“Our strength is our knowledge, and the foundation of healthy people,
healthy communities and healthy nations”
What First Nations People Think About
Their Health and Health Care
National Aboriginal Health Organization’s
Public Opinion Poll on Aboriginal Health and
Health Care in Canada
SUMMARY OF FINDINGS
FIRST NATIONS CENTRE
National Aboriginal Health Organization
July 2003
Table of Contents
Introduction...............................................................................................................................3
Definitions .................................................................................................................................4
Highlights of First Nations Results in the NAHO Public Opinion Poll .................................5
1.
First Nations Perceived Personal Health.......................................................................5
2.
First Nations Access to Health Care Providers .............................................................7
3.
First Nations Use of the Health Care System .............................................................. 10
4.
First Nations Satisfaction with the Health Care System ............................................. 13
5.
Sources of First Nations Health Information ............................................................. .16
6.
First Nations Attitudes Toward, and Use of, Healers and Medicines ........................ 16
7.
Ways to Improve Aboriginal Health ............................................................................ 18
2
Introduction
During the summer of 2002, the National Aboriginal Health Organization (NAHO) undertook its
first national Public Opinion Poll on Aboriginal Health and Health Care in Canada. The First
Nations component of the telephone poll was developed in co-operation with the First Nations
Centre (FNC) at NAHO and was conducted by the Strategic Counsel, a polling firm in Toronto.
The main focus of the poll was to obtain baseline information on First Nations People’s views and
opinions regarding certain health and health care issues, including:
•
perceived personal health;
•
access to health care providers;
•
use of the health care system;
•
satisfaction with the health care system;
•
sources of health information;
•
attitudes toward, and use of traditional healers and medicines; and
•
ways to improve Aboriginal health.
The national telephone poll involved 1,209 First Nations individuals (18 years and over) living on, or
near, a reserve. Conducted between July 24 and Aug. 6, 2002, 488 men and 721 women participated
in the poll.
First Nations respondents were included from every province and territory except Nunavut. Due to
the small sample sizes for the Northwest Territories and the Yukon, data for Alberta/N.W.T. and
British Columbia/Yukon were combined.
Respondents represented a cross-section of education and income levels, as well as, a cross-section
of communities based on population size and degree of isolation.
To obtain the First Nations sample, postal codes were compiled for each reserve and phone
numbers were purchased to match the postal codes. As some postal codes cover areas that include
communities, or areas that are not on-reserve, it is possible that the sample includes First Nations
individuals who off-reserve.
Based on a sample of 1,200, the results of the poll are accurate +2.83 points, 19 times out of 20.
The NAHO Public Opinion Poll on Aboriginal Health and Health Care in Canada is the first of its
kind in Canada. As an Aboriginal-defined and -controlled process, it is intended to measure and
amplify First Nations voices regarding general health issues. While the results of the poll do not
represent the views and perspectives on health and health care of all First Nations People in Canada,
the results do provide a snapshot of opinions and general perceptions of the First Nations
respondents at the time of the poll.
One of the key objectives of the FNC is to improve and promote the health of First Nations People
and their communities through knowledge-based activities. In this context, the First Nations
3
component of the NAHO poll can serve as one source of information to assist and inform First
Nations communities and their leadership in their work on health issues.
This report provides a summary and highlights of key findings of the First Nations component of
the NAHO poll.
Definitions
The following are terms that are used throughout this report:
Non-isolated communities:
Communities with road access of less than 90 km to the
nearest physician services.
Semi-isolated communities:
Communities with road access of more than 90 km to the
nearest physician services.
Isolated/remote communities:
Communities with no road access or scheduled flights, and
with minimal telephone or radio service.
Large community:
Communities with a population of 30,000 people or more.
Medium-sized community:
Communities with a population of 1,000 to 29,999 people.
Small community:
Communities with a population of less than 1,000 people.
4
Highlights of First Nations Results
in the NAHO Public Opinion Poll
1.
