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Indigenous students in Canada face barriers like intergenerational trauma and lack of resources, contributing to lower educational attainment.

These challenges result in lower graduation rates compared to non-Indigenous peers.

Solutions focus on improving support and educational resources.

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Indigenous people in Canada face healthcare barriers like racism, long travel distances, and unmet needs.

Many value traditional healing but encounter systemic inequities.

Improving access and reducing discrimination are ongoing priorities.

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Indigenous people, especially women, are vastly overrepresented in Canadian provincial jails.

Their incarceration rates are significantly higher than non-Indigenous populations, influenced by systemic issues like poverty and discrimination.

Reform efforts aim to prioritize rehabilitation over punishment.

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Indigenous women in Canada experience violence at rates far higher than non-Indigenous women.

They are four times more likely to be victims of homicide or go missing.

Efforts, like the National Inquiry's Calls for Justice, aim to reduce this systemic violence.

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Indigenous peoples fight to preserve their languages.

They face inequalities in the justice system.

In Quebec, French laws threaten their cultural rights.

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Many First Nations endured decades without clean water.

A $8-billion settlement compensates victims and funds water system improvements.

Trust and long-term solutions are still needed.

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Because of all the cultural genocides, they have been through generational trauma and the effect are still evident today.

They suffer from socioeconomic disparities from all the mistreatment.

Also because of literacy and education, cultural differences, racism, discrimination, stereotypes, self-esteem, poverty, lack of driving license, transportation and child care.

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One in six Indigenous people live in a house who needs major repairations, this is three times higher than the non-Indigenous population.

Especially in the North, Indigenous people are more than twice as likely to experience hidden homelessness, also known as couch surfin.

Overcrowding compound risks for family violence, intimate partner violence, and education, growth, and development challenges for children are issues that cause significant health risks to occupants, such as mold and other hazardous toxins.

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They are affected by intergenerational trauma and they still experience collective trauma's coming from colonization and the effect has passed on from one generation to the next.

Because of the trauma's, some Indigenous people have tried to forget them but by drinking alcohol or by taking drugs to exess, self-harm and isolation from support systems.

The trauma's also leads to depression and mental illness and feeling hopeless and those elements also leads to suicides.

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Postsecondary educational attainment and labour market outcomes among Indigenous peoples in Canada, findings from the 2021 Census

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This study uses data from the 2021 Census to report on postsecondary educational attainment and labour market outcomes among Indigenous adults aged 25 to 64 years. As First Nations people, Métis and Inuit are more likely to live in certain regions, which can impact their participation in both education and the labour market, the article pays particular attention to patterns in educational attainment and employment among those residing in remote areas, on reserve, and communities across Inuit Nunangat.

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8 Basic Barriers to Indigenous Employment

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Inadequate Housing and Crowded Living Conditions - #3 of 8 Key Issues

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This article explains some of the basic information about the reserve system to understand the housing situation’s complexities better.

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The Housing Gap - Assembly of First Nations

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Limited access to essential infrastructure including housing has resulted in long-standing intergenerational inequality.In 2021, 53.8% of foster children in Canada were Indigenous. The Prairie regions report that 68% of shelter users are Indigenous.First Nations urgently need 157,453 new homes as well as repairs to 55,700 existing ones.Closing the housing gap to help First Nations overcome

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Mental wellness resources and crisis help for First Nations people, Métis and Inuit
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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).

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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

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Suicide among First Nations people, Métis and Inuit (2011-2016): Findings from the 2011 Canadian Census Health and Environment Cohort (CanCHEC)

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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.

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How long have Indigenous peoples struggled to access clean water?

For hundreds of years, many First Nation, Inuit and Métis communities have struggled with access to clean drinking water, as well as other necessities like quality food and safe housing. The impacts of colonization and ongoing colonialism for Indigenous people in Canada include a lack of access to basic needs and rights such as housing, equitable education and employment opportunities, and clean drinking water.

The current federal government has zeroed in on ending long-term boil water advisories in First Nation communities. But that's just the start of what's needed to end decades of water injustice and discrimination once and for all.

The focus on long-term boil water advisories in First Nation communities is just the start of ending water injustice and discrimination once and for all.

In 1876, the federal government introduced the . Under the Act, the government is responsible for building and upkeep of infrastructure on First Nation reserves such as drinking water treatment plants and pipes to deliver water to homes and buildings.

Since then, the federal government has chronically underfunded First Nation reserves, including water infrastructure needs. Governments have harmed access to clean water for Indigenous peoples in many other ways. One example is the forced relocation of Indigenous peoples onto reserves that were sometimes very far from their traditional territories. Government inaction on pollution and industrial accidents caused by corporations have also harmed water sources.

