2018 10 04 Affidavit of Grand Chief Kavanaugh

Court File No.
544/18
ONTARIO
SUPERIOR COURT OF JUSTICE
DIVISIONAL COURT
BETWEEN:
THE ELEMENTARY TEACHERS’ FEDERATION OF ONTARIO and CINDY

GANGARAM
Applicants
- and –
HER MAJESTY THE QUEEN IN RIGHT OF ONTARIO AS REPRESENTED BY THE

MINISTER OF EDUCATION
Respondent
APPLICATION UNDER Rule 14.05(2) of the Rules of Civil Procedure, RRO 1990, Reg 194
and Sections 2(1) and 6(2) of the Judicial Review Procedure Act, RSO 1990, c J.1
AFFIDAVIT OF GRAND CHIEF OGICHIDAA FRANCIS KAVANAUGH
I, Ogichidaa Francis Kavanaugh, of Noatkagemwanning First Nation, in the Province of Ontario,
MAKE OATH AND SAY AS FOLLOWS:
1. I am the Grand Chief of Treaty #3. I was selected as Grand Chief by a Traditional
Selection Process on May 25, 2016. I was previously Grand Chief from the years 1997-1999, and
have been involved with the Grand Council of Treaty #3 in a variety of capacities for over 40
years.
2. I am Anishnaabe, born in Migisi Sahgaigan (Eagle Lake) First Nation, Treaty #3. I was
raised in Naotkamegwanning (Whitefish Bay) First Nation, Treaty #3, where I continue to reside.
I am 67 years old; I am a father and a grandfather.
3. As such, I have personal knowledge of the matters attested to herein. Where I have
attested to evidence based on information provided to me by others, I have identified the source
of that information, and affirm that I verily believe it to be true.
Grand Council Treaty #3
4. Treaty #3 (“Treaty 3”) is an area of some 55,000 square miles of territory in Ontario and
Manitoba that is the historic home of the Anishinaabe Nation. Today, it includes 28 First Nation
communities, with a population of approximately 25,000 which includes members residing both
on reserve and off reserve.
5. The Grand Council Treaty #3 (“GCT3”) is the traditional government of the Anishinaabe
in Treaty 3 Territory. GCT3 staff receive their mandate from the 28 First Nation Chiefs in Treaty
3 Territory, which is referred to as the Chiefs in Assembly or the Grand Council. GCT3 is
heavily involved in several mandates, including education, health, and youth initiatives.
First Nation populations are vulnerable as a result of the Indian Residential Schools system
6. First Nation communities in Canada are vulnerable populations as a result of historical
trauma inflicted by the federal and provincial governments through colonial policies such as the
Indian Residential Schools system, the “sixties scoop” program, and an array of discriminatory
policies implemented under the Indian Act. The former Chief Justice of the Supreme Court of
Canada, the Right Honorable Beverley McLachlin, called these assimilationist policies “cultural
genocide” (see “Unity, diversity and cultural genocide: Chief Justice McLachlin’s complete
speech,” (2015) Globe and Mail, attached hereto as Exhibit A.
7. While significant progress has been made as a result of our resiliency and cultural focus
on healing, we continue to disproportionately suffer from difficulties accessing higher levels of
education, and our communities experience higher rates of substance abuse, gender-based
violence, and poorer physical and mental health indicators.
8. This vulnerability is one of the many devastating legacies of the Indian Residential
Schools system. The sexual, emotional, physical, and cultural abuse widely perpetrated within
that system are well known (see Truth and Reconciliation Commission, “Canada’s Residential
Schools: The Legacy,” (2015) 5 McGill-Queen’s University Press, attached hereto as Exhibit
B).
9. The legacy of the Indian Residential Schools does not end with the survivors of those
schools. There is well-documented intergenerational trauma, which describes the cumulative
and ongoing effect of this trauma on the population. Much of this was documented by the Truth
and Reconciliation Commission of Canada. Many of these impacts are also reflected in academic
literature and studies of Indigenous communities.
10. For example, an article in the journal Transcultural Psychiatry by Amy Bombay et. al.
acknowledges that “the data currently available suggests that [Indian Residential Schools]
continue to undermine the health and well-being of today’s Aboriginal population” and that, “the
risk associated with [Indian Residential School] trauma may accumulate across generations”. A
copy of the “Bombay Article” is attached hereto as Exhibit C.