First Nations Perceived Personal Health
First Nations respondents in the NAHO poll were asked to rate whether they perceived their
personal health as excellent, very good, good, fair, or poor. The majority of First Nations
respondents (73 per cent) provided a positive rating (good to excellent) in respect of their perceived
health status with 13 per cent rating their health status as excellent, 27 per cent as very good, and 33
per cent as good. Twenty-seven per cent (27 per cent) of respondents reported their health status as
being fair or poor. Male respondents reported a slightly higher positive rating for their perceived
health status (at 76 per cent) than female respondents (at 70 per cent). (See Chart 1.)
% of total respondents
% of total female respondents
% of total male respondents
40%
35%
31%
30%
27%
25%
22%
20%
15%
12%
34%
27%
20%
10%
5%
33%
27%
13%
15%
8%
18%
7%
6%
0%
"Excellent"
"Very Good"
"Good"
"Fair"
"Poor"
Chart 1: First Nations respondents’ self-rated health, nationally and by gender
Overall, respondents in Quebec (at 80 per cent) reported the highest positive rating (good to
excellent) for perceived health status while the lowest positive rating reported by respondents was in
the Atlantic region (at 51 per cent).
There was a correlation between a positive health rating and the level of income and
education. Respondents earning $30,000 or more annually were more inclined to rate their
perceived health status as excellent or very good (at 50 per cent), as compared to respondents who
earned $30,000 and less (at 35 per cent). Similarly, 50 per cent of respondents with a high school or
higher education reported their perceived health status as being excellent or very good, while only 36
per cent of those with less than a high school education did the same. (See Chart 2.)
5
"Excellent" or "Very Good"
"Good"
"Fair" or "Poor"
33%
National (total)
27%
40%
34%
High school or less
30%
36%
29%
High school or more
21%
50%
32%
$30,000 or less
33%
35%
32%
$30,000 or more
50%
18%
Chart 2: First Nations respondents’ self-rated health, nationally and by income and education
First Nations respondents who considered their health status as being excellent or very
good identified regular exercise (48 per cent) and a balanced diet (43 per cent) as practices
that contribute most to their good health. Fifteen per cent (15 per cent) of respondents
attributed physical, emotional, mental, and spiritual balance, and 10 per cent work as factors
contributing to their good health. Finally, nine per cent of respondents attributed their good health
to not smoking, drinking or doing drugs, and eight per cent believed that it was a result of feeling in
control of their lives.
Despite the relatively high positive rating for perceived health status, First Nations
respondents reported being in poorer health than the Canadian population in general. Forty
per cent (40 per cent) of First Nations respondents in the NAHO poll, 18 years of age and older,
rated their perceived health status as being excellent or very good while 27 per cent rated their health
status as being fair or poor. In comparison, 61 per cent of Canadian respondents, 12 years and older,
in the Canadian Community Health Survey 2000/01 (CCHS) rated their health status as being excellent
or very good, and only 12 per cent perceived their health status as being fair or poor. 1 (See Chart 3.)
1
Figures have not been adjusted for the differences in sample age groups.
6
70%
61%
NAHO Poll, 2002
60%
50%
CCHS, 2000/01
40%
40%
33%
27%
30%
27%
20%
12%
10%
0%
"Excellent" or "Very
Good"
"Good"
"Fair" or "Poor"
Chart 3: Comparison of self-rated health between First Nations People and Canadians
2.
First Nations Access to Health Care Providers
When asked how easy it was to get appointments with various health care providers, First Nations
People reported having easier access to nurses (78 per cent), community health representatives
(CHRs) (73 per cent), social workers (68 per cent), addictions treatment professionals (68 per cent),
dentists (65 per cent), family doctors (59 per cent), and eye doctors (56 per cent) than to
pediatricians (49 per cent), mental health workers/psychologists (46 per cent),
obstetricians/gynecologists (41 per cent), and midwives (29 per cent). (See Chart 4.)
"Very" or "Somewhat" Easy Access
Midwives
Obstetricians/gynecologists
Mental health workers
Pediatricians
Eye doctors
Family doctors
Dentists
"Very" or "Somewhat" Difficult Access
29%
59%
41%
52%
46%
45%
49%
43%
56%
37%
59%
33%
65%
29%
Addictions workers
68%
25%
Social workers
68%
24%
CHRs
Nurses
73%
78%
20%
17%
Chart 4: First Nations respondents’ ease/difficulty of access to appointments with health
care providers
7
A significant percentage of respondents did not know whether access was easy or difficult in the
case of some service providers. Almost half of respondents (48 per cent), including half of female
respondents, did not know about midwife accessibility. One-fifth of respondents (20 per cent) did
not know how easy it would be to access mental health workers, with smaller but significant
percentages saying the same about pediatricians (18 per cent), addictions workers (16 per cent) and
social workers (14 per cent).
