# data[].attributes.attachment_link.readable_text
Skip to text

Text begins

Start of text box
Mental wellness resources and crisis help for First Nations people, Métis and Inuit
End of text box

Acknowledgments

We would like to acknowledge the review of preliminary findings and/or draft versions of the report by Indigenous organizations, including Inuit Tapiriit Kanatami, the Métis National Council, and the National Association of Friendship Centres, and federal departments including Indigenous Services Canada and Crown Indigenous Relations and Northern Affairs Canada. The analysis and the report were greatly strengthened by the suggestions and recommendations provided in the process. We also thank Jodie Golden, Public Health Agency of Canada ( PHAC) for reviewing the draft report for safe messaging.

Abstract

Suicide rates have consistently been shown to be higher among First Nations people, Métis and Inuit in Canada than the rate among non-Indigenous people; however, suicide rates vary by community, Indigenous group, age group and sex. The historical and ongoing impacts of colonization, forced placement of Indigenous children in residential schools in the 19th and 20th centuries, removal of Indigenous children from their families and communities during the "Sixties scoop" and the forced relocation of communities has been well documented. These resulted in the breakdown of families, communities, political and economic structures; loss of language, culture and traditions; exposure to abuse; intergenerational transmission of trauma; and marginalization, which are suggested to be associated with the high rates of suicide. While suicide among Indigenous people has been examined previously, studies were based on a decades-old cohort or used an area-based geozones approach. Past studies also examined suicides among only one or two Indigenous groups using the same methodology. Finally, they did not examine suicide among Indigenous people for some geographies such as on and off reserve, rural areas and small, medium and large population centres.

This article attempts to fill some of these knowledge gaps using the 2011 Canadian Census Health and Environment Cohort (CanCHEC), resulting from a record integration between the 2011 National Household Survey (NHS) and the Canadian Vital Statistics Database (CVSD). It presents suicide rates for the 2011 to 2016 time period among self-identifying First Nations, Métis, Inuit, and non-Indigenous people in private dwellings in Canada. It also explores the influence of socioeconomic factors in the disparity in risk of suicide between First Nations people, Métis, Inuit and non-Indigenous people in Canada.

Suicide rates among First Nations people, Métis and Inuit were significantly higher than the rate among non-Indigenous people. The rate among First Nations people (24.3 deaths per 100,000 person-years at risk) was three times higher than the rate among non-Indigenous people (8.0 deaths per 100,000 person-years at risk). Among First Nations people living on reserve, the rate was about twice as high as that among those living off reserve. However, suicide rates varied by First Nations band, with just over 60% of bands having a zero suicide rate. The rate among Métis (14.7 Note E: Use with caution deaths per 100,000 person-years at risk) was approximately twice as high as the rate among non-Indigenous people. Among Inuit, the rate was approximately nine times higher than the non-Indigenous rate (72.3 versus 8.0 deaths per 100,000 person-years at risk). Suicide rates and disparities were highest in youth and young adults (15 to 24 years) among First Nations males and Inuit male and females.

Socioeconomic factors, including household income, labour force status, level of education, marital status and geographic factors such as living on or off reserve (First Nations people) and community size (Inuit) accounted for a notable proportion of the disparity in risk of death by suicide among First Nations people (78%), Métis (37%) and Inuit (40%) adults, 25 years or older. However, due to limitations of the data, the role of other previously-identified factors such as historical and intergenerational trauma, community distress, cultural continuity, family strength and mental wellness were not explored here.

The findings from this study could contribute further to the understanding of suicide among First Nations people, Métis and Inuit in Canada, particularly with respect to the variability in suicide rates and socioeconomic factors associated with the disparity in suicide risk.

Introduction

First Nations people living on and off reserve, Métis and Inuit, die by suicide at a higher rate than non-Indigenous people. These suicides not only result in loss to family, friends and peers leading to immense grief and bereavement, but also to the community and society at large, in particular when the deceased is a young person. The impact of suicide is more widespread and severe in small Indigenous communities where many people are related and many experience similar personal and collective adversity.

The suicide rate for children and youth was previously reported to be 10 times higher among males and 22 times higher among females between 2005 and 2007 in areas with a high percentage of First Nations people compared with low-percentage areas. In Inuit Nunangat, the Inuit homeland made up of the Inuvialuit Region (northwest part of Northwest Territories), Nunavut, Nunavik (Northern Québec), and Nunatsiavut (Northern Labrador), the suicide rate among children and youth was 33 times higher than for the rest of Canada between 2004 and 2008. In fact, suicide is one of the leading causes of death among children and youth in areas with a high proportion of First Nations people and in Inuit Nunangat.

In adults, the suicide rates (1991 to 2006) among First Nations people and Métis have been reported to be twice as high as that among non-Indigenous adults. The suicide rate among adults in Inuit Nunangat (1999 to 2003) was four times higher than the rate among all adults in Canada; the disparity was greater among men than women.

It is important to note, however, that national level suicide rates may underestimate regional or community level differences. For example, previous reports have shown that suicide rates among First Nations youth in British Columbia range from 0 to 633 deaths per 100,000 people by tribal council. In fact, the majority of these tribal councils had a zero or very low suicide rate. A similar regional variance has been seen among Inuit communities in Nunavut. The suicide rate varied from under 50 deaths per 100,000 in Whale Cove to just over 250 deaths per 100,000 people in Qikiqtarjuaq.

Several representatives of Indigenous peoples and governments, communities and government agencies have developed programs, policies or strategies to address the high suicide rate among First Nations people, Inuit and Métis. Development and evaluation of these require timely data on suicide rates. Many existing estimates of suicide rates are based on an older cohort (1991 Census cohort), which excluded non-tax filers and those under 25, or are from studies that used an area-based geozones approach. The latter classified areas with higher proportions of First Nations residents as First Nations "identity areas" or examined mortality rate in Inuit Nunangat as a proxy for the rate among Inuit. These approaches may have led to under or over estimation of suicide rates. In addition, past reports have only estimated suicide rates among one or two Indigenous groups using the same methodology. Finally, there are gaps in knowledge of suicide rates among Indigenous people for certain geographical areas, including urban areas and on or off reserve.

This article presents suicide rates among self-identifying First Nations, Métis, Inuit and non-Indigenous peoples, who lived in private dwellings (i.e., excluding those who were in collective dwellings and institutions), for the 2011 to 2016 time period. These findings are based on the 2011 Canadian Census Health and Environment Cohort (CanCHEC), which was developed by integrating records in the the 2011 National Household Survey (NHS) and the Canadian Vital Statistics - Deaths Database (CSVD from 2011 to 2016). Suicides that occurred over the follow up period of 5.63 years (from Census day on May 10, 2011 to end of follow-up on December 31, 2016) were used to generate age-standardized and age-specific mortality rates. These are presented as estimated number of deaths by suicide per 100,000 person-years at risk. The person-year concept is often used in cohort studies and represents unit of time when individuals are at risk of dying, and can be roughly understood as persons per year. Specifically, the article (1) presents suicide rates among First Nations people, Métis and Inuit alongside comparisons with the suicide rates of non-Indigenous people to explore disparities, a better understading of which could inform prevention strategies, (2) presents the estimated proportion of First Nations bands that experienced no suicides as an estimate of the variability in suicide rates, and (3) explores the role of socioeconomic and geographic factors in explaining the excess mortality from suicide among the three groups.

Results

Suicide among First Nations people in Canada

In the current analyses, among the 851,280 First Nations people (based on population estimates using the 2011 CanCHEC and its weights), including status and non-status individuals, living on and off reserve and in private dwellings in 2011, an estimated 1,180 people died by suicide between 2011 and 2016. This resulted in an age-standardized suicide rate of 24.3 deaths per 100,000 person-years at risk (Table 1), which was three times higher than the suicide rate among non-Indigenous people (8.0). The suicide rate was higher among males than females (29.6 versus 19.5, respectively). This pattern is similar to that seen among non-Indigenous people among whom males (12.3) also had a higher suicide rate than females (3.9). However, these numbers indicate that the disparity in suicide rates - measured by dividing the suicide rate among First Nations people by that among non-Indigenous people (or rate ratios [ RR]) - between First Nations and non-Indigenous peoples is higher among females than males (RR = 5.0 among First Nations females and RR = 2.4 among First Nations males; Table 1).

﻿

Suicide rates were highest among youth aged 15 to 24 (48.7; non age-standardized) (data not shown) when compared with other age groups. Suicide rates were lower among the older age groups. They were significantly higher among First Nations people than non-Indigenous people in most age groups under 45 years of age, but the disparities were widest among those under 15 years ( RR = 8.9) and 15 to 24 years ( RR = 6.3) (data not shown). This was particularly apparent among females between 15 and 24 years of age ( RR = 12.0; Table A.1 in appendix).

The suicide rate was nearly twice as high among First Nations people living on reserve than among First Nations people living off reserve (non age-standardized rate of 34.1 versus 19.5, respectively). Among on-reserve First Nations people, suicide rates were highest for males aged 15 to 24 years (78.8) (Chart 1). Rates were lower in the older age groups among both males and females on reserve (Table A.2 in appendix). Disparities were particularly elevated among 15 to 24-year-old First Nations females living on reserve ( RR = 15.8) in comparison to non-Indigenous females across Canada. Disparities were smaller in the older age groups, but continued to be seen until age 55 for females and age 45 for males. For those aged 55 and older, suicide rates were not statistically different between on-reserve First Nations and non-Indigenous people. A similar comparison to rates among First Nations people living off reserve was not done since most age-specific estimates were not published due to low cell counts or precision (table A.2 in appendix).

No significant differences were seen in the suicide rates among First Nations people (on and off reserve combined) by province and territory. However, in every province, the suicide rate among First Nations people was higher than the non-Indigenous rate (Atlantic provinces were grouped together to increase sample size; suicide rates were not reportable for the non-Indigenous population in Yukon, Northwest Territories and Nunavut). And, the rate ratios were notably higher in the Prairie provinces. It was 4.6, 4.5 and 3.5 in Manitoba, Saskatchewan and Alberta, respectively. In other provinces, it ranged from 1.9 to 2.6. Suicide rates did not differ significantly by type of population centre. It was 28.8 among First Nations people in rural areas, 22.9 Note E: Use with caution among those in small population centres and 18.8 Note E: Use with caution among those in large population centres. The suicide rate among First Nations people in each of these areas was significantly higher compared with non-Indigenous rates (9.3 for rural areas, 9.0 for small population centres and 7.2 for large population centres).

These national and provincial level estimates, while useful, underestimate the variability in the suicide rates among individual First Nations communities. Suicide rates were estimated at the band level using a geographic approach (for more details, please refer to the methods section). Of the just over 600 First Nations bands in Canada, 555 were associated with reserves that were enumerated in the 2011 NHS and with individuals in the CanCHEC cohort. Just over 60% of First Nations bands had experienced no suicides between 2011 and 2016. The proportion of bands without suicides, when examined in the context of the overall on-reserve suicide rate among First Nations people (34.1) highlights the obscuring of variability in the national level estimate. This proportion of bands with zero suicide rate varied by province and territory. A larger proportion of bands in the Atlantic provinces (55%), Ontario (71%), Saskatchewan (53%), British Columbia (78%), Yukon (80%) and Northwest Territories (74%) had zero suicide rates. In the other provinces, the proportion ranged from 39% to 44%. It should be noted that 31 reserves were incompletely enumerated in the 2011 Census many of which were in Ontario and Québec (a brief description of these reserves can be found in the methods section), and were not included in this analysis. Also, band members who did not live on their band's reserve at the time of the Census were not included in the analysis.

