Aboriginal Health Human Resources:
A Matter of Health
Emily Lecompte, PhD Candidate, Research and Policy Officer, Aboriginal Health Human
Resource Initiative (AHHRI), Health Canada, Ottawa, Ontario
Disclaimers: Health Canada recognizes that Inuit in Canada do not reside on-reserve but
in northern communities and settlements. Further, Health Canada also acknowledges that
Métis people may reside in Métis communities and settlements in Canada. Data used for
this report were provided by Statistics Canada and information in this document does not
reflect the above-mentioned distinctions. Please consult the Statistics Canada website for
more information on data, methods, and operational definitions used for the Census.
ABSTRACT
This report examines the supply and distribution of Canadian health human resources based
on geographic region, area of residence, Aboriginal identity, and occupation. Analyses are
from the Census’ long form survey (20 per cent data sample) from 1996, 2001, and 2006.
Statistics are used to illustrate trends in health care. In 2006, health care providers accounted
for 1,012,615 people; 2.15 per cent identified as Aboriginal and of this, 46 per cent were First
Nations, 48 per cent were Métis, and 2 per cent were Inuit. Upward trends are noted in registered nursing, midwifery and practitioners of natural healing, dieticians and nutritionists,
and physicians.
KEYWORDS
Aboriginal people, health human resources, health care occupation, social determinants of
health, census data
INTRODUCTION
T
he report of the Royal Commission on
Aboriginal Peoples (RCAP) is a 4,000-page
study on issues affecting Aboriginal persons
and provides 440 recommendations. It was launched
in 1991 by the Government of Canada. During the
following 5 years, the RCAP analyzed different
issues and released a final report in November 1996,
including a section on a human resource strategy.
Four objectives were outlined in order to address
important issues affecting Aboriginal people:
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Journal de la santé autochtone, mars 2012
1) Increasing the capacity and number of education
and training programs that are provided by
Aboriginal institutions;
2) Improving the contribution of mainstream
education and training programs to the development
of Aboriginal human resources;
3) Improving Aboriginal students’ ability to pursue
education and training through financial and other
supports; and
4) Improving the cultural appropriateness and
effectiveness of education and training programs
to meet the needs of Aboriginal students and
Aboriginal Health Human Resources
communities (Indian and Northern Affairs Canada,
n.d.).
RCAP recommended to the federal government
to train 10,000 Aboriginal people in health careers
(Downey, 2003) over the next decade. While progress
in health care appears positive, data used for this
report indicate that critical gaps in Aboriginal health
human resources in Canada still exist. Increases have
been noted in key health professions and assisting
professions (paraprofessions) in a previous study
(Lecompte & Baril, 2008). However, a key component
to progress is looking at the impact of certain
programs, services, and initiatives that have recently
been implemented on the increasing numbers of
health care occupations, and examining the demand
for health services across Canada.
Aboriginal Canadians and the health care system
According to the 2006 Census, Aboriginal people make up
almost 4 per cent (3.8 per cent) of Canada’s population, with
the fastest growth found among Métis people (Statistics
Canada, 2008a). With growing numbers of Aboriginal
peoples in Canada over time, there is also a growing need for
Aboriginal health human resources and human resources in
general to address the particular needs and concerns of this
population in a way that is culturally competent, adequate,
and efficient.
Objectives
The current report had several objectives:
1) To build on a previous analysis that examines labour
force characteristics and Census data as a means to better
illustrate and explain trends in health care occupations as
they affect First Nations, Inuit, and Métis people.
2) To provide a more complete portrait of the Aboriginal
and non-Aboriginal workforce in health occupations using
Census data collected on three separate occasions from 1996
to 2006. The following variables were analyzed in order to
illustrate labour market tendencies: Aboriginal identity,
geographic location, area of residence, age, gender, and
health care occupation.
3) To highlight cumulative tendencies in the field of heath
care to better understand and predict future outcomes in the
supply and demand, recruitment, and retention of health
care providers as well as detecting differences in spatial
trends.