Intergenerational trauma includes higher rates of sexual abuse
11. One of the many devastating aspects of intergenerational trauma experienced by First
Nation peoples is a higher rate of sexual abuse or violence. Bombay et. al. note in their article
that, “the widespread sexual abuse suffered by generations of children while attending these
schools were implicated as key factors that contributed to high rates of sexual abuse in some
communities. This was attributed, in part, to the alteration of social norms generated by Indian
Residential Schools, including the tendency for individuals not to report these abusive incidents.”
12. Ms. Bombay’s analysis is consistent with data about the abuse at Indian Residential
Schools. One longitudinal study found that one-third of Indigenous people who were forced into
residential schools experienced sexual abuse at the school. A copy of the First Nations
Information Governance Committee “First Nations Regional Longitudinal Health Survey” is
attached hereto as Exhibit D.
13. As a result, research suggests that Indigenous youth are twice as likely to be sexually
assaulted as non-Indigenous youth (see the article Self-reported sexual assault in Canada, 2014,
published by the Canadian Centre for Justice Statistics and attached hereto as Exhibit E).
14. The above research is entirely consistent with what I have witnessed personally in my
community.
Intergenerational trauma also includes compromised parenting skills
15. It is also important to understand that the intergenerational trauma Indigenous people
have suffered includes broken parenting and communication skills. While our people are
working hard to heal and ameliorate these and other consequences, there is still considerable
disadvantage as a result of historic trauma.
16. Indigenous people self-report a strong belief that their parents’ and grandparents’
attendance at residential schools negatively affected the parenting they received as children (per
Exhibit D, p. 133).
17. Academic studies suggest that:
a. the, “failure of survivors to be taught positive strategies for dealing with interpersonal
conflict may have led to high rates of family breakdown and problems that youth carried with
them into their adult lives.” (Exhibit D, p. 136);
b. “[t]he loss of parenting skills places First Nations children today at a higher risk for some
negative health and overall well-being outcomes.” (Exhibit D, p. 297); and, similarly,
c. “the intergenerational effects of residential schools include communication barriers and a
lack of communication between family members” (Aboriginal Healing Foundation, “Reclaiming
Connections: Understanding Residential School Trauma Among Aboriginal People, A resource
Manual” (2005), attached hereto as Exhibit F).
18. This is consistent with what formal healing processes have revealed. Many former Indian
Residential Schools students told the Truth & Reconciliation Commission that they were denied
the opportunity to learn nurturing parenting skills, and instead unintentionally replicated the
strict and uncaring discipline they received at the Indian Residential Schools (see Exhibit B
hereto).
19. All of this is consistent with my own observations as a leader within the Anishinaabe
Nation of Treaty 3.
The elementary public school curriculum plays a critical role in mitigating our children’s
vulnerability
20. Many First Nation children are educated in schools on reserves, where the curriculum is
not necessarily the same as (and does not have to be the same as) that mandated by the Ontario
government. However, a significant number of First Nation children are educated in Ontario
public schools located off reserves, where the curriculum is mandated by the provincial
government.
21. There are two public school boards and two Catholic school boards serving Treaty #3
territory. Of the public school boards, I am informed by Heather Campbell, the Director of
Education for the Rainy River District School Board, that 40% of students within that board self-
identify as Indigenous. News reports indicate that 54% of the students attending schools within
the Keewatin Patricia District School Board self-identify as Indigenous (see article “Ontario
school board hires first superintendent of Indigenous education, reconciliation,” (2018)
CBC News attached hereto as Exhibit “G”). I verily believe these statistics to be true.
22. As I have previously stated in my government’s statement with respect to the changes to
Ontario’s sexual-education curriculum, a robust and fact-based elementary school curriculum is
vitally important for our youth because it may be the only source of accurate health and sexual
education information they receive. Despite ongoing efforts, our children in many cases may not
have access to the same guidance at home as do their non-Indigenous peers. I therefore consider
it of the utmost importance and my responsibility as Grand Chief to advocate for delivering to
Indigenous youth in particular information about healthy and safe relationships, sexual
orientation and gender identity, and resources related to consent and gender-based violence.
23. While not speaking directly to the relationship between curriculum and proper sexual
health education, the American Journal of Public Health has published papers concluding that
school attendance and connectedness is an important factor in reducing the likelihood that young
Indigenous people will have sex at a young age, or have unprotected sex (see Devries, K.M.,
Free, C., Morison, L. & Saewyc, E.M., “Factors associated with the sexual behavior of Canadian
Aboriginal young people and their implications for health promotion” (2009) 99 American
Journal of Public Health, attached hereto as Exhibit H, at p. 857).
24. Elementary education is a particularly important tool in sexual health education of First
Nation children because of the difficulty First Nation youth have with educational attainment
compared to their non-Indigenous peers. A 2005 study found that 26% of First Nation youth
were unable to achieve a grade 9 education (see Exhibit F hereto).
25. The Truth & Reconciliation Commission noted that while educational success rates
among Indigenous youth are slowly improving, “Aboriginal people still have lower educational
and economic achievements than other Canadians. This is the legacy of residential schools.”
(Exhibit B, vol. V, p. 62).
Conclusion
26. I believe that the public school, elementary-level curriculum is a critical component of
helping to mitigate vulnerability of our community, including our children, as well as to
ameliorate the effects of intergenerational trauma.