Socioeconomic factors have previously been shown to be associated with suicide among Indigenous people in North America. To examine if similar patterns were evident in the 2011 CanCHEC cohort, the role of individual socioeconomic factors such as household income, labour force status, level of education, marital status and geographic factors such as living on or off reserve on risk of death by suicide were examined for First Nations people aged 25 years or older. After adjusting for age and sex, the risk of suicide among First Nations adults was twice as high as that among non-Indigenous adults (hazard ratio [HR] = 2.0; Table A.4 in appendix). Adjusting for household income resulted in a decrease in risk by 35%. After further adjusting for labour force status, level of education and marital status, First Nations adults were still at a higher risk of suicide than non-Indigenous adults ( HR = 1.4). Together, these factors accounted for 66% of the excess suicide risk. Further adjusting for living on and off reserve resulted in a HR of 1.2, which was not significantly different from 1.0. Together, all these factors accounted for 78% of the excess suicide risk among First Nations adults.

Suicide among Métis in Canada

Based on the current analysis, of the 452,985 self-identifying Métis (based on population estimates using the 2011 CanCHEC and its weights) who lived in private households in 2011, approximately 415 individuals died by suicide in the 2011 to 2016 period. As a result, the suicide rate was 14.7 Note E: Use with caution deaths per 100,000 person-years at risk (Table 2), which was nearly twice as high as the rate among non-Indigenous people (8.0). The rate among Métis males (22.6 Note E: Use with caution ) was more than three times higher than the rate among Métis females (7.2 Note E: Use with caution ). The suicide rate was nearly twice as high among Métis (22.6 Note E: Use with caution ) as non-Indigenous males (12.3). However, the suicide rates for Métis (7.2 Note E: Use with caution ) and non-Indigenous females (3.9) were not significantly different from each other.

﻿

Among the provinces and territories, because of low counts when broken down, suicide rates for Métis could only be generated for Ontario, Manitoba, Saskatchewan, Alberta and British Columbia combined (Ontario and west). In these provinces, the rate among Métis (13.4 Note E: Use with caution ) were higher than that among non-Indigenous people (7.6). Suicide rates among Métis in rural (16.5 Note E: Use with caution ), small (12.8 Note E: Use with caution ) and large population centres (15.5 Note E: Use with caution ) were not significantly different. The rate among Métis in large population centres was higher than the rate among non-Indigenous people (7.2; marginally significant). Suicide rates could not be published for medium population centres due to low cell counts.

Among Métis adults over 25, after adjusting for age and sex, the risk of suicide was twice as high as that among non-Indigenous adults (hazard ratio = 1.9; Table A.4 in appendix). Adjusting for household income, labour force status, population centre type of place of residence, level of education and marital status accounted for 37% of excess suicide risk. The risk of suicide was 1.6 times higher among Métis than non-Indigenous people after adjusting for these factors.

Suicide among Inuit in Canada

There were approximately 59,220 Inuit in Canada in 2011 who lived in private households (based on population estimates using the 2011 CanCHEC and its weights). Among them, there were an estimated 250 deaths by suicide between 2011 and 2016. This lead to a suicide rate of 72.3 deaths per 100,000 person-years at risk (Table 3). This was nine times higher ( RR = 9.0) than the suicide rate among non-Indigenous people (8.0). The suicide rate was three times higher among Inuit males than Inuit females (109.3 versus 35.4 Note E: Use with caution , respectively).

﻿

Suicide rates among Inuit were highest in youth; the highest suicide rate was seen among Inuit males between 15 and 24 years of age (363.2; non age-standardized) living in Inuit Nunangat (Chart 2). Publishable estimates could only be produced for Inuit females between the ages of 15 and 24 and 25 to 34. Suicide rate among females 15 to 24 years of age was 108.9 Note E: Use with caution , which was 33 times higher than non-Indigenous females of that age (Table A.3 in appendix).

Rates among Inuit were also compared by Inuit Nunangat region. Rates were significantly higher among Inuit in Nunatsiavut (188.2 Note E: Use with caution ; non age-standardized) than those in Nunavik (98.1) and Nunavut (94.0). Rates among Inuit in Inuvialuit region could not be published due to low reliability of estimates.

The national, Inuit Nunangat and Inuit regional level estimates underestimate the variation in rates among individual Inuit communities. Among the 50 Inuit communities, 11 communities had a suicide rate of zero. However, for most communities (66%), estimates were too unreliable to be published. It should be noted that some deaths may not have linked to the NHS and others may not have been in Vital Statistics at the time of data integration. The latter shortcoming has previously been reported by Jack Hicks. These exclusions may have biased the estimate of number of communities without suicides.

In multivariate analyses, among Inuit adults 25 years and older, the risk of death by suicide was 4.8 times higher than the risk among non-Indigenous adults, after accounting for age and sex (Table A.4 in appendix). After further adjusting for household income, labour force status, level of education and marital status, the hazard ratio decreased to 3.4 suggesting that these factors accounted for 37% of the excess risk of death by suicide among Inuit. After adjusting for size of community (population centre type), Inuit adults were still at 3.3 times higher risk of suicide than non-Indigenous adults ( HR = 3.3). All combined, these factors accounted for 40% of the excess risk of suicide among Inuit adults.

Discussion

The report is the first to examine suicide rates among all three Indigenous peoples, including First Nations people, Métis and Inuit, of different age groups and living in different geographies using one methodology. However, gaps in knowledge remain. Further research is needed to assess long-term trends and estimate the role of other risk and protective factors of suicide among Indigenous peoples, which should be done in consultation with First Nations people, Métis and Inuit, as recommended by the Truth and Reconciliation Commission of Canada.

In the current analysis, the suicide rates among First Nations people, Métis and Inuit were many times higher than the non-Indigenous rate during the 2011 to 2016 time period. The rates were highest among Inuit and, specifically, adolescents and young adults. The suicide rate among First Nations people living on reserve was higher than that among those living off reserve, and among males than females. The higher suicide rate among males has been attributed to their tendency to use more lethal methods and to the differential effect of specific stressors in the two sexes. However, greater disparities were observed among First Nations females, where higher suicide rates were seen when compared with non-Indigenous females. These patterns are similar to what has been previously reported.

Of particular concern is the high rate of suicide among Indigenous children under 15. The suicide rate among First Nations boys, nationally, was four times higher than among non-Indigenous boys. It was ten times higher among First Nations boys living on reserve. As with other national trends, this rate may obscure regional differences. Previously reports have suggested that in some remote First Nations communities in Ontario, under-15 suicide rates were nearly 50 times higher than non-Indigenous rates. And, among Inuit communities of Nunatsiavut, the age-specific disparity was largest among 10 to 19-year-olds relative to their non-Indigenous counterparts outside Inuit Nunangat ( RR = 15.8). Also, rate of death by suicide among Inuit children 10 to 14 years of age appears to be increasing since 1989 although significant fluctuations are seen across time. In line with these rates among children, suicidal ideation among grade 5 to 8 school children in Saskatoon was nearly twice as high among Indigenous children as non-Indigenous children after accounting for mental health, cognitive abilities and bullying experiences. While risk factors for suicide among children are numerous and complex, a recent report suggests that Inuit children and youth in Nunavut experience a lack of mental health services that are specific to them, culturally relevant and of adequate quality.

And, while time trends were not examined here, suicide attempts among First Nations people in British Columbia have been reported elsewhere to be declining. Risk of self-inflicted injury hospitalization among Registered Indians, and disparity between them and their non-Indigenous counterparts decreased between 1991 to 2010. However, this is in contrast to trends in remote First Nations communities in Ontario. There, Indigenous youth suicide was previously reported to be on the rise because of the emergence of suicide among communities that previously did not experience it, exposure to suicide or suicide attempts among family members and peers, and increase in clusters of suicides.

Methods

Data

The 2011 Canadian Census Health and Environment Cohort (CanCHEC) used here is a population-based integrated dataset that follows the non-institutional (household) population enumerated in the 2011 National Household Survey (NHS) for different health outcomes such as mortality, cancer, and hospitalizations. Briefly, record integration for the 2011 CanCHEC was carried out using Statistics Canada's Social Data Linkage Environment (SDLE). The SDLE helps create linked population data files for social analysis through integration to the Derived Record Depository (DRD), a dynamic relational database containing only basic personal identifiers. Survey and administrative data are linked to the DRD using a generalized record integration software that supports deterministic and probabilistic integration.

The NHS is a voluntary survey, conducted in May 2011, of approximately 4.5 million (30%) private dwellings randomly selected from the 2011 Census of Population. The NHS covers all persons who usually live in Canada, including permanent and non-permanent residents, and individuals living on First Nations reserves, Métis settlements or Inuit communities. There were 36 incompletely enumerated First Nations reserves in the 2011 NHS. In 13 of these communities, enumeration was delayed because of forest fires in Northern Ontario and occurred at a later date. The NHS excludes residents of institutions (for example, hospitals, nursing homes, penitentiaries) and collective dwellings (for example, work camps, hotels, shelters).

Records for approximately 6.7 million NHS respondents were eligible for integration; 97% linked to the DRD using a probabilistic approach based on telephone number, surnames, given names, birthdate, and place of residence. No differences in integration rates were found by collection mode, province, sex, or birth decade. To ensure representativeness of the linked cohort, weights were calculated to adjust for non-integration.

To protect the confidentiality of Census respondents, data made available for analysis did not contain personal identifiers such as name, and address. In addition, estimates based on small cell counts (fewer than five deaths or fewer than 10 total individuals) were suppressed.

Variables

Self-reported Indigenous identity, age, sex, household income, labour force status, highest level of education, marital status and province of residence variables were available in the 2011 NHS dissemination dataset. Variables for the Inuit Nunangat regions were generated using Standard Geographical Classification (SGC) codes. Similarly, a variable for on and off-reserve areas of residence was generated using SGC. A binary suicide variable was created using ICD-10 codes in the "Underlying cause of death" variable in the CVSD. Generation of suicide and person-years at risk variables are described in the following section.

Estimation of weighted suicide rates

For suicide rate estimates, each person's time at risk of death by suicide was split into single years of follow-up, and within each year of follow-up, into durations before and after birth date. In the process, each person was aged on his or her birthday. This allows for the appropriate categorization into age groups for computing suicide rates. Weighted age-standardized suicide rates (ASMRs) (see figure 1 for a brief description of this measure) and their 95% confidence intervals were estimated. Those under the age of one were excluded from the analysis due to under-representation of this group in the integrated dataset. Briefly, ASMRs were computed by dividing the count of cohort members who died by suicide in the follow-up period by the total person-years at risk. Age standardization was done with age-specific mortality rates in 5-year age groups using the 2011 total Indigenous population as the reference population. Weighted age-specific suicide rates generated without age standardization were used for comparisons between age groups within an Indigenous group or between an Indigenous group and the non-Indigenous population. These rates were also used to compare suicide rates in the on and off-reserve First Nations populations since their age structures were somewhat similar in 2011 (median age: 23.9 and 27.1 years, respectively). Suicides were identified using the following International Statistical Classification of Diseases and Related Health Problems 10th Revisions ( ICD-10) codes: X60-X84, Y87.0. For each member of the cohort, person-years of follow-up were calculated as the number of days from the beginning of the study period to the date of death or end of study divided by 365.25. Variance was calculated using 500 bootstrap weights.