Today, many Indigenous peoples still do not have access to clean drinking water. This violates the internationally recognized human right to water. In 2015, Justin Trudeau committed to end boil water advisories by 2021. That deadline has passed and while many long-term boil water advisories have ended, the Liberal government says many communities won't have long-term solutions until 2026.

How could this have gone on for so long?

Many Indigenous people and allies have wondered the same thing! For decades, one federal government after another has made commitments to provide Indigenous peoples with safe drinking water. But no government has delivered adequate funding to build and maintain drinking and wastewater water treatment plants as well as appropriate pipe systems connecting the plants to homes, or provide enough trained and fairly-paid staff to run the systems.

Which Indigenous peoples are affected?

The question of which communities or how many communities are impacted by not having access to clean drinking water is not simple, but one thing is clear: over the last several hundred years, most Indigenous communities and Nations have faced threats to clean drinking water.

Over the last several hundred years, most Indigenous communities and Nations have faced threats to clean drinking water.

The federal government limits which Indigenous peoples it has financial and legal responsibilities to for clean drinking water. The Liberal government pledge to end boil-water advisories in First Nation communities only covers long-term drinking water advisories for water systems serving five or more homes on First Nation reserves, which the government refers to as ' public systems.' The government is not focusing on fixing piping into homes, or on homes with no piping that rely on large tanks of water called cisterns, or on supporting wastewater treatment systems, which are vital to protect safe drinking water.

Many Indigenous peoples and communities are left out, and federal statistics don't tell the whole story.

Many Indigenous peoples and communities are left out of these specific efforts. In addition, federal tracking statistics don't tell the whole story, as they don't count First Nation communities living under short-term water advisories, most Métis people, Inuit people, all communities north of the 60 th parallel, seven member First Nations of the Saskatoon Tribal Council, First Nations people who use wells and private water systems and First Nation reserves in British Columbia.

Inuit and some other communities receive separate federal funding, but it is important to note how many Indigenous peoples are affected by a lack of clean drinking water, and who is excluded from the federal campaign to end boil water advisories.

What's it like to live under a long-term boil water advisory?

Some First Nations have endured decades of boiling their water before it's safe to drink. Members of Shoal Lake 40 First Nation lived under a long-term boil water advisory for 24 years, from 1997 until 2021, when the construction of effective roads made the building and upkeep of a new water treatment plant possible.

June 2022 marked 10,000 days that members of Neskantaga First Nation have lived under a long-term boil water advisory. Since 1995, their tap water has at times been unsafe even for bathing or laundry, known as a 'do not use' advisory.

Communities without safe drinking water must spend large amounts of money supplying members with bottled water and must deal with the mountains of plastic waste that pile up. Households often must ration drinking water and water for bathing and cleaning. Water that is unsafe to drink, but deemed safe enough for bathing, can cause skin conditions such as eczema and infections.

Communities struggle to have clean clothes and find safe places to bathe. They must factor the timing, costs, and logistics of picking up water into their everyday lives.

Communities living with water they can't use at all struggle to have clean clothes and find safe places to bathe. Community members must factor the timing, costs, and logistics of picking up water into their everyday lives. The COVID-19 pandemic has affected Indigenous communities more than non-Indigenous communities. A significant factor is inadequate access to clean water for drinking or doing additional washing and hygiene to prevent the spread of the virus. One recent study found that Indigenous communities with water cisterns had double the cases of COVID-19 compared to communities with running water to their homes.

What about short-term boil water advisories?

Short-term boil water advisories are a big problem! As of May 2022, there were 30 short-term drinking advisories in First Nations communities south of the 60 th parallel (excluding communities in British Columbia and that are members of the Saskatoon Tribal Council). Often communities will have their boil-water advisory or other water advisory removed, and then a few weeks or months later, they will receive a short-term boil water advisory.

Listen, learn and act

Indigenous peoples have been fighting threats to their clean drinking water for generations. It is vital to recognize the strength and dignity of Indigenous peoples who have been impacted by these conditions, and who have fought for change. The work of Indigenous activists and allies is what has led to government commitments advancing the work to ensure access to clean drinking water for Indigenous peoples.

It is vital to recognize the strength and dignity of Indigenous peoples who have been impacted by these conditions, and who have fought for change.

CUPE's Water is life campaign provides educational tools to learn about Indigenous water issues and mobilize in support of Indigenous peoples and allies to protect and fix the water. For a list of ways to support Indigenous communities fighting for clean drinking water, check out Water is life: Listen, learn, act.