How easy it was for First Nations People to access health care providers varied by the
degree of community isolation and community size. In general, First Nations People living in
non-isolated and semi-isolated communities, and large and medium sized communities reported
easier access to health-care professionals than those living in isolated/remote and small
communities. Overall, respondents reported relatively lower accessibility to pediatricians, mental
health workers, obstetricians/gynecologists, and midwives, regardless of the degree of community
isolation and community size. However, those living in isolated/remote communities reported the
highest ease of access to CHRs, social workers and mental health workers.
In comparison to non-isolated and semi-isolated communities, respondents in isolated/remote
communities reported a higher degree of difficulty in accessing dentists, family doctors,
pediatricians, ophthalmologists/optometrists and obstetricians/gynecologists. (See Chart 5.)
In general, First Nations respondents living in small communities reported more difficulty in getting
appointments with health care providers than their counterparts living in medium or large-sized
communities. This was particularly true in respect of their accessibility to dentists, social workers,
drug and alcohol treatment workers, family doctors, pediatricians, and obstetricians/gynecologists.
(See Chart 6.)
8
Non-isolated communities
Semi-isolated communities
Midwives
62%
Obstetricians/gynecologists
48%
Mental health workers
47%
Pediatricians
32%
Family doctors
30%
58%
51%
60%
54%
44%
46%
41%
Eye doctors
48%
46%
49%
33%
42%
30%
Addictions workers
23%
33%
Social workers
26%
29%
Dentists
24%
CHRs
21%
Nurses
Isolated/remote communities
26%
18%
26%
41%
18%
17% 16%
18%
17%
Chart 5: First Nations respondents who reported that access to health care providers was
very or somewhat difficult by degree of community isolation
Small community
Medium-sized community
Midwives
Large community
28% 32% 35%
48%
Obstetricians/gynecologists
38%
Mental health workers
43%
60%
Pediatricians
47%
58%
53%
49%
58%
Eye doctors
55%
60%
Family doctors
56%
63%
64%
72%
Addictions workers
65%
76%
79%
Social workers
66%
76%
72%
Dentists
63%
CHRs
72%
Nurses
77%
71%
76%
82%
74%
78%
80%
Chart 6: First Nations respondents who reported that access to health care providers was very
or somewhat easy by community size
9
3.
First Nations Use of the Health Care System
First Nations respondents in the NAHO Poll were asked a number of questions concerning their
use of medical services, specifically: whether they had undergone a check-up or other health
treatment in the previous year; whether they had a regular doctor; and whether they had undergone
any of a number of tests.
More than three-quarters of respondents (78 per cent) reported having received a check-up or
treatment from a health care provider in the previous year. Respondents in non-isolated (81 per
cent) and semi-isolated (82 per cent) communities were more likely to have received care within the
last 12 months than respondents in isolated/remote communities (70 per cent). (See Chart 7.)
% of First Nations who said "yes"
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
82%
81%
78%
% of First Nations who said "no"
70%
30%
22%
National (total)
19%
Non-isolated
communities
18%
Semi-isolated
communities
Isolated/Remote
communities
Chart 7: First Nations respondents who reported receiving/not receiving treatment or check-up
in the previous year by degree of community isolation
Seventy-six per cent (76 per cent) of respondents reported having a regular doctor. Female
respondents reported a higher incidence of having a regular doctor (at 81 per cent) than
male respondents (at 68 per cent). (See Chart 8.)
10
% who said "yes"
90%
80%
% who said "no"
81%
76%
68%
70%
60%
50%
40%
32%
24%
30%
19%
20%
10%
0%
National (total)
Female respondents
Male respondents
Chart 8: First Nations respondents who reported having/not having a regular doctor,
nationally and by gender
Consistent with the general trend in respect of access to health care providers, respondents in nonisolated and semi-isolated communities were more likely to report having a regular doctor,
respectively at 85 and 81 per cent, than respondents in isolated/remote communities who reported a
significantly lower incidence of having a regular doctor at 52 per cent. (See Chart 9.)