Description for Figure 1
﻿

Figure 1 is a schematic showing the method used to estimate the suicide rate using number of deaths as the numerator and person-years as the denominator. The schematic illustrates a hypothetical example with seven individuals who were "followed" from May 10, 2011 (Census day) to December 31, 2016 (end of follow-up period) to see if they had died. In this example, three of the seven individuals died during follow-up. Person 1, 4 and 7, who died during the follow-up period, each contributed 3.0, 1.5 and 4.2 person-years at risk, respectively, to the denominator. The others, who were alive as of December 31, 2016, each contributed 5.6 person-years to the denominator. In all, the seven individuals contributed 31.1 person-years to the denominator. The crude mortality rate is calculated by dividing the number of deaths by the total person-years contributed by the seven individuals, and multiplied by 100,000. In this hypothetical example, the crude suicide-related mortality rate is 9,646.3 deaths per 100,000 person-years of follow-up.

Age-standardized and age-specific suicide rates, expressed as the number of deaths by suicide per 100,000 person-years at risk, were generated by sex, Indigenous identity and select geographic areas. Indigenous identity, as self-reported in the 2011 NHS Survey, included: First Nations, Métis, Inuit, Multiple Indigenous identity, Indigenous identity responses not indicated elsewhere and non-Indigenous. However, in this paper, only estimates for single identity groups are presented. Geographic areas studied include: province/territory; on or off-reserve; rural areas or small, medium and large population centres, and for Inuit, inside/outside Inuit Nunangat and by the four regions of Inuit Nunangat (Nunatsiavut, Nunavik, Nunavut, and the Inuvialuit region), as well as outside Inuit Nunangat. Rate ratios, or the ratio of suicide rate among First Nations people, Métis or Inuit over suicide rate among non-Indigenous people were computed to examine the magnitude of disparity in the Indigenous group compared to the non-Indigenous population. To estimate variance of the rate ratios, variance and covariance of the mortality rates in the Indigenous group of interest and non-Indigenous population were estimated using PROC RATIO in SAS-callable SUDAAN. Variance of the rate ratios was then computed using Taylor linearization and the variance and covariance estimates from PROC RATIO, and used in generating 95% confidence intervals.

Hypothesis testing was done to identify suicide rates that were significantly different from one another using p<0.05. The weighted number of suicides and suicide rates were not published if (1) the unweighted number of suicides in a cell was less than five, (2) the weighted population count in the cell were less than 10, or (3) coefficient of variance (CV) was greater than 33.3% (40% for those under 15 years). Weighted numbers of suicides were also randomly rounded to base five. ASMRs with CV greater than 16.6% and less than or equal to 33.3% are presented with an "E" to indicate that these should be used with caution.

Estimation of suicide rate by First Nations band

For estimating suicide rates by First Nations band, reserve CSDs associated with each band were grouped. Reserves that were shared by multiple bands were grouped separately. This was done for seven reserves. Three of these had a population of 10 or less. And, one was incompletely enumerated in the 2011 NHS. This grouping resulted in about 600 First Nations bands. Of these, 561 included individuals that were in the 2011 CanCHEC. Others were associated with reserves that were incompletely enumerated in the 2011 NHS or had participated in the 2011 Census and not the NHS. In the end, 555 bands were included in the analysis. Suicide rates were computed by First Nations band, from which the number and percentage of bands with a reportable zero suicide rate were identified. The percentage of bands with a zero suicide rate were calculated with and without the reserves that were associated with multiple bands and were found to be similar.

Multivariate analysis

To examine the role of socioeconomic and geographic factors in the excess risk of suicide among Indigenous people relative to non-Indigenous people, Cox proportional hazards modelling was performed. Analyses were restricted to those 25 years and older to allow for the use of labour force status, level of education and marital status as covariates. For this analysis, age at baseline on Census day, was used since other covariates also had the same reference period. Hazard ratios for suicide were estimated among First Nations people, Métis and Inuit (with non-Indigenous people as the reference group). Covariates were entered sequentially into the model in this order: age group together with sex, household income quintile (based on after-tax income adjusted for economic family size), labour force status (employed, unemployed and not in the labour force), highest level of education (less than high school, high school, post-secondary education below Bachelor's level and university degree), marital status (never legally married or single, legally married and not separated, separated but still legally married, divorced or widowed) and living on or off reserve (for First Nations people) or in population centres or rural areas (for Métis and Inuit). Household income quintiles were generated for each province and territory separately to account for regional differences. In secondary analysis, household income was used as a continuous variable or household income quintiles were generated at the national level and used in place of the original income quintile variable to examine the robustness of the influence of this predictor on the relative risk of death by suicide among First Nations people, Métis and Inuit. Covariates were chosen based on previous literature on the relationship between socioeconomic factors and suicide. and the availability of related variables in the 2011 NHS data.

From the hazard ratios (age and sex-adjusted and additionally adjusted for socioeconomic factors), the percent of excess risk of suicide among First Nations, Métis and Inuit people accounted for by household income, labour force status, highest level of education, marital status and geography was computed. The proportion of excess mortality explained was calculated as the difference between the age and sex-adjusted and the final hazard ratios, divided by the former minus 1. Analyses were not carried out separately by sex due to sample size limitations.

Assessing validity of suicide rates

Suicide rates based on the linked 2011 CanCHEC cohort were compared with previously generated estimates using different methodologies to assess validity.

The non age-standardized suicide rate for the total population of Canada between 2009 and 2013 was previously estimated to be 11.4 deaths per 100,000 people; in comparison, in the CanCHEC cohort, the overall suicide rate was 10.5 deaths per 100,000 person years between 2011 and 2016. While there are no published rates of suicide for First Nations people, Métis and Inuit for the 2011 to 2016 period, suicide rates for all individuals in Inuit Nunangat, which is home to 73% of Inuit in Canada, was previously estimated to be 83.5 deaths per 100,000 people. In the 2011 CanCHEC cohort, the rate was 83.5 deaths per 100,000 person years at risk. However, the estimates by Inuit Nunangat region between 2011 and 2016 (167.3 Note E: Use with caution in Nunatsiavut, 87.5 in Nunavik and 83.1 in Nunavut) were somewhat different in comparison to previous estimates from the 2009 to 2013 period (185.4, 98.3, 79.0, respectively). While, the estimates are similar, there are several potential reasons for this discrepancy between the two sets of estimates. While there is some overlap in time periods for the two estimates (2009 to 2013 for previous estimates and 2011 to 2016 for the estimates in this report), they are not identical. There is some year-to-year fluctuation in suicides rates. For example, in Nunavut, previous estimates suggest that the rate ranged from 58.2 to 108.5 deaths per 100,000 people. Some deaths that occurred between 2011 and 2016 were not linked to the 2011 NHS. Also, the CanCHEC cohort excludes institutional population (e.g., nursing homes, jails), and those living in collective dwellings (e.g., motels, hotels, rooming houses) at the time of census collection and those that were not enumerated by the 2011 NHS. The denominators used in the two studies are also different; in the previously published tables, the suicide rates are per 100,000 people; in the current study, the rates are per 100,000 person years.

Limitations

Several limitations of the analysis should be noted. Suicide rates presented in this article may underestimate the true rates because of (1) exclusion of the institutional population and population living in collective dwelling, (2) exclusion of persons not enumerated by the 2011 NHS including the homeless among whom Indigenous people are overrepresented, (3) non-integration of some deaths between 2011 and 2016 to the 2011 NHS, (4) potential integration error, (5) potential misclassification of suicides in the CVSD to avoid stigmatization or as a result of misclassification as an accident, or inability in ascribing a cause, etc., and (6) potentially missing deaths, due to processing delays, in Vital Statistics at the time of data integration. Furthermore, Indigenous identity in the Census is self-reported, which may have led to underestimation or overestimation of suicide rates in some Indigenous groups. Also, 36 Indian reserves and Indian settlements were incompletely enumerated in the 2011 NHS, which could have resulted in under or over-estimation of suicide rates. Most (29) of these reserves were in Québec and Ontario, with the rest in Saskatchewan, Alberta and British Columbia. Among the ones in Québec and Ontario, some are proximal to Census Metropolitan Areas (CMA) while others were rural or remote. The former includes Kahnawake, Kanesatake and Wendake. Mortality rates for small areas and small subgroups of the population may experience substantial year-to-year random fluctuations since death is a relatively rare event, particularly death by suicide. Finally, baseline socioeconomic and demographic factors used in the multivariate analysis may not reflect conditions at the time of death. This may have led to some biases in the findings.

Appendix

﻿ ﻿ ﻿ ﻿ ﻿ ﻿

# data[].attributes.attachment_link.title
Suicide among First Nations people, Métis and Inuit (2011-2016): Findings from the 2011 Canadian Census Health and Environment Cohort (CanCHEC)

# data[].attributes.attachment_link.description
The article presents suicide rates for the 2011-2016 time period among self-identifying First Nations, Métis, Inuit, and non-Indigenous people in private dwellings in Canada. It also explores the influence of socioeconomic factors in the disparity in risk of suicide between First Nations people, Métis, Inuit and non-Indigenous people in Canada.

# data[].attributes.attachment_link.readable_text
In 2018 and 2019, there was a continual increase in suicides amongst Indigenous Peoples, specifically in Australia. Why is this happening at such an alarming rate? What is the cause of these deaths, especially among the youth?

Globally, suicide is the second highest contributor to adolescent deaths. Studies from high-income countries including Australia, New Zealand, the United States, Canada, and Arctic nations consistently find elevated suicide rates among Indigenous populations, with substantial rate disparities compared to non-Indigenous populations. According to the World Health Organization, low- and middle-income countries and high-income countries have similar annual standardized suicide rates. However, low- and middle-income countries account for 75 percent of suicide deaths worldwide, and there is often a disproportionate burden amongst specific subgroups within countries, such as Indigenous Peoples.

In Canada, the highest suicide rates have been reported among First Nations Peoples. According to Canada's Centre for Suicide Prevention, suicide and self-inflicted injuries are the leading causes of death for First Nations youths and adults up to age 44. The suicide rate for First Nations male youths ages 15-24 is 126 per 100,000, compared to 24 per 100,000 for non-Indigenous male youth. For First Nations females, the suicide rate is 35 per 100,000 compared to 5 per 100,000 for non-Indigenous females. Suicide rates for Inuit youth are among the highest in the world, at 11 times the national average.

In Australia, Aboriginal and Torres Strait Islanders between the ages of 15-24 are almost 4 times more likely to commit suicide than non-Indigenous people in the same age bracket. The Australian Bureau of Statistics reported that suicide is the leading cause of death for Indigenous children ages 5-17. From 2014-2018, Aboriginal and Torres Strait Islander children accounted for close to 25 percent of all child suicide deaths.