Helpful language to understand what Indigenous communities are facing:
Boil water advisory (BWA): Home users should bring their tap water to a rolling boil for at least one minute before they drink the water or use the water to cook, feed pets, brush teeth, wash fruits and vegetables, and other purposes.
Long-term BWA : A boil water advisory that has been in place for over a year.
Short-term BWA: A boil water advisory that has been in place for less than a year.
Public water system: Indigenous Services Canada refers to on-reserve water systems serving five or more households, or serving schools, community centres and other public facilities, as public water systems.
Art: Aaron Paquette

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Water is life: The fight for clean drinking water continues

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For hundreds of years, many First Nation, Inuit and Métis communities have struggled with access to clean drinking water, as well as other necessities like quality food and safe housing. The current federal government has zeroed in on ending long-term boil water advisories in First Nation communities.

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With the deadline just a week away, the law firm representing victims of unsafe drinking water in First Nation communities is urging those who qualify to file their claims for long-awaited compensation.

After a years-long battle, the federal government opened the First Nations drinking-water settlement process in 2022, offering compensation to First Nations that have suffered for long periods under drinking-water advisories.

"The settlement is about providing a new dawn for First Nations people on reserve who've gone too long without regular access to clean, safe drinking water." said Darian Baskatawang, an Associate with Olthuis Kleer Townshend LLP and Class Counsel for the First Nations Drinking Water Class Action Settlement.

This settlement compensates those affected by a lack of clean drinking water in First Nation communities between Nov. 20,1995, and June 20, 2021.

The legal fight began in 2019, when two separate lawsuits were filed against the federal government: one by Curve Lake First Nation and Neskantaga First Nation, both from Ontario, in the Federal Court of Canada, and the second by Tataskweyak Cree Nation in Manitoba Court of Queen's Bench, concerning prolonged drinking-water advisories on First Nations reserves across the country.

Now the settlement is for all First Nations across the country.

The $8-billion settlement deal covers 142,000 individuals from 258 First Nations who could be compensated, along with 120 First Nations communities.

Nine out of 10 of the individuals eligible have submitted their claim for the settlement, Baskatawang said. That leaves 10 per cent of eligible claimants who still haven't submitted a claim.

Eligible First Nation communities and individuals now have until March 7, 2024, to submit, after receiving a year extension.

"One of the biggest wins as part of the settlement is that it provides legal commitments on a few issues to make sure that drinking water advisories come to the close and never happen again." Baskatawang said.

"The settlement has within it legal commitments to fund what it actually costs to provide clean, safe drinking water in communities."

Hopes to soon lift boil-water advisories

Kiashke Zaaging Anishinaabek otherwise known as Gull Bay First Nation is one of those communities receiving compensation.

The reserve has contended with a long-running boil-water advisory first put in place in 1998.

Now, Gull Bay First Nation is finally in the process of lifting that advisory. Wilfred King is the long-standing chief of Gull Bay First Nation.

He says a new drinking water treatment plant will make a huge difference for his community. The long-term maintenance of the new facility will be a priority for the community, and federal compensation funds could help to ensure it provides pristine water far into the future.

King said he's grateful to the First Nations that led the legal fight for the settlement.

"I really take my hat off to those communities that took legal action because I think without the legal action we would have probably been still in this lobbying effort. In many communities, if you don't have that lobbying effort, you'll be just put on the back burner." King said.

Work remains to rebuild trust

Neskantaga First Nation, which has been under a drinking water advisory for longer than any other community, will also receive compensation under the agreement.

While chief and council have not decided how to use the compensation funds, like Gull Bay, Neskantaga has been fighting for a new water treatment facility, rather than upgrades to its current non-functioning water treatment plant.

Years of living without safe water have left deep scars on the community, said Neskantaga Chief Chris Moonias.

Even when members of his community visit a big city, he said, they are often unable to trust what comes out of the taps.

"Even for myself, I have to go buy water because we are so used to living under a boil water advisory," said Chief Moonias. "And when I visited my daughter there's cases of water in her house."

This is one of the residual effects of living or growing up under a boil water advisory.

On February 1st, Neskantaga marked the 29th anniversary of its boil-water advisory. At the event Indigenous Services Minister Patty Hajdu committed to the design of a new water treatment plant for Neskantaga.

Chief Chris Moonias of Neskantaga hopes that in the next couple of weeks he can get a commitment in writing.

"It's hard being optimistic," Chief Moonias said, after so many years of promises that a new treatment plant is in the works.

It will take time and work, he said, for community members to rebuild trust in both the government, and the water, even if a new facility is built.

"I just remind myself you know that I'm doing this for the people," said Chief Moonias.

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First Nations that have gone years without clean drinking water hope compensation signals a 'new dawn' | CBC News

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Eligible First Nation communities and individuals have until March 7, 2024, to submit a claim under the First Nations drinking-water settlement, after receiving a year extension to submit.

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Indigenous foster children living in private households: Rates and sociodemographic characteristics of foster children and their households

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The current study uses the 2011 National Household Survey and the 2016 and 2021 Censuses to provide data on the number of Indigenous foster children in private households, foster child rates, and disparity between Indigenous and non-Indigenous foster care rates between 2011 and 2021. Subsequently, select sociodemographic characteristics of Indigenous children in foster care and household characteristics are explored using the 2021 Census.

