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Métis activist and retired senator Thelma Chalifoux has died.

Chalifoux's daughter, Debbie Coulter, says her mother passed away Friday evening at a care home in St. Albert, near Edmonton, and had been in declining health for some years. She was 88.

Chalifoux was appointed to the upper chamber in 1997 and served until she retired at age 75 in 2004.

Chalifoux was born in Calgary in 1929 and noted when she was named to the Senate that she raised seven children, so she was used to hard work.

She began working in community development when she was offered a job by the Métis Association of Alberta, and she later served as chairwoman of the Métis National Council Senate and vice-president of the Aboriginal Women's Business Development Corporation.

She was also the first Métis woman on the Senate of the University of Alberta.

"We spent the last couple of days in her room surrounding her with love, music and stories," Coulter said Sunday, noting that children, grandchildren and great-grandchildren were present during that time.

"We like to think that she could still hear us."

'It's like working in the trenches'

In her job with Alberta's Métis Association, Chalifoux was sent from the cities of south and central Alberta to the northern bush country of Slave Lake, where she was to spend the next 12 years.

Working with the Company of Young Canadians, a government agency that brought young workers in to help people in poor communities organize to improve their lot, she began fighting for better conditions for her people, especially better housing.

She modelled her work on the writings of Saul Alinsky, who wrote about community development in black neighbourhoods in American cities.

"When you develop communities, it's like working in the trenches. You train the people to become self-sufficient," Chalifoux told The Canadian Press in an interview in 1997.

Radio pioneer

Along the way, she became one of the first Indigenous women to broadcast on private radio, Peace River's CKYL.

She received a National Aboriginal Achievement Award in 1994.

During her time as senator she appointed a task force to consult with Edmonton's Indigenous community about violent Indigenous youth gangs, and argued for better education and partnerships between the community, police and other Canadians.

She also challenged a claim by then-Alberta premier Ralph Klein that she should have been elected to the post, noting she could have won an election.

Chalifoux said she wouldn't have a chance because she was a woman, Métis and didn't have the finances for a campaign.

After leaving the Senate, Coulter said her mother founded an organization to preserve and protect the Métis history in northern Alberta, called the Michif Institute. Coulter and her sister took it over when their mother became ill, and a version of it continues today.

"There's a saying that nobody wants on their grave that they wish they would have worked more. We were laughing about that the other day and we thought, well, except for my mother. She might have said that," Coulter said.

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Thelma Chalifoux, former senator and Métis activist, dies in Alberta at 88 | CBC News

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Métis activist and retired senator Thelma Chalifoux has died. Chalifoux's daughter, Debbie Coulter, says her mother passed away Friday evening at a care home in St. Albert, near Edmonton, and had been in declining health for some years. She was 88.

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Senator Thelma Chalifoux

Public Service (1994)

Thelma Chalifoux's mother and father had a profound effect on the path that she has chosen to follow in her life. Her father, Paul Villeneuve, told her that she would be strong and independent because she was born in a blizzard. He taught her that the Métis have always worked for their families. Her mother, Helen Villeneuve, kept the family strong by keeping them united.

From the time Ms. Chalifoux was young, she cared for others, including elders in her family. After leaving an abusive marriage in the 1950s, she went back to school to study sociology at the Lethbridge Community College, and construction estimating at the Southern Alberta Institute of Technology, while working to support her seven children. Since the late 1960s, Thelma Chalifoux has worked extensively with rural and Aboriginal organizations, and in other forums where she has contributed to the betterment of the Métis and has supported and initiated programs for all Aboriginal people.

She has negotiated and assisted in getting facilities and programs for many Aboriginal organizations such as Friendship Centres, and has worked tirelessly in areas that include Aboriginal communications, housing, education, suicide prevention, prisons, battered women, cross-cultural training in government departments, and alcoholism.

Ms. Chalifoux was one of the founders of the Slave Lake Native Friendship Centre, and was instrumental in getting the Cree language taught in northern schools. She has worked for the Company of Young Canadians in community development, and rural and native housing; as the first full-time Métis woman staff announcer, producer and host of a weekly show on CKYL Radio Peace River; and as the co-producer of Our Native Heritage series on Allarcom (ITV). She was the first Metis woman to serve on the Senate of the University of Alberta.

She is currently a Social Allowance Appeal Panel member, Child Welfare Appeal Panel member, co-chair of the Metis Nation of Alberta, and chair of the Métis National Senate Commission.

In accepting the National Aboriginal Achievement Award, Ms. Chalifoux wrote, "The struggle has been a challenge, but my blessings have been many. This award is the icing on the cake, but my heart sings when someone comes to me and says that because of what I did their lives are better."

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Thelma Chalifoux's mother and father had a profound effect on the path that she has chosen to follow in her life. Her father, Paul Villeneuve, told her that she would be strong and independent because she was born in a blizzard. He taught her that the Métis have always worked for their families.

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Our mothers are more than just a physical person, just as our houses are more than just a structure to live in; our mothers and our homes are an all encompassing presence, they are beings and spaces deeply rooted in our personal consciousness. In the same way that our homes are a safe haven, our mothers are a physical space to hold our stories, to carry the heaviness of our lives, to shelter our tender existence with their mere presence. In celebration of the power and grace of motherhood, it is an honour to share with you the life story and wisdom of Thelma Chalifoux, Métis matriarch.

Thelma Chalifoux was born mid-winter of 1929, in Calgary. The first year of her life was marked by both flood and famine; in June the Bow and Elbow Rivers burst their banks immersing the community in a deluge of water, dams and bridges were washed away by the heaviest rains the area had seen in decades. Later that year, the nation's financial institutions failed to keep their stocks afloat, thereby causing the economy to plummet. In these unsteady times, Thelma's parents were a bedrock force, setting the groundwork for Thelma's greatness. As a child of the Depression, Thelma's first decade was one of both scarcity and abundance, as the world around her tightened its proverbial purse strings, she was shown the value of cooperation and community, sacrifice and solidarity. Upon this foundation, a truly incredible woman was built; a Métis matriarch who has brightened the world and served all people by standing up for children, women, the elderly, families and the larger Métis nation. Just as a house has walls, windows and floors to hold it steady and upright through time, no matter the weather, no matter the forces that may press against its pillars, Thelma's parents built within her an adaptability and graciousness that continues to this day.

Our Mothers are a center point, a guiding light and a vessel upon which we may endlessly draw strength, wisdom and a sense of rightness. Thelma's mother, Helené, grew a huge garden and canned every ounce of its abundance to put up for later or to trade. Although it was illegal at the time for 'Indians' to take part in commercial activities, Helené would swap whatever extra vegetables she had with local First Nation families who had access to game animals. The door of Thelma's childhood home was always open, as were the hearts and minds of her parents, no matter the sensibilities of the day, their hearth was a place of friendship and warmth.

Thelma's father, Paul, was a skilled carpenter, a horse whisperer, ranch hand and labourer. He attended residential school as a child and had fought in the First World War, managing to make it home from both. He is described by Thelma as her hero and best friend. No doubt, his immeasurable dedication to his family was shown in his ability to strike a balance between necessity and his own need to be close to his children as the Depression sent him far afield to work. From Helené, Thelma received the gifts of independence and fearlessness. From Paul, she was gifted a sense of belonging and the knowledge that she was deeply loved. These treasures are now shared with Thelma's 8 children, 32 grandchildren, 34 great grandchildren and 4 great-great grandchildren. It is a legacy of love and the mark of her true greatness as a Métis matriarch.

Thelma's family was considered small for that era, she had two sisters and two brothers. Her fondest childhood memories are of farm life, cattle drives and horses, and warm summer days spent with her family at the Calgary Stampede. Despite the droughts, and the distances her father had to travel for work, no matter the shortage of new shoes or clothes, Thelma most remembers her parents' resilience and resourcefulness, their connection to the Indigenous community and their absolute respect for their Métis culture. One of Thelma's favorite mantras comes from her father, "We are the Métis and we are the best!". Those early years built within her a solid set of values and real clarity of purpose; Thelma's sense of self, her love for family, her respect for culture and her fierce work ethic united to create one of the Métis People's most notable citizens.

Having lived 86 years, Thelma has seen a lot of changes for women, for families and for the larger Métis community. In the 1950's, an era in which neither women's nor Indigenous rights were given much space in the national mindset, Thelma left an unhealthy relationship to create a new life for herself and her children. In many ways, not to minimize Thelma's later accomplishments, this act could be viewed as her most brave and is certainly testament to her greatness as a matriarch. Motherhood has many roles and responsibilities, it is never-ending, selfless and fraught with a myriad of energy depleting duties. Her faith in God and her personal strength are what kept Thelma going during those years of single parenthood, but it was her connection to the Métis community that allowed her to thrive. Friendship has always meant a lot to Thelma as she has never liked doing things alone, her sensibility is that people are best served by many hands and minds. Her circle of lifelong friendships with other steadfast women have produced a myriad of organizations that continue to serve the Métis and First Nations community. By the grace of God and the goodness of others, including her older children who kept an eye on the little ones while she worked, Thelma was able to keep food on the table and a roof over their heads. Because she knows, firsthand, the struggles people experience, Thelma has always worked for the betterment of others. She is a mother, a friend and an advocate for the voiceless.

Amongst her many accomplishments, Thelma is a founding member of The Slave Lake Native Friendship Centre and the Michif Cultural Institute in St. Albert. She was the the first Métis woman to receive the National Aboriginal Achievement Award and the first Métis and first Aboriginal woman to be appointed to the Senate of Canada. The world can be a daunting and cruel place, a place of coldness and apathy. When life gets to be too much, people need somewhere to rest, someone to lean upon. Thelma Chalifoux is so much more than a person, she is a woman of tremendous tenacity and boundless compassion, a venerable sacred place where others may find solace. If asked to describe her greatest accomplishment, it is doubtful that Thelma would list off her lengthy resume, but rather, she is more likely to say that her success lives in her children and grandchildren, her broad circle of friends and allies, and, in her deep connection to the Métis community. This is the house that Thelma built for us, this is the home where our hearts may find sanctuary. A house of strength and compassion, a home filled with light, faith and laughter and hope.

© 2016 Jenna Chalifoux

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Our mothers are more than just a physical person, just as our houses are more than just a structure to live in; our mothers and our homes are an all encompassing presence, they are beings and spaces deeply rooted in our personal consciousness. In the same way that our homes are a safe haven, our...

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From Wikipedia, the free encyclopedia

Thelma J. Chalifoux (February 8, 1929 - September 22, 2017) was a Canadian teacher and senator.

Chalifoux was born in Calgary, Alberta on February 8, 1929. One of five children, her mother, Helené, helped support the family by trading garden-grown vegetables. Her father, Paul Villeneuve, was a residential school survivor and served in the First World War working as a carpenter and farm hand. She studied sociology at Lethbridge Community College and later took courses in construction estimation at the Southern Alberta Institute of Technology.