27. It is my belief that the Ontario government’s changes to the sexual education curriculum
to remove, delay, or reduce education about issues of consent, bodily integrity, sexual assault and
other similar issues will disproportionately affect Indigenous young people because:
a. of the significant vulnerability they have as a result of intergenerational trauma;
b. of the rate of sexual abuse is higher within Indigenous populations than it is for
non-Indigenous Canadians; and,
c. school, and elementary school in particular, is a critical aspect of educating

Indigenous youth because in some cases their parents were deprived of the
opportunity to learn nurturing parenting skills and open communication, such that
school may be the best opportunity for Indigenous youth to learn about sexual
education.
SWORN before me at the City of Toronto, in

the Province of Ontario, this 4th day of
October, 2018
Ogichidaa Francis Kavanaugh
A Commissioner, &c.
This is Exhibit “A” referred to in the Affidavit of Grand Chief
Kavanaugh sworn October 4, 2018
Commissioner for Taking Affidavits (or as may be)

Unity, diversity and cultural genocide: Chief
Justice McLachlin’s complete speech
CONTRIBUTED TO THE GLOBE AND MAIL
PUBLISHED MAY 29, 2015UPDATED JUNE 5, 2017
Reconciling Unity and Diversity in the Modern Era: Tolerance and Intolerance
Remarks of the Rt. Hon. Beverley McLachlin, P.C.
Chief Justice of Canada
At the Aga Khan Museum
Toronto, Ontario
May 28, 2015
Brightcove player
Play Video1:74:41
Tolerance: the willingness to allow the

existence of opinions or behavior that one does
not agree with.
Oxford English Dictionary
Canada is a diverse, multi-cultural state. With that comes a plethora of diverse religions,
opinions and behaviors.
History shows there are two ways societies can deal with diversity of opinion and
behavior. The first is to confine, minimize or eject those who have different views and
behaviors. This is the response of segregation and the ghetto; of marginalizing
discrimination; in extreme cases, of exile and genocide.
The second approach is to adopt an attitude of tolerance – a willingness to live with