METHODS
Data sources and material
Results from the long form questionnaires (20 per cent data
sample) of the 1996, 2001, and 2006 national Censuses from
Statistics Canada were used. A national population census is
conducted every 5 years in order to better understand trends
affecting Canadians in all ten provinces and three territories.
The long form of the Census questionnaire is given to one in
every five Canadian households (20 per cent).
During each collection period, cross-sectional data
was gathered by Statistics Canada. Several variables were
examined such as Aboriginal identity, geographic region,
area of residence, age, gender, and type of health occupation.
This study uses three consecutive periods of cross-sectional
data to examine trends within health occupations over a
10-year period for Aboriginal and non-Aboriginal health
human resources. During 1996, 77 Indian reserves and
Indian settlements did not take part in data collection,
which affected the Census data quality. The number of
incompletely enumerated Indian reserves and settlements
decreased in 2001, when a total of 30 did not participate.
In 2006, the Census counted 22 Indian reserves where
interruptions to data collection were experienced. As a
result, Census data has been adjusted to reflect changes in
participation rates for Indian reserves and settlements by
Statistics Canada (Statistics Canada, 2008a). Thus, while
response rates varied over the 10-year period, the quality
of Census data increased over time where the number of
incompletely enumerated Indian reserves and settlements
decreased.
RESULTS
Statistics were used to illustrate trends in Canadian health
occupations over the three consecutive census periods (1996,
2001, and 2006).
In 2006, Canadian workers in health occupations
surpassed the million mark, with health professional and
paraprofessionals accounting for a workforce of 1,012,615
people (Table 1). In this year, Aboriginal health human
resource providers represented approximately 2.2 per cent
(21,815 people) of Canadian health human resources
(Statistics Canada, 2008b). This proportion is an increase
from 1.65 per cent in 2001 (Statistics Canada, 2003a) and
1.16 per cent in 1996 (Statistics Canada, 2003b). Of the 2.2
Journal of Aboriginal Health, March 2012
17
Aboriginal Health Human Resources
per cent of the Aboriginal health human resource workforce,
46 per cent were First Nations, 48 per cent were Métis, and
2 per cent were Inuit (Statistics Canada, 2008b).
Occupational tendencies
Proportional increases can be observed in many health
care occupations for Aboriginal people since Census data
was gathered in 1996. In particular, increasing trends are
seen in nurses, midwives, practitioners of natural healing,
dieticians and nutritionists, general practitioners and family
physicians, specialist physicians, and occupational therapists.
A proportional increase of 130 per cent is observed for
registered nurses between 1996 and 2006. Over this decade,
the number of Aboriginal midwives and practitioners
of natural healing increased by 230 positions or 418 per
cent. Moreover, a 460 per cent increase of Aboriginal
dieticians and nutritionists is observed from 1996 to 2006.
Aboriginal general practitioners and family physicians have
increased 246 per cent, from 65 to 225, while Aboriginal
specialist physicians have gone up 300 per cent or a total
of 75 positions. Over this same period, the number of
occupational therapists went from 30 to 70, representing an
increase of 133 per cent. In most health care occupations,
the highest increases can be observed from 1996 to 2001.
For example, a 340 per cent increase is observed during this
5-year period but only a 27 per cent increase is observed
Table 1. Aboriginal and non-Aboriginal health care workers from 1996 to 2006*
Census Year
1996 Census
2001 Census
2006 Census
Aboriginal Health Human
Resources
8,840 (1.2 per cent)
13,980 (1.6 per cent)
21,805 (2.15 per cent)
Non-Aboriginal Health
Human Resources
Total Canadian Health
Human Resources
757,995 (98.8 per cent)
766,830
844,675 (98.4 per cent)
858,655
990,805 (97.85 per cent)
1,012,610
*Adapted from Statistics Canada, 2003a; 2003b; 2008b
between 2001 and 2006. Similar tendencies are noted for
previously mentioned health occupations with the exception
of nursing. While the number of registered nurses increased
39 per cent from 1996 to 2001, the number further
increased to 65 per cent from 2001 to 2006.