To better understand the issue of suicide among Indigenous Peoples, Cultural Survival Indigenous Rights Radio Producer, Shaldon Ferris (KhoiSan), recently spoke to Pat Dudgeon (Bardi), director of the Centre of Best Practice in Aboriginal and Torres Strait Islander on Suicide Prevention at the University of Western Australia (UWA). She is a psychologist, professor, Fellow of the Australian Psychological Society, and Poche Research Fellow at the School of Indigenous Studies at UWA in Perth.

Cultural Survival: Is the spike in the Indigenous suicide rate a recent trend, or has it been on the rise for some time?
Pat Dudgeon: Indigenous suicides have always been a big issue. It's probably gained a lot more national media attention in recent times, but it has been a growing concern in the last 40 years. Our Indigenous suicide rate is twice that of the general population, so it's become a big, big issue.

CS: What are some of the leading reasons for Indigenous suicides?
PD: For any suicide there is a whole matrix of different issues and problems. We believe that it's the history of colonization that Indigenous people have lived through. The country was taken over, there was genocide, people were removed from their countries and moved into missions and reserves. We went through a period we call the Stolen Generations, where people were forcibly taken from their families and put into institutions. In contemporary times, as well as having intergenerational trauma that's been passed down, there are a whole lot of social determinants that impact Indigenous people. We have higher rates of poverty and incarceration, and racism is ongoing, so those are factors that contribute to suicide and bad mental health. It's not a simple or clear answer. There's a lot of grief and loss in the community, substance abuse issues, sexual abuse, and so on, but for Indigenous people, having that history of colonization and ongoing racism is certainly a big part of the story.

CS: Is a loss of identity due to the impacts of colonialism a factor?
PD: Absolutely. We've gone out and done workshops and roundtables with community people, and we've done empowerment programs. What amazes me is how people implicitly know that what the mainstream has done-what the State has done to them-is wrong. They've seen their mothers and grandmothers subject to racist acts and treatments. To have it explicitly taught to them, to say, 'yes, this legislation happened and this was the impact,' validates their experience, and people are very conscious to hold on and to strengthen their cultural identity. I think we're in a process of remaking and restrengthening our cultural identity. Lucky for us, colonization has been a relatively short history compared to other countries. It could've been much more damaging. With Stolen Generations, some of those people were moved far away from home, and we have had some big initiatives called Bringing Them Home, which were about helping people come back to rediscover who their family or language group were, and to reconnect. Archie Roach (a local Indigenous singer) has written about the children coming home. That's important for us, to ensure that we strengthen our identity and people build faith so they know who they are and their role in the future.

CS: Are there patterns of similar occurrences happening in other Indigenous communities around the world?
PD: Yes, it's a very similar story. In November 2018, we held the second World Indigenous Suicide Prevention Conference. We ran it in a certain way where we privileged Indigenous presence and voices. When we formed our committees to plan the conference, we ensured there were youth representatives on there, elders, members of our LGBTQIA+ groups. Having the World Indigenous Suicide Prevention Conference was very important because we had people from Canada, New Zealand, the U.S., and so on, present. We looked at the global Indigenous suicide rates; they are very similar, it's a similar story. So I think all Indigenous societies are in a greater or lesser state of recovery from colonization, and one of the markers is a very high suicide rate, much higher than the rest of the population. That was important to us, to come together as world Indigenous people and to share our stories and to share what the solutions could be. We are seeing a global movement happening, and that's very important. I think we join up with our Indigenous brothers and sisters from other countries to talk, to learn from each other, and to share our knowledge and go forward. And, while we claim the right to have leadership in the discussion, there are certainly great nonIndigenous supporters and governments that support us as well.

CS: Do you think we should be talking to our respective governments about solutions, or should this issue be solved by us as Indigenous Peoples?
PD: Definitely from the people. The State has a very important role, and that is to give the resources to the people. It's very important to ensure that resources are sent into the community. Our position is for Aboriginal people themselves. Unless they're in charge of identifying the problem, the issues, and then implementing the solutions, we're going to have very limited effective suicide prevention or any kind of programs. We know that culture, self- determination, and cultural reclamation is important. Both were assumptions on the work done by Professor Michael J. Chandler in Canada, where they did some research with First Nations people and showed that communities with little self-determination and little cultural reclamation had higher suicide rates. We also used the work of the Harvard Project on American Indian Economic Development in the United States, where they've shown that Indigenous communities that are much happier and have higher health rates are ones that are also exercising their self-determination. That's very important for any group of human beings: they need to be there at the table, making decisions, being part of deciding what happens, how, when, and where.

CS: Is enough being done to reduce the Indigenous suicide rate? Do you think there's hope?
PD: I'm optimistic. I think Australia is alarmed at what's happening in its country. I think the government does want change to happen. I think the communities themselves want change to happen, because we had an elders group at our World Indigenous Suicide Prevention conference who were very vocal in what they wanted. They wanted a royal commission to look at the issue, and they were very vocal in what they thought the government should do. I think that all supporters of our society, whether it's governments, whether it's people on the ground, certainly the communities themselves, they want accountability and they want to be part of the discussion. So, I think things will change. I don't think it'll be an overnight solution, because it's taken us years to get to this point. For some sections it might take time to turn this around, but it will be turned around.

CS: What message can we give the Indigenous person who is in a remote area somewhere, contemplating suicide?
PD: Firstly, don't do it. Do not do it. Things will get better, but go and get help. It would be great if we could have a telephone crisis center that's culturally appropriate and knows our values and our issues and can give immediate help. Counselors too, they need to be trained to be more culturally knowledgeable. But there will be people in your family and in your community who can help. In every family and every community there is usually one strong person, or more, who will help the others. We need to nurture those people. They're the people we go to, and we've all got one or two in our lives, so go to those people, talk to them, get help from them.

Top photo: Pat Dudgeon speaks at the 2nd World Indigenous Suicide Prevention Conference. Photo courtesy of Pat Dudgeon.

# data[].attributes.attachment_link.title
Combatting Suicide Amongst Indigenous Peoples: An Interview with Pat Dudgeon

# data[].attributes.attachment_link.description
In 2018 and 2019, there was a continual increase in suicides amongst Indigenous Peoples, specifically in Australia. Why is this happening at such an alarming rate? What is the cause of these deaths, especially among the youth? Globally, suicide is the second highest contributor to adolescent deaths.

# data[].attributes.attachment_link.authors[].name
Robert Olson, Librarian, BA, MLIS, Centre for Suicide Prevention

# data[].attributes.attachment_link.title
Canada’s Indigenous Communities and Suicide - Centre for Suicide Prevention

# data[].attributes.attachment_link.description
Why do some Indigenous communities have higher suicide rates than others? This editorial examines factors that put Indigenous communities at risk.

# data[].attributes.attachment_link.readable_text
The suicide rate among First Nations people was three times higher than in non-Indigenous populations between 2011 and 2016 in Canada, according to Statistics Canada.

The agency reported Friday on the rates of death by suicide for self-identifying First Nations people, Metis and Inuit from 2011 to 2016, compared to non-Indigenous people.

The suicide rate among First Nations people was 24.3 deaths per 100,000 person-years at risk, which StatsCan says is "roughly understood as number of deaths per persons per year." That is compared to eight deaths per 100,000 person-years at risk for non-Indigenous people.

The suicide rate for First Nations people living on a reserve was twice as high than those living off reserve, according to the agency.

Story continues below advertisement
WATCH: Indigenous leader says he's waiting for a national strategy around issue of suicides
Indigenous leader says he's waiting for a national strategy around issue of suicides

For those who self-identify as Metis, their suicide rate was around twice as high as the rate of non-Indigenous people, at 14.7 deaths per 100,000 person-years at risk.

For Inuit, the rate was around nine times higher than non-Indigenous, at 72.3 deaths per 100,000 person-years at risk.

Suicide rates were highest for youth and young adults aged 15 to 24 years old among First Nations men and Inuit men and women.

However, StatsCan did point out that there is a high level of variability for suicide rates "at the community level" for Indigenous people.

Story continues below advertisement

"When examined by First Nations band, just over 60 per cent of bands had a suicide rate of zero," the agency reported.

Statistics Canada says the higher risk of suicide for Indigenous people compared to non-Indigenous is due to "socioeconomic characteristics," such as household income, labour force status, level of education, marital status, as well as whether they live on or off a reserve and the community size.
WATCH: Cape Breton's Eskasoni First Nation experiencing mental health crisis
Cape Breton's Eskasoni First Nation experiencing mental health crisis

"Among First Nations people, 78 per cent of the higher risk of death by suicide was accounted for by these characteristics, while it was 37 per cent among Metis and 40 per cent among Inuit adults aged 25 years and older," the report stated.
If you or someone you know is in crisis and needs help, resources are available. In case of an emergency, please call 911 for immediate help. The Canadian Association for Suicide Prevention, Depression Hurts and Kids Help Phone 1-800-668-6868 all offer ways of getting help if you, or someone you know, may be suffering from mental health issues.

# data[].attributes.attachment_link.title
First Nations suicide rate 3 times higher than for non-Indigenous people: StatsCan | Globalnews.ca

# data[].attributes.attachment_link.description
The suicide rate among First Nations people was three times higher than in non-Indigenous populations between 2011 and 2016 in Canada, according to Statistics Canada. The agency reported Friday on the rates of death by suicide for self-identifying First Nations people, Metis and Inuit from 2011 to 2016, compared to non-Indigenous people.

# data[].attributes.attachment_link.readable_text
Indigenous peoples refer to the original inhabitants of Canada and include Inuit, Métis and First Nations living on- and off-reserve. National data on Indigenous peoples and household food insecurity in Canada primarily come from the cycles of the Canadian Community Health Survey (CCHS). However, the CCHS excludes individuals living on-reserve in Canada, and thus data from these surveys do not represent the experience of on-reserve Indigenous peoples, who represent just over one-third of the Indigneous peoples in Canada.

Studies of Indigenous peoples repeatedly demonstrate their extraordinary vulnerability to household food insecurity. Indigenous households in Canada are more likely than non-Indigneous households to experience the sociodemographic risk factors associated with household food insecurity (e.g. extreme poverty, single-motherhood, living in a rental accommodation, and reliance on social assistance). Even after these factors are taken into account, Indigenous households remain at a much higher risk of household food insecurity and are more likely to be severely food-insecure.

Researchers and practitioners in Indigenous communities have highlighted the distinct food procurement, preparation and distribution practices among Indigenous groups. The measure of household food insecurity used in the CCHS was developed in non-indigenous contexts and does not probe for information that may be important to Indigenous peoples' household food insecurity. For example, household food insecurity may be related to food procurement from both market and traditional sources (e.g. fishing, hunting), and broader factors such as climate change and environmental pollution may be salient due to their impact on the availability of edible plants and animals found in nature. Research in the area of household food insecurity among Indigenous peoples that is grounded in the realities of Indigenous peoples' culture, beliefs and political systems is vital to the development of appropriate interventions to reduce household food insecurity among this vulnerable group.