people who are different from us – what Jean-Paul Sartre called “the other” – and to co-
exist with the opinions and behaviors one does not agree with.
Most modern multi-cultural nations have – sometimes after great struggle and trauma –
adopted the second approach of tolerance. They have rejected the responses of
segregation, discrimination and exile – these cause too much pain and in the end,
history teaches, do not work. The only way forward, these societies believe, is to move
forward together. Citizens may not agree with the behaviors and opinions voiced by
some of those with whom they share their communal space. But they are willing to allow
them to voice those opinions or act as their particular religion or values dictate. This is
what his Highness the Aga Khan has called the “cosmopolitan ethic”. 1
1.
Lecture by His Highness the Aga Khan: The LaFontaine-Baldwin Lecture (Toronto, Canada) 15 October 2010.
In a modern democratic society, tolerance must be the norm. It is the point of departure,
the default position. But tolerance, most people would agree, has its limits. There are
some things that cannot and should not be tolerated in a civilized society, because they
harm individuals or the body politic. Sometimes it is right to be intolerant.
This brings us to one of the great debate of the modern, multi-cultural society – the
debate between tolerance and intolerance. It is not a question of either tolerance or
intolerance; as I have said, in a democracy tolerance is the default position, the norm. It
is rather a question of where we draw the line between behaviors and opinions that
should be tolerated – the vast majority – and behaviors or opinions that are so nefarious
that they cannot be accepted in civilized society. Where to draw the line in a particular
situation may not be easy or obvious.
The task of drawing the line when opinions differ falls first to citizens. Fair-minded
people, however, may draw the line in different places. When they cannot agree the task
of drawing the line between what is accepted and what cannot be accepted falls to the
legislators and the courts.
Today, I would like to explore the interface between tolerance and intolerance in
Canadian society. I will begin by placing tolerance within a broader context – the
philosophical and Canadian historical context which shapes the debate. I will then turn
to the limits on tolerance, using examples drawn from cases that have come before
Canadian courts. I will conclude by describing three conditions that I believe are
essential to maintaining the norm of tolerance: first, insisting on respect for the human
dignity of each person; second, fostering inclusive institutions and cultural attitudes in
civil society; and third, maintaining the rule of law.
A residential school in Fort Providence, N.W.T., photographed in 1921. (NWT Archives)
TOLERANCE: THE PHILOSOPHICAL AND HISTORICAL CONTEXT
A perusal of the works of John Milton, John Stuart Mill, John Dewey and John Rawls
indicates that tolerance is a cornerstone of democratic societies. It is a necessary
condition of peace in a pluralistic society. This said, scholars are quick to point out that
tolerance is not the ideal, nor the highest expression of how diverse peoples can live
together. As one scholar writes, it is a term for interaction “anchored too much in the old
idea of mutual indulgence and not enough in the more constructive idea of active
embrace.” 2-3
2-3.
Bruce A. Jacobs, Race Manners for the 21st Century: Navigating the Minefield Between Black and White Americans
in an Age of Fear (New York: Arcade Publishing, Inc., 2006) at 202.
Tolerance, without more, suggests that it is enough for us to merely put up with one
another.
Tolerance requires that we behave with dignity

and consideration toward one another, but it
leaves room for us to internally retain our
biases and our inclinations to make culturally
centric judgments. Tolerance demands that we
do a certain amount of important and positive
external work, but it does not necessarily insist
that we do our internal work.
Ideally, what is needed is not mere tolerance, but the embrace of the validity of other
people’s experiences, cultures and orientations. Only by embrace and the active
acceptance, these critics argue, can we fulfil our moral obligation to understand that all
lives are qualitatively equal.
Yet, while we acknowledge the ideal of embrace and active acceptance and strive toward
it, the hard reality of day-to-day life is that citizens living in a diverse, multi-cultural
society – even those who consider themselves fair-minded and unbiased – are
sometimes confronted with beliefs and practices with which they do not agree – indeed,
which they may abhor.
The question then becomes, what should be tolerated. Whether we like it or not, we are
forced to draw lines between what we can accept – the basic norm of tolerance – and
what we cannot accept. This brings me to Canada’s experience with tolerance – the
historical context in which the Canadian tolerance – intolerance debate is embedded.
Canada sees itself and is seen by others as a nation of tolerance. We are a peaceful multi-
cultural country. A Canadian, John Humphreys, was a principle drafter of the United
Nations Declarations of Human Rights. In 1982, we adopted the Charter of Rights and
Freedoms, constitutionalizing our commitment to freedom of religion, equality and a
multi-cultural society. As the Supreme Court of Canada stated in 2007: 4
Canada rightly prides itself on its evolutionary

tolerance for diversity and pluralism. This
journey has included a growing appreciation
for multiculturalism, including the recognition
that ethnic, religious or cultural differences
will be acknowledged and respected. Endorsed
in legal instruments ranging from the statutory
protections found in human rights codes to
their constitutional enshrinement in the
Canadian Charter of Rights and Freedoms, the
right to integrate into Canada’s mainstream
based on and notwithstanding these
differences has become a defining part of our
national character.
4.
Bruker v. Marcovitz, 2007 SCC 54 at para. 1.
Canada, we like to boast, is founded on the coming together of three peoples – our First
Nations, the French and the English.5
5.
John Ralston Saul, A Fair Country: Telling Truths About Canada (Toronto: Viking Canada, 2008) at 3.
It is built on successive waves of immigration – a tradition it maintains to this day. We