Chalifoux was a social justice activist and politician, and an active figure in the Métis community. As an employee of the government agency Company of Young Canadians, she worked to advance community development initiatives in northern communities and advocated for improved housing conditions. Chalifoux co-founded the Slave Lake Friendship Centre, assisting women struggling with alcoholism and domestic abuse. She additionally championed the teaching of Cree in northern schools. Along with her community work, Chalifoux produced programming focused on Métis culture and history. She was the first woman to host a weekly show "Smoke Signals from the Peace" on Peace River's CKYL Radio and was the co-producer of the Allarcom series Our Native Heritage. In 1994 she founded and became a senior partner of Chalifoux and Associates Educational and Economic Consulting. She also owned Secret Garden Originals, a craft, and floral design business.

Chalifoux was appointed to the Canadian Senate on the advice of Prime Minister Jean Chrétien on November 26, 1997, making her the first Indigenous woman and fourth Metis person to serve in the Canadian Senate, following Richard Hardisty, William Albert Boucher, and Gerry St. Germain. She held the position until 2004 when, at the age of 75, she retired and returned to Alberta. The following year Alberta Venture magazine ranked her number 8 on their list of 50 Greatest Albertans.

After her retirement, she founded the Michif Cultural and Resource Institute now the Michif Cultural Connections Company, an organization dedicated to preserving and sharing the Métis history of Alberta. Chalifoux was the first woman to receive the National Aboriginal Achievement Award - known today as the Indspire Award - in 1994.

Chalifoux died at the age of 88 surrounded by her family on September 22, 2017, after a period of failing health.

On May 8, 2018, the Edmonton Public School Board of Trustees voted to name the new Thelma Chalifoux School (grade 7- 9) in Larkspur in her honour.

Chalifoux joined the Métis Association in the late 1960s during the early growth of local-level activism within Métis communities. Upon joining, Chalifoux strove to fix major issues affecting the Metis by advocating within governmental bodies. She argued that there were inadequate levels of social welfare programs despite clear indications that Métis communities were among a large majority of those in Canada not meeting their basic needs. Chalifoux, advocated for the increase of affordable shelter, food, and higher welfare grants and subsidies for Métis families. She later focused her efforts on the formation of the Welfare Unit, a group of investigators that looked into complaints concerning the Alberta Government Welfare Department's dealings with Métis communities and families. Her efforts exposed welfare injustices like those that occurred at Fort Chippewa concerning the lack of funds given to various families in desperate need of assistance. Her investigations revealed accounts like that of a widow parenting "five children [and was given] $60 a month to live on." She took a special interest in helping disadvantaged Métis women who had fallen through the cracks of government bureaucracy and otherwise would have remained voiceless.

National Aboriginal Achievement Award (1995)

Métis National Council Lifetime Achievement Award (2014).

Honorary Doctorate, University of Toronto (2004). (Awarded for her advocacy work.)

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From Wikipedia, the free encyclopedia Thelma J. Chalifoux (February 8, 1929 - September 22, 2017) was a Canadian teacher and senator. Chalifoux was born in Calgary, Alberta on February 8, 1929. One of five children, her mother, Helené, helped support the family by trading garden-grown vegetables.

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NAIT Metis elder, retired Sen. Thelma Chalifoux, at the Michif Cultural and Resources Institute in St. Albert. May 11, 2009.

("Thelma Chalifoux" by N A I T is licensed under CC BY-ND 2.0)

Early Life and Education

Chalifoux was born to Helene (née Ingwersen) and Paul Villeneuve in 1929. Her family is Métis on her father's side, with ancestry rooted in the early Métis communities of St. Albert and Lac Ste. Anne. Born just before the Great Depression, Chalifoux grew up during a challenging economic time, one from which she learned the value of hard work early on in life. Always looking to help others, Chalifoux volunteered in soup kitchens during the Second World War. She also joined the military reserve force and worked in a Salvation Army canteen.

Chalifoux married Robert Coulter at a young age. He returned from the Korean War with what was likely post-traumatic stress disorder. She eventually left him, and according toThe Globe and Mail (6 October 2017), when she went to social services seeking support for her family in 1958, her four children were taken away from her in what has become known as the Sixties Scoop. Chalifoux worked diligently to get her children back, finishing her high school education and holding down at least two jobs. For a single mother - who had also given birth to a daughter during this time - reuniting her family was no easy task. However, by 1965, Chalifoux regained custody of her children. She gave birth to other children some time after this ordeal. Chalifoux's experience informed her activist work later on in life, particularly her work with Indigenous children, families and communities. ( See also Social Conditions of Indigenous Peoples in Canada.)

Chalifoux studied sociology at Lethbridge Junior College (now simply Lethbridge College), and took courses in construction estimation at the Southern Alberta Institute of Technology.

Early Career

In the late 1960s, Chalifoux moved to Edmonton to look for work. It was there that she went into the Métis Association of Alberta to get her membership card updated, which brought her into contact with two former staff of the organization, Clarence Longmore and Ben Courtoureille, and she was offered a job as a fieldworker almost immediately. The late Stan Daniels was president of the association at this time, and gave Chalifoux the responsibility of setting up the welfare and land departments within the organization. During her time working as part of the association, Chalifoux advocated for the increase of affordable shelter, food and higher welfare grants and subsidies for Métis families. As part of her job, she was sent from cities in south and central Alberta to Slave Lake in northern Alberta, where she lived for the next 12 years.

Chalifoux served in the Company of Young Canadians, working on rural and Indigenous housing as well as community development. She was also the host and producer of a weekly radio show on CKYL Radio Peace River, making her the first Métis woman broadcast on private radio.

Political Career

Image: Elise Cotter/Historica Canada.

In the early 1980s, Chalifoux became involved in constitutional talks with Prime Minister Pierre Elliott Trudeau as part of a Métis delegation that went to Ottawa. The delegation was dedicated to getting Inuit, First Nations and Métis people recognized as separate and distinct nations.

On 26 November 1997, Prime Minister Jean Chrétien appointed Chalifoux as a senator, making her the first Indigenous woman and Métis person to serve in the Canadian Senate. She retired from the senate on 8 February 2004, at the mandatory retirement age of 75, and returned to Alberta.

During her time as a senator, she was chair of the Standing Committee on Aboriginal Peoples. She was also a member of various other standing committees, including those on agriculture and forestry, human rights, fisheries and oceans, illegal drugs, and legal and constitutional affairs.

As a senator, she was concerned with a range of issues, including Métis housing, drug company relations with the federal government, and environmental legislation. She contributed to the "Gathering Strength" report (1997) - the response of the Department of Indian Affairs and Northern Development to the report of the Royal Commission on Aboriginal Peoples.

In an interview with Dr. Denis Wall of the University of Alberta on 13 September 1999, Chalifoux stated that her role as a senator was "partly education and partly bringing the issues forward, especially for the Métis because we are truly the forgotten people."

DID YOU KNOW?
Among her many other "firsts," Chalifoux was the first Métis woman to be appointed to the University of Alberta Senate in the 1970s. She was also the first Métis person to chair the National Métis Senate and the Senate Constitution Commission.

Community Work

Throughout her career, Chalifoux was invested in fighting for women's and Indigenous rights. ( See also Indigenous Women's Issues in Canada.) She served as co-chair of the Alberta Métis Senate and was an appeal panel member with Alberta Family and Social Services. She also served as vice-president of the Aboriginal Women's Business Development Corporation. Chalifoux spent several decades in Alberta working with organizations such as the Métis Women's Council. In Slave Lake, she co-founded the Native Friendship Centre in the 1970s, and ran the first safe house for victims of domestic violence. ( See also Friendship Centres.)

After her work in the Senate, Chalifoux founded the Michif Cultural Institute (now Michif Cultural Connections), a museum and resource centre dedicated to preserving and promoting Métis culture in the northern region of Alberta. A few years before she died in 2017, Chalifoux fought for the creation of St. Albert's Meadowview Centre for Women's Health and Wellness, which opened in 2011. Meadowview is dedicated to helping women recover from drug addiction.

Chalifoux was also concerned with preserving the Cree language and having it taught at northern schools. Her interest in language led to her writing the foreword for the book The Alberta Elders' Cree Dictionary (1998) by Nancy LeClaire and George Cardinal. ( See also Indigenous Languages in Canada.)

Chalifoux served as an Elder at both the Nechi Institute: Centre of Indigenous Learning in Alberta and the Northern Alberta Institute of Technology.

Death and Legacy

Suffering from failing health, Chalifoux died at the age of 88 at a care home in St. Albert, Alberta. She is remembered as a trailblazer for her work in Métis communities and for her support of Indigenous and women's rights in Canada.

The Senator Thelma Chalifoux Award, presented annually by the Northern Alberta Institute of Technology since 2000 to individuals or organizations outside of the institute that have consistently demonstrated a commitment to Indigenous student success, honours Chalifoux's political leadership and community work.

In June 2018, the University of Alberta announced that a residence building would be named after Chalifoux. Thelma Chalifoux Hall will house 520 students starting in Fall 2018.

Honours and Awards

Aboriginal Achievement Award, now Indspire Award (1994). (Chalifoux was the first Métis woman to receive this award).

Honorary Doctorate, University of Toronto (2004). (Awarded for her advocacy work.)

Métis National Council Lifetime Achievement Award (2014).

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NAIT Metis elder, retired Sen. Thelma Chalifoux, at the Michif Cultural and Resources Institute in St. Albert. May 11, 2009. ("Thelma Chalifoux" by N A I T is licensed under CC BY-ND 2.0) Chalifoux was born to Helene (née Ingwersen) and Paul Villeneuve in 1929.

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Thelma Califoux's actions were effective. But why?

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Thelma Califoux's actions were effective. But why?

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Her main focus was on fighting for Women's, Indigenous rights, and advocating for the voiceless. What motivated her were friendships, the grace of god, the goodness of others, and her children. She always wanted the betterness of others.
*Co-founded a Friendship centre in Slave lake to provide services to help women that were struggling with alcoholism and domestic abuse since lots of women in the 1950s were not given much space in the national mindset.
*Influenced the teaching of the language Cree to be available in more Northern schools because she wanted to preserve the language and have it not be totally forgotten by those who are unaware that it exists, as well with all the community work that she did, she was able to produce programming focused on Métis culture and history to teach others.

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Infographic: Where the World’s Indigenous People Live

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This chart shows the countries with the largest population of indigenous people according to the IWGIA’s publication “The Indigenous World 2020”.

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The World Social Report 2020, published by the UN Department of Economic and Social Affairs (DESA), shows that income inequality has increased in most developed countries, and some middle-income countries - including China, which has the world's fastest growing economy.

The challenges are underscored by UN chief António Guterres in the foreword, in which he states that the world is confronting "the harsh realities of a deeply unequal global landscape", in which economic woes, inequalities and job insecurity have led to mass protests in both developed and developing countries.