The following articles present research on the Indigenous peoples and food insecurity:

# data[].attributes.attachment_link.description
Indigenous peoples refer to the original inhabitants of Canada and include Inuit, Métis and First Nations living on- and off-reserve. National data on Indigenous peoples and household food insecurity in Canada primarily come from the cycles of the Canadian Community Health Survey (CCHS).

# data[].attributes.attachment_link.title
10 year study finds ‘extremely high’ rates of First Nations food insecurity - National | Globalnews.ca

# data[].attributes.attachment_link.description
The findings are contained in the first full draft of the final report of the First Nations Food, Nutrition and Environment Study, released this week as part of a national Indigenous food and health forum in Ottawa.

# data[].attributes.attachment_link.provider_name
Centre for Indigenous Peoples' Nutrition and Environment

# data[].attributes.attachment_link.readable_text
The Council of Canadian Academies Expert Panel on the State of Knowledge of Food Security in Northern Canada assessed the knowledge of the factors influencing food security in the Canadian North and of the health implications of food insecurity for northern Aboriginal populations. They found that food insecurity among northern Aboriginal peoples requires urgent attention in order to mitigate impacts on health and well-being. Aboriginal Food Security in Northern Canada: An Assessment of the State of Knowledge offers policy-makers a holistic starting-point for discussion and problem-solving. It also provides evidence and options to researchers and communities engaging in local responses.

Key findings

1. Food insecurity is a serious problem in northern and remote Aboriginal communities across Canada.

2. Food security is a complex issue with significant implications for health and wellness.

3. There is no single way to "solve" food security issues in the North. A range of holistic approaches is required.

4. There is a nutrition transition taking place in the rapidly changing North.

5. The concepts of food security and food sovereignty are equally important in understanding the problem and finding effective, multi-sectoral solutions.

6. Many factors enable or serve as barriers to food security and food sovereignty.

7. There is no single experience of food insecurity.

8. There exists a strong body of research and traditional knowledge with respect to food security and northern Aboriginal health, but several knowledge gaps persist.

9. The food security measurement methods used to date have been valuable, but their ability to respond to the complex issue of food security in the northern Canadian Aboriginal context is limited

Access the full report here...

# data[].attributes.attachment_link.title
Northern Canada Aboriginal Food Security

# data[].attributes.attachment_link.description
The Council of Canadian Academies Expert Panel on the State of Knowledge of Food Security in Northern Canada assessed the knowledge of the factors influencing food security in the Canadian North and of the health implications of food insecurity for northern Aboriginal populations.

# data[].attributes.attachment_link.readable_text
33k Accesses

61 Citations

6 Altmetric

Metrics

Abstract

Background

Food insecurity is a serious public health issue for Aboriginal people (First Nations [FN], Métis, and Inuit) living in Canada. Food security challenges faced by FN people are unique, especially for those living in remote and isolated communities. Conceptualizations of food insecurity by FN people are poorly understood. The purpose of this study was to explore the perceptions of food insecurity by FN adults living in a remote, on-reserve community in northern Ontario known to have a high prevalence of moderate to severe food insecurity.

Methods

A trained community research assistant conducted semi-directed interviews, and one adult from each household in the community was invited to participate. Questions addressed traditional food, coping strategies, and suggestions to improve community food security and were informed by the literature and a community advisory committee. Thematic data analyses were carried out and followed an inductive, data-driven approach.

Results

Fifty-one individuals participated, representing 67% of eligible households. The thematic analysis revealed that food sharing, especially with family, was regarded as one of the most significant ways to adapt to food shortages. The majority of participants reported consuming traditional food (wild meats) and suggested that hunting, preserving and storing traditional food has remained very important. However, numerous barriers to traditional food acquisition were mentioned. Other coping strategies included dietary change, rationing and changing food purchasing patterns. In order to improve access to healthy foods, improving income and food affordability, building community capacity and engagement, and community-level initiatives were suggested.

Conclusions

Findings point to the continued importance of traditional food acquisition and food sharing, as well as community solutions for food systems change. These data highlight that traditional and store-bought food are both part of the strategies and solutions participants suggested for coping with food insecurity. Public health policies to improve food security for FN populations are urgently needed.

Peer Review reports

Background

Food insecurity is a serious public health issue for Canada's indigenous population [ 1, 2]. The term "Aboriginal people" describes the three groups that comprise Canada's indigenous population; First Nations [FN], Métis, and Inuit. First Nations are the largest of these three groups, making up nearly 60% of the Aboriginal population living in Canada with approximately 60% of FN people living off-reserve lands. Data on food security in off-reserve Aboriginal people are alarming; 24% of Aboriginal households had a compromised diet (reduced quality and/or quantity), and 33% experienced food insecurity compared to 8.4% and 9%, respectively across the rest of Canada [ 3- 5]. In on-reserve FN households and Inuit households in Arctic communities the prevalence of food insecurity appears to be even higher. The First Nations Regional Health Survey found just over half (54.2%) of households surveyed were food insecure, while the Inuit Health Survey conducted in 36 Arctic communities found a range of household food insecurity from 45-69% depending on region [ 6, 7]. Food insecurity in Aboriginal households in Canada has been associated with high levels of poverty, multi-child households, low levels of education attainment and labour force participation, reliance on social assistance/welfare, and female lone-parent households [ 5].

Food security challenges faced by Aboriginal people are unique [ 1, 8- 12], especially for Aboriginal people living in remote and isolated communities. Aboriginal food systems are primarily characterized by two avenues of food provision: the harvesting, sharing and consumption of traditional (or country) foods and the purchasing and consumption of market (or commercial or store-bought) foods [ 11, 12]. Food harvested from the wild by FN people is called "traditional food" while the Inuit call wild-harvested food "country food". Despite the combination of the traditional food system and market food system as being distinct from the non-Aboriginal food system, current conceptualizations of food security lack the context, food practices, and perspectives of Aboriginal people [ 1].

Regardless of evidence that food insecurity is prevalent in Aboriginal communities, little information is known about the characteristics of the individuals or households experiencing this problem [ 13]. While numerous food system studies have been published on Inuit people living in the Canadian Arctic in recent years [ 7, 14- 23], there are still few food system studies with on-reserve FN communities [ 12]. Many gaps remain about the nature and extent of food insecurity for FN people in Canada. Lead authors in this field [ 1, 2, 5] have recommended qualitative studies to better understand the food security situation for FN people. The knowledge gained can help to tailor food security programs and policies to the unique needs of these communities and population [ 1, 5].

In this study, we explored food insecurity from the perspective of FN adults living in a remote, on-reserve subarctic community in northern Ontario, Canada. Previous work by our group had identified a high prevalence of household food insecurity (70%) using the Household Food Security Survey Module [ 4, 24]. The intention of this study was to determine participants' perceptions of food security and the range of adaptive strategies they use at an individual and household level. The two research questions addressed by this study were: (1) "What are the coping strategies for food insecurity used by community members?"; and, (2) "What suggestions do they have to improve food security in their community?"

Community profile and study population

This study was conducted in Fort Albany First Nation which is situated on the west coast of James Bay in the Mushkegowuk Territory along the Albany River in northern Ontario, Canada. As described previously [ 25, 26], the Fort Albany reserve is home to approximately 850 people. Fort Albany is geographically remote (52° 15′ N; 81° 35′ W); it is accessible only by plane year-round, by boat and barge during the ice-free season, and by ice road after freeze-up. In Canada, a remote community is defined as being more than 350 kilometres from the nearest service centre (or city) having year-round road access. Fort Albany also is categorized as a community with "special access" which means that it is located in a zone where there is no year-round road access to a service centre. Timmins, Ontario is 769 kilometres from Fort Albany and is one of the closest cities with road access. Timmins is considered a main entry point for food distribution to Fort Albany as food is flown from there during most of the year with the exception of 6-8 weeks in the winter when the ice road allows for accessibility to closer communities. One of the communities accessible by ice road is Moosonee, which is 128 kilometres southeast of Fort Albany and has train access. As a result of being remote with special access, transportation of goods into the community of Fort Albany, including commercial food, is very expensive.

At the time of this study, the community had one main grocery store and two small convenience stores. Although traditional foods remain an important part of their diet, the majority of dietary intake is from store bought food. Community members participate in traditional harvesting activities (also referred to as traditional food acquisition) including hunting, fishing, and gathering food from the land. However, these activities have been declining in recent decades, especially for young people. As these endeavours are seasonal, are limited by financial constraints for harvesting transportation and equipment, and the yield varies greatly depending on the success of the harvest, there is much variability in the consumption of traditional foods between households and over the course of the year. Traditional foods commonly harvested and consumed include berries (e.g., ground berries - Gaultheria procumbens), fish (e.g., whitefish - Coregonus clupeaformis), large land-based animals (e.g., moose - Alces alces), game birds (e.g., goose - Branta canadensis interior and Anser caerulescens caerulescens), and small game (e.g., hare - Lepus americanus). Community members live in small houses and many households have extended family living together.

Fort Albany First Nation was an ideal location for this project for a number of reasons: we have established a community advisory committee with broad community representation; have good rapport with the community and school as we have been working on school programs for healthy eating and physical activity for many years; and community members have a keen interest in improving the dietary habits of their population [ 25- 28].

Methods

This study builds upon our previous work where community focus groups and individual interviews with Fort Albany community members identified food insecurity as a constraint to healthy eating in children and youth [ 25, 27]. This study was also part of a larger project to examine food security in the community. The theoretical framework for the larger project was based on systems thinking and a critical social theory perspective [ 29]. Critical social theory includes aspects of theories from feminism, postcolonialism, and Indigenist critical theory which better reflects Indigenous ways of knowing than a purely postcolonial approach [ 29]. This theory allows for a more holistic spiritual viewpoint and represents an Indigenous research paradigm that supports self-determination. The theory also focuses on specific language used by participants as a source of information about meaning [ 29].

Community advisory committee

A community advisory committee (CAC) of six community members representing local stakeholder organizations (e.g., Band Council, Health Centre, school) and parents and the community at large was established prior to the study. For this study, members of the CAC were involved in the design of data collection tools (e.g., qualitative questions and probes), helped to adapt approaches to decrease the cultural sensitivity of study methodologies, assisted in collecting data, provided input on the interpretation of results, and assisted with the dissemination of results. Although a trusting relationship between the investigators and members/organizations in the community has been previously established, the specific formation of a CAC was fundamental to this participatory research. Ethics approval for this study was obtained from the Office of Research Ethics at the University of Waterloo and permission to conduct this study was obtained from Fort Albany First Nation.

Question development

As part of the larger project, the first part of each interview began with having the participants respond to the 18-item US Household Food Security Survey Module (HFSSM). The HFSSM is a government questionnaire that was used by Health Canada in the 2004 Canadian Community Health Survey (Cycle 2.2) to determine the prevalence and severity of food insecurity in the off-reserve population [ 4]. The qualitative interviews for the current study were conducted following completion of the HFSSM, which is why the first interview question refers to the government questionnaire.

Lambden and colleagues [ 30] concluded that traditional food attributes must be included in studies of food security in the Arctic. Although this study was in the subarctic, it is apparent from previous work with Cree in the western James Bay region that questions related to traditional food are very important for studying food security in this community. These considerations were taken into account during the question development for the qualitative interviews.