accept refugees and immigrants from all parts of the world and from all cultures. When
the Ismali community in east Africa faced expulsion, we opened our doors to them. A
decade later, we once again opened our doors to fleeing Vietnamese refugees. In the
years that have followed, many thousands of people fleeing war and persecution around
the globe have found homes in Canada. Canada has been enormously enriched by the
presence in its midst of these people and by their contributions.
Yet while celebrating our inclusionary historical record, we should not forget its
blemishes.
In the 19th century, we welcomed Chinese men to build our railroads – dangerous and
arduous work – but denied them the right to bring their wives and families unless they
paid a head tax – a tax which remained on the books until 1923.6 When Jews fleeing the
Holocaust in 1939 aboard the St. Louis sought refuge in Canada, we turned them away.
Denied entry here and the United States, they returned to Europe, where many of them
perished. When Japan bombed Pearl Harbour in World War II, we dispossessed the
Japanese population of British Columbia of their homes and businesses and locked
them up in concentration camps. Slavery was not unknown in our country in the 18th
and 19th centuries, and black people suffered systemic exclusion throughout much of
the 20th century.
6.
In addition, in 1923, Parliament passed the Chinese Immigration Act, known today as the Chinese Exclusion Act,
which banned most forms of Chinese immigration to Canada. This act remained in place until 1947
The most glaring blemish on the Canadian historic record relates to our treatment of the
First Nations that lived here at the time of colonization. An initial period of cooperative
inter-reliance grounded in norms of equality and mutual dependence (described
eloquently by John Raulston Saul in his book, A Fair Country), was supplanted in the
nineteenth century by the ethos of exclusion and cultural annihilation. Early laws forbad
treaty Indians from leaving allocated reservations. Starvation and disease were rampant.
Indians were denied the right to vote. Religious and social traditions, like the Potlach
and the Sun Dance, were outlawed. Children were taken from their parents and sent
away to residential schools, where they were forbidden to speak their native languages,
forced to wear white-man’s clothing, forced to observe Christian religious practices, and
not infrequently subjected to sexual abuse. The objective was to “take the Indian out of
the child”, and thus to solve what John A. Macdonald referred to as the “Indian
problem”. “Indianness” was not to be tolerated; rather it must be eliminated. In the
buzz-word of the day, assimilation; in the language of the 21st century, cultural
genocide.
We now understand that the policy of assimilation was wrong and that the only way
forward is acknowledgement and acceptance of the distinct values, traditions and
religions of the descendants of the original inhabitants of the land we call Canada. In a
moving ceremony in Parliament in 2008, the Prime Minister formally apologized to
Canada’s First Nation people for the abuses of the residential school system. A truth and
reconciliation commission, whose report is about to be released, was established. Yet the
legacy of intolerance lives on in the lives of First Nation people and their children – a
legacy of too much poverty, too little education, and over-representation of aboriginal
people in our courts.
Three lessons emerge from the Canadian experience with tolerance and intolerance.
First, intolerance – the marginalization of difference – doesn’t work. It may seem to
provide a solution in the short term. But in the long run it is bound to fail. Second,
intolerance imposes inhumane and unacceptable costs in terms of human suffering and
lost human and economic potential. Third, the way forward is not to use intolerance to
eliminate difference, but embrace tolerance in the spirit of reconciliation.
These lessons from the Canadian experience are replicated wherever intolerance has
been systemically imposed – from the Nazi attempts to eliminate Jews, gypsies and
homosexuals, to the apartheid of South Africa, to the genocide of Rwanda. Intolerance
doesn’t work and imposes enormous and unacceptable costs. Ultimately, the only way
forward is the way of tolerance.
The Supreme Court of Canada building in Ottawa. (Fred Lum/The Globe and Mail)
THE LIMITS ON TOLERANCE

