With National Indigenous People’s Day on June 21st, Medlior is reflecting on health disparities for Indigenous peoples in Canada. First Nations, Inuit, and Métis people have typically been underrepresented in research studies, but there are promising signs of change.
A recent publication in the journal CMAJ Open by McVicar et al. (2022) described research to understand the outcomes of Inuit patients from the Qikiqtaaluk Region of Nunavut undergoing inpatient elective or emergency surgical procedures. Using a retrospective cohort design, with over 98,000 surgical episodes, Inuit patients had a significantly increased risk of death or postoperative complications vs. non-Inuit patients after adjusting for surgical and demographic variables. Healthcare resource utilization was also higher among the Inuit patients. Additional research is needed to better understand these health inequalities, and how to improve the health outcomes of Indigenous populations.
Recognizing that codes for identifying race (including Indigenous populations) from administrative data across Canada have been limited and heterogeneous, the Canadian Institute for Health Information (CIHI) recently published minimum standards and guidance (2022) for collecting these identifiers consistently across jurisdictions. These standards, which can be voluntarily adopted within existing health data collection systems, align with Statistics Canada census data on Indigenous identity. In 2020, CIHI released an interim version of this standard to study the disproportionate impact of COVID-19 on racialized communities.
Federal institutions are establishing strategic directions and resources. The Canadian Institutes of Health Research (CIHR) Institute of Indigenous Peoples’ Health strives to improve the health of First Nations, Inuit, and Métis people by supporting innovative research. Significant investments are being made to deliver on the Institute’s strategic priorities for 2019-2024 (see links below).
Network Environments for Indigenous Health Research (NEIHR) is a $100.8 M investment over 16 years to establish a national network of centers focused on strengthening research capacity, research, and knowledge translation surrounding First Nations, Inuit and Métis people. https://cihr-irsc.gc.ca/e/51161.html
Closing the Gaps
All of these initiatives address previous calls to action by the Truth and Reconciliation Commission of Canada for the Federal government to “close the gaps in health outcomes” between Indigenous and non-Indigenous populations, particularly with respect to infant mortality, maternal health, suicide, mental health, addictions, life expectancy, birth rates, infant and child health issues, chronic diseases, illness and injury incidence, and the availability of appropriate health services (recommendation #19, 2015).
If Indigenous populations can be identified from the health system data, similar to other under-represented populations from clinical trials (e.g., elderly, adolescent, complex/severe disease populations), then the examination of these real-world data sources may provide critical insights into the unmet needs of these populations, ultimately leading to improvements in care delivery, including personalized medicine.