A set of three questions and probes were developed using an iterative process: 1) Initially, nine questions were informed by the qualitative food security literature, including studies with Aboriginal populations in Canada (e.g., [ 15, 22, 31]); 2) During subsequent drafts, questions were reviewed to ensure they were more understandable, culturally appropriate and relevant to the food security issues in FN communities based on consultation with and input from members of the CAC (n = 3) and the investigators' (n = 3) personal experiences with the people and community of Fort Albany. The number of questions for the final draft (n = 3) was kept small to reduce the response burden for the participants. The final three questions were: (1) The government questionnaire we did seemed to ask mostly about store-bought foods. Can you tell me about traditional foods and your household?, (2) How do you adapt if there doesn't seem to be enough food (traditional or store-bought) for your household?, and (3) What do you think can be done to make it easier for people in Fort Albany to get enough (healthy) food (store-bought and/or traditional food)?. Table 1 displays the final three questions and probes.

Table 1 Interview questions and probes

Participant recruitment, consent, and data collection

A local community research assistant was hired to collect the data. He had been employed by our research team in the past and trained in proper protocols for data collection, including the administration of surveys and conducting interviews. He had an understanding of the project's aims, was instructed to provide probes when appropriate, and was familiar with the practice of active listening during interviews [ 32]. The community assistant spoke Cree, which was helpful if any of the participants requested Cree translation. The assistant was also a member of Fort Albany First Nation, had stature in the community, and has lived there for more than 25 years. Therefore, the assistant had full understanding of the language and culture of the respondents as well as established trust and rapport; all of which are important elements for conducting qualitative interviews [ 33]. The status of the interviewer was very important for the comfort of the participants in discussing the sensitive topics around food insecurity.

One adult in each of the on-reserve FN homes in Fort Albany was approached in-person by the community research assistant to participate in the study. Participants were provided with an information/recruitment letter and/or the study was explained orally. Participants were given the option to be interviewed in their language of choice and their location of choice. As in our previous studies, verbal consent was obtained from all participants, being culturally appropriate for the Western James Bay region for this type of project [ 27, 34]. Semi-directed, in-depth interviews were conducted with each willing participant from June 2009 to January 2011. Interviews were guided by the three open-ended questions and the probes were only used to prompt more discussion if the participant needed examples to stimulate the conversation. The CAC decided that due to the sensitive nature of the topic of food insecurity it was not appropriate to audio-record the interviews. The community research assistant took verbatim handwritten notes during interviews. Demographic characteristics of the respondent and household were also collected. Interviews were coded by number for anonymity and to maintain confidentiality of respondents. All willing respondents participated in the interview regardless of whether their household was classified as food secure or food insecure.

The university research team was in regular contact with the community assistant either in-person or by telephone to discuss progress on data collection and to answer any questions that might come up related to the data collection. Interview transcripts were periodically returned to the research team in batches as they were completed.

Data management and analysis

The handwritten interviews were transcribed verbatim. Organization and coding of the transcribed data for the qualitative analysis was conducted both by hand and using QSR NVivo® computer software (NVivo, version 8.0; Doncaster, Australia: Sage Publications Software, 2008). Thematic data analyses were carried out according to the stages and steps described by Boyatzis [ 35] and followed an inductive, data-driven approach [ 35]. Initially, the raw data were reduced into logical and meaningful segments on paper [ 36]. Subsequently, data were organized into groups, and "themes" [ 37] were identified within a subsample of data from ten randomly selected interviews. The themes were then compared across subsamples and codes were created. Creating the codes was an iterative process of the writing, editing, and reconstruction of statements from the preliminary themes into a set of revised themes using the qualitative techniques of the constant comparison method and searching for deviant cases [ 38]. The qualitative analysis continued until saturation was reached, where no new themes emerged from the data. This also was an indication that there were a sufficient number of interviews and the sample size was adequate [ 39]. During the process of analyses, the theme and subtheme labels were created based on an interpretation of the statements and phrases of the participants. Therefore, the thematic labels presented in the study findings are not a verbatim representation of the exact words spoken by the participants during the interviews. Memos were used to record thoughts and ideas about the codes during the process of code development [ 40]. The codes were then used to analyse the rest of the qualitative data from all of the interviews. Initially the three interview questions were coded separately. Then the analysis was opened and coded across the three questions as the analyst found that the questions asked "triangulated". The final codes were arranged into a hierarchical coding list.

Initial thematic analysis was conducted by the lead author. To determine the consistency of judgment of the coders and to establish inter-rater reliability [ 41, 42], the codes for the themes and subthemes were confirmed by a second independent analyst who had documented expertise with qualitative methods and analysis and expertise on the topic of food security [ 43, 44]. The second analyst applied the themes to a subset of the data which was a random selection of 50% (n = 25) of the interviews. The percent agreement between the two coders was 83%. The second coder also recommended the reorganization and addition of two subthemes and one main theme. The additions of these themes were discussed between the two coders and it was agreed that they should be included in the analysis. The final code included 10 themes and 39 subthemes.

Final emergent themes and subthemes were shared with a few of the interviewed participants (n = 5) by the lead author to confirm that they accurately reflected their perspectives. A listing of the themes and subthemes was discussed with members of the CAC and revisions to the wording of the final themes and subthemes were suggested. Sharing the themes with participants and the CAC was a form of member checking to verify results of the study [ 45].

Results

Of the 76 individuals approached to participate in this study, 10 declined participation in the larger study, and 15 refused to participate in the interviews, resulting in a response rate of 67%. A total of 51 respondents participated in the interviews, 27 male and 24 female with an average age of 43.7 years. The main reason 15 individuals chose not to participate in the interviews was respondent fatigue as they had already completed the HFSSM questionnaire. Just over half of the non-participants were male (n = 8, 53%) and lived in households categorized as food secure (n = 8, 53%) and their average age was 41.3 years. Personal and household characteristics of the participating study population are shown in Table 2. Although more than three-quarters of the 51 participants had a salary from employment as their main source of income, 75.5% lived in households that were classified by the HFSSM as food insecure.

Table 2 Personal and household characteristics of participants (n = 51)

The results section documents an interpretation of the findings based on the three interview questions that were asked and selected discussions that followed between participants and interviewer. Figure 1 illustrates the hierarchical coding list of themes and subthemes that represent the participant's perspectives on food insecurity. Although there was some overlap between the questions asked, the interviews generally fell into the three question categories: traditional food acquisition; coping strategies for food insecurity; and suggestions to improve food security. For the remaining Results section, the paragraph headings are the themes. The full list of themes and subthemes are depicted in Figure 1.

Themes and subthemes that emerged from the thematic analysis of participant perspectives on food insecurity. The themes are the darkly shaded boxes where the number in parentheses denotes the number of times each theme was represented by a quote. The subthemes under each theme are listed in order according to the number of participants with at least one quote for the subtheme.

"Can you tell me about traditional foods and your household"

Barriers to traditional food acquisition

When describing traditional food acquisition for their household, the majority of participants reported various barriers that prevented them from acquiring traditional food on a regular basis despite their desire to eat game meats more often. The two main barriers reported were the high cost of hunting and environmental change affecting their ability to hunt in specific areas and during specific times. The high costs were attributed primarily to the cost of fuel to travel to hunting sites and the financial means to own hunting equipment. Hunting equipment included vehicles for transportation, guns, and ammunition. A number of participants pointed out that even if money was spent to go out hunting, there was no guarantee that the hunt would be successful.

"It costs money to go hunting - gas, snow machine, and you need that money for everything else because everything is expensive." (Interview 4, female)

"Gas is expensive...$1.85 a litre. But you can spend all the money to go out hunting and come back with nothing. So you've spent your money, but still have no food." (Interview 25, male)

"Still go hunting, geese, moose, caribou but the seasons are changing and it gets harder to get wild food. For spring hunting - geese fly at odd times now. In April it is still too cold, snow and sometimes it gets too warm and snow melts too fast. Geese won't land where there is no snow. I guess we have to change our hunting season [May and June] and go hunting at the Bay instead of the muskeg [swamp]. We try to get 12 geese at least and cook one per month." (Interview 17, male)

Other categories of barriers mentioned included the loss of culture as a reason for no more hunting; less [personal] time for hunting, fishing and cooking traditional food due to employment, and concern about environmental contaminants in hunted food.

No barriers to traditional food acquisition

A few participants did express that they thought there were no barriers to traditional food acquisition. However most of these people also admitted that they did not hunt, did not prefer game meat, or consumed only store-bought food.

"How do you adapt if there doesn't seem to be enough food for your household"

Importance of hunting/fishing/gathering and traditional food practices

This importance of traditional food acquisition and traditional food practices was a prevalent discussion topic throughout the interviews and was the predominant theme across all three of the interview questions. In addition to describing their access of traditional food from hunting, fishing, and gathering for themselves, the participants also mentioned accessing food from other people and the importance of food practices such as storing and preserving traditional food for future consumption.

"As for me, I don't really eat traditional food only when family member gives me wild meat. Would be nice to eat traditional food every supper." (Interview 46, female)

Food sharing

When asked how they adapt when there wasn't enough food, the majority of participants mentioned food sharing. Food sharing with family was the most common, followed by food shared between community members and then food shared with friends. Food sharing with family included immediate family as well as relatives, even if the relatives lived in another community. Food sharing was seen as a normal part of daily life and occurred more often during hunting seasons when game meat was made available by hunters. Most of the participants described that the food shared was traditional game meats.

"We have get-togethers as family and we go to another family house and we share what we have in our homes and the other family does as well." (Interview 29, male)

"Our parents have a lot of wild meat and share with our family." (Interview 19, female)

"One way is to give food if other families can't afford to buy what they run out of." (Interview 45, female)

Dietary change, rationing, and food purchasing patterns

Participants explained how they would change their eating and food purchasing patterns in times where they didn't have enough food or when they couldn't afford to purchase certain foods. They described how they bought food in bulk from the south and stocked up their provisions of non-perishable food when the winter road was usable. Some mentioned reducing portion sizes and changing their consumption patterns. For example, buying dry goods like rice and pasta which were cheaper to purchase.

"We buy more in Moosonee during the winter months. Buy foods such as macaroni, rice, other dry food. " (Interview 2, male)

"What do you think can be done to make it easier for people in Fort Albany to get enough (healthy) food"

Improve income and food affordability

When participants were asked to suggest ways to make it easier for community members to get enough food, the majority pointed to the high prices of food at the local store and the low incomes of community residents. They thought that the store food should be reduced in price to become more affordable and that freight costs for shipping food should be decreased. Increasing income by increasing the amount of social assistance (welfare) payments or having more employment opportunities were also mentioned.

"Lower cost of food would be nice so all people can afford, especially welfare recipients. " (Interview 5, male)

Building community capacity and engagement

Many participants discussed the importance of increasing independence and self-sufficiency so that they didn't have to rely on food transported from the south. They wanted to advocate for food security initiatives and put some of the responsibility for improving food security towards community leaders. For example, the Band and Band council were frequently mentioned and were viewed to be in a position to make positive changes towards increasing food availability and affordability. Many participants said "the Band should do this...". The participants used terms that indicated a collective movement whereby community members could work together towards solutions. For example, many respondents used the words "we could..." or "we should..." or "we need...".