% who said "yes"
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
85%
% who said "no"
81%
76%
52% 48%
24%
15%
National (total)
Non-isolated
communities
19%
Semi-isolated
communities
Isolated/Remote
communities
Chart 9: First Nations respondents who reported having/not having a regular doctor by
degree of community isolation
Similarly, there was a significant difference between respondents living in large communities and
those residing in small or medium-sized communities. Ninety-two per cent (92 per cent) of
respondents living in large communities reported have a regular doctor, while 74 per cent of
respondents in small and medium-sized communities, respectively, did the same. (See Chart 10.)
11
% who said "yes"
92%
100%
80%
% who said "no"
76%
74%
74%
60%
40%
24%
26%
26%
20%
8%
0%
National (total)
Large
communities
Medium-sized
communities
Small
communities
Chart 10: First Nations respondents who reported having/not having a regular doctor, by
community size
Respondents in the Atlantic region (97 per cent) and in Alberta/N.W.T. (84 per cent) were most
likely to report having a regular doctor while respondents in Manitoba (67 per cent) were least likely.
As part of the questions regarding the use of the health care system, respondents were asked
whether they had undergone any of a number of medical tests in the previous 12 months. The most
commonly undergone test was the blood pressure test (72 per cent), followed by the dental exam (57
per cent), blood sugar test (56 per cent), and an eye exam (54 per cent). The cholesterol test (39 per
cent) and the hearing exam (19 per cent) were the least common. Half (50 per cent) of female
respondents reported having had a pap smear and 22 per cent a mammogram in the last 12 months.
(See Chart 11.)
% who underwent test
Hearing exam
Mammogram
Cholesterol test
Pap smear
% who did not undergo test
81%
19%
75%
22%
60%
39%
46%
50%
Eye test
54%
46%
Blood sugar test
56%
44%
Dental exam
57%
43%
Blood pressure test
72%
28%
Chart 11: First Nations respondents who reported having/not having undergone medical tests
12
First Nations respondents were moderately more likely to have experienced an occasion, in
the previous year, when they did not receive needed health care, than the Canadian
population in general. Eighteen per cent (18 per cent) of First Nations respondents in the NAHO
poll, 18 years of age and older, reported they had not obtained needed health care. In comparison,
12.5 per cent of the Canadian population, 12 years of age and older, surveyed as part of the CCHS
reported they had not received needed health care in the previous 12-month period. 2 (See Chart 12.)
20%
18%
15%
NAHO Poll, 2002
12.5%
CCHS, 2000/01
10%
5%
0%
NAHO Poll, 2002
CCHS, 2000/01
Chart 12: First Nations People and Canadians who reported not receiving needed health care
in the previous year.
For almost one-half of First Nations respondents (47 per cent) who said they did not receive needed
health care in the previous year, the care in question dealt with a physical health problem. For 23 per
cent, it dealt with a regular medical visit. For 12 per cent, it was for an injury. And for seven per
cent, it was a mental health problem.
Of those who said they did not receive needed health care, the largest single group (22 per
cent) said it was because waiting time was too long. The next largest two categories were those
who said the care needed was not available in the area (14 per cent) or was not available at the time
required (13 per cent). All three categories involve availability issues. Other reasons cited by
respondents involved quality of care issues and included responses such as “didn’t get any help,”
“didn’t get proper care,” or “the service was culturally inappropriate.” Less than one-third of
respondents identified personal reasons for not being able to access needed health care, such as, the
cost and being too busy. Finally, eight per cent of respondents cited non-coverage, or the denial of
coverage by Non-Insured Health Benefits as reasons for not receiving needed health care.
4.
First Nations Satisfaction with the Health Care System
The majority of First Nations respondents rated the quality of health care they had received
in the previous year as being excellent or good. However, a positive rating for the quality of
health care received in the previous year was lower among First Nations respondents in the
NAHO poll than the Canadian population in general. Sixty-seven per cent (67 per cent) of First
2
Figures have not been adjusted for the differences in sample age groups.