"Income disparities and a lack of opportunities", he writes, "are creating a vicious cycle of inequality, frustration and discontent across generations."

'The one per cent' winners take (almost) all

The study shows that the richest one per cent of the population are the big winners in the changing global economy, increasing their share of income between 1990 and 2015, while at the other end of the scale, the bottom 40 per cent earned less than a quarter of income in all countries surveyed.

One of the consequences of inequality within societies, notes the report, is slower economic growth. In unequal societies, with wide disparities in areas such as health care and education, people are more likely to remain trapped in poverty, across several generations.

Between countries, the difference in average incomes is reducing, with China and other Asian nations driving growth in the global economy. Nevertheless, there are still stark differences between the richest and poorest countries and regions: the average income in North America, for example, is 16 times higher than that of people in Sub-Saharan Africa.

Four global forces affecting inequality

The report looks at the impact that four powerful global forces, or megatrends, are having on inequality around the world: technological innovation, climate change, urbanization and international migration.

Whilst technological innovation can support economic growth, offering new possibilities in fields such as health care, education, communication and productivity, there is also evidence to show that it can lead to increased wage inequality, and displace workers.

Rapid advances in areas such as biology and genetics, as well as robotics and artificial intelligence, are transforming societies at pace. New technology has the potential to eliminate entire categories of jobs but, equally, may generate entirely new jobs and innovations.

For now, however, highly skilled workers are reaping the benefits of the so-called "fourth industrial revolution", whilst low-skilled and middle-skilled workers engaged in routine manual and cognitive tasks, are seeing their opportunities shrink.

Opportunities in a crisis

As the UN's 2020 report on the global economy showed last Thursday, the climate crisis is having a negative impact on quality of life, and vulnerable populations are bearing the brunt of environmental degradation and extreme weather events. Climate change, according to the World Social Report, is making the world's poorest countries even poorer, and could reverse progress made in reducing inequality among countries.

If action to tackle the climate crisis progresses as hoped, there will be job losses in carbon-intensive sectors, such as the coal industry, but the "greening" of the global economy could result in overall net employment gains, with the creation of many new jobs worldwide.

For the first time in history, more people live in urban than rural areas, a trend that is expected to continue over the coming years. Although cities drive economic growth, they are more unequal than rural areas, with the extremely wealthy living alongside the very poor.

The scale of inequality varies widely from city to city, even within a single country: as they grow and develop, some cities have become more unequal whilst, in others, inequality has declined.

Migration a 'powerful symbol of global inequality'

The fourth megatrend, international migration, is described as both a "powerful symbol of global inequality", and "a force for equality under the right conditions".

Migration within countries, notes the report, tends to increase once countries begin to develop and industrialize, and more inhabitants of middle-income countries than low-income countries migrate abroad.

International migration is seen, generally, as benefiting both migrants, their countries of origin (as money is sent home) and their host countries.

In some cases, where migrants compete for low-skilled work, wages may be pushed down, increasing inequality but, if they offer skills that are in short supply, or take on work that others are not willing to do, they can have a positive effect on unemployment.

Harness the megatrends for a better world

Despite a clear widening of the gap between the haves and have-nots worldwide, the report points out that this situation can be reversed. Although the megatrends have the potential to continue divisions in society, they can also, as the Secretary-General says in his foreword, "be harnessed for a more equitable and sustainable world". Both national governments and international organizations have a role to play in levelling the playing field and creating a fairer world for all.

Reducing inequality should, says the report, play a central role in policy-making. This means ensuring that the potential of new technology is used to reduce poverty and create jobs; that vulnerable people grow more resilient to the effects of climate change; cities are more inclusive; and migration takes place in a safe, orderly and regular manner.

Three strategies for making countries more egalitarian are suggested in the report: the promotion of equal access to opportunities (through, for example, universal access to education); fiscal policies that include measures for social policies, such as unemployment and disability benefits; and legislation that tackles prejudice and discrimination, whilst promoting greater participation of disadvantaged groups.

While action at a national level is crucial, the report declares that "concerted, coordinated and multilateral action" is needed to tackle major challenges affecting inequality within and among countries.

The report's authors conclude that, given the importance of international cooperation, multilateral institutions such as the UN should be strengthened and action to create a fairer world must be urgently accelerated.

The UN's 2030 Agenda for Sustainable Development, which provides the blueprint for a better future for people and the planet, recognizes that major challenges require internationally coordinated solutions, and contains concrete and specific targets to reduce inequality, based on income.

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Rising inequality affecting more than two-thirds of the globe, but it's not inevitable: new UN report

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Inequality is growing for more than 70 per cent of the global population, exacerbating the risks of divisions and hampering economic and social development. But the rise is far from inevitable and can be tackled at a national and international level, says a flagship study released by the UN on Tuesday.

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Where are Indigenous People Around the World?

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Where are Indigenous People Around the World?

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What Economic Inequalities do People Face?

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What Economic Inequalities do People Face?

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Who are Indigenous Peoples in Canada?

There are three categories of Indigenous peoples in Canada: Inuit, Métis and First Nations. The Inuit primarily inhabit the northern regions of Canada. Their homeland, known as Inuit Nunangat, includes much of the land, water and ice contained in the Arctic region. Métis peoples are of mixed European and Indigenous ancestry, and live mostly in the Prairie provinces and Ontario, but also in other parts of the country. First Nations peoples were the original inhabitants of the land that is now Canada, often occupying territories south of the Arctic.

The - the principal statute through which the federal government manages a variety of issues concerning Indigenous affairs - further divides Indigenous peoples into two categories: Status Indians and Non-Status Indians. ( See also Indian Status.) Status Indians are individuals who are listed in the Indian Register and are issued identification cards (known as status cards) that contain information about their identity, band and registration number. Non-Status Indians are Indigenous peoples who are not registered with the federal government ( See also Indian).

All Indigenous peoples in Canada are protected by section 35 of the Constitution Act, 1982, which enshrines Indigenous rights. The federal government departments responsible for the affairs of Indigenous peoples are Crown-Indigenous Relations and Northern Affairs and Indigenous Services.

Many Indigenous nations have signed treaties with the Crown. These agreements have allowed for the use of Indigenous lands in exchange for annual payments and/or other benefits. Treaties form the constitutional and moral basis of alliance between Indigenous peoples and Canada.

History

Indigenous peoples have been in Canada since time immemorial. They formed complex social, political, economic and cultural systems before Europeans came to North America.

With colonization and white settlement, traditional Indigenous ways of life were forever altered. Colonial practices and policies, such as the , pass system, reserves and residential schools, sought to control and assimilate Indigenous peoples. These have had historic and ongoing impacts on generations of Indigenous peoples.

Such practices and polices, when combined with racism, acts of segregation, loss of land, and declining or unequal access to food resources and public services, have had devastating consequences on the health and socio-economic well-being of Indigenous peoples. ( See also Social Conditions of Indigenous Peoples and Economic Conditions of Indigenous Peoples.)

The final reports of the Truth and Reconciliation Commission and the National Inquiry into Missing and Murdered Indigenous Women speak to ongoing work of reconciliation.

Demographics

In the 2021 census, 1,807,250 people in Canada identified as Indigenous, making up 5 per cent of the national population. The First Nations population numbered 1,048,405, the Métis population was 624,220, and the Inuit population reached 70,545.

The Indigenous population in Canada is growing steadily; between 2006 and 2016, it has grown by 42.5 per cent, more than four times the growth rate of the non-Indigenous population. From 2016 to 2021, the Indigenous population grew 9.4 per cent. This indicates the Indigenous population was growing at nearly twice the rate of the non-Indigenous population. Statistics Canada projected, in 2016, that in the next 20 years, the Indigenous population will likely grow to more than 2.5 million people. The changes in population reflect increased life expectancy, high birth rates, and more people identifying as Indigenous in the 2016 census.

The 2016 census showed population growth in First Nations communities both on and off reserve; from 2006 to 2016, the on-reserve population grew 12.8 percent while the off-reserve population grew 49.1 per cent. Statistics Canada also reported that the Métis are the most likely Indigenous group to live in an urban community; nearly two-thirds of the population lived in a city in 2016. For the Inuit, nearly 75 per cent of the population inhabit Inuit Nunangat, a stretch of traditional territory covering the land, water and ice contained in the Arctic.

Did you know?
In the 2016 Census, 11,620 people in Canada claimed Cherokee ancestry. The Cherokee Nation is the largest tribal nation in the United States.

Regional and Cultural Diversity

Indigenous peoples, both historical and contemporary, in North America can be divided into 10 cultural areas. Only the first six areas are found within the borders of Canada:

Contemporary political borders in North America do not reflect (and often overlap) traditional lands. For example, the Mohawk Nation at Akwesasne straddles both provincial ( Québec and Ontario) and international (New York State) borders, as its existence predates the establishment of the international border in 1783 ( See also Indigenous Territory).

These areas are based on linguistic divisions first defined by the ethnologist and linguist Edward Sapir in 1910, while he was head of the Anthropology Division at the Geological Survey of Canada, which later became the Canadian Museum of History ( See also Indigenous Languages in Canada). Sapir's geographical framework was adopted by the Smithsonian Institution's Handbook of North American Indians, the first volumes of which were published in 1978, and continues to be used widely in scholarship.

The Handbook states that these categories are "used in organizing and referring to information about contiguous groups that are or were similar in culture and history," but it is important to note that these delineations are not concrete, and neighbouring peoples always share some similarities and some differences. Rather than representing 10 distinct cultures, these areas reflect geographic and cultural groupings that are fluid and often intermixed. In addition, contemporary Indigenous peoples may live far from their ancestral homelands, and indeed may form new communities rooted in urban centres rather than traditional lands.

These cultural areas are massive and generalized; what is true of a part is not always true of the whole. For example, some sources further divide the Eastern Woodlands into the Southeast and Northeast regions, while others combine these regions into simply Woodlands, and as such one must not assume that all peoples in a cultural area shared the same experiences.

Research overviews of the six cultural areas in Canada provide only some specific anthropological information. The peoples included in these areas are in some ways similar and in other ways different. What is true for the Wendat may not have been true for the Mi'kmaq, and indeed there existed variations among bands within a group. When considering contemporary situations, it is impossible to assume that one issue, set of beliefs, or cultural reference can relate to all Indigenous people in Canada, though in contemporary politics, large-scale political movements like Idle No More have gained wide acceptance and mobilization.

The ethnologists, archaeologists and anthropologists who have written about these cultural regions were often not Indigenous themselves. Though much of this research was done through interviews and fieldwork, it inevitably operated within a settler-colonial framework - a worldview that privileges property acquisition, European-style government and economic growth - regardless of the positive intentions of the researcher. Nevertheless, this research remains valuable both as historical and historiographical tools.