"As for the last part of the question, one method is to move back in the upper bush land (upriver) and not depend on the white society. But...we, the First Nations in the communities have already accepted everything from the start...like the signing of the treaty or letting our kids go in the residential school to get educated...we need to be independent and start doing things for ourselves." (Interview 52, female)

"[There should be] scheduled hunting trips where gas and supplies are paid [by the Band] and traditional food/meat caught given to lower income families - salary for the hunter. This would provide jobs and feed the lower income groups. Lots of great hunters and trappers in this community - utilize them." (Interview 49, female)

Community-level initiatives

Participants also pointed out a number of community-level initiatives that they thought could improve food security. The most common community initiative suggested was related to gardening or farming. Community members were reminiscent about times in the past when they gardened or remembered when there used to be farming activity in the community.

" Start a garden. You could grow things like rhubarb for jam or pies. We used to have a garden and we grew potatoes. We used the potatoes at the goose camp. We know that you can grow things here." (Interview 50, female)

Community members also were keen to continue and support the 'Farmer's Markets' that had been started by a few community food champions. The 'Farmer's Market' was an event initially held once every few months where food was purchased from a southern store and a plane was chartered to fly the food into the community. The food was then sold to community members at prices that covered the cost of the food and freight with no profit. These events were organized by a few people in the community who wanted to improve food access and affordability for community residents.

" Okay, as for me I think they should hold more Farmer's Markets." (Interview 47, female)

Another suggestion was to employ community hunters. This was seen as a way to increase the harvesting of traditional foods as well as income support for community members who were willing and keen to hunt, but might be unable to afford to hunt due to financial constraints.

"Get Band Council to get some hunters to go hunting for spring and fall. Supply the hunters with guns, shells, gas for their trip. Whatever game [meat] is killed, it should be shared within the community." (Interview 51, female)

Improving the built environment/infrastructure

Participants made recommendations for building physical structures to promote food security and these were categorized as improving the built environment or infrastructure. They primarily mentioned the building of an all-season road in the community. An all-season road could provide year-round access to southern stores and reduce the cost of transporting food into the community.

" Maybe an all-season road will help to have more food in cupboards, like winter time." (Interview 37, male)

Some participants also mentioned having a larger grocery store with more healthy food and that greenhouses should be built to grow local food in the community. The one main store in the community was regarded by residents as being too small for the size of Fort Albany, even when it was first built. In addition to housing groceries, the store also serves as the local bank and the only local business where residents can buy clothing, appliances, furniture, and electronics. Respondents expressed a desire to have better quality and more quantity of fresh fruits and vegetables as well as more fresh meat that had not been frozen. It is important to note that a small greenhouse was built at the community school over the summer and fall of 2010. The five by six meter greenhouse was partially funded through a university research grant as a case study of food security intervention strategies in the community. It was not clear from the interviews whether the respondents were motivated by the school greenhouse to suggest that more greenhouses be built or whether the idea of building greenhouses originated elsewhere.

Discussion

Over the past century, Aboriginal populations living in northern communities have become increasingly vulnerable to the transformation of local culture and society, including a significant shift from a primarily subsistence way of life [ 47]. They are no longer nomadic and do not experience extreme feast or famine situations as they had in the past; however in many communities the experience of food insecurity prevails. The introduction of store-bought foods and reduction in traditional food acquisition has been a detrimental nutrition transition resulting in considerable changes to their health and well-being [ 11]. As northern and remote populations in Canada are continuing to be exposed to external stressors, such as environmental change; they become increasingly reliant on coping mechanisms to maintain food access [ 14, 19]. Issues related to food security in Aboriginal populations that have not been studied in-depth include: how traditions of sharing and reciprocity of food contribute to food security; how families cope internally with food shortages; how individuals within families experience or cope with food shortages differently; how communities cope with widespread food insecurity; and what solutions or strategies have worked (or not worked) in the past and what new strategies are suggested by community members [ 1, 2, 12]. The goal of this study was to begin to explore some of these understudied issues from the perspectives of individuals living in a remote FN community. To our knowledge, this is the first study to examine coping strategies for food insecurity with a remote, subarctic FN population. The findings point to the continued importance of traditional food acquisition and food sharing as well as listening to proposed community solutions for food systems change.

Traditional food acquisition and coping strategies for food insecurity

Similar to findings from this study, the high cost of hunting and environmental change have been cited as barriers to traditional food acquisition and affecting food security for Aboriginal people living in Canada's north [ 15, 19, 48- 53]. In this study, hunting, fishing, gathering of traditional food and traditional food practices (e.g., traditional food preservation and storage) were important ways for community members to cope with food shortages. Subsistence harvesting for Cree of the western and eastern James Bay region remains an integral part of the culture [ 54- 59]. Outside of the clear nutritional value of wild food, the spring and fall harvesting periods constitute a cultural event which increases social and community cohesiveness. The extremely high cost of market food is prohibitive [ 60, 61]. Thus, the contribution of wild food to the Cree diet must be preserved for both economic and cultural reasons [ 56]. The importance of traditional food for northern populations has been well documented [ 18, 52, 53]. Traditional food storage has become modernized with the use of freezers to store game meat for future consumption. It was not clear from the interviews whether the preservation of food, such as smoking or drying, has decreased with the increased use of freezers.

Food sharing was expressed by 63% of participants as a means of coping with food shortage. This important part of Aboriginal culture and traditions has been documented widely in the literature [ 6, 15, 19, 55, 62- 66] including food sharing by the James Bay Cree [ 57, 58]. The First Nations Regional Health Survey [ 6] found that nearly nine of ten (85.5%) respondents had traditional food shared with their household in the past year prior to the survey. Fort Albany residents felt that food sharing between family, community members, and friends was a key coping strategy when their household did not have enough food. In contrast to a few recent studies reporting that food sharing has been decreasing in northern Aboriginal communities [ 14, 19, 66], the current study found that food sharing continues to be an important way for community members to adapt to food shortages and a weakening of food sharing was not mentioned during interviews. Other studies pointing to a decline in food sharing networks cite reasons including the high cost of hunting; an increasing number of households without a hunter; and stress on hunting yields due to environmental changes [ 14, 19, 62, 66]. The high costs of hunting and environmental change were both subthemes that emerged as barriers to traditional food acquisition in Fort Albany.

Dietary change, such as consuming less expensive food like rice and pasta, and rationing of food intake are coping mechanisms for food insecurity that emerged from the current interviews and are commonly cited in the literature [ 67- 70]. Less severe forms of food rationing include cutting portion sizes to more severe behaviours such as skipping meals completely [ 67, 71]. Participants of this study even mentioned drinking water to feel full, which indicates the severity of food insecurity for some Fort Albany residents. Specific food purchasing patterns, such as buying in bulk from more southern stores and using this practice to build up home food provisions may be unique to remote communities with seasonal road access. After freeze-up when the winter road can be safely travelled is a time of year with a great flurry of community activity as people try to buy supplies that they otherwise have difficulty accessing due to reduced availability and cost at their local store.

Suggestions to improve food security

It must not be overlooked that the key determinant of food insecurity is poverty [ 72, 73]. Income and food costs become more powerful determinants of food selection due to wide spread poverty and reliance on social assistance in many Aboriginal communities [ 2]. Suggestions to improve food security in Fort Albany reflect the reality of low incomes and high food costs in the community. However, it is positive that Fort Albany members are keen to start building community capacity and engagement and initiate community-level initiatives to improve their food security. Community-driven initiatives in FN communities tend to result in greater community buy-in and more successful outcomes.

Initiating and maintaining nonconventional agricultural initiatives have the potential for the community to increase self-sufficiency and reduce reliance on imported produce [ 74]. Likewise, hiring community hunters could reduce dependence on meat transported from the south and provide employment. While gardening and farming would require considerable commitment by community residents, it is already gaining momentum in the community and has benefitted from pilot-projects, including a provincially funded "Get Growing" community garden project [ 75] and a pilot agroforestry (local-substitution) project [ 74]. Community gardens have been suggested by other studies as a step towards greater food security and food sovereignty [ 66, 74]. Harvester support programs that subsidize the cost of hunting, fishing, and trapping have been carried out in the Arctic [ 16, 76] and subarctic [ 77] resulting in benefits at the community level.

In 2007 community food champions in Fort Albany began to organize a non-profit 'farmer's market' event every few months. A plane would be chartered to fly in fresh and healthy food to be sold at cost to local residents. This means the prices are at least 50% lower than the same foods sold at the local grocery store because there are no overhead costs. Fort Albany has now started to call their 'Farmer's Markets' an 'alternative market'. The concept of their alternative market has begun to receive attention from a broader audience, has grown into a bi-weekly event and is being supported by external agencies that are aiming to improve northern food systems [ 61]. Awareness by external groups of the alternative market increased after it was presented at a national food security conference in November 2012 [ 78, 79]. While the alternative food market does not move the community food system towards greater self-sufficiency, it can help the community take more control over food pricing of transported foods and may lead to feeling empowered for food system change.

Building an all-season road into the community was suggested by numerous participants, but is a contentious issue. On one hand, having an all-season road would mean the ability to travel by truck to other neighbouring communities - and a year-round land connection to more southerly communities - where food costs are lower even taking into account the added cost of transportation for foods imported into the community. However year-round land access could also have negative consequences, such as the greater ease of transporting drugs and alcohol. Thompson and colleagues [ 80] found that fly-in communities in northern Manitoba generally had more severe and higher rates of food insecurity than those with road or train access.

The participants in this study spoke about the need to increase independence and self-sufficiency with respect to accessing adequate food. They are not alone with this plea as the indigenous food sovereignty movement has been gaining momentum in Canada and has been documented through the People's Food Policy project. They state that the "tribal values of giving, sharing and trading are at the heart of land care and food sovereignty" and that "the core of food sovereignty is reclaiming public decision-making power in the food system." [ 81]. Fort Albany residents did not use the exact term food sovereignty during their interview dialogue, but food sovereignty was, in essence, what they were describing; they expressed a desire and suggested strategies to enhance their independence, self-sufficiency and acquisition of new skills, in addition to advocating for better food security. Food security is a precondition for, and outcome of, food sovereignty. The goal is to achieve food security concurrently with food sovereignty.

The strengths of this research include the large sample of community members that participated in the interviews and the willingness of the respondents in describing their experience of food insecurity despite the sensitivity of the topic. Participants were likely more willing to discuss their perceptions of being food insecure because of their comfort level and rapport with the local community research assistant who conducted the interviews. There were two main limitations of this study: the inability to audio-record the interviews and the generalizability of the results. First of all, although it was deemed inappropriate by the CAC to audio-record the interviews, audio-recording would have allowed the interviewer to focus all of his attention on questioning and listening during the conversation as well as capturing elements of tone and emphasis made by the participants. However, one advantage of the absence of a tape recorder is that it may have led to the relaxed nature of the interviews. Secondly, the findings in this study are not generalizable to individuals living in contexts that vary greatly in terms of food accessibility and availability. For example, those living off-reserve and in more accessible geographic locations where store bought food is considerably less expensive and where traditional food practices are not an integral and important part of the food system.