13
Nations respondents, 18 years and older, provided a positive rating (excellent or good) for the
quality of health care received. In comparison, 84 per cent of Canadian respondents, 15 years and
older, in the CCHS reported a positive rating (excellent or very good) for the quality of health care
they had received in the previous year. 3 (See Chart 12.)
NAHO Poll, 2002 (18+ years)
CCHS, 2000/01 (15+ years)
100%
80%
84%
67%
60%
40%
20%
0%
NAHO Poll, 2002
CCHS, 2000/01
Chart 12: First Nations People and Canadians who provided a positive rating for the quality of
health care received
Almost half of First Nations respondents in the NAHO poll believed that the quality of
health care they had received was the same as that of other Canadians. Forty-nine per cent (49
per cent) of First Nations respondents said they believed the quality of health care services they had
received was the same as that of the general Canadian population. Twenty per cent (20 per cent)
rated their care as better and 24 per cent as worse than that of Canadians.
Respondents in the Atlantic region (83 per cent) followed by respondents in Quebec (81 per cent)
provided the highest positive rating (excellent or good) for the quality of health care received while
respondents in British Columbia/Yukon (60 per cent) and Manitoba (57 per cent) were the lowest.
(See Chart 13.)
3
Figures have not been adjusted for the differences in sample age groups.
14
"Excellent" or "Good"
"Fair" or "Poor"
60%
British Columbia/Yukon
38%
64%
Alberta/NWT
36%
68%
Saskatchewan
31%
42%
57%
Manitoba
34%
66%
Ontario
Quebec
81%
19%
Atlantic
83%
17%
67%
National (total)
32%
Chart 13: First Nations respondents’ rating of the quality of health care received in the previous
year, nationally and by region
Respondents residing in non-isolated and semi-isolated communities were more inclined to provide
a positive rating for the quality of health care received, respectively at 71 and 68 per cent, than were
respondents in isolated/remote communities, who reported the highest fair or poor rating for the
quality of care received at 57 per cent. (See Chart 14.)
"Excellent" or "Good"
80%
70%
60%
50%
40%
30%
20%
10%
0%
71%
67%
"Fair" or "Poor"
68%
57%
43%
32%
National (total)
29%
Non-isolated
communities
31%
Semi-isolated
communities
Isolated/Remote
communities
Chart 14: First Nations respondents’ rating of the quality of health care received in the previous
year, nationally and by degree of community isolation
The reasons given for both positive and negative ratings related to the quality and accessibility of
care. Forty-two per cent (42 per cent) of respondents who rated the health care they had received as
excellent or good did so because of the quality of care, and 39 per cent because of the accessibility of
care. At the same time, the one-third of respondents (32 per cent) who rated their received care as
15
fair or poor identified the lack of quality care (30 per cent) and the inaccessibility of care (32 per
cent) as reasons.
The majority of First Nations, who reported an incidence of unfair or inappropriate
treatment from a health care provider because they are Aboriginal, were receiving their
health services off-reserve. Fifteen per cent (15 per cent) of respondents reported having been
treated unfairly or inappropriately by a health care provider, in the last twelve months, because they
are Aboriginal, of which, 75 per cent were receiving their health services off-reserve when they
experienced the inappropriate treatment.
5.
Sources of First Nations Health Information
First Nations respondents who reported seeking health information did so from a variety of
sources. More than one-third (36 per cent) of respondents reported seeking information on
personal health issues such as nutrition, fitness and quitting smoking over the past year. Those who
sought information did so from a doctor (29 per cent), a CHR (20 per cent), a nurse (13 per cent), a
pharmacist (five per cent), and a health centre/clinic (10 per cent). Respondents also sought
information from written sources, such as pamphlets (12 per cent) and magazines, books or
newspapers (seven per cent). Seventeen per cent (17 per cent) of respondents sought information
from the Internet.
The tendency to use the Internet as a source of information was greater for respondents in nonisolated communities (21 per cent) than those in semi-isolated (11 per cent) or isolated/remote
communities (10 per cent).
6.
