Aboriginal People and Other Canadians: Shaping New Relationships

Chapter 5 Aboriginal Peoples: Health and Healing

Chapter 5 Aboriginal Peoples: Health and Healing Geoffrey Mercer Introduction Throughout the twentiethcentury, the health status of the Aboriginal population, whether assessed by mortality or morbidity rates or other indicators of general social malaise, has been significantly worse than for the rest of Canadians. Aboriginal peoples have been denied control of their own communities and lives, and have felt helpless in the midst of wide-ranging social and political injustices. Not until the 1970s did the growth ofpolitical protest impress governments with the need for a change in Aboriginal-state relations in order to address these deepseated inequalities, including the significant "health divide."Indeed, a central objectiveof theseAboriginal campaignshas been to link action against the sources of ill-health with a wider healing process that restores Aboriginalrights andself-government. This chapter will examine the emergence of "health and healing" in recent policy debates. It will: first, outline the sorry legacy of Aboriginal ill-health during the twentieth century; second, outline the changing trajectory of health policy; third, explore the central features of a wide-ranging critique and the promotion of a "new strategy," as presented in the Report of the Royal Commission on Aboriginal Peoples (RCAP, 1996b, 1996c); and finally, examine specific recommendations for health services, together with the initial government proposals for a "renewed partnership" in the health care system. 131 Geoffrey Mercer A Sorry Legacy The contact ith Europeans is widely accepted as disastrous for the health of Aboriginal Peoples: with the population decimated by infectious diseases, and the environment and its resources increasingly diminished and polluted (Young, 1988). The pattern of ill-health is maintained through the twentieth century, with much higher mortality rates among Aboriginal peoples compared with the rest of the Canadian population. There have been important reductions in Aboriginal mortality rates, particularly over the last three decades, but a significant health divide remains because of parallel improvements for all Canadians. Thus, the Infant Mortality Rate (IMR) for Registered Indians in the late 1980s was one-sixth of what it was in the 1950s, while the Inuit IMR declined even more sharply. Again, recent figures show a fall in the IMR for Registered Indians from 28 to 11 per 1,000 live births between 1979 and 1993 but this was matched by a decline from 11 to 6 in the overall Canadian rate. These patterns are replicated across most measures of health status and well-being: • life expectancy at birth in 1990 was 7-8 years less for First Nations than for Canadians as a whole—ranging from 66.9 years for men to 74 years for women, compared with national rates of 73.9 and 80.5 years respectively; • mortality rates for registered Indians in the late 1980s were the highest for all age groups, with infant mortality (at 14 and 20 per 1,000 births for Registered Indians and Inuit) more than twice the national rate; • the causes of mortality demonstrate significant contrasts: accidents, violence and self-injury are particularly high, with the Aboriginal suicide rate six times more than the Canadian average (and eight times higher among Aboriginal females aged 15-24 years); • levels of infectious diseases are much higher in the Aboriginal population (with the incidence of tuberculosis rate almost seven times greater); while visual, hearing and communication impairments, degenerative and life threatening conditions (particularly diabetes and heart disease) are more prevalent and/or increasing at a faster rate (including HIV/AIDS and cancer); 132 Aboriginal Peoples: Health and Healing • higher rates of utilisation of health services, and longer lengths of stay in hospital; and • higher levels of social malaise, as instanced by rates of alcoholism, drug and solvent addiction, accidents, violence and self-harm, child and sexual abuse (Young, 1994; RCAP, 1996b). The data base on which these conclusions are drawn is far less reliable for the Aboriginal than the non-Aboriginal population. The Department of Indian Affairs and Northern Development (DIAND) is responsible for those First Nations people (Registered Indian and Inuit) living on reserves or in northern communities for whom the federal government has constitutional jurisdiction. In contrast, census data have recently shifted to self-definition as the criterion for Aboriginal status. Indeed, both data sets are characterised by changes in collection and reporting practices, particularly in their recording of morbidity levels and patterns. Consequently, for most of the twentieth century, the health status of the non-status Indian and Metis populations, who comprised two-thirds...