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Interrupted childhoods: Over-representation of Indigenous and Black children in Ontario child welfare | Ontario Human Rights Commission

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When child welfare authorities remove children from their caregivers because of concerns about abuse or neglect, it can be traumatic and tragic for everyone involved – children, their families and even their communities. Being admitted into care comes with far-reaching consequences that can have a negative impact on children’s future ability to thrive. It is an unfortunate reality that some children need to be placed in care to keep them safe. But too often, for First Nations, Métis, Inuit, Black and other racialized families, being involved with the child welfare system and having a child removed is fraught with concerns that the system is not meeting their or their children’s needs, is harmful, and may be discriminatory.

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How many First Nations women and children are murdered? The figures are shocking – and yet incomplete

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Data collected from a variety of sources shows Indigenous women and children are killed and disappear at disproportionately high rates

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Overrepresentation: The Nature and Extent of the Problem

Failures of the criminal justice system for Indigenous people are manifested in many ways, perhaps most notably in the extreme overrepresentation of Indigenous individuals as incarcerated offenders. This can be demonstrated in two ways: by examining the Indigenous inmate population as a proportion of the total inmate population; and by looking at the comparative rates of Indigenous incarceration and changes in those rates.

The 2017-2018 Annual Report of the Office of the Correctional Investigator (OCI) pointed to increasing numbers of incarcerated Indigenous people. Indigenous inmates in federal institutions rose from 20 percent of the total inmate population in 2008-2009 to 28 percent in 2017-2018, while representing only 4.1 percent of the overall Canadian population. Similarly, the percentage of federally incarcerated Indigenous women rose from 32 percent of the female inmate population to 40 percent. While proportions of Indigenous incarceration have risen substantially, the overall inmate population (Indigenous and non-Indigenous) has risen only slightly. The Correctional Investigator stated:

In the ten-year period between March 2009 and March 2018, the Indigenous inmate population increased by 42.8% compared to a less than 1% overall growth [in the total adult custodial population] during the same period. As of March 31, 2018, Indigenous inmates represented 28% of the total federal in-custody population while comprising just 4.3% of the Canadian population. The situation continues to worsen for Indigenous women. Over the last ten years, the number of Indigenous federally sentenced women increased by 60%, growing from 168 in March 2009 to 270 in March 2018. At the end of the reporting period, 40% of incarcerated women in Canada were of Indigenous ancestry. These numbers are distressing. (OCI, 2018: 61)

The Department of Justice Canada (2018c) has examined trends in adult federal custody populations based on data points for the last three census years (2006, 2011, and 2016). The Department's report draws a number of conclusions, including the following that relate directly to adult Indigenous individuals admitted to federal correctional institutions:

Although the incarceration rates for both Indigenous and non-Indigenous men have decreased over the past decade, the rate of Indigenous male offenders remains eight times higher than that of non-Indigenous men. The number of Indigenous male offenders continues to increase while the number of non-Indigenous male offenders has decreased slightly.

The incarceration rates and total numbers for both Indigenous and non-Indigenous women have increased over the past decade; the incarceration rate of Indigenous women continues to be much higher (12.5 times) than that of non-Indigenous women. (Department of Justice Canada, 2018c)

Statistics Canada has provided data that expand on the overrepresentation issue by addressing provincial and territorial corrections, as well as federal corrections. In 2016-2017, Indigenous adults accounted for 28 percent of admissions to provincial and territorial correctional services and 27 percent of admissions to federal correctional services (Statistics Canada, 2018a). Yet they represented only 4.1 percent of the total Canadian population ( ibid.). According to Statistics Canada:

An admission is counted each time an individual begins any type of custody or community supervision program. Aboriginal adults represented 4.1% of the Canadian adult population in 2016/2017, while accounting for 28% of admissions to provincial/territorial correctional services and 27% of admissions for federal correctional services. In comparison, in 2006/2007, Aboriginal adults accounted for 21% of admissions to provincial and territorial correctional services (excluding Prince Edward Island and the Northwest Territories) and 19% to federal correctional services. (Statistics Canada, 2018a)

Overall adult admissions to federal institutions (Indigenous and non-Indigenous adults combined) grew less than one percent in 2018. However, Statistics Canada data indicate admissions of Indigenous adults to federal correctional services increased significantly between 2006-2007 and 2016-2017 to 27 percent. The proportion of Indigenous adult admissions to provincial and territorial institutions was slightly higher at 28 percent in 2016-2017 ( ibid.).
The numbers for Indigenous youth involved in provincial and territorial correctional services are even more serious:

