A new study from the Canadian Institutes of Health Research (CIHR) has found that while Indigenous communities in the United States are experiencing significant challenges accessing health care, they are also experiencing a dramatic drop in their overall health care access.
In the study, researchers looked at data from the Health Status Index (HSI), which is the primary indicator of the health status of the population in Canada, and the Health Outcomes and Outcomes Analysis (HOA) database, which was developed by CIHR in the 1990s.
In total, the HSI recorded a drop of 16.6 per cent between 2006 and 2015, according to a report from CIHR published in the Canadian Medical Association Journal.
“This represents a dramatic decrease in the health outcomes of Indigenous people, compared to the general population,” said lead author Anne-Marie Ouellette, a postdoctoral researcher in the School of Public Health at the University of British Columbia in Vancouver.
Ouellette and her colleagues looked at the Hsi and HOA databases over a 12-year period, tracking the health of the Indigenous population over that time frame.
“The Hsi database provides us with a snapshot of the trends in health of a population,” she said.
The researchers found that in 2010, the population of Indigenous peoples was projected to decline by 6.2 per cent, but by 2020, the overall population of the country would be projected to grow by 12.3 per cent.
While the overall health of Canada’s Indigenous people was not impacted, the Indigenous health index was, Ouelette said.
While there was a significant drop in the HsI over that 12-month period, the researchers found a marked increase in the number of cases of cancer in Indigenous people.
While Indigenous communities are projected to experience a drop in overall health, there is a large drop in cancer cases, Oullette said.
In contrast, the incidence of cancer cases among the general Canadian population rose, according the CIHR study.
The number of cancer deaths fell.
“Overall, cancer rates are lower in Indigenous populations than in the general populations,” Ouellet said.
“We know from the Hsa and Hsa+ databases that cancer incidence is lower in Aboriginal populations and the HSA is higher than the Hse, and that’s the opposite of what we’ve seen in the population.”
The researchers also noted that while there was an increase in cancer deaths in Indigenous communities, the rates were lower than in non-Indigenous populations.
“It’s possible that in some communities there are more cancers and more deaths that would be expected if they had more cancers,” Oullet said, adding that she believes there may be other factors at play.
“I think that this is a very strong evidence for the importance of the Hsis, but also of the importance for Indigenous people in terms of their health,” Ohulette said, noting that the Hses data is based on mortality rates and survival.
“What we know is that if we’re looking at mortality, there’s a very high correlation between the His, Hsi, and Hsi+ databases,” she added.
“That’s why we need to be careful about extrapolating from that to what we need as health outcomes.”
The study also found that Indigenous women experienced a significant increase in their risk of breast cancer.
However, that increase in risk was not as great as the cancer cases reported by the Hsieh and Hsia data.
“There are some women who have breast cancer, but they’re very unlikely to be at a higher risk of developing cancer,” Oulette said of Indigenous women.
“It’s important to be aware that it is a small percentage of women in our population.”
Ouellet’s team hopes that this new study will help inform how Indigenous communities can better understand the impact of healthcare inequity in the country.
“There’s a lot of good data out there that shows the effects of healthcare inequality and that we can use it to make policy,” she suggested.
The CIHR report comes as Canada’s provincial and territorial governments continue to negotiate over health care legislation.
The federal government has made progress in its efforts to include health and social services in the omnibus budget bill, but the legislation is expected to be passed in the coming weeks.
Oulette noted that the study shows that Indigenous people are not the only ones experiencing a significant reduction in health care services.
“The federal government’s omnibus health bill has been very good on health equity,” she noted.
“But it’s still a work in progress.”