List of Indigenous Peoples in Canada

In 2016, more than 1.6 million people identified as Indigenous in Canada. Below is a list of separate entries on various Indigenous nations in Canada. This is not a comprehensive list, but it provides insight into the history, society, culture, politics and contemporary life of various First Nations, Inuit and Métis communities in Canada.

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In Canada, the term Indigenous peoples (or Aboriginal peoples) refers to First Nations, Métis and Inuit peoples. These are the original inhabitants of the land...

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Health inequalities in Canada exist, are persistent, and in some cases, are growing. Many of these inequalities are the result of individuals' and groups' relative social, political, and economic disadvantages. Such inequalities affect peoples' chances of achieving and maintaining good health over their lifetimes . Where inequalities in health outcomes or in access to the resources that support health are systematic (that is, the patterns of difference are consistently observable between population groups) and can plausibly be avoided or ameliorated by collective action, they may be deemed unjust and inequitable .

This report describes the magnitude and distribution of key health inequalities in Canada, a critical step in facilitating action to advance health equity. It is a product of the Pan-Canadian Health Inequalities Reporting Initiative, a collaborative undertaking by the Public Health Agency of Canada, the Pan-Canadian Public Health Network, Statistics Canada, and the Canadian Institute for Health Information.

The Health Inequalities Reporting Initiative aims to strengthen health inequalities measurement, monitoring, and reporting capacity in Canada. It is intended to support surveillance and research activities, inform policy and program decision making to more effectively reduce health inequalities, and enable the monitoring of progress in this area over time.

The Health Inequalities Reporting Initiative's theoretical foundations are based on a conceptual framework originally developed by the World Health Organization Commission on Social Determinants of Health . This framework highlights the critical roles that broad social, economic, and political factors (e.g. systems of governance; macroeconomic, social, and public policies; and societal values and norms) play in generating and reinforcing societal hierarchies. These differences in socioeconomic positions shape the health-influencing social and physical conditions in which individuals are born, grow, live, work, and age. These conditions include material circumstances (e.g. living and housing standards, workplace conditions, neighbourhood amenities and safety); psychosocial factors (e.g. job strain, social connectedness or isolation, access to social support); health behaviours (e.g. diet, physical activity, tobacco and alcohol consumption); and biological (including genetic) factors. The interactions between these various domains are the means by which inequitable social processes are translated into inequities in health and well-being outcomes.

Building on a set of indicators proposed by the Pan-Canadian Public Health Network in 2010, the Health Inequalities Reporting Initiative brought together data on more than 70 indicators of health outcomes, risk factors, and social determinants of health. These indicators were systematically disaggregated across a range of socioeconomic and sociodemographic variables ("social stratifier groups") meaningful to health equity (see Figure 1).
Figure 1. Summary of the analytical approach for the Health Inequalities Reporting Initiative

Indicators
Health status

Including indicators for:

Life expectancy and health-adjusted life expectancy

Mortality and disability

Perceived physical and mental health

Infectious and chronic diseases

Health determinants

Including indicators for:

Health behaviours

Early childhood development

Physical and social environments

Working conditions

Access to health care

Social protection

Social inequities

Jurisdiction: National or Provincial/Territorial

The resulting portrait of the state of health inequalities in Canada is available through the Health Inequalities Data Tool, an online interactive database.

Drawing from the full set of health outcome and health determinant indicators in the Data Tool, the present report highlights results for 22 indicators that represent some of the most pronounced and widespread health inequalities in Canada, as potential priority areas for initial action (see Figure 2).

Life expectancy at birth

Health-adjusted life expectancy

Infant mortality

Unintentional injury mortality

Suicide mortality

Perceived mental health (fair or poor)

Mental illness hospitalization rate

Arthritis

Asthma

Diabetes (excluding gestational)

Disability

Lung cancer incidence

Obesity

Oral health (inability to chew)

Tuberculosis

Health Determinants A:
Daily Living Conditions

Alcohol use - heavy drinking

Smoking

Housing below standards

Exposure to second-hand smoke in the home

Early childhood development (Early Development Instrument)

Food insecurity

Working poor

Health determinant indicators can be daily living conditions such as high alcohol consumption; smoking, and exposure to second-hand smoke; early childhood development; and housing below standards. Similarly, structural drivers, for example, household food insecurity and working poverty, can be health determinant indicators.

The indicators featured in this report were selected based on several considerations, including whether they:

reveal inequalities that are particularly pronounced and widespread across population groups;

cover a range of health outcomes, health behaviours and broader social determinants of health;

allow for systematic disaggregation of data across key population groups; and

are policy-relevant and actionable.

Social determinants of health and health inequalities - Indigenous perspectives

Prepared by the First Nations Information Governance Centre and Métis National Council

Traditionally, Indigenous peoples have viewed health in a balanced and holistic way, with connections between spiritual, emotional, mental and physical dimensions. Similarly, the determinants of Indigenous health are seen as closely interconnected . They include proximal determinants (e.g. health behaviours), intermediate determinants (e.g. community infrastructure, kinship networks, relationship to the land, language, ceremonies, and knowledge sharing), and structural determinants (e.g. historical, political, ideological, economic, and social foundations, including elements of strength such as Indigenous world views, spirituality, and self-determination) . From the Métis perspective, it is important to integrate Indigenous and Western knowledge development approaches in order to draw holistically from the narratives, experiences, information and data available from both of these ancestral 'ways of knowing' .

In order to understand health inequalities between Indigenous and non-Indigenous peoples, it is necessary to contextualize them within the historical, political, social, and economic conditions that have influenced Indigenous health. The colonial structure, which sought to assimilate Indigenous peoples into the dominant Euro-Canadian culture, has been largely responsible for destabilizing the determinants of Indigenous health . The forced displacement of First Nations into remote communities and reserves that were uninhabitable and lacking in resources; the claiming of traditional areas rich in resources by colonial powers; the oppression of First Nations created by the Indian Act; the damaging legacy of Indian Residential Schools and the Sixties Scoop; systemic discrimination against all Indigenous peoples across social, criminal justice, health care, and employment environments; and the lack of public or private economic development investments for Indigenous communities are all examples of how the colonial structure have contributed to the health inequities that exist today . In addition to this lived experience of colonialism, racism and inability to pursue self-determination, health inequalities in Métis peoples have also been particularly influenced by social exclusion and loss of Indigenous language due to cultural assimilation .

The indicators selected for this report are useful for highlighting health inequalities that exist between Indigenous and non-Indigenous peoples and for gauging progress towards the elimination of such inequalities. However, on their own, these quantitative and largely deficit-based indicators do not adequately incorporate Indigenous concepts of health and wellness; are insufficient for creating programs and policies that contribute to improving the health of the Indigenous population; and may even be harmful if used incorrectly, as they risk continuing to label Indigenous peoples with negative stereotypes . Moreover, without adequate explanatory context about the structural factors that have impacted Indigenous communities (e.g. inadequate infrastructure funding, discriminatory policies that limited access to loans or mortgages), indicators that focus solely on the problems in these communities can reinforce discriminatory attitudes towards Indigenous peoples. Ultimately, for health planning and action to be effective, indicators must be Indigenous-specific and community-driven, taking into consideration Indigenous peoples' holistic worldviews, histories, and resources . A balanced approach that identifies protective factors such as resilience, self-determination, and identity provides a more complete understanding of the issue and can be more effective in empowering and mobilizing individuals or a community towards improving health.

This report draws on a number of national surveys and administrative databases to populate the indicators, including the Canadian Community Health Survey, Canadian Vital Statistics Database, and the Canadian Cancer Registry. While many of these sources capture data for First Nations people living off reserve, the Métis and the Inuit, most exclude First Nations people living on reserve and in northern communities. Helping to fill this information gap is the First Nations Regional Health Survey, the only First Nations-governed national health survey in Canada. The First Nations Regional Health Survey, coordinated by the First Nations Information Governance Centre in collaboration with its 10 Regional Partners, collects information about First Nations people living on reserve and in northern communities based on both Western and traditional understandings of health and well-being. In the present report, where applicable, national-level First Nations Regional Health Survey data and contextual information for First Nations people living on reserve and in northern communities are provided by the First Nations Information Governance Centre. The Public Health Agency of Canada has worked in partnership with the First Nations Information Governance Centre to ensure that the inclusion of on-reserve First Nations data in this report is in compliance with the First Nations principles of OCAP ®(Ownership, Control, Access and Possession).

Findings

Overall, significant health inequalities were observed among Indigenous peoples, sexual and racial minorities, immigrants, and people living with functional limitations, and a gradient of inequalities by socioeconomic status (income, education levels, employment, and occupation status) could be seen for many indicators. Some populations (in particular, those with lower socioeconomic status as well as First Nations, Inuit and Métis peoples) had consistently less favourable results, while other groups (e.g. recent immigrants and racial minorities) experienced mixed outcomes in terms of health behaviours, health outcomes, and structural determinants of health.

Health Outcomes

Life expectancy and mortality. Clear socioeconomic gradients were observed across life expectancy and mortality indicators. Life expectancy and health-adjusted life expectancy were consistently lower and infant mortality and unintentional injury mortality were consistently higher among those living in lower-income areas, with lower educational attainment, and with greater material and social deprivation. These health outcomes were also worse in areas with a high concentration of First Nations, Inuit, and Métis people. Similar socioeconomic gradients by income, education, and material and social deprivation could be seen for suicide mortality. Suicide mortality was also relatively high in areas with a high concentration of First Nations, Inuit, and Métis people, and particularly high among men living in areas with a high concentration of people identifying as Inuit. Across all social stratifier groups, suicide mortality was higher among men than women.

Mental health and mental illness. Low self-rated mental health was more common among those with the lowest income, lower levels of educational attainment, and unskilled and semi-skilled occupations, and decreased as socioeconomic gradients increased. Low self-rated mental health was also more common among those identifying as bisexual or gay/lesbian compared with those identifying as heterosexual.

Clear socioeconomic gradients were likewise observed for mental illness hospitalizations, which increased with each step-wise decrease in neighbourhood income and educational attainment levels, and with each step-wise increase in material and social deprivation. Also, in areas with a high concentration of people identifying as Métis, Inuit, or First Nations, mental illness hospitalization rates were two to three times the rate among people who live in areas with a low concentration of people identifying as Indigenous.

Cause-specific outcomes. Compared with employed adults, those who were permanently unable to work reported significantly higher prevalence of arthritis, asthma, and diabetes. Similarly, people with lower income and lower educational attainment levels consistently reported higher prevalence of these chronic diseases than those in higher socioeconomic status groups. Arthritis, asthma, and obesity were less prevalent among immigrant Canadians, especially recent immigrants (in Canada for 10 years or less), than among non-immigrant Canadians. However, diabetes prevalence was higher among long-term immigrants than non-immigrants.

Indigenous peoples also face inequalities in cause-specific outcomes. The prevalence of arthritis, asthma, diabetes, and obesity were higher among First Nations adults living off reserve, First Nations adults living on reserve and in northern communities, and Métis adults than among non-Indigenous adults. Among Inuit adults, obesity was also higher than among non-Indigenous Canadians; results for other cause-specific outcomes were not statistically significant.

