First Peoples lost: Determining the state of status First Nations mortality in Canada using administrative data

• Published date: 01 May 2019
• Author: Donna Feir,Randall Akee
• Date: 01 May 2019
• DOI: http://doi.org/10.1111/caje.12387

490 D. Feir and R. Akee

Canadian Journal of Economics / Revue canadienne d’économique 2019 52(2)

May 2019. Printed in Canada / Mai 2019.Imprimé au Canada

ISSN: 0008–4085 / 19 / pp. 490–525 /©Canadian Economics Association

First Peoples lost: Determining the state

of status First Nations mortality in Canada

using administrative data

Donna Feir

Department of Economics, University of Victoria; Federal Reserve

Bank of Minneapolis, Center for Indian Country Development

Randall Akee

UCLA, Brookings and NBER

Abstract. We present the most comprehensive set of estimates to date for status First

Nations mortality in Canada. We use administrative data from Indigenous and Northern

Affairs Canada to establish a set of stylized facts regarding status First Nations mortality

rates. Between 2010 to 2013, the mortality rates of status First Nations men and boys

are highest in nearly all age groups of status First Nations considered, with the exception

of status girls between the ages of 10 to 14. On reserve, status boys between the ages

of 15 to 19 have mortality rates nearly four times that in the general population, while

status girls between the ages of 15 to 19 have mortality rates five times that in the

general population. We demonstrate substantial regional variation in mortality rates.

Finally, we document that there has been no improvement in mortality among status

women and girls living on reserve in the last 30 years and relative mortality rates for all

status people on reserve has not changed in 40 years.

Résumé. Premières Nations perdues : évaluation du taux de mortalité des membres

des Premières Nations inscrits au Canada basée sur des données administratives. Nous

présentons l’ensemble de données le plus complet relativement à la mortalité des mem-

bres des Premières Nations inscrits au Canada. Nous avons utilisé les données adminis-

tratives des Affaires autochtones et du Nord Canada pour établir un ensemble de faits

stylisés concernant le taux de mortalité des membres des Premières Nations inscrits.

Entre 2010 et 2013, les taux de mortalité parmi les hommes et jeunes garçons membres

des Premières Nations inscrits étaient les plus élevés dans presque tous les groupes d’âge

visés, à l’exception des filles membres des Premières Nations inscrits âgées de 10 à 14

ans. Dans les réserves, les taux de mortalité concernant les jeunes hommes membres

des Premières Nations inscrits âgés de 15 à 19 ans sont presque quatre fois supérieurs à

Corresponding author: Randall Akee, rakee@ucla.edu

We would like to thank two anonymous referees for invaluable feedback. We would also like

to thank Siwan Anderson, Patrick Button, Pascal Courty, David Green, Robert

L. A. Hancock, Stephen Hume, Anke Kessler, Eric McGregor, Kevin Milligan, David

Scoones, Manisha Shah, Erin O’Sullivan, Steven Stillman, Jacqueline Quinless and all those

who commented on this work along the way. We would also like to thank Statistics

Canada’s Research Data Centre staff and the former Indigenous and Northern Affairs

Canada for the access they granted to the data. Any errors or omissions are ours alone.

Status First Nations mortality in Canada 491

ceux de la population générale; ces taux de mortalité sont presque cinq fois supérieurs

à ceux de la population générale pour les filles membres des Premières Nations inscrits

âgées de 15 à 19 ans. Nous montrons des disparités régionales importantes concernant

les taux de mortalité. Enfin, nous expliquons qu’en matière de mortalité, il n’y a pas

eu d’amélioration pour les femmes et les jeunes filles membres des Premières Nations

inscrits vivant dans des réserves au cours des 30 dernières années, et que les taux de

mortalité relatifs pour tous les membres des Premières Nations inscrits n’ont pas évolué

depuis 40 ans.

