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Mind the Gap: What Factors Determine the Worse Health Status of Indigenous Women Relative to Men Living Off-Reserve in Canada?

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Abstract

Background

Indigenous populations have the poorest health outcomes in Canada. In addition, some studies report notable gender health gaps among Indigenous populations of Canada, with greater disadvantages for Indigenous women. To date, the driving factors behind the health gaps between Indigenous women and men are poorly understood.

Method

Using the four available Aboriginal People Surveys (APS) (2001, 2006, 2012, and 2017), we measure gender gaps in good general health (GGH) (i.e. good/very good/excellent self-rated health) among Indigenous adults (age 18 and above) living off-reserve in Canada. We apply the Oaxaca–Blinder (OB) decomposition method to identify the relative contribution of health endowments and the return to these endowments to the gender health gaps among Indigenous peoples.

Results

Indigenous men are found to have a higher rate of GGH than their female counterparts. The gender health gap among Indigenous people has somewhat widened over the period 2001 to 2017. The widening of the gender health gap was observed in all four Indigenous identity groups, viz. registered First Nations, non-registered First Nations, Métis, and Inuit. The OB decomposition suggests that differences in endowments such as employment status and income between men and women explain between 30 to 60% of the gender health gap among Indigenous populations in Canada over the study period.

Conclusion

The social determinants of health appear to be the main factor explaining the gender health gap within the Indigenous peoples living in Canada. Policies improving employment opportunities and income among Indigenous women may potentially reduce the gender health gap within Indigenous population in Canada.

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Figure 1

Source: authors’ calculation based on the Oaxaca–Blinder decomposition analysis results from APS 2001, 2006, 2012, to 2017. The vertical axis represents the health gaps, and the horizontal axis represents the survey year. The proportion that explained by different factors unexplained in the model are presented in different colours as shown in the legend of the figure

Figure 2

Source: authors’ calculation based on the Oaxaca–Blinder decomposition analysis results from APS 2001, 2006, 2012, to 2017. The vertical axis represents the health gaps, and the horizontal axis represents the survey year. The proportion that explained by different factors unexplained in the model are presented in different colours as shown in the legend of the figure

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Data Availability

We accessed the Aboriginal People Surveys via the Statistic Canada’s Research Data Centre (RDC). Data access through the RDC requires strict disclosure protocols in line with Statistics Canada Acts.

Code Availability

We accessed the Aboriginal People Surveys via the Statistic Canada’s Research Data Centre (RDC). Code access through the RDC requires strict disclosure protocols in line with Statistics Canada Acts.

Notes

  1. See “Health Fact Sheets” from Statistics Canada that summarize reports for health conditions, lifestyle, well-being, disability, Health Fact prevention, and detection of disease, deaths, pregnancy and birth, health care services, and environmental factors (https://www150.statcan.gc.ca/n1/en/catalogue/82-625-X).

  2. See “Trends in Income-Related Health Inequalities in Canada” from CIHI for details on health inequality issues in Canada (https://www.cihi.ca/en/trends-in-income-related-health-inequalities-in-canada).

  3. RFN is the only official record of Status Indians or registered Indians in Canada. RFNs in Canada are entitled to access to a wide range of government programs, and benefits such as extended hunting season, exemptions from federal, and provincial taxes, government funding, and more freedom in the management of gaming, and tobacco franchises. See the following link for more information: https://www.aadnc-aandc.gc.ca/eng/1461939932579/1461939954663.

  4. As per the Statistics Canada’s Research Data Centres (RDC) policy, the sample size is rounded to base 10.

  5. We also compared gender health gaps within Indigenous populations using two objective health measures of diagnosed asthma and diabetes. Similar to the results of self-reported health status, the proportions of Indigenous women with diagnosed asthma and diabetes were higher than their male counterparts.

  6. Traditional activities are partially affected by gender (gender orientated). For example, females are less likely to participate in fishing, hunting and trapping and less likely to participate in wild plant gathering than their male counterparts. Thus, we combined all the traditional activities as one single binary indicator.

  7. We assume there is a potential disadvantage (negative discrimination) on Indigenous females’ health compared to their Indigenous male counterparts.

  8. The 2012 APS drew its sample from the 2011 National Household Survey (NHS). A potential sampling error due to the low survey response rate in the NHS might have an impact on the sampling of 2012 APS [73].

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Acknowledgements

The analysis presented in the paper was conducted at the Atlantic Research Data Centre (ARDC), which is part of the Canadian Research Data Centre Network (CRDCN). The views expressed in this paper do not necessarily represent the CRDCN or those of its partners. We are also grateful to the ARDC analysts Heather Hobson and Theresa Kim for their assistance. We are grateful to seminar participants at the Department of Economics — Dalhousie University and the CRDCN 2019 National Conference for their helpful comments on earlier versions of this paper. We also would like to thank Casey Warman, Shelly Phipps, Ana Ferrer, and Daniel Rosenblum for their helpful comments. All errors are our own. The usual caveats apply.

Funding

The authors acknowledge funding for this research provided by the Research Nova Scotia Establishment Grant program (Grant Number: 1017). The services and activities provided by the Atlantic Research Data Centre (ARDC) are made possible by the financial or in-kind support of the Social Sciences and Humanities Research Council (SSHRC), the Canadian Institutes of Health Research (CIHR), the Canada Foundation for Innovation (CFI), Statistics Canada, and Dalhousie University.

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Authors and Affiliations

  1. Department of Economics, Philosophy, and Political Science, University of British Columbia, Okanagan Campus, BC, Kelowna, Canada

    Min Hu

  2. School of Health Administration, Dalhousie University, NS, Halifax, Canada

    Mohammad Hajizadeh

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  1. Min Hu
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Contributions

Both authors contributed to the conception and design of the study, Min Hu performed the statistical analysis, both authors interpreted results, Min Hu drafted the manuscript, and Mohammad Hajizadeh helped with revisions. Both authors read and approved the final version of the manuscript.

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Correspondence to Min Hu.

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Ethics Approval and Consent to Participate

We accessed the Aboriginal Peoples Surveys through Statistics Canada’s Research Data Centre Network. Studies conducted at the RDC are exempted from research ethics board review based on the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS2) article 2.2 (a). Furthermore, this study is part of a successful funding application entitled: “The dynamics of health inequalities faced by indigenous populations in Canada: What factors account for the inequality”, which has already been granted ethics approval by Dalhousie University (REB No: 2017-4295). This research grant was approved by the Research Nova Scotia in 2017.

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Appendix

Appendix

Table 9 Description of variables used in this study
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Table 10 Summary statistics of APS 2001
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Table 11 Summary statistics of APS 2006
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Table 12 Summary statistics of APS 2012
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Table 13 Summary statistics of APS 2017
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Table 14 Summary statistics of the means of good general health by categories from 2001 to 2017
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Table 15 Marginal effects obtained from logistic regressions for the First Nations in 2001, 2006, 2012, and 2017
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Table 16 Marginal effects obtained from logistic regressions for Métis and Inuit in 2001, 2006, 2012, and 2017
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Table 17 The Blinder–Oaxaca decomposition of logistic regression for First Nations in 2001, 2006, 2012, and 2017
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Table 18 The Blinder–Oaxaca decomposition of logistic regression for Métis and Inuit in 2001, 2006, 2012, and 2017
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Hu, M., Hajizadeh, M. Mind the Gap: What Factors Determine the Worse Health Status of Indigenous Women Relative to Men Living Off-Reserve in Canada?. J. Racial and Ethnic Health Disparities 10, 1138–1164 (2023). https://doi.org/10.1007/s40615-022-01301-x

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