Aboriginal youth accounted for 46% of admissions to correctional services in the 10 reporting jurisdictions in 2016/2017, while representing 8% of the general youth population in those same jurisdictions. Aboriginal youth are overrepresented in both custody and community supervision, accounting for 50% of custody admissions and 42% of community supervision admissions. Aboriginal females accounted for a greater proportion of custody admissions among youth relative to their male counterparts. Aboriginal female youth accounted for 60% of female admissions, while Aboriginal male youth made up 47% of male youth admissions. (Statistics Canada, 2018a)

A telling way to see the trend to higher Indigenous incarceration numbers is to compare percentages of adult Indigenous admissions to provincial and territorial correctional services by type of supervision between 2012-2013 and 2016-17. These numbers represent the percentage of Indigenous inmates as a proportion of the total inmate population. It is also important to remember that the Indigenous population as a percentage of the overall Canadian population was only 4.1 percent in 2016-2017 (Statistics Canada, 2018a).

Between 2013-2014 and 2016-2017, total Indigenous admissions to custody rose from 25 percent of total admissions to 30 percent. Sentenced admissions rose from 26 percent to 30 percent. Remands rose from 23 percent to 29 percent. And other custodial statuses rose from 32 percent to 33 percent. (Statistics Canada 2016a; Statistics Canada, 2017a)

A number of significant points arise from these numbers. First, Indigenous admissions to custody are substantially higher than non-Indigenous admissions in all categories. Second, admission percentages for Indigenous offenders increased in all categories between 2012-2013 and 2016-2017. This means, of course, that the admission percentages for non-Indigenous offenders decreased in all categories. Third, when one considers the relative overall Indigenous population size, the differences are striking. For example, while representing 4.1 percent of the overall Canadian population, Indigenous adults accounted for almost 30 percent of total custodial admissions in 2016-2017 (Statistics Canada 2016a; Statistics Canada, 2017a).

It is worth noting that custodial admissions of adult Indigenous offenders vary by province and territory, as do the proportions of Indigenous inmates compared to the relative proportions of Indigenous people in the general population. Ontario, the western provinces, and the territories have significantly higher proportions of Indigenous incarceration relative to the Indigenous percentage of the population than do Quebec and the Atlantic provinces. For example, in 2011-2012, Saskatchewan had a relatively high proportion of Indigenous people in its total adult population at 12 percent, but 78 percent of the total adult incarcerated population were Indigenous. In Nova Scotia, on the other hand, Indigenous adults were 3 percent of the provincial adult population and 11 percent of the incarcerated adult population (Statistics Canada, 2014). Thus, the relative incarceration numbers are lower compared to overall population rates in Nova Scotia than in Saskatchewan. These relative differences apply generally when comparing jurisdictions across the country.

In 2016-2017, Indigenous youth (12 to 17 years) accounted for 8 percent of all youth in the provinces and territories (Department of Justice Canada 2018a). However, in 2016-2017 they accounted for a much higher proportion of young people admitted to the corrections system: 46 percent ( ibid.). The overrepresentation of Indigenous youth was even more disproportionate among girls in 2016-2017. Indigenous female youth accounted for 60 percent of all female youth admitted to provincial and territorial corrections systems, compared to 47 percent for Indigenous male youth (Statistics Canada, 2018a).

Finally, we should look at the victimization of Indigenous people in Canada. Statistics Canada has provided data relating to this problem for the year 2014 (Statistics Canada, 2016c: 3):

In 2014, a higher proportion of Aboriginal people than non-Aboriginal people in Canada reported being victimized in the previous 12 months. Overall, 28% of Aboriginal people living in the provinces and territories compared with 18% of non-Aboriginal people reported being the victim of one of the eight types of offences measured by the General Social Survey (GSS) on Victimization.

In 2014, the overall rate of violent victimization among Aboriginal people was more than double that of non-Aboriginal people (163 incidents per 1,000 people versus 74 incidents per 1,000 people). Regardless of the type of violent offence, rates of victimization were almost always higher for Aboriginal people than for non-Aboriginal people.

While victimization rates are relatively high for Indigenous people, it is important to recognize that this does not mean Indigenous people are inherently more likely to commit crimes, including violent crimes, than non-Indigenous people. Nor are Indigenous people inherently more likely to be victimized than non-Indigenous people. As the Statistics Canada analysis below indicates, being Indigenous in itself is not the most significant risk factor in becoming a victim. Rather, other social and economic factors - both historical and current - have greater statistical weight in potential victimization.