First Nations Attitudes Toward, and Use of, Tra
ditional Healers and
Traditional
Medicines
More than half of respondents (51 per cent) reported having used a traditional Aboriginal
healer or medicines. Of those, 37 per cent had done so in the previous six months.
Respondents in Saskatchewan reported the highest use of traditional healers and medicines at 62 per
cent while respondents in Ontario had the lowest at 43 per cent. (See Chart 15.)
There were slight variations in respect of the use of traditional care by degree of community
isolation. Respondents in semi-isolated (at 54 per cent) and non-isolated communities (at 52 per
cent) were more likely to report having used traditional care than those in isolated/remote
communities at 47 per cent. (See Chart 16.)
16
% who said "yes"
British Columbia/Yukon
% who said "no"
53%
46%
57%
Alberta/NWT
42%
62%
Saskatchewan
38%
Manitoba
44%
55%
Ontario
43%
57%
Quebec
Atlantic
National (total)
55%
45%
55%
45%
51%
49%
Chart 15: First Nations respondents who reported using/not using traditional healers and
medicines, nationally and by region
% who said "yes"
60%
50%
51% 49%
52%
% who said "no"
54%
47%
53%
45%
47%
40%
30%
20%
10%
0%
National (total)
Non-isolated
communities
Semi-isolated
communities
Isolated/Remote
communities
Chart 16: First Nations respondents who reported using/not using traditional healers and
medicines by degree of community isolation
While there was little variation in the use of traditional healers and medicines according to income
levels, there was a correlation between the use of traditional care and the level of education.
Respondents who reported having a high school education or higher were more likely to report
having used traditional care (at 62 per cent) than those with a high school education or less (at 47
per cent). (See Chart 17.)
17
% who said "yes"
National (total)
High school or less
High school or
more
% who said "no"
51%
47%
62%
49%
53%
38%
$30,000 or less
51%
48%
$30,000 or more
53%
47%
Chart 17: First Nations respondents who reported using/not using traditional healers and
medicines by level of income and education
The majority of First Nations respondents reported using traditional healers and medicines, and
would be more likely to use traditional care if it were locally available and covered by the health care
system. Seventy-two per cent (72 per cent) of respondents reported trusting the effects of traditional
medicine and 64 per cent said they knew where to access traditional care. However, 64 per cent also
said they knew very little about traditional medicines or healing practices. Sixty-eight per cent (68 per
cent) said they would use traditional care more often if it were available through their local health
centre and 62 per cent said they would use traditional care more often if it were covered by the
health care system. Finally, 44 per cent said they had to travel too far to get traditional care and 35
per cent identified cost as an issue.
7.
Ways to Improve Aboriginal Health
First Nations respondents in the NAHO poll were asked whether they agreed with a number of
statements on Aboriginal health, as well as to rate ideas to improve the health of Aboriginal Peoples.
The majority of First Nations respondents recognized the adverse effects of residential schools and
the loss of land and culture on Aboriginal health and identified a number of health priority areas for
improvement. Sixty-eight per cent (68 per cent) of First Nations respondents in the NAHO poll
agreed that the residential school experience and the loss of land and culture (63 per cent) have
contributed to the poorer health of Aboriginal Peoples. While 61 per cent of respondents believed
there was a lack of respect for Aboriginal cultures in the health care system, 56 per cent felt
Aboriginal Peoples are treated as well as non-Aboriginal peoples by the health care system. Finally,
less than half of respondents (43 per cent) preferred to visit an Aboriginal health care provider.
When asked which ideas would most improve Aboriginal health, respondents identified a number of
health care priorities they believed would improve Aboriginal health:
18
First Nations Ideas to Improve Aboriginal Health
Percentage of total
respondents
More information on health related topics available in the community
85 per cent
Increased funds for health care services
84 per cent
Better housing
84 per cent
Better translation and interpretation services in the health care system
83 per cent
Decreased use of drugs and alcohol
82 per cent
Better relations between Aboriginal and non-Aboriginal peoples
80 per cent
Developing culturally-relevant/responsive health care programs
80 per cent
Revival of Aboriginal cultures and traditions
75 per cent
Increased use of Aboriginal languages
72 per cent
A return to Aboriginal medicines and healing practices
67 per cent
Aboriginal control of health care services
66 per cent
19