Inequalities in disability and poor oral health (inability to chew) were particularly pronounced between socioeconomic groups (by employment status, educational attainment, and income level).

Finally, based on case report data, the incidence of active tuberculosis was exceptionally high among the Inuit, at nearly 300 times the rate among Canadian-born non-Indigenous people. Active tuberculosis incidence rates were also very high among First Nations people living on reserve and foreign-born Canadians, at 32 times and 20 times, respectively, the rate among Canadian-born non-Indigenous people.

Health Determinants: Daily Living Conditions

Health behaviours. A strong socioeconomic gradient was evident for smoking, exposure to second-hand smoke in the home, and lung cancer incidence: all three indicators increased as levels of income, educational attainment, and occupational skill (for smoking and second-hand smoke) decreased, and as neighbourhood social and material deprivation (for lung cancer incidence) increased. The prevalence of smoking among adults with less than a high school education was nearly 4 times that of university graduates, and prevalence among unskilled workers more than twice that of professional workers. Similarly, exposure to second-hand smoke was significantly higher among those in the lower educational attainment, occupational status, and income groups.

In contrast, high alcohol consumption was more prevalent among people with higher income. In terms of educational attainment, heavy drinking prevalence was lowest among university graduates and similar across other education groups. High alcohol consumption was about 3 times higher among White adults than among Black, East/Southeast Asian, South Asian, and Arab/West Asian Canadians. The prevalence of high alcohol consumption and smoking were also higher among Inuit, Métis, and First Nations people living both off reserve and on reserve than among non-Indigenous peoples.

Physical and social environments. The prevalence of housing below standards among Canadians in the lowest income group was nearly 7.5 times as high as among Canadians in the highest income group, decreasing along a step-wise gradient, from lowest to highest income. Recent immigrants reported a prevalence of housing below standards twice that of non-immigrants; the magnitude of inequality in housing below standards was even higher between recent immigrants who are visible minorities compared with non-immigrants who were not visible minorities.

Health Determinants: Structural Drivers

Early childhood development. The proportion of developmental vulnerability in early childhood among children living in the most materially and socially deprived neighbourhoods was more than twice as high as among children living in the least deprived neighbourhoods. Similarly, this proportion was twice as high among children who were identified by their teacher as Indigenous than among those who were identified as non-Indigenous. A clear socioeconomic gradient is evident here as well, where observed prevalence of developmental vulnerability increases as neighbourhood income and education levels decrease.

Social inequities. Low socioeconomic status was strongly related to structural drivers of inequity. For example, household food insecurity due to financial constraints increased dramatically as household income decreased, with the prevalence among adults in the lowest income group nearly 30 times that of adults in the highest income group. Among adults in households where none of its members had completed high school, the prevalence of food insecurity was 8.5 times that of adults in households with at least one university graduate. Food insecurity was 3.7, 2.7, and 2.2 times as prevalent among Inuit, First Nations living off reserve, and Métis adults, respectively, as among non-Indigenous adults. (The prevalence of household food insecurity was also high among First Nations people living on reserve and in northern communities, although results cannot be directly compared with the prevalence among non-Indigenous Canadians due to methodological limitations.) The prevalence of household food insecurity was also nearly 3 times higher among adults who identified as bisexual than those who identified as heterosexual. The prevalence of working poverty was notably higher among Canadians who had not completed high school, First Nations people living off reserve, recent immigrants, and racial minorities.

Discussion and implications

Canadians are among the healthiest people in the world. However, as this report shows, the benefits of good health are not equally enjoyed by all Canadians. Some of these observed inequalities are consistent with what is known from other research on the social determinants of health and health equity, while others remain to be more fully explored. Regardless, the persistence, breadth, and depth of health inequalities in Canada constitute a call to action across all levels and sectors of society. In recent decades, the global evidence on what works to reduce health inequities has grown, making it possible to identify key principles for action and promising practices that can be adapted to advance health equity within the Canadian context.

1. Adopt a human rights approach to action on the social determinants of health and health equity. A human rights approach recognizes that equitable access to opportunities for health, well-being, and their determinants is an issue of fairness and justice. The right to health in particular is recognized in a number of United Nations covenants and conventions to which Canada is a party, including the International Covenant on Economic, Social and Cultural Rights. Implementation of a human rights approach to health can be supported by evidence-based, participatory, and coherent action across governments and sectors, including working with communities most affected by health inequalities to design interventions that are both relevant and effective.

2. Intervene across the life course with evidence-informed policies and culturally safe health and social services. Advantages and disadvantages in health and the distribution of its social determinants accumulate over an individual's life course and over generations. Interventions at different life stages, particularly during critical or sensitive periods (e.g. early years) can substantially affect health outcomes and health equity.

3. Intervene on both proximal (downstream) and distal (upstream) determinants of health and health equity. Public health actions that focus on individual-level behavioural determinants may inadvertently increase health inequalities in the absence of accompanying efforts that target "upstream" socioeconomic, political, cultural, and environmental factors.

4. Deploy a combination of targeted interventions and universal policies/interventions. Policy and program interventions may be specifically targeted towards those with the poorest health outcomes and greatest social disadvantage or they may be designed for universal delivery across the whole population but implemented at different levels of intensities depending on the varying needs of specific sub-groups ("proportionate universalism"). Pairing targeted and universal interventions helps ensure that the targeted intervention effects are not "washed out" by broader conditions that may sustain social inequalities.

5. Address both material contexts (living, working, and environmental conditions) and sociocultural processes of power, privilege, and exclusion (how social inequalities are maintained across the life course and across generations). Both material deprivation and sociocultural processes that maintain privilege and disadvantage and inclusion and exclusion play important roles in generating and reinforcing social and health inequities. In addition to addressing material conditions, effective action on health equity must also include efforts to empower disadvantaged communities and tackle the harmful processes of marginalization and exclusion (e.g. systemic discrimination and stigmatization) embedded in hierarchies of power and privilege.

6. Implement a "Health in All Policies" approach. Recognizing that many of the policy levers that influence the social determinants of health lie outside of the health sector and, as such, can only be addressed through collaborative engagement with others, the World Health Organization has developed a "Health in All Policies" framework to support government sectors in systematically taking into account the health implications of their policy decisions in order to better avoid harmful health impacts and improve population health and health equity.

7. Carry out ongoing monitoring and evaluation. Improving population health and health equity requires current, systematic, and robust evidence to inform policy actors, practitioners, community organizations, and citizens about how health and its determinants are distributed across subpopulations, and how policies and interventions affect health and health equity. Ongoing monitoring and reporting on the magnitude and trends of health inequalities and their determinants supports public actors in evaluating their progress.

Ultimately, achieving the goal of health equity demands that we acknowledge our interdependence-our shared responsibility to create and sustain healthful living and working conditions and environments, and the shared benefits that we can all enjoy when those conditions are in place. Tackling health inequities requires effort, innovation and ingenuity, but Canadians are up to the task if we apply our collective will and wits in service of our common good.

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Key Health Inequalities in Canada: A National Portrait - Executive Summary

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Health inequalities in Canada exist, are persistent, and in some cases, are growing. Many of these inequalities are the result of individuals' and groups' relative social, political, and economic disadvantages. Such inequalities affect peoples' chances of achieving and maintaining good health over their lifetimes .

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How Much Socioeconomic Inequality do Indigenous People Face?

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How Much Socioeconomic Inequality do Indigenous People Face?

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In our modern societies, opportunities and rewards are still unequally distributed across different social groups (e.g. between women and men, people from different families of origins, between migrants and nationals). Our research on socio-economic inequalities will focus on the development and perpetuation of inequalities during individuals' life course and the role of contextual factors.

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Abstract

Using three nationally representative Aboriginal Peoples Surveys (2001, 2006 and 2012, n = 68,040), we examined income-related inequalities in self-perceived poor/fair general health status among Indigenous adults (18+) living off-reserve in Canada. We used the relative and absolute concentration indices (, respectively) to quantify income-related inequalities in health for men and women, within the three Indigenous populations (First Nations, Métis, and Inuit), and in different geographic regions. Moreover, we performed decomposition analysis to determine factors that explain income-related inequality in health within the Indigenous peoples living off-reserve in Canada. The prevalence of poor/fair health status among the Indigenous population living off-reserve increased from 18% in 2001 to 22% in 2012. The extent of pro-rich relative (absolute) income-related inequalities in health increased by 23% (42%) from 2001 to 2012. Income-related inequalities in health increased statistically significantly within First Nations and Métis populations as well as in Atlantic provinces, Ontario, Alberta, British Columbia and Territories. Decomposition analyses indicated that, besides income itself, occupational status and educational attainment were the most important factors contributing to the pro-rich distribution of health among Indigenous peoples living off-reserve. Growing socioeconomic inequalities in health among Indigenous peoples should warrant more attention. Policies designed to address the broader array of RC and AC social determinants of health may mitigate the continuing inequalities in health among Indigenous peoples living off-reserve in Canada.

Introduction

There is great interest in reducing health inequalities across different social groups in Canada [1,2] and globally [3]. This interest was further invigorated by the work of the World Health Organization's Commission on the Social Determinants of Health and the subsequent Rio Political Declaration in 2011 [4], in which participating countries, including Canada, committed to reducing health inequalities [1,5]. In fact, achieving health equity - eliminating unfair inequalities in health - is now considered as one of the strategic priorities for many jurisdictions across Canada [6,7].

Notwithstanding several federal and provincial initiatives and political commitments to reduce health inequalities, several studies [[8], [9], [10], [11]] have documented persistent differences in health by socioeconomic status (SES) among the general population in Canada. The extent of the SES-health gradient was found to be significantly higher in Canada compared to most European countries [12]. A recent report from the Canadian Institute for Health Information (2015), Trends in Income-Related Health Inequalities in Canada, showed that inequalities are persistent between richer and poorer Canadians for a broad set of health indicators and health risk factors (e.g., chronic disease, measures of well-being, access to housing and food, smoking and obesity) [10]. Additionally, work by Hajizadeh and colleagues [11] suggested that socioeconomic inequality in health has widened over the past one and half decades in Canada, especially among women.

Indigenous peoples in Canada currently experience the poorest level of health status, and their health indicators are often similar to that of developing countries [13]. The persistent inequalities in health between Indigenous and non-Indigenous peoples in Canada are pervasive for a range of health measures, including life expectancy, incidence of chronic diseases (e.g., diabetes and obesity) [14], rates of infectious diseases (in particular tuberculosis and childhood Respiratory Syncytial Virus bronchiolitis), and prevalence of substance abuse, suicide and addiction [[15], [16], [17], [18]]. A growing body of research has demonstrated how these inequalities are linked with various historical and contemporary aspects of colonization that discriminate against Indigenous groups in Canada [19,20]. In 2015, the federal government committed to implementing the Calls to Action outlined by the final report of Truth and Reconciliation Commission (TRC) of Canada [21], including calls to "close the gaps in health outcomes" between Indigenous and non-Indigenous peoples.