On- and off-reserve tendencies
The distribution of Aboriginal health human resources in
Canada varies from north to south and from east to west
(Table 2). In 2006, the majority of Aboriginal health human
resources were located in Ontario (24.8 per cent), and 56.6
per cent were located across British Columbia, Alberta,
Saskatchewan, and Manitoba. Ten per cent of Canada’s
Aboriginal health human resources were distributed across
Quebec, and 6.14 per cent of provided health care services
were in Newfoundland, Nova Scotia, Prince Edward Island,
and New Brunswick, inclusively. In the northern territories
including Yukon, Northwest Territories, and Nunavut, 2.34
per cent of Canada’s Aboriginal health human resources
services were provided.
Higher numbers of Aboriginal health workers can be
found working in off-reserve areas. Off-reserve tendencies
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Journal de la santé autochtone, mars 2012
from 1996 to 2006 show large increases in the number
of Aboriginal health human resources for First Nations
and Métis groups, however, the number of Inuit health
professionals and paraprofessionals has remained stable. The
number of Métis health professionals and paraprofessionals
working in off-reserve areas has significantly increased,
from 2,895 in 1996 to 10,425 a decade later. The largest
increase for this group is observed between 2001 and 2006,
when Métis representation in health careers grew from
5,835 health workers in 2001 to almost 5,000 more just 5
years later. For First Nations people, these numbers have
increased from 3,745 to 7,530 over the same period. For the
Inuit, an increase of 105 positions from 1996 to 2001 can be
observed, however, numbers stabilized to approximately 430
health care workers from 2001 to 2006.
On-reserve populations are mostly being served by First
Nations health care providers. Since 1996, the number of
First Nations health human resources has increased by over
1,100 positions, from 1,435 to 2,550 over a 10-year period.
However, the number of health care providers identifying
as Métis and Inuit working on-reserve has decreased since
2001. Increases for both groups can be observed from 1996
Aboriginal Health Human Resources
Table 2. The distribution of Aboriginal health care providers across Canada in 2006*
Province/Territory
Aboriginal Health Human Resources
Non-Aboriginal Health Human
Resources
Total Health Human Resources
Newfoundland/
Labrador
475
(2.18 per cent)
15,770
(1.59 per cent)
16,245
(1.6 per cent)
Prince Edward
Island
30
(0.14 per cent)
4,710
(0.48 per cent)
4,740
(0.47 per cent)
Nova Scotia
530
(2.43 per cent)
32,475
(3.28 per cent)
33,000
(3.26 per cent)
New Brunswick
305
(1.4 per cent)
25,320
(2.56 per cent)
25,625
(2.53 per cent)
Quebec
2,190
(10 per cent)
248,810
(25.11 per cent)
251,005
(24.79 per cent)
Ontario
5,415
(24.82 per cent)
356,460
(35.97 per cent)
361,880
(35.74 per cent)
Manitoba
4,035
(18.5 per cent)
39,200
(3.96 per cent)
43,235
(4.27 per cent)
Saskatchewan
2,020
(9.26 per cent)
32,255
(3.25 per cent)
34,280
(3.39 per cent)
Alberta
3,230
(14.8 per cent)
107,635
(10.86 per cent)
110,865
(10.95 per cent)
British Columbia
3,065
(14 per cent)
126,320
(12.75 per cent)
129,385
(12.78 per cent)
Yukon
105
(0.48 per cent)
870
(0.09 per cent)
980
(0.096 per cent)
Northwest
Territories
285
(1.31 per cent)
765
(0.08 per cent)
1,050
(0.1 per cent)
Nunavut
120
(0.55 per cent)
210
(0.02 per cent)
330
(0.032 per cent)
Canada
21,815
(100 per cent)
990,805
(100 per cent)
1,012,615
(100 per cent)
*Adapted from Statistics Canada, 2008b
to 2001, specifically from 15 to 80 health providers for the
Métis and from 0 to 15 for the Inuit. Between 2001 and
2006, a difference of 30 Métis health providers and an
absence of Inuit representation are observed.
