (communicable) disease data to the appropriate provincial and regional authorities. In the case of tuberculosis and HIV/AIDS, these provincial data are aggregated at Health Canada.
• The First Nation and Inuit Health Branch Pacific Region Office was unable to report specific First Nations on-reserve communicable disease information for the year 2000 and is not included in the national rates.

Communicable disease rates can vary from year to year, as many cases occur in region-specific outbreaks. Until several years of data are available for a time-trend comparison, it is difficult to interpret these figures due to considerable fluctuations in the rates of reportable diseases over time. Also, due to incomplete coverage of First Nations across Canada, some degree of underreporting must be assumed.

Incidence rate for measles

No cases of measles were reported to FNIHB for the year 2000.

Does not include data from Pacific Region.

Source: Health Canada, First Nations and Inuit Health Branch in-house statistics.

Incidence rate for Haemophilus influenzae b (invasive) (Hib)

No cases of Haemophilus influenzae b were reported to FNIHB for the year 2000.

Does not include data from Pacific Region.

Source: Health Canada, First Nations and Inuit Health Branch in-house statistics.

Incidence rate for Verotoxigenic E. coli

In 2000, the rate of verotoxigenic Escherichia coli in First Nations was 2.6 cases per 100,000 population.

Does not include data from Pacific Region.

Source: Health Canada, First Nations and Inuit Health Branch in-house statistics.

Incidence rate for tuberculosis

In 2000, the age standardized rate of tuberculosis in First Nations was 34.0 cases per 100,000 population.

Age-standardized tuberculosis rates in the First Nations population remained 6 to 11 times higher than in the Canadian population throughout the 1990s. The 2000 First Nations rate was due in part to large outbreaks in several regions, rather than an overall high rate.

Rate standardized to 1996 Canadian population.
Rate calculation does not include Quebec figures.

Source: Health Canada, 2001, Tuberculosis in First Nations Communities, 1999, Ottawa.

Incidence rate for chlamydia

The 2000 reported rate of genital chlamydia was very high in the First Nations population, at 1,071.5 cases per 100,000 population. This is about six times higher than the Canadian rate (178.9 per 100,000 population in 2001). First Nations females suffer disproportional rates of chalmydia infection than males. At a rate of 6,572.2 cases per 100,000 population, females aged 15 to 24 years accounted for 53.5% of all First Nations cases where age and sex were recorded.

Age groups include males and females combined.

Source: Health Canada, First Nations and Inuit Health Branch in-house statistics.

Rate of newly reported HIV cases

Aboriginal is identified as First Nations, Inuit or Métis.
AIDS - acquired immune deficiency syndrome.

The proportion of AIDS cases among Aboriginal people climbed from 1.7% of all cases in Canada in 1992 to 7.2% in 2001. It should be noted that not all HIV/AIDS reporting forms have complete ethnicity information, which would affect the results reported.

Aboriginal identity (First Nations, Inuit or Métis) is recorded on most HIV/AIDS reporting forms. From this, we can determine the proportion of those diagnosed with AIDS that are Aboriginal. The following graph shows the number of newly diagnosed AIDS cases that were identified as Aboriginal (First Nations, Inuit or Métis), and the percent of all diagnoses identified as Aboriginal for the years 1992 to 2001.

Source: Health Canada, April 2002, HIV/Aids Among Aboriginal Persons in Canada: A Continuing Concern, HIV/AIDS Epi Update, Centre for Infectious Disease Prevention and Control, Population and Public Health Branch.

See HIV/AIDS Among Aboriginal Peoples in Canada: A Continuing Concern for further information on the limitations of HIV/AIDS surveillance and Aboriginal identifications.

For more information on First Nations data, visit the statistical profile on the health of First Nations in Canada page to view highlights of our A Statistical Profile on the Health of First Nations in Canada for the Year 2000 report.