When controlling for various risk factors, Aboriginal identity by itself did not remain associated with increasing one's overall risk of violent victimization. Rather, the higher rates of victimization observed among Aboriginal people appeared to be related to the increased presence of other risk factors among this group-such as experiencing childhood maltreatment, perceiving social disorder in one's neighbourhood, having been homeless, using drugs, or having fair or poor mental health. (Statistics Canada, 2016c)

While this is true in statistical terms, it must be recognized that being Indigenous is often a strong factor in victimization. We know this from the many disturbing examples of violence, including murder, experienced by Indigenous women and young people. The cases addressed by the National Inquiry into Missing and Murdered Indigenous Women and Girls (2019), and the inquiry into the deaths of seven Indigenous high school students in Thunder Bay from 2000 to 2011 (Talaga, 2017) demonstrate this point. The problem is further complicated by the fact that colonialism, socio-economic marginalization, and systemic discrimination always play a role in these terrible cases.

Numerous Commissions of Inquiry and courts, including RCAP (1996), the TRC (2015), and the Supreme Court of Canada (various rulings), have confirmed that a broad range of factors have contributed to the overrepresentation of Indigenous people as offenders and victims. These factors are discussed in the following section.

Footnotes

Footnote 5

Slight discrepancies appear in different official publications with respect to the Indigenous percentage of the overall Canadian population; for example, while the OCI estimated the percentage of Indigenous people to be 4.3 percent of the total Canadian population, Statistics Canada concluded the proportion to be 4.1 percent.
Absolutely accurate Indigenous population counts are difficult to achieve and may vary according to timing and the enumeration techniques employed. Regardless, the variances are small enough such that they do not affect the message in the overall incarceration numbers as expressed here. See Footnote 11.

Footnote 6

Footnote 7

Footnote 8

Footnote 9

Footnote 10

Footnote 11

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Overrepresentation: The Nature and Extent of the Problem - Research and Statistics Division - Overrepresentation of Indigenous People in the Canadian Criminal Justice System: Causes and Responses

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Department of Justice Canada’s Internet site

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Over-representation of Indigenous persons in adult provincial custody, 2019/2020 and 2020/2021

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This Juristat article presents data and information on the extent of Indigenous over-representation in correctional systems across Canada in 2019/2020 and 2020/2021, using three new corrections indicators recently developed: Incarceration Rates for Indigenous and non-Indigenous persons, the Over-Representation Index, and the Custodial Involvement Rate. In addition, trends in the use of bail and remand will be explored, along with possible impacts on over-representation. The findings are presented from five provincial correctional service programs reporting to the Canadian Correctional Services Survey (CCSS): Nova Scotia, Ontario, Saskatchewan, Alberta, and British Columbia.

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Access to primary health care services for Indigenous peoples: A framework synthesis - International Journal for Equity in Health

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Background Indigenous peoples often find it difficult to access appropriate mainstream primary health care services. Securing access to primary health care services requires more than just services that are situated within easy reach. Ensuring the accessibility of health care for Indigenous peoples who are often faced with a vast array of additional barriers including experiences of discrimination and racism, can be complex. This framework synthesis aimed to identify issues that hindered Indigenous peoples from accessing primary health care and then explore how, if at all, these were addressed by Indigenous health care services. Methods To be included in this framework synthesis papers must have presented findings focused on access to (factors relating to Indigenous peoples, their families and their communities) or accessibility of Indigenous primary health care services. Findings were imported into NVivo and a framework analysis undertaken whereby findings were coded to and then thematically analysed using Levesque and colleague’s accessibility framework. Results Issues relating to the cultural and social determinants of health such as unemployment and low levels of education influenced whether Indigenous patients, their families and communities were able to access health care. Indigenous health care services addressed these issues in a number of ways including the provision of transport to and from appointments, a reduction in health care costs for people on low incomes and close consultation with, if not the direct involvement of, community members in identifying and then addressing health care needs. Conclusions Indigenous health care services appear to be best placed to overcome both the social and cultural determinants of health which hamper Indigenous peoples from accessing health care. Findings of this synthesis also suggest that Levesque and colleague’s accessibility framework should be broadened to include factors related to the health care system such as funding.

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In 2024, the majority of First Nations people living off reserve (86%), Métis (70%) and Inuit (82%) reported that it was very or somewhat important to have health care services that support Indigenous traditional medicines, healing and wellness practices.

Released today, new data from the Survey Series on First Nations People, Métis and Inuit sheds light on health care access and experiences among Indigenous people aged 15 and older. The purpose of this survey series is to improve the visibility of First Nations people living off reserve, Métis and Inuit in national statistics and to fill key data gaps with timely and culturally relevant data.

Over one-quarter of Indigenous people wait two weeks or more for non-urgent care with a health care provider

Primary health care providers serve a crucial role in health maintenance and are linked to better health outcomes. In 2024, 70% of Métis, 66% of First Nations people living off reserve, and 52% of Inuit consulted a health care provider for a non-urgent primary health care need (such as check-ups and prescription refills) in the 12 months prior to the survey.