Gender in the workplace
The predominance of specific genders can be observed across
certain health careers and fields of education and training.
While most health care providers are female, there is a large
increase in Aboriginal health workers for both genders since
1996, a proportional increase of 139 per cent for males and
148 per cent for females (Table 3). In particular, the 2006
Census reports that 66 per cent of specialized physicians and
61 per cent of general practitioners and family physicians
are male, while 94 per cent of the 288,500 registered nurses
in Canada are female. These numbers are made up of
Aboriginal and non-Aboriginal health human resources.
Further, the field of dentistry is also mostly male, with
13,145 (69%) of health workers representing this gender.
Age distribution of Aboriginal and nonAboriginal health human resources
Since 1996, most of the health labour force has been
between 25 to 44 years of age. While almost 50 per cent of
health workers (48.6 per cent) were in this age bracket in
2006, a significant increase is observed in the age bracket of
45 to 64 years of age between the 1996 and 2006 Censuses.
In 1996, health workers in this age bracket accounted for
247,735 people. Ten years later, this number rose to 416,850.
In 2006, 41.16 per cent of health human resources were
between 45 to 64 years of age, compared to 32.3 per cent
10 years earlier. Of those entering the health labour force,
78,740 (7.77%) were between 15 to 24 years of age in 2006
and the remaining 24,530 (2.42 per cent) were over 65 years
of age.
This trend can also be noted in the age distribution
of Aboriginal health human resources as reported in the
2006 Census. Almost 55 per cent of Aboriginal health
workers identify themselves as between 25 to 44 years of age
(11,945), and 33.5 per cent of Aboriginal health workers
Journal of Aboriginal Health, March 2012
19
Aboriginal Health Human Resources
identify themselves as between 45 to 64 years and are
approaching the age of retirement (7,305). Encouragingly,
10.7 per cent of Aboriginal people in health occupations are
between the ages of 15 to 24, and those over the age of 65
represent only 1 per cent.
Limitations and implications of this report
Statistics Canada appears to be making significant
improvements in reaching hard-to-count populations.
However, the undercounting of certain Aboriginal
settlements and reserves affects our ability to make
accurate predictions on spatial trends and the supply of
Aboriginal and non-Aboriginal health professionals and
paraprofessionals. The number of incompletely enumerated
Aboriginal communities and settlements has decreased from
77 in 1996 to only 22 in 2006 (Statistics Canada, 2008a).
For this reason, we may only draw tentative conclusions
based on the systematic analysis of Census data. Further, due
to concerns over the privacy, confidentiality, and autonomy
of Canadians who participate in the Census, generalizations
of data cannot be made at the individual level. However,
Statistics Canada has worked hard to address certain levels
of generalizations that can be made, and have data from
the 2006 Census available at the municipal and postal
code level. Moreover, information collected by Statistics
Canada is limited since we may not be able to know non-
Table 3. The distribution of Aboriginal men and women in the health
workforce: 1996 to 2006*
Census Year
Aboriginal Men
Aboriginal Women
1996 Census
1,305
7,530
2001 Census
2,135
11,845
2006 Census
3,125
18,685
*Adapted from Statistics Canada, 2003a; 2003b; 2008b
quantitative information affecting health care professionals
and paraprofessionals. A mixed model approach may be
more useful to capture the experiences and reality of health
care workers in Canada. Despite these limitations, the use
of Census data remains one of the most cost-effective ways
of knowing quantitative information about Canadians at a
nation-wide level.
