Assembly of Manitoba Chiefs

BackgroundCanadian First Nations, the largest of the Aboriginal groups in Canada, have had lower cancer incidence and mortality rates than non-Aboriginal populations in the past. This pattern is changing with increased life expectancy, a growing population, and a poor social environment that influences risk behaviors, metabolic conditions, and disparities in screening uptake. These factors alone do not fully explain differences in cancer risk between populations, as genetic susceptibility and environmental factors also have significant influence. However, genetics and environment are difficult to modify. This study compared modifiable behavioral risk factors and metabolic-associated conditions for men and women, and cancer screening practices of women, between First Nations living on-reserve and a non-First Nations Manitoba rural population (Canada).MethodsThe study used data from the Canadian Community Health Survey and the Manitoba First Nations Regional Longitudinal Health Survey to examine smoking, binge drinking, metabolic conditions, physical activity, fruit/vegetable consumption, and cancer-screening practices.ResultsFirst Nations on-reserve had significantly higher rates of smoking (P < 0.001), binge drinking (P < 0.001), obesity (P < 0.001) and diabetes (P < 0.001), and less leisure-time physical activity (P = 0.029), and consumption of fruits and vegetables (P < 0.001). Sex differences were also apparent. In addition, First Nations women reported significantly less uptake of mammography screening (P < 0.001) but similar rates for cervical cancer screening.ConclusionsBased on the findings of this retrospective study, the future cancer burden is expected to be high in the First Nations on-reserve population. Interventions, utilizing existing and new health and social authorities, and long-term institutional partnerships, are required to combat cancer risk disparities, while governments address economic disparities.

To examine inequalities in health status of Registered First Nations Manitobans compared to all other Manitobans. Three mortality indicators--premature mortality rate (PMR) defined as an age- and sex-adjusted rate of death before age 75 years; life expectancy from birth; and potential years of life lost (PYLL)--are compared between Registered First Nations (RFN) people and all other Manitobans (AOM) by geographical areas of Manitoba. Data were derived from the Population Health Research Data Repository, linked to the federal Status Verification System (SVS) files for the years 1995 through 1999. First Nations experienced double the PMR compared to all other Manitobans (6.6 versus 3.3 deaths per thousand, p < 0.05), an eight-year gap in life expectancy (males: 68.4 versus 76.1 years; females 73.2 versus 81.4 years), and over twice the PYLL (males 158.3 versus 62.5 years of life lost per thousand; females 103.3 versus 36.5). RFN male life expectancy was geographically-related (better health status in the north), and inversely related to the corresponding regional AOM life expectancy (r = -0.61, 9 df, one-tailed, p < 0.03). As regional percentage of RFN decreased, male life expectancy decreased (r = 0.77, 9 df, one-tailed, p < 0.003). In contrast, RFN female indicators showed no such relationship. The inequality in health status between RFN and all other Manitobans is large, but also shows differential geographical and gender effects.

The history and legacy of Western, colonial research methodologies and policy frameworks continue to create and maintain dichotomies of superior/inferior, and valued/not valued between Western and First Nations cultures, peoples and knowledge. This article was written to awaken discussion on how First Nations are working to shape the direction of research and policy development. It draws upon the author's personal observations and experiences of Western and Indigenous frameworks. The author also draws upon the growing body of work on this issue presented by indigenous researchers and scholars. The Health Information Research Committee of the Assembly of Manitoba Chiefs rejects colonial research frameworks and promotes and supports culturally-respectful research. The Dakota in Manitoba are identifying our own Quality of Life indicators and developing policies based on our own cultural values. The Mohawk of Akwesasne have developed research ethics and protocols based on their cultural principles of skennen (peace), kariwiio (good word), and kasastensera (strength). First Nations people in Canada and the world are increasingly rejecting Western, colonial frameworks of research and policy development. Instead, we are reclaiming our right to be who we are, and we are revitalizing our cultures through promotion and utilization of indigenous research methodologies and development of culturally-rooted policy. Though the response of researchers and policy-makers is not yet known, these developments will continue into the future due to the commitment and work of First Nations people.