Timely access to a primary health care provider is important, yet wait times have been increasing in Canada and they tend to be longer in more remote areas among Indigenous people. Among those who had consulted a primary health care provider in the 12 months prior to the survey, most reported wait times that ranged from two days to less than two weeks. Inuit were most likely to report waiting one month or more to access a primary health care provider (18%, compared with 14% for First Nations people living off reserve and 11% of Métis) (Chart 1).

When asked about their level of satisfaction with wait times, about half of First Nations people living off reserve (50%), Métis (52%) and Inuit (57%) reported being satisfied or very satisfied.

Over one-quarter of Indigenous people have unmet health care needs

Indigenous people often face barriers to health care that contribute to health disparities, including navigating complex health care policies and funding, and sometimes even having to travel outside their communities to access services.

Unmet health care needs in the 12 months prior to the survey were reported by 32% of First Nations people living off reserve, 30% of Métis, and 29% of Inuit. A higher percentage of off-reserve First Nations women than men reported unmet health care needs in the 12 months prior to the survey (Table 1).

When asked why their health care needs were unmet, commonly reported reasons among First Nations people living off reserve, Métis and Inuit were difficulty getting a referral to a specialist and not being given the correct treatment or prescription. Among First Nations people living off reserve and Inuit, another commonly reported reason was health care services not being in their area/being too far away (Table 2).

Among Indigenous people who need mental health care and seek such care, about three-quarters report needs that are partially met or unmet

Mental health disparities among Indigenous people have been widely reported. These disparities are rooted in historical factors such as colonial, assimilationist policies, that have had adverse direct and intergenerational impacts, as well as contemporary factors such as access barriers to mental health services.

Almost half (47%) of First Nations people living off reserve, 43% of Métis and 35% of Inuit reported needing mental health care in the 12 months prior to the survey. More First Nations, Métis, and Inuit women than men reported that they needed mental health care. The need for mental health care trended higher among younger than older First Nations people living off reserve, Métis and Inuit with significant differences found between the oldest and youngest age groups (Table 3).

Among those who needed mental health care and sought such care, 28% of First Nations people living off reserve, 23% of Métis and 22% of Inuit reported that their needs were fully met, while nearly three-quarters reported partially met or unmet mental health care needs.

Inuit report travelling significant distances from their community to access health care

For some Indigenous people, extensive travel is necessary to access health care, and this can result in financial burdens, emotional stress, anxiety, and feelings of isolation. Roughly one in five First Nations people living off reserve (18%), 16% of Metis and 40% of Inuit travelled outside their community to access health care services in the 12 months prior to the survey.

While most First Nations people living off reserve and Métis who travelled for health care in the 12 months prior to the survey reported travelling less than 500 km (55% and 63%, respectively), a different scenario was seen among Inuit, just over half of whom reported travelling 1,500 km or more (Table 4).

Roughly one in five Indigenous people report experiencing unfair treatment, racism or discrimination from a health care professional

Racism, discrimination, and marginalization within the health care system are documented barriers to health care for Indigenous people. About 24% of First Nations people living off reserve, 23% of Inuit and 18% of Métis reported that they experienced some form of unfair treatment, racism, or discrimination from a health care professional in the 12 months prior to the survey. First Nations women living off reserve and Métis women were nearly twice as likely to report this compared to men (Chart 2).

Among First Nations people living off reserve and Inuit who had experienced unfair treatment, racism or discrimination from a health care professional, the most reported setting was the hospital emergency room (50% for First Nations people living off reserve and 34% for Inuit), with 36% of Métis also reporting similar experiences in this setting. Among Métis, the most reported setting was the doctor's office (46%) (Table 5).

Most Indigenous people report that having health care services that support Indigenous traditional medicines, healing and wellness practices are very or somewhat important

In the Indigenous context, the integration of culturally appropriate and safe care-defined as care that reflects the values, traditions, and social norms of a patient's culture and where patients feel respected, safe and valued-is important. In addition, the Truth and Reconciliation Commission of Canada called on the Canadian health care system to recognize and integrate traditional knowledge, therapies and healing practices into the treatment approach for Indigenous people.

In 2024, health care services that support Indigenous traditional medicines, healing and wellness practices in the Canadian health care system were very or somewhat important to First Nations people living off reserve (86%), Inuit (82%) and Métis (70%) (Chart 3).

However, most Indigenous people experiencing unfair treatment, racism or discrimination felt that their concerns and values were not taken into consideration in their interactions with health care professionals. More specifically, among those who experienced unfair treatment, racism or discrimination in the 12 months preceding the survey, 67% of First Nations people living off reserve, 65% of Métis and 58% of Inuit reported that their health concerns were minimized or dismissed (Table 6).

A further 21% of First Nations people living off reserve, 12% of Métis and 9% of Inuit indicated that their cultural protocols were not respected (e.g., not allowed to smudge or use traditional medicines).