What is evident in this report is that recruitment and
retention strategies of First Nations health care givers in
on-reserve areas are effective. What we are unsure of is
where the Métis and Inuit caregivers are working once they
exit from working on-reserve (or northern territories or
Métis communities and settlements) since there is a slight
decline in Métis and Inuit health care workers in this area
over time. In the future, it may be beneficial to concentrate
on increasing the number of skilled, qualified, and trained
Métis and Inuit health care providers to meet the needs and
concerns of these Aboriginal sub-groups in these areas. For
example, the Métis are recognized as the fastest growing
Aboriginal population (Statistics Canada, 2008c). As these
people age, they may benefit from the knowledge and
20
Journal de la santé autochtone, mars 2012
skills of an Aboriginal workforce that is trained to manage,
account for, and consider the broader issues and concerns at
the core of certain determinants of health and illness. Exit
surveys can further investigate why Métis, Inuit, or nonAboriginal health care workers leave on-reserve sites. These
surveys may help identify what motivates health workers
to practice and provide health services in off-reserve areas
or in other provinces or territories. Qualitative research can
be used to further inquire about how to retain health care
workers in on-reserve areas or even in rural or remote areas.
Also, while this report identifies aging Aboriginal
and non-Aboriginal health care providers, it is difficult to
determine the exact point when individuals plan on retiring
based on Census data. However, as Aboriginal and nonAboriginal health care workers increase in age and number,
so does the general Canadian population. Although more
people are working in the health care system than a decade
ago, demand for particular services may be increasing. This
may translate to more frequent clinic or hospital visits, and
thus an increased need for skilled and knowledgeable health
care staff. As certain illness and disease rates increase in
Aboriginal Health Human Resources
some Aboriginal groups, the need for specialized services
and consultations may further increase. Therefore, a more indepth examination of the supply, demand, recruitment, and
retention of Aboriginal health human resources in specific
fields is strongly suggested. This would better address wait
times across different regions in Canada and help direct
programs and initiatives seeking to increase Aboriginal and
non-Aboriginal health human resources.
CONCLUSION
Findings from this report can help guide health human
resource strategies by highlighting trends on the mix
and distribution of skilled, qualified, and knowledgeable
health care professionals and paraprofessionals over unique
Canadian regions. These findings can also help Aboriginal,
federal, provincial, territorial, and health professional
associations and educational institutions to develop and
implement initiatives to support Canadian health care.
Research activities and programs are typically guided and
driven by specific information and data and should be
complimentary to policy in order to improve the health and
the lives of Aboriginal people.
As access to health care programs, services, information,
and resources changes due to economic, political, social,
geographic, cultural, and religious reasons, so will the supply
and demand of health care providers who offer services and
support in different areas and jurisdictions. By being aware
of trends and tendencies in the health care system, we, as
researchers, evaluators, analysts, and decision-makers, can
translate this knowledge to various levels of governments
who can then better act and respond to the unique needs
and concerns of the most vulnerable citizens who use and
benefit from Canada’s health care services.
Census data used in this report illustrate the number
of Aboriginal people working in health careers over the
past 10 years. Results from this report show that the
recommendation of the RCAP to train approximately
10,000 Aboriginal people in allied health careers since 1996
(Downey, 2003) has been reached and exceeded. Almost
13,000 (12,965) First Nations, Inuit, and Métis people
have entered health careers since 1996 (Statistics Canada,
2003b; Statistics Canada, 2008b), which has enabled the
meaningful and important contribution of Aboriginal
people to the delivery of health care to Canadians.
The social determinants of health, as well as geography,
have an impact on health care systems and access for First
Nation, Inuit, and Métis people. Certain chronic diseases
such as diabetes (The Canadian Press, 2009; Young,
Reading, Elias, & O’Neil, 2000), cardiovascular disease,
and atherosclerosis continue to disproportionately affect
First Nations, Inuit, and Métis people and Aboriginal
communities in Canada (Anand et al., 2001) and around
the world (The Canadian Press, 2009). The importance
of increasing the number of Aboriginal people in health
careers, in particular specialized health fields, has attracted
more attention and demand in recent times. As health
services and culture have been recognized as key social
determinants of health (Health Canada, 1996), governmentand non-government-funded initiatives have sought to
improve these indicators to improve Aboriginal health.
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Journal de la santé autochtone, mars 2012
Your Health at Home
What you can do!
An Environmental Health Guide for Inuit
Get your guide today!
To learn more about environmental
health issues and tips on how to
make changes in your home, visit
your local health centre or go to
www.healthycanadians.gc.ca/
environment