For the first time, researchers have access to detailed information about how an urban Aboriginal population in Canada uses health care. A new study, called Our Health Counts, uses this health database to clearly demonstrate the unique challenges faced by urban Aboriginal people in Canada -- according to researchers at St. Michael's Hospital.
The findings, published in BMJ Open, illustrate striking disparities between urban First Nations individuals and the general population.
Researchers interviewed 554 First Nations adults in Hamilton, Ont. -- chosen for its large Aboriginal population and strong infrastructure of Aboriginal community health and social services. Researchers collected data for factors that influence a person's health such as poverty, illness and income for Hamilton's First Nations population.
"Compared to Hamilton's general adult population, we found elevated emergency room use, multiple barriers to health care access and significant rates of chronic disease among urban Aboriginal adults," said Dr. Michelle Firestone, an associate scientist with St. Michael's Hospital's Centre for Research on Inner City Health.
More than 10 per cent of First Nations adults visited the emergency room six times or more in the previous two years -- only 1.6 per cent of Hamilton's general adult population could say the same.
"Hamilton has extensive health and social services but 40 per cent of respondents felt their access to health care was either fair or poor," said Dr. Firestone, who holds a PhD in public health. "This shows geography is not the only health care barrier for First Nations people."
Almost half of respondents reported that long waiting lists to see a specialist were a barrier. Other common barriers included not being able to arrange transportation; not being able to afford direct costs or transportation; services not covered by non-insured health benefits and lack of trust in health care providers.
More than 60 per cent of Aboriginal people living in Ontario live in urban areas. An increasing number of First Nations individuals are moving to urban centers to seek better housing, employment and education opportunities and for the services and amenities available.
The most common chronic conditions of Hamilton's First Nations adults included arthritis (30.7 per cent), high blood pressure (25.8 per cent), asthma (19 per cent) and diabetes (15.6 per cent).
Among First Nations adults living in Hamilton:
- 73 per cent of respondents reported an upper respiratory tract infection in the past 12 months
- 25 per cent reported having been injured over the past 12 months
- 78 per cent earn less than $20,000 per year
- 70 per cent live in the city's lowest-income neighbourhoods
Aboriginal people are often excluded, unidentified, or under-represented in most Canadian health information databases. Our Health Counts fills this health information void by using respondent-driven sampling -- a research method used to recruit hidden or stigmatized populations by relying on participants to identify the next wave of study recruits. Our Health Counts is the first respondent-driven sampling of urban First Nations people in Canada.
"Our Health Counts is a significant contribution to public health," said Dr. Firestone. "This data will have important implications for health service delivery, programming and policy development. It should directly inform strategic directions and improve health of urban Aboriginal people in Ontario."
- Michelle Firestone et al. Unmasking health determinants and health outcomes for urban First Nations using respondent-driven sampling. BMJ Open, July 2014 DOI: 10.1136/bmjopen-2014-004978
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