Of those who stated that culturally appropriate services were important, 68% of First Nations people living off reserve, 67% of Inuit and 61% of Métis reported such services would make them feel respected for their culture, beliefs and identity. Roughly half of First Nations people living off reserve (49%) and Inuit (50%) reported that such services would make them more likely to seek health care. About half of Inuit (48%), 41% of First Nations people living off reserve and 32% of Métis reported that these services would make them feel safer discussing sensitive or traumatic experiences (Table 7).

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Contact information

For more information, or to enquire about the concepts, methods or data quality of this release, contact us (toll-free 1-800-263-1136; 514-283-8300; infostats@statcan.gc.ca) or Media Relations ( statcan.mediahotline-ligneinfomedias.statcan@statcan.gc.ca).

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The Daily — Health care access and experiences among Indigenous people, 2024

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In 2024, the majority of First Nations people living off reserve (86%), Métis (70%) and Inuit (82%) reported that it was very or somewhat important to have health care services that support Indigenous traditional medicines, healing and wellness practices.

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The Unemployment Crisis of Indigenous People in Canada | Journey to Diversity Workplaces

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How many Canadian Indigenous voices will it take for us to remember that unemployment is an intersectional issue? Unemployment among Indigenous communities is definitely not rooted in a singular factor, but rather, is a quilt of a multitude of reasons spanning generations. The Indigenous population comprises 4.9% of the Canadian population, totalling a rough estimate

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Lower Education - #2 of 8 Key Issues for Indigenous Peoples in Canada

Canada has one of the highest levels of educational attainment, yet the graduation rate for Indigenous students remains far lower than their peers.

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Native American women see high rates of violence. Here’s how officials are taking it on

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Officials on Friday said nearly 85% of Indigenous women suffer violence. A new Michigan task force hopes to tackle that problem.

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Note to readers

The Homicide Survey collects police-reported data on the characteristics of all homicide incidents, victims and accused persons in Canada. For the purposes of the Homicide Survey, Indigenous identity includes those identified as First Nations persons (either status or non-status), Métis, Inuit or persons with an Indigenous identity where the Indigenous group is not known to police.

The Integrated Criminal Court Survey ( ICCS) collects statistical information on adult and youth court cases involving Criminal Code and other federal statute offences. The primary units of analysis in this study focus on charges and cases linked to homicides. Cases and charges can link to multiple incidents or victims if they are processed by the courts within a single case.

To understand how charges related to the homicides of Indigenous women and girls are processed within the Canadian criminal court system, police-reported data from the Homicide Survey were linked with data from the Uniform Crime Reporting Survey and the ICCS to allow for the analysis of how incidents moved through the court system. Homicides reported by police from 2009 to 2021 where at least one accused person was identified and charges were laid or recommended by police were considered in scope and were linked to the ICCS data files for the fiscal years 2009/2010 to 2020/2021. Homicides that were uncleared (unsolved) and homicides where an accused individual was identified but no charges were laid (cleared otherwise) were excluded from the study, because these incidents did not move to court.

According to the Homicide Survey, 389 Indigenous women and girls were the victims of a homicide from 2009 to 2021 where police laid or recommended charges against at least one accused person in the incident. Of these, 48% were successfully linked to at least one charge in court. This linkage rate was comparable to the homicides of non-Indigenous women and girls (44%) and homicides of men and boys (49%) over the same period.

There are limitations that should be considered when interpreting the findings, namely data coverage, which has a particularly notable impact on homicide data, and elapsed time between an incident and the completion of a court case. It is also possible that incidents are not successfully linked because of missing or incomplete information in one or more of the files. Despite these limitations, the linked file affords the opportunity to examine quantitative and contextual factors, such as Indigenous identity, relationship, motive and other characteristics, that may be associated with court case characteristics and outcomes, in greater detail than would be possible if using the ICCS data on their own.

For more information on the victimization of Indigenous women, see " Homicide in Canada, 2021" and " Violent victimization and perceptions of safety: Experiences of First Nations, Métis and Inuit women in Canada".

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The Daily — Court outcomes in homicides of Indigenous women and girls, 2009 to 2021

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At both the policing stage and when charges were completed in court, homicides of Indigenous women and girls resulted in charges of manslaughter instead of murder more often than when the victims were non-Indigenous women or girls. A new study released today, ‘Court outcomes in homicides of Indigenous women and girls, 2009 to 2021,’ examines how homicides of Indigenous (First Nations, Métis and Inuit) women and girls moved through the court system, how they were treated at crucial decision points along the way, and how their outcomes compared with the homicides of non-Indigenous women and girls.

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Missing and Murdered Indigenous Women (MMIW)

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We're facing a crisis of Missing and Murdered Indigenous Women (MMIW) in the United States. Here's what you need to know about it.