JEL classification: J15, J16, I15, I14

1. Introduction

A

A

voiding an early death is one of the greatest advantages of being

born in a wealthy country (Deaton 2013). However, this advantage

is not shared equally. In Canada, there is evidence of substantial health

disparities between First Nations peoples and the general population, but

existing statistics are at best sparse (Truth and Reconciliation Commission of

Canada [TRC] 2015, p. 161). In this work, we provide the most comprehensive

analysis to date of the patterns and trends in mortality rates for the largest

First Nation’s population in Canada—status First Nations individuals.1

We do this by using administrative data from Indigenous and Northern

Affairs Canada (INAC)2from 1974 to 2013, which, to our knowledge, is the

most complete and consistent source of First Nations vital statistics data

available. Our goal in this work is to provide a benchmark set of stylized

facts on status First Nations mortality in Canada that can be used for

future academic and policy research. This work was conducted in response

to the recent calls in Canada for reconciliation between Indigenous and non-

Indigenous people by the Truth and Reconciliation Commission of Canada:

the commission called for all Canadians to contribute to the process of

reconciliation and called for the establishment of comprehensive measures

of well-being for Indigenous peoples (TRC 2015, p. 161). The commission

also called for cooperation between the federal government and Indigenous

groups to “establish measurable goals to identify and close the gaps in health

outcomes between Indigenous and non-Indigenous communities and to publish

annual progress reports and assess long-term trends” (TRC 2015, p. 322). It

is our hope that this work helps to establish a foundation for the dialogue and

that it takes a step towards establishing comprehensive measures of well-being

for Indigenous peoples.

1 “Status First Nations” are individuals who are governed explaicitly under the

Indian Act as “Indians.” “Indian status” is determined through genetic relation

to the First Peoples classified by the federal government as “Indians.”

2 With the dissolution in August 2017 of the former Indigenous and Northern

Affairs Canada, two new departments of the Canadian federal government were

created in its place: Indigenous Services Canada and Crown–Indigenous

Relations and Northern Affairs Canada.

492 D. Feir and R. Akee

Using administrative data on births and deaths for status First Nations

people that include information on the gender, age, band of membership and

whether an individual resides on or off reserve allows us to create measures

of mortality rates at the national level and by location on and off reserves.

We also link patterns in mortality over time and, at the regional level, with

data available from the 1991 to 2006 Canadian censuses and 2011 National

Household Survey.3With this data, we make three main contributions: (1)

we provide the first national- and regional-level estimates of mortality among

status youth, (2) we provide the first modern estimates of how status mortality

rates differ by reserve residence and province and (3) we provide the first

description of how status mortality rates have changed since the 1970s and

how this is related to changes in status First Nations definitions. Despite the

relative simplicity of our analysis, we find striking and unsettling results.

We begin by confirming the findings of earlier, less comprehensive studies

using our data: age-standardized mortality is higher for status males than

for status females and age-standardized mortality for status First Nations

is always higher than for the general population. Using the most recent data

available, 2010 to 2013, we find that age-standardized mortality rates are close

to twice that of the general population. However, these aggregate statistics

mask significant differences by age: status women and girls have mortality

rates that are three to four times that of the general female mortality rates

between the ages of 10 and 44. These relative mortality rates are statistically

higher than the relative mortality rates for status males, which are themselves

two to two and a half times that of the general population. Beyond that,

the mortality rates of status girls between the ages of 10 to 14 are actually

higher than those of status boys of the same age. While previous research

has found some evidence for the relatively higher rates of mortality for status

women, to our knowledge no one has identified the disproportionately high

mortality rates borne by status women and girls at such young ages at the

national level (Health Canada 2008, 2014; Mao et al. 1992; Park et al. 2015;

Tjepkema et al. 2009). We also demonstrate that the proportional difference

in mortality between status people and the general Canadian population is

larger than the proportional difference in mortality between Native Americans

and non-Hispanic Whites and the difference between African Americans and

non-Hispanic Whites in the United States. The gender bias that we find in

relative mortality rates for status First Nations women and girls is not present

among either Native Americans or African Americans relative to non-Hispanic

American Whites.4

3 Unfortunately, the data do not provide information on cause of death or

detailed individual socioeconomic characteristics, and we do not report on these

causes in the current analysis.

4 This is not simply due to relatively higher female, non-Hispanic White

mortality rates in the United States.