Conclusions

Aboriginal people in Canada like the remote community of Fort Albany experience staggering rates of food insecurity and it continues to be an urgent and pervasive public health issue. Findings from this study point to the continued importance of traditional food acquisition and food sharing as well as listening to proposed community solutions for food systems change. These data highlight that traditional and store-bought food are both part of the strategies and solutions participants suggested for coping with food insecurity. The findings can be used to inform assessment and program planning activities and to advocate for policies at the local, provincial and federal levels to strengthen community food security, specifically in remote Aboriginal communities. Public health policies to improve food security for FN populations are urgently needed. While short and medium term strategies (e.g., greater employment and building community gardens and greenhouses) are important for initiating food systems change, long term sustainable food systems require policy strategies and instruments to be effective in building and strengthening food security and community capacity. Thompson and colleagues [ 80, 82] have suggested that community economic development and supporting sustainable livelihoods through local food production and local food networks can improve food security and re-establish food sovereignty in northern FN communities.

Fort Albany was at the forefront of the Food Secure Canada conference in 2012 when the newly elected Chief of Fort Albany received a standing ovation for his emotional speech on food sovereignty in remote communities [ 79]. Community members in Fort Albany are speaking up about the need for food systems change, and it appears that their local leaders are listening and supporting their mission. It's time for the provincial and federal governments in Canada to pay attention and to work with remote communities towards greater food security and to support a vision for food sovereignty.

Abbreviations

FN:

First Nations

CAC:

Community Advisory Committee

HFSSM:

Household Food Security Survey Module

Acknowledgements

The authors are grateful to all the community members that participated, the Community Advisory Committee, the community research assistant who collected the data and for the support of Fort Albany First Nation. The lead author was supported by a Doctoral Research Award from the Canadian Institutes of Health Research and an Ontario Graduate Scholarship. This study was funded by the Canadian Institutes of Health Research, the Social Science and Humanities Research Council of Canada and the Canadian Foundation for Dietetic Research.

Author information

Affiliations

1. School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada

Kelly Skinner, Rhona M Hanning & Leonard JS Tsuji

2. Department of Geography and Environmental Management, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada

Ellen Desjardins

3. Department of Environment and Resource Studies, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada

Leonard JS Tsuji

Corresponding author

Correspondence to Kelly Skinner.

Additional information

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

KS, RH and LT designed and coordinated the study. KS conducted the qualitative analysis and wrote the manuscript. ED assisted with analysis. All authors read and approved the final manuscript.

Authors' original submitted files for images

Below are the links to the authors' original submitted files for images.

Rights and permissions

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reprints and Permissions

About this article

Download citation

# data[].attributes.attachment_link.title
Giving voice to food insecurity in a remote indigenous community in subarctic Ontario, Canada: traditional ways, ways to cope, ways forward - BMC Public Health

# data[].attributes.attachment_link.description
Background Food insecurity is a serious public health issue for Aboriginal people (First Nations [FN], Métis, and Inuit) living in Canada. Food security challenges faced by FN people are unique, especially for those living in remote and isolated communities. Conceptualizations of food insecurity by FN people are poorly understood.

# data[].attributes.attachment_link.readable_text
A new report from Statistics Canada shows unemployed Indigenous people are disproportionately affected by the COVID-19 pandemic and the resulting job losses from businesses being forced to close.

Figures from December 2019 to February 2020 show the Indigenous unemployment rate at 10 per cent while it was just 5.5 per cent for non-Indigenous people.

That jumped more than six percentage points for both groups between February and May.

Indigenous unemployment shot up to 16.6 per cent while non-Indigenous sat at 11.7 per cent.

When businesses started to reopen across the country, unemployment fell for non-Indigenous groups between May and August to 11.2 per cent but rose for Indigenous people to 16.8 per cent.

The Federation of Sovereign Indigenous Nations ( FSIN) feels as if Ottawa ignored their concerns, especially a $9-billion funding request at the start of the pandemic only offering a fraction of that.

"When they were announcing COVID-19 relief funds for reopening the economy and things like that, we First Nations were at the bottom of the barrel," Chief Bobby Cameron told Global News, adding he thought the federal government failed First Nations.

Kelly Foley, a University of Saskatchewan economics professor, said disadvantaged people in the labour market disproportionately suffer in this kind of economic climate.

"I do believe they come from a lot of the same structural barriers that were preventing Indigenous people from finding employment even before the pandemic occurred," Foley said.

She added those hurdles include education levels, living in remote parts of the country and discrimination.

Cameron said all stakeholders, including the government, business community and Indigenous leaders, need to be involved in order to address the higher unemployment rates.

# data[].attributes.attachment_link.title
Unemployed Indigenous workers disproportionately suffering from COVID-19 economy compared to non-Indigenous | Globalnews.ca

# data[].attributes.attachment_link.description
A new report from Statistics Canada shows unemployed Indigenous people are disproportionately affected by the COVID-19 pandemic and the resulting job losses from businesses being forced to close. Figures from December 2019 to February 2020 show the Indigenous unemployment rate at 10 per cent while it was just 5.5 per cent for non-Indigenous people.

# data[].attributes.attachment_link.title
8 Basic Barriers to Indigenous Employment

# data[].attributes.attachment_link.description
Listed here are just some of the more obvious barriers to Indigenous employment and meaningful, lasting careers.

# data[].attributes.attachment_link.readable_text
View the most recent version.

[an error occurred while processing this directive]11-402-x[an error occurred while processing this directive] [an error occurred while processing this directive]

Even before the 2008-2009 recession, Aboriginal people-North American Indian (or First Nations people), Métis and Inuit-had a harder time finding work and faced higher unemployment than non-Aboriginal people. The gap widened following the downturn, as Aboriginal people aged 15 and older (excluding those living on reserves or in the territories) experienced sharper declines in employment rates than non-Aboriginal people did.

In 2009, the average employment rate for Aboriginal people was 57.0%, compared with 61.8% for non-Aboriginal people. The gap in employment widened to 4.8 percentage points from 3.5 percentage points in 2008.

At the same time, the unemployment rate rose sharply for Aboriginal people, rising from 10.4% in 2008 to 13.9%. The rate for non-Aboriginal people rose from 6.0% to 8.1%.

Among Aboriginal people, the top employer of core-age workers (aged 25 to 54) in 2009 was the health and social assistance industry, followed by trade, construction and manufacturing. For non-Aboriginal people, trade was the top employer for core-age workers, followed by manufacturing, health care and social assistance, and professional, scientific and technical services.

In 2009, nearly 15% of employed core-age Aboriginal people worked in the health care and social assistance industry. Aboriginal employment in this industry increased by 12% or 4,000 jobs from 2008, outstripping the 2% increase in this industry among non-Aboriginal people.

Larger job losses among Aboriginal people

Canada's manufacturing industry posted the largest employment losses during 2009. Among non-Aboriginal manufacturing workers in the core-age group, employment declined by 8% or 14,000 jobs, with the bulk of the jobs lost in Ontario. At the same time, manufacturing employment among their Aboriginal counterparts fell by 30% or 7,000 jobs, with jobs mostly lost in the Western provinces.

In the construction industry, Aboriginal employment fell by 16% or 4,000 jobs, while it decreased by 5% or 45,000 jobs among non-Aboriginal workers.

Young workers hit by labour downturn

The labour market downturn had an especially large impact on young people (aged 15 to 24). From 2008 to 2009, the employment rate for Aboriginal youth (excluding those on reserves) fell by 6.8 percentage points, compared with a decline of 4.2 percentage points among non-Aboriginal youth. Both decreases were much larger than the employment losses experienced by core-age workers over this period.

In 2009, the employment rate was 45.1% for Aboriginal youth, whereas it was 55.6% for their non-Aboriginal counterparts.

While the period was a turbulent one in the labour market for youth and core-age adults, Aboriginal and non-Aboriginal people aged 55 and older were finding jobs, and so their employment rate increased slightly.

Core-age Aboriginal people in British Columbia and Alberta, two of the provinces hardest hit by the downturn, experienced more pronounced changes in their employment and unemployment rates than did their counterparts in other provinces.

In Alberta, the employment rate among core-age Aboriginal people fell from 75.1% in 2008 to 69.5% in 2009, more than double the drop seen among non-Aboriginal people. In British Columbia, the core-age employment rate among Aboriginal people fell to 65.1%, a drop of 5.6 percentage points and the lowest rate for Aboriginal people among all the provinces.

Education matters in the labour market

Educational attainment also played a role both before and during the downturn. Aboriginal people who had completed postsecondary education were not as affected: their employment rate declined to 79.4%, down 1.8 percentage points from 2008 to 2009. The employment rate for Aboriginal people with less than a high school diploma fell by 5.5 percentage points to 47.7%. Those with a high school diploma and some postsecondary education fared better, as their employment rate declined by 3.3 percentage points to 66.3%.

The employment rate among non-Aboriginal people with a completed postsecondary education was higher than that of their Aboriginal counterparts, but the decline in their employment rate was comparable at 1.5 percentage points.

View data source for chart 1.1

# data[].attributes.attachment_link.description
View the most recent version. [an error occurred while processing this directive]11-402-x[an error occurred while processing this directive] [an error occurred while processing this directive] Even before the 2008-2009 recession, Aboriginal people-North American Indian (or First Nations people), Métis and Inuit-had a harder time finding work and faced higher unemployment than non-Aboriginal people.

# data[].attributes.body
Suicide, heavy subject, am I right? In 2016, suicide accounted for 1.4% of all deaths worldwide, making it the 18th leading cause of death. That's INSANE! Did you know, Indigenous populations account for 75 percent of suicide deaths worldwide. Where did we go wrong? Don't they deserve the same things as us? Many are situated on the very Edge of Life and Death

According to Statistics Canada, Indigenous people have a higher risk of suicide than non-Indigenous people because of "socioeconomic characteristics" such as household income, labor force status, level of education, and marital status. For example, suicide rates are 35 per 100,000 for First Nations women, compared to 5 per 100,000 for non-Indigenous women. That's a pretty big difference if you ask me. These suicides not only cause profound grief and bereavement for families. It also affects the community and society at large, especially when the deceased is a young person.

Suicide has a relatively large and significant influence in small Indigenous communities, where many people are related and face similar personal and collective adversity.

Did you know? The suicide rate among First Nations people in Canada was three times higher than the non-Indigenous, between 2011 and 2016.

We can no longer ignore this issue. It's been a concerning problem for the past 40 years, but only now are we hearing about the ugly truth. It's no longer good enough for us to tell Indigenous people that it'll get better. What if it was your friend? or your mom? We have to make it better. We have to raise our voices. We have to step up and make the change. That means you, your friends, your teachers, your parents, your dog. You may be thinking I can't change anything, I'm just one person. You don't have to break down doors or start riots to make a point. Whether it's speaking up on social media, writing letters to the government, donating, setting up shelters, or going to protests. Just don't ignore the issue and don't be invisible. The indigenous community already lost 169 lives last year. That's 169 too many.

# data[].attributes.body
https://www.youtube.com/watch?v=w4H60jTkGYI