In addition to facing the disproportionate burden of health issues, Indigenous peoples also continue to be the most socioeconomically disadvantaged and marginalized [22,23]. In 2006, non-Indigenous Canadians had higher income, employment and education levels compared to the three main Indigenous groups in Canada, with Métis faring better than First Nations or Inuit [24]. With the exception of the increased number of Indigenous women who had completed a university degree between 1996 and 2006, these socioeconomic inequalities had not diminished over the previous 10 years [24]. Similar to the health issues faced by Indigenous peoples, socioeconomic outcomes have also been linked with various aspects of colonization. For example, analyses of 2006 data of Indigenous peoples living off-reserve revealed that income, employment status, and educational attainment mediated the effect of personal attendance at Indian residential school attendance on health [25]. Likewise, analyses of the same 2006 data set showed that the intergenerational effects of parental residential attendance on their children's school success was also mediated by socioeconomic status [26]. The Indian residential school system was only one key aspect of the governments' explicit goal of assimilation, and numerous other past and ongoing policies have also contributed to the socioeconomic and health gaps Indigenous peoples in Canada face [21,24].

The monitoring of socioeconomic inequalities in health plays a significant role in the assessment of progress toward the commitments made by governments to reduce socioeconomic inequalities in health [27]. Furthermore, identifying the factors accounting for socioeconomic inequalities in health is essential to implementing effective interventions and policies to address these inequalities [27,28]. While there is much documented information about inequalities between Indigenous and non-Indigenous populations [[14], [15], [16], [17], [18]], the extent of socioeconomic-related inequalities between Indigenous groups have not been examined. It is important to explore such between-group inequalities within Indigenous populations, considering the significant differences in cultures, collective histories, and present-day circumstances between First Nations, Métis, and Inuit peoples [15,29]. Even within each of these three main Indigenous groups in Canada, there is significant variation across tribal groups, communities, and/or regions. While some Indigenous peoples are thriving despite their collective history of colonization, others are still struggling to heal and regain wellness [30,31]. Keeping such variation in mind, a critical first step to addressing ongoing inequities is identifying risk and resilience factors that influence the health and well-being of Indigenous peoples. Using information from three waves of a nationally representative Aboriginal Peoples Survey (APS, 2001, 2006 and 2012), we aim to contribute to filling the gaps in the literature by studying the extent and socioeconomic factors accounting for inequalities in self-perceived poor/fair health status (the most widely-used and well-validated measure of health status [32]) among First Nations, Métis, and Inuit adults living off-reserve over the period between 2001 and 2012.

Section snippets

Data

Our analysis is based on data from confidential master files of three waves of the Aboriginal Peoples Survey (APS, 2001, 2006 and 2012) conducted by Statistics Canada. The APS is a large national cross-sectional survey that collects unique and detailed data on the social and economic conditions (e.g., education, employment, health, language, income, housing and mobility) from Indigenous peoples (i.e., First Nations, Métis, and Inuit), aged 6 years and older, mainly living off-reserve in urban,

Trends in the prevalence of poor/fair health status among Indigenous populations

Table 1 presents the prevalence of self-rated poor/fair health status among off-reserve Indigenous adults over the period between 2001 and 2012. The results showed that the prevalence of self-reported poor/fair health status increased from 18.2% in 2001 to 21.7% in 2012 among off-reserve Indigenous peoples. As reported in Table 1, the prevalence of self-reported poor/fair health status stratified by sex, Indigenous groups, and region also increased over the study period.

The prevalence of

Discussion

Although the existence of socioeconomic inequalities in health has been well-documented among the general Canadian population [[8], [9], [10], [11], [12],[67], [68], [69], [70]], few studies have assessed such socioeconomic differences in health among Indigenous populations in Canada. Using information from three waves of a nationally representative APS, we examined the extent and factors accounting for inequalities in self-perceived poor/fair health status over the period between 2001 and

Conclusions

Although the existence of socioeconomic inequalities in health has been well-documented among the general population of Canada [[8], [9], [10], [11], [12],[67], [68], [69], [70]], few studies have assessed such socioeconomic differences in health among Indigenous populations. In this study, for the first time, we measured and decomposed income-related inequalities in health among Indigenous peoples living off-reserve in Canada over the period between 2001 and 2012. Caveats considered, our

Conflict of interest

We declare that we have no conflict of interest.

Authors' contributions

All authors contributed to the conception and design of the study, Mohammad Hajizadeh and Min Hu performed the statistical analysis, all authors interpreted results, Mohammad Hajizadeh drafted the manuscript, and Min Hu, Amy Bombay and Yukiko Asada helped with revisions. All authors read and approved the final version of the manuscript.

Funding

The authors acknowledge funding for this research provided by the Faculty of Health - Research Development Grant, Dalhousie University and Nova Scotia Health Research Foundation (NSHRF) Establishment Grant program (Grant Number: 1017).

Acknowledgements

We would like to thank the Statistics Canada's Atlantic Research Data Centre (ARDC) at Dalhousie University for facilitating the access to the Aboriginal Peoples Surveys (APS). We also thank Ardeshir Sepehri, the participants of the 2017 Canadian Economics Association conference, the 2017 Canadian Public Health Association conference and 12th World Congress on Health Economics for their helpful comments on earlier versions of this paper. As well, comments from seminar participants at the

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Reducing health inequalities: a challenge for our times

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Socioeconomic inequalities in health among Indigenous peoples living off-reserve in Canada: Trends and determinants

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Using three nationally representative Aboriginal Peoples Surveys (2001, 2006 and 2012, n = 68,040), we examined income-related inequalities in self-perceived poor/fair general health status among Indigenous adults (18+) living off-reserve in Canada. We used the relative and absolute concentration indices (, respectively) to quantify income-related inequalities in health for men and women, within the three Indigenous populations (First Nations, Métis, and Inuit), and in different geographic regions.

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How do Socioeconomic Inequalities Affect Health?

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How do Socioeconomic Inequalities Affect Health?

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How can Socioeconomic Inequalities be seen in Canada ?

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How can Socioeconomic Inequalities be seen in Canada ?

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by Tracey Bushnik, Michael Tjepkema and Laurent Martel

https://www.doi.org/10.25318/82-003-x202000100001-eng

Life expectancy (LE) and health expectancy have increased throughout much of the world, including Canada. However, these gains in years lived and years lived in good health are not distributed equally across all population groups. Disparities exist, particularly according to socioeconomic position. Understanding the magnitude, distribution and shift over time in these disparities is increasingly relevant for policy development and planning to advance health equity.

It has been reported in many countries-including the United States, Norway, Denmark and Belgium-that people with less education or lower income are disadvantaged in terms of life and health expectancies, and that this disadvantage has persisted or increased over time. Past and current findings suggest that such disparities also exist in Canada. However, differences in methodologies and data sources have made it difficult to ascertain how, if at all, these disparities have changed with time.

This study uses the 1996 and 2011 Canadian Census Health and Environment Cohorts (CanCHECs), with a five-year mortality follow-up, to estimate the LE of the household population. It also incorporates information from two national health surveys to estimate health-adjusted life expectancy (HALE).

The objectives of this study are to examine LE, HALE and disparities in LE and HALE in the 1996 and 2011 cohorts at ages 25 and 65 for men and women, according to highest level of educational attainment and household income quintile; to examine these disparities according to the combination of education and income in the 2011 cohort; and to examine how education- and income-related disparities in LE and HALE changed over time.

Methods

Data sources
1996 and 2011 CanCHECs
The 1996 and 2011 CanCHECs are population-based linked datasets that follow the non-institutional population at the time of the census for different health outcomes such as mortality, cancer and hospitalizations. In brief, records from census years 1996 and 2011 were linked to mortality data using Statistics Canada's Social Data Linkage Environment (SDLE). The records from 1996 included mandatory long-form census respondents only, aged 19 or older, from about one in five non-institutional households including collectives. The records from 2011 included voluntary National Household Survey (NHS) respondents, from about one in three households in private dwellings, and no age restriction. The SDLE helps create linked population data files for social analysis through linkage to the Derived Record Depository (DRD), a dynamic relational database that contains only basic personal identifiers. For this analysis, records were included for individuals who were aged 25 or older on Census Day and who were living in private households. This resulted in an analytical sample of 3,203,700 in the 1996 cohort and 4,526,300 in the 2011 cohort (count rounded to the nearest 100).

Mortality

Mortality data were based on the Canadian Vital Statistics Death Database, which was linked to the DRD. The linkage rate of deaths to the DRD exceeded 99% for 1996 and 2011.

The National Population Health Survey and the Canadian Community Health Survey

Estimates for the Health Utilities Index Mark 3 (HUI3) are derived from responses to the 1994/1995 National Population Health Survey (NPHS) and the 2009 and 2010 Canadian Community Health Survey (CCHS). Information about both surveys is available at www.statcan.gc.ca. The target population of the NPHS household component was residents of private households in the provinces, excluding residents of Indian reserves, Canadian Armed Forces bases, and some remote areas in Ontario and Quebec. The selected household and selected person response rates were 88.7% and 96.1%, respectively. The target population of the CCHS was the household population aged 12 or older in the provinces and territories, with similar exclusions as the NPHS (representing less than 3% of the CCHS target population). The combined household and selected person response rate for the 2009/2010 CCHS was 72.3%.

This study uses data from respondents with a valid HUI3. In general, the non-response rate for HUI3 was less than 1% in either survey year, resulting in an analytical sample size of 15,989 from the NPHS and 121,606 from the CCHS.

Measures

Health Utilities Index Mark 3

HUI3 measures eight attributes of self-reported health status: vision, hearing, speech, ambulation, dexterity, emotion, cognition and pain. A respondent's attribute levels-from normal to highly impaired-are summarized by a weighted scoring function into a single value that represents their overall health state. This value can range from -0.36 (state worse than death; death is represented by 0) to 1.00 (best possible health state).

Highest level of educational attainment

This was the highest certificate, diploma and degree of the individual collected by the census and NHS and the NPHS and CCHS. It was grouped into four separate categories: less than secondary graduation (E1), secondary graduation or trades certificate (E2), postsecondary certificate or diploma excluding university degree (E3), and university degree or equivalent (E4). The proportion of men and women in each category is presented in Appendix Table A.

Income quintiles

Income was self-reported in the NPHS and CCHS, and in the 1996 Census. In the 2011 NHS, 73% of respondents gave permission for income information available from their tax data to be used. Weighted quintiles-Q1 (lowest), Q2, Q3, Q4 and Q5 (highest)-were derived from total annual household pre-tax income from all sources, adjusted for household size. In the NPHS and CCHS, these were tabulated within each census metropolitan area (CMA) or provincial residual. In the census and the NHS, the weighted quintiles were derived within each CMA, census agglomeration or provincial residual.

