Changes in health indicator gaps between First Nations and other residents of Manitoba

Background:The Truth and Reconciliation Commission of Canada has called for better reporting of health disparities between First Nations people and other Canadians to close gaps in health outcomes. We sought to evaluate changes in these disparities using indicators of health and health care use over the last 2 decades.Methods:We used linked, whole-population, administrative claims data from the Manitoba Centre for Health Policy for fiscal years 1994/95 to 1998/99 and 2012/13 to 2016/17. We measured indicators of health and health care use among registered First Nations and all other Manitobans, and compared differences between these groups over the 2 time periods.Results:Over time, the relative gap between First Nations and all other Manitobans widened by 51% (95% confidence interval [CI] 42% to 60%) for premature mortality rate. For potential years of life lost, the gap widened by 54% (95% CI 51% to 57%) among women and by 32% (95% CI 30% to 35%) among men. The absolute gap in life expectancy widened by 3.14 years (95% CI 2.92 to 3.36) among men and 3.61 years (95% CI 3.38 to 3.84) among women. Relative gaps widened by 20% (95% CI 12% to 27%) for ambulatory specialist visits, by 14% (95% CI 12% to 16%) for hospital separations and by 50% (95% CI 39% to 62%) for days spent in hospital, but narrowed by 33% (95% CI −36% to −30%) for ambulatory primary care visits, by 22% (95% CI −27% to −16%) for mammography and by 27% (95% CI −40% to −23%) for injury hospitalizations.Interpretation:Disparities between First Nations and all other Manitobans in many key indicators of health and health care use have grown larger over time. New approaches are needed to address these disparities and promote better health with and for First Nations.

Comprehensive data on the health of First Nations people in Canada are urgently needed.^1,2 This is a priority identified by the Truth and Reconciliation Commission of Canada, which highlights the striking health disparities between Indigenous and non-Indigenous populations in Canada and recognizes the disparities in their Calls to Action as “a direct result of previous Canadian government policies.”³ These health disparities are understood to be part of the continuing impact of colonization and genocidal policies aimed specifically at Indigenous people.^4,5The underlying causes of the health gap between Indigenous and non-Indigenous people, resulting from attempts by European settlers to assimilate Indigenous people into their own societies, have been detailed elsewhere.⁶ The collective trauma that Indigenous populations have experienced through colonial policies and practices include, among others, racism and marginalization in virtually every aspect of their lives; major disruptions of families and communities through forced attendance at residential schools and by the child welfare system; trauma from physical, emotional and sexual abuse, carried over into future generations; and damage to their Indigenous identity through loss of culture, language, traditions and teachings.^6,7 Other social determinants (e.g., poverty, social exclusion and poor access to clean water, quality housing, education and heath services) and the governments’ failure to address these issues also influence the health of First Nations people.^8,9A previous population-based study of First Nations’ health and health care use in Canada, published in 2002, focused on the Manitoba population, which has the highest proportion of First Nations residents among Canadian provinces.¹⁰ It identified substantial gaps in the health of First Nations and their access to health services compared with other Manitobans. Others have since reported on health disparities between Indigenous peoples and other Canadians;^11–14 however, the Manitoba data provide a unique opportunity to compare changes in health-related outcomes over nearly 2 decades. In the present study, we sought to compare indicators of health and health care use between First Nations people and other residents of Manitoba, to determine whether the gap between the 2 groups has changed over the past 18 years and establish whether any progress has been made in improving First Nations’ health.