Statistical analysis
Life expectancy
The number of deaths by sex, age group and socioeconomic measure (education and income in 1996 and 2011, composite in 2011 only) during a five-year follow-up period were tabulated for each CanCHEC. The number of people who were alive during the follow-up periods ( i.e., the at-risk population) by sex, age and socioeconomic measure was also tabulated. Person-years-at-risk were calculated based on census date and date of death or end of follow-up. Since most individuals who were alive during the follow-up period did not remain at the same age for an entire follow-up year, a year-at-risk was partitioned between two ages, and potentially two age groups. For example, someone who turned from age 49 to 50 exactly halfway through the follow-up year contributed 0.5 person-years-at-risk to the 45-to-49 age group, and 0.5 person-years-at-risk to the 50-to-54 age group. A five-year follow-up period was chosen to ensure enough deaths to provide reliable estimates and to minimize mortality overlap in follow-up periods across the different CanCHEC years.

Life expectancy (LE) is the number of years a person at a given age would be expected to live if the mortality rates observed during a specific period persisted throughout their remaining life. For this study, abridged period life tables (based on five-year age groups starting at age 25 and ending at age 90 or older) were calculated according to the Chiang method, using deaths and person-years-at-risk from each CanCHEC for men and women according to education category and income quintile, with an additional table based on a composite measure of education and income by sex for the 2011 CanCHEC only. Because of data constraints, a table for the composite measure was not estimated for the 1996 CanCHEC. The cohort weight was applied to ensure that the LE estimates were representative of the target population (people aged 25 years or older in private households on Census Day), and the bootstrap replicate weights were used to estimate appropriate standard errors and 95% confidence intervals.

Health-adjusted life expectancy

To estimate HALE, mean HUI3 scores by sex and age group according to education category and income quintile were tabulated using the 1994/1995 NPHS and the 2009 and 2010 CCHS, and according to the composite measure of education and income using the 2009 and 2010 CCHS only. The age groups were 25 to 44, 45 to 54, 55 to 64, 65 to 79, and 80 or older. These age groups maximized sample size and were age groups within which mean HUI3 scores-assessed for the full population-remained relatively stable. Survey weights were applied so that the mean HUI3 estimates were representative of the health status of the underlying target populations, and bootstrap weights were applied so that the standard errors were estimated taking into account each survey's complex design. Appendix Table A presents estimates for age groups 25 to 44 and 65 to 79 by education and income categories. A difference of 0.03 or greater in mean HUI3 is considered clinically important.

HALE was estimated for each cohort using a modified version of the Sullivan method. The life expectancy information from each set of CanCHEC-based abridged period life tables was weighted by the number of life-years lived at a particular age x using the mean HUI3 for that age, sex and socioeconomic measure. HALE was obtained by then dividing the sum of the adjusted life-years beyond age x by the number of survivors at that age. The HALE variance was estimated using the method proposed by Mathers, which takes into account stochastic fluctuations in the observed death probabilities and the mean global HUI3 scores. The ratio of HALE to LE ( HALE/ LE) was multiplied by 100 and expressed as a percentage. The HALE/ LE variance was estimated taking into account the variance of the mortality rates, using the Jagger et al. approach (Appendix Equation 1).

Testing of equality

The equality of two estimates of LE, HALE or HALE/ LE across groups (disparities) or over time (2011 versus 1996) was conservatively tested by the following Z-score (Appendix Equation 2).

Results

Education and income

In the 2011 cohort, 17% of men and women had less than a secondary graduation (E1), compared with 23% and 24%, respectively, with a university degree (E4) (Appendix Table 1). In the 1996 cohort, 32% of men and 33% of women were at E1, compared with 16% and 13%, respectively, at E4. In both cohorts, a larger proportion of men were in the highest income quintile (Q5) than in the lowest income quintile (Q1). Among women, 21% were in Q1 and 19% were in Q5 in the 1996 cohort, while 20% were in both Q1 and Q5 in the 2011 cohort. In the 2011 cohort only, 5% of men and 6% of women were in the lowest combined education and income category (E1, Q1), whereas 9% of men and women were in the highest (E4, Q5) (data not shown).

Education-related disparities in LE and HALE

Income-related disparities in LE and HALE

Education-within-income-related disparities in LE and HALE

For the most part, the gradient in LE ₂₅ and HALE ₂₅ for men and women persisted by level of education within and across income quintiles (Figure 1). Among women with a university degree (E4), however, LE varied little by income. Those in the lowest combined socioeconomic category (E1, Q1) had the greatest LE ₂₅ and HALE ₂₅ disadvantage, which was larger than disadvantages in either E1 or Q1. The LE ₂₅ of men and women in E1, Q1 was 13.0 and 9.7 years lower, respectively, than the LE ₂₅ of men and women in E4, Q5. The HALE ₂₅ disadvantage was even greater: 19.9 fewer HALE ₂₅ years for men and 16.2 fewer HALE ₂₅ years for women. There was also a gradient in HALE ₂₅/ LE ₂₅ across combined socioeconomic categories. Those in E1, Q1 could expect to spend about 75% of their total life expectancy in good health, compared with 89% to 91% among those in E4, Q5. Gradients in LE ₆₅ and HALE ₆₅ across combined categories were evident but attenuated, and there was less of an education gradient in HALE ₆₅/ LE ₆₅ within income categories (data not shown).

LE and disparities in LE over time

HALE and disparities in HALE over time

Discussion

This study found that disparities in LE and HALE still exist in Canada. People with higher levels of education or a higher income have longer life expectancies and are expected to spend a greater portion of those years in good health compared with those with less education or with a lower income. A distinct stepwise gradient in LE and HALE also exists by level of education within and across income quintiles. There is evidence that disparities are wider than they were 15 years ago, but not necessarily to the same extent for both sexes or at different ages.

The pathways through which socioeconomic position can affect health outcomes are multi-factorial and complex. Education and income are frequently used as indicators of socioeconomic position in health disparities research and, though related, are not considered interchangeable. Education is widely thought to increase health knowledge and literacy, which in turn can promote the adoption of healthier lifestyles and facilitate access to appropriate health care. Higher income allows access to better-quality material resources-such as food and shelter-and better, easier or faster access to services, which can have a direct ( e.g., health services) or indirect ( e.g., education) effect on health. That this study found gradients in LE, HALE and HALE/ LE by education or income is consistent with other studies and speaks to the well-recognized role of social stratification in determining health outcomes. Moreover, the stepwise gradient in LE and HALE by education level within income strata underscores how multiple aspects of social disadvantage can intersect in their association with health outcomes. This is emphasized by the finding that people in the lowest combined socioeconomic categories were at a greater LE and HALE disadvantage than those in either a low education category or low income quintile.

Many studies have examined education-related disparities because of the availability and appeal of education as an indicator of socioeconomic status. Although differences in data sources, methodologies and definitions limit the direct comparability of these studies, it is possible to compare overall patterns and trends. This study found significant disparities in LE at ages 25 and 65 for both sexes between the lowest and highest education categories, and greater gaps for men than for women. These findings are consistent with what has been reported in many Organisation for Economic Co-operation and Development countries. The widening education gap in LE between 1996 and 2011 for both sexes that was reported in this study has also been reported elsewhere. This widening has been partly attributed to the significant decline in the population size of the lowest education category, a category that is thought to be increasingly composed of individuals with characteristics that compound the risk of ill health and death. This study found that the health status of those in the lowest education category declined between 1996 and 2011. However, it has been noted that compositional change cannot fully account for the worsening LE of those with the lowest education, particularly among women.

This study's finding of significant and widening income-related disparities in LE has also been reported by others, despite significant heterogeneity in the way income has been defined ( e.g., career earnings versus tax data, linked at the individual level or area-based). Alcohol and smoking have been identified as contributing substantially to income differences in LE. Negative health behaviours such as these might also help explain why people in the lowest combined education and income category in this study were at the greatest LE disadvantage.

Health expectancy goes beyond LE by estimating the number of years a population may expect to live in good health. Disparities in HALE-this study's measure of health expectancy-and in HALE/ LE were significantly larger at age 25 across education and income for both sexes than disparities in LE. In other words, people with the highest education and income were not only living longer than those with a lower income or less education, but were also spending a greater share of those years in good functional health. This is consistent with other published work, regardless of the measure used to estimate health expectancy, and suggests that disparities may be more pervasive with respect to quality rather than quantity of remaining life. However, the disparity in HA LE ₆₅ was considerably smaller than the disparity in HALE ₂₅. This may reflect the "age as leveller" theory, which suggests that earlier gaps in healthy life will narrow in advanced age.

Disparities in HALE ₂₅ widened between 1996 and 2011 for men across education categories and for women across income quintiles. The former partly reflects the fact that the functional health of men in the lowest education category declined over time, while it remained relatively unchanged for men in the highest education category. The reverse occurred for women. The functional health of women in the lowest income quintile remained stable, whereas it increased for the women in the highest income quintile. These findings suggest there may be differences by sex in how the association between different components of social disadvantage and health outcomes may be evolving over time.

This study has many strengths. The CanCHECs are large, nationally representative cohorts that were created using a consistent methodology and allow for a robust examination of change over time. Two important social determinants of health-education and income-measured at the individual level for people aged 25 or older were examined. Education has the advantage of having a low risk of "reverse causality" with health, while household income is a strong indicator of material living standards. Rarely have both determinants at the individual level been included in the same study of disparities in LE or HALE. HALE was estimated using HUI3, which is a continuous scale. This makes it less sensitive to measurement error than dichotomous estimates of health status.

Several limitations should be acknowledged. The analysis did not account for other population characteristics ( e.g., ethnicity, marital status) that may have changed over time within education or income categories and may have, in turn, contributed to the observed disparities. The results pertain solely to the household population since data constraints prevented the institutional population from being included in this study. Excluding the institutional population has been shown to significantly increase population estimates of HALE and HALE/ LE. Changes over time in question wording, collection mode and response rates for each census and health survey should be kept in mind when interpreting the results of this study. Specifically, revisions introduced in the 2006 Census to correct the underreporting of high school completion that had occurred previously, coupled with a potential increase over time in the homogeneity of people in the lowest education category, may have complicated the interpretation of trends. Additionally, 2006 was the first census year in which respondents were given the option to allow linkage to their tax records rather than self-report their income data. This reduced the clustering around "round" dollar amounts, such as $30,000, which then increased the variability in the income distribution compared with previous censuses. However, the fact that this study derived income quintiles for each cohort separately helped circumvent the potential impact of distributional change in income groups over time. Although the cohort weights were designed to help mitigate bias associated with data linkage, unknown bias might exist if people missing from the cohorts differed systematically from those who were included.

Conclusion

Education- and income-related disparities in life and health expectancy persist and may be wider than they were 15 years ago among the household population in Canada. These findings underscore the importance of ongoing data development for routine monitoring of trends in mortality and morbidity, which in turn can inform policy development and planning to advance health equity.

Acknowledgements

The authors gratefully acknowledge the help of Philippe Finès, who provided the syntax to estimate life expectancy and health-adjusted life expectancy based on the Canadian Census Health and Environment Cohorts.

Appendix

Equation 1
Calculation of variance of the ratio ofHALE to LE (HALE/LE)
MathType@MTEF@5@5@+= feaagKart1ev2aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq=Jc9 vqaqpepm0xbba9pwe9Q8fs0=yqaqpepae9pg0FirpepeKkFr0xfr=x fr=xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaaeaaaaaaaaa8 qacaWGwbGaamyyaiaadkhacaGGGcWaaeWaa8aabaWdbmaalaaapaqa a8qacaWGibGaamyqaiaadYeacaWGfbaapaqaa8qacaWGmbGaamyraa aaaiaawIcacaGLPaaacqGH9aqpdaWcaaWdaeaapeGaamisaiaadgea caWGmbGaamyra8aadaahaaWcbeqaa8qacaaIYaaaaaGcpaqaa8qaca WGmbGaamyra8aadaahaaWcbeqaa8qacaaIYaaaaaaakiaacQcadaWa daWdaeaapeWaaSaaa8aabaWdbiaadAfacaWGHbGaamOCamaabmaapa qaa8qacaWGibGaamyqaiaadYeacaWGfbaacaGLOaGaayzkaaaapaqa a8qacaWGibGaamyqaiaadYeacaWGfbWdamaaCaaaleqabaWdbiaaik daaaaaaOGaeyOeI0YaaSaaa8aabaWdbiaadAfacaWGHbGaamOCamaa bmaapaqaa8qacaWGUbGaam4BaiaadshacaWGibGaamyqaiaadYeaca WGfbaacaGLOaGaayzkaaGaeyOeI0IaamOvaiaadggacaWGYbWaaeWa a8aabaWdbiaadYeacaWGfbaacaGLOaGaayzkaaGaeyOeI0IaamOvai aadggacaWGYbWaaeWaa8aabaWdbiaadIeacaWGbbGaamitaiaadwea aiaawIcacaGLPaaaa8aabaWdbiaadIeacaWGbbGaamitaiaadweaca GGQaGaamitaiaadweaaaGaey4kaSYaaSaaa8aabaWdbiaadAfacaWG HbGaamOCamaabmaapaqaa8qacaWGmbGaamyraaGaayjkaiaawMcaaa WdaeaapeGaamitaiaadweapaWaaWbaaSqabeaapeGaaGOmaiaaccka aaaaaaGccaGLBbGaayzxaaaaaa@834C@
where Var = variance and = the difference between LE and HALE.

Equation 2
Testing the equality of two estimates ofLE, HALE or the ratio of HALE to LE (HALE/LE)
MathType@MTEF@5@5@+= feaagKart1ev2aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq=Jc9 vqaqpepm0xbba9pwe9Q8fs0=yqaqpepae9pg0FirpepeKkFr0xfr=x fr=xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaaeaaaaaaaaa8 qacaWGAbGaeyOeI0Iaam4CaiaadogacaWGVbGaamOCaiaadwgacqGH 9aqpdaWcaaWdaeaapeGaaiikaiaadIeacaWGbbGaaiykaiaadYeaca WGfbWdamaaBaaaleaapeGaaGymaaWdaeqaaOWdbiabgkHiTmaabmaa paqaa8qacaWGibGaamyqaaGaayjkaiaawMcaaiaadYeacaWGfbWdam aaBaaaleaapeGaaGOmaaWdaeqaaaGcbaWdbmaakaaapaqaa8qacaGG OaGaam4ua8aadaahaaWcbeqaa8qacaaIYaaaaOWaaeWaa8aabaWdbi aadIeacaWGbbaacaGLOaGaayzkaaGaamitaiaadweapaWaaSbaaSqa a8qacaaIXaaapaqabaGcpeGaey4kaSIaam4ua8aadaahaaWcbeqaa8 qacaaIYaaaaOWaaeWaa8aabaWdbiaadIeacaWGbbaacaGLOaGaayzk aaGaamitaiaadweapaWaaSbaaSqaa8qacaaIYaaapaqabaaapeqaba GccaGGPaaaaaaa@5CBE@
where (HA)LE = (health-adjusted) life expectancy, or HALE/ LE, and = variance of the (health-adjusted) life expectancy, or HALE/ LE.

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Socioeconomic disparities in life and health expectancy among the household population in Canada

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This study uses the 1996 and 2011 Canadian Census Health and Environment Cohorts (CanCHECs), with a five-year mortality follow-up, to estimate the life expectancy (LE) of the household population. It also incorporates information from two national health surveys to estimate health-adjusted life expectancy (HALE).

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Houses in Naples, Florida. (Jeffrey Greenberg/Education Images/Universal Images Group via Getty Images)

Rising economic inequality in the United States has become a central issue in the race for the Democratic presidential nomination, and discussions about policy interventions that might help address it are likely to remain at the forefront in the 2020 general election.

As these debates continue, here are some basic facts about how economic inequality has changed over time and how the U.S. compares globally.

For this analysis, we gathered data from the U.S. Census Bureau, Organization for Economic Cooperation and Development and the World Bank. We also used previously published data points from Pew Research Center surveys and analyses of outside data.

Over the past 50 years, the highest-earning 20% of U.S. households have steadily brought in a larger share of the country's total income. In 2018, households in the top fifth of earners (with incomes of $130,001 or more that year) brought in 52% of all U.S. income, more than the lower four-fifths combined, according to Census Bureau data.

In 1968, by comparison, the top-earning 20% of households brought in 43% of the nation's income, while those in the lower four income quintiles accounted for 56%.

Among the top 5% of households - those with incomes of at least $248,729 in 2018 - their share of all U.S. income rose from 16% in 1968 to 23% in 2018.

Income inequality in the U.S. is the highest of all the G7 nations, according to data from the Organization for Economic Cooperation and Development. To compare income inequality across countries, the OECD uses the Gini coefficient, a commonly used measure ranging from 0, or perfect equality, to 1, or complete inequality. In 2017, the U.S. had a Gini coefficient of 0.434. In the other G7 nations, the Gini ranged from 0.326 in France to 0.392 in the UK.

Globally, the Gini ranges from lows of about 0.25 in some Eastern European countries to highs of 0.5 to 0.6 in countries in southern Africa, according to World Bank estimates.

The black-white income gap in the U.S. has persisted over time. The difference in median household incomes between white and black Americans has grown from about $23,800 in 1970 to roughly $33,000 in 2018 (as measured in 2018 dollars). Median black household income was 61% of median white household income in 2018, up modestly from 56% in 1970 - but down slightly from 63% in 2007, before the Great Recession, according to Current Population Survey data.

Overall, 61% of Americans say there is too much economic inequality in the country today, but views differ by political party and household income level. Among Republicans and those who lean toward the GOP, 41% say there is too much inequality in the U.S., compared with 78% of Democrats and Democratic leaners, a Pew Research Center survey conducted in September 2019 found.

Across income groups, U.S. adults are about equally likely to say there is too much economic inequality. But upper- (27%) and middle-income Americans (26%) are more likely than those with lower incomes (17%) to say that there is about the right amount of economic inequality.

These views also vary by income within the two party coalitions. Lower-income Republicans are more likely than upper-income ones to say there's too much inequality in the country today (48% vs. 34%). Among Democrats, the reverse is true: 93% at upper-income levels say there is too much inequality, compared with 65% of lower-income Democrats.

The wealth gap between America's richest and poorer families more than doubled from 1989 to 2016, according to a recent analysis by the Center. Another way of measuring inequality is to look at household wealth, also known as net worth, or the value of assets owned by a family, such as a home or a savings account, minus outstanding debt, such as a mortgage or student loan.

In 1989, the richest 5% of families had 114 times as much wealth as families in the second quintile (one tier above the lowest), at the median $2.3 million compared with $20,300. By 2016, the top 5% held 248 times as much wealth at the median. (The median wealth of the poorest 20% is either zero or negative in most years we examined.)

The richest families are also the only ones whose wealth increased in the years after the start of the Great Recession. From 2007 to 2016, the median net worth of the top 20% increased 13%, to $1.2 million. For the top 5%, it increased by 4%, to $4.8 million. In contrast, the median net worth of families in lower tiers of wealth decreased by at least 20%. Families in the second-lowest fifth experienced a 39% loss (from $32,100 in 2007 to $19,500 in 2016).

Middle-class incomes have grown at a slower rate than upper-tier incomes over the past five decades, the same analysis found. From 1970 to 2018, the median middle-class income increased from $58,100 to $86,600, a gain of 49%. By comparison, the median income for upper-tier households grew 64% over that time, from $126,100 to $207,400.

The share of American adults who live in middle-income households has decreased from 61% in 1971 to 51% in 2019. During this time, the share of adults in the upper-income tier increased from 14% to 20%, and the share in the lower-income tier increased from 25% to 29%.

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6 facts about economic inequality in the U.S.

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Over the past 50 years, the highest-earning 20% of U.S. households have steadily brought in a larger share of the country's total income.

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Why is it Important to Address Socioeconomic Inequality?

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Why is it Important to Address Socioeconomic Inequality?

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- Many women and Men or people from different racial groups struggle to fit into social groups because of their pasts or where they come from. There are Individual and Institutional factors that are considered and affect children growing up which affects their school engagement, and achievements.
-Different groups all over the world say that there is the right amount of economic inequality, but groups of people with lower incomes are more likely to say that there is too much inequality in the country today. The wealth Gap between Rich people and people with lower amounts of income has increased more than double since 1989. The richest 5% of families had 114 times more wealth than families that had lower incomes. They are also the only families that experience a high increase in the years after the start of the Great Recession. The great recession also affected Canada because credit was not being extended and became a great problem for Business leaders who were super critical of what they saw as excessive tightening by banks. The recession did not affect Canadians as much as it did Americans. Families in the second-lowest fifth experience a 39% loss during this time in America. Clearly, rich more high-class people are treated with more respect because of their pasts and reputation than the lower class. Different groups of people earn different amounts of money based on race as well. This should be brought up more often, so these different groups of individuals can earn the right amount of money.
-Indigenous people ( Métis, First Nations, and Inuit peoples) make up a significant amount of the population in Canada and have faced many issues throughout the history of Canada (ex: residential schools and less access to healthcare or vaccines). They face a significant amount of Socioeconomic issues like education, employment, health, and occupation. Health Inequalities have been determined by the Euro-Canadian culture, and they have been destabilizing Indigenous health by forcing the displacement of First Nations in remote communities and reserves that were lacking resources. Indigenous people should be able to have the same amount of health privileges that non-indigenous citizens of Canada have access to.