For a society made up of a people who share different cultures, religions, practices and
opinions – which means virtually every society in the modern world – tolerance is the
only way forward . But even tolerance has its limits.
It is one thing to accept the right of others to beliefs and practices that one does not
agree with. It is another thing to stand by and allow these beliefs and practices to be
used in a way that imposes harm on innocent individuals and groups.
The jurisprudence of the Supreme Court of Canada accepts that some things cannot be
tolerated. In Big M v. The Queen, 7 the Court held that freedom of religion does not
extend to practices that harm others. The state is therefore permitted to ban religious
practices that harm others – to say that these practices will not be tolerated.
7.
R. v. Big M Drug Mart Ltd., [1985] 1 S.C.R. 295.
Similarly, in R. v. Keegstra,8 the Court held that hate speech is not protected by the
guarantee of freedom of expression because of the harm which such speech may
produce.
8.
R. v. Keegstra, [1990] 3 S.C.R. 697.
Tolerance stops where harm begins; this much seems clear. The difficulty, however, lies
in defining harm. Religious zealots throughout history have claimed that in forcing
assimilation they are in fact benefitting their victims, by encouraging them to repent and
accept the true religion. As the priests of the inquisition stoked the flames of their fires
of execution, they prayed for the souls of the departed, just as 21st century jihadists
claim their elimination of the infidel purges their sin and purifies the state. We are not
doing harm, but good, they contend. No one in Canada would accept these arguments,
but that is not the point. The point is rather that views on whether a practice is harmful
may differ. Even if the harm threshold is set in a generous and tolerant fashion, as it is
in Canada, people may argue about what constitutes harm and hence a permissible limit
on the basic ethic of tolerance.
For example, France it is an offence for a woman to wear a niqab that covers the face, on
the ground that to permit this harms women by fostering inequality.9
9.
Loi interdisant la dissimulation du visage dans l'espace public, Loi n° 2010-1192 du 11 octobre 2010.
In other western states, including Canada, the harm threshold is set higher, and women
are generally allowed to wear face coverings. However, in a recent case in the Supreme
Court of Canada, the majority of the Court ruled that in some cases, allowing a witness
to wear a face covering could harm the accused’s right to make full answer and
defence.10
10.
R. v. N.S., 2012 SCC 72, [2012] 3 S.C.R. 726.
A dissenting Justice took the view that this harm would never suffice to prevent a
witness from wearing a face covering required by her sincere religious belief. And not
long ago, the Province of Quebec found itself engaged in a debate on what limits the
state could impose on religious practices of people engaged in the provision of public
services surrounding a proposed Charter of Values.
The simple point is this – what constitutes harm, and when that harm will justify a
decision not to tolerate a particular practice, may be neither clear nor easy to decide.
Still, in a society based on tolerance, the lines must sometimes be drawn. How is this to
be done? The first avenue is civil debate. When issues like those I have been discussing
arise, they find themselves discussed and debated – in coffee shops, living rooms and
newspapers; on television and on chat lines. At best, this civil debate may produce some
sort of consensus. Failing that, it will provide the context for the legislatures and the
courts, if called upon, to draw the necessary lines between tolerance and intolerance.
(Fred Chartrand/The Canadian Press)
MAINTAINING A TOLERANT SOCIETY
I have suggested that absolute tolerance is not possible; in some cases, limits must be
imposed, whether by civil society, the legislatures, or the courts. I have also suggested
that, in a modern multi-cultural democratic state, tolerance must be the norm. Respect
for difference is the essential glue that binds such a society together and allows it to
function and move forward in constructive harmony. In this, the final part of my talk, I
turn to the question of how a society can maintain the basic norm of tolerance.
Three things, I believe, are essential to maintaining the norm of tolerance: acceptance of
the inherent human dignity of every person; inclusive institutions and cultural attitudes
in civil society; and the rule of law. Allow me to say a few words about each.
ACCEPTANCE OF THE HUMAN DIGNITY OF EACH PERSON
The idea that each person is possessed of innate worth and dignity is deeply rooted in
western religion and thought. The great religious traditions of Judaism, Christianity and
Islam saw man as created in the image of God. Cicero, in De Officiis, spoke of the dignity
of human beings qua humans.11
11.
See Michael Rosen, Dignity: Its History and Meaning (Cambridge, MA: Harvard University Press, 2012) at 11.
In the holy Quran we read, “O mankind Be careful of your duty to your Lord who created
you from a single soul ... [and] joined your hearts in love”. Kant asserted in profound
philosophical terms the unconditional, absolute value of the moral law inherent in
human beings, and drew from it the necessity for each person to treat others not as
means, but as ends in themselves.12
12.
See Michael Rosen, Dignity: Its History and Meaning (Cambridge, MA: Harvard University Press, 2012) at 30.
In the aftermath of the Holocaust and World War II the concept of human dignity
moved beyond the domains of theology and philosophy and entered the discourse of
legal rights. The United Nations Universal Declaration of Human Rights in 1948 set out
in clear and ringing terms the intrinsic worth and value of every human life. In the half
century that followed the precept was ensconced in seminal constitutional documents
around the world.13
13.
See, for example, the 1949 German Basic Law, the Grundgesetz; the 1992 Israel Basic Law: Human Dignity and
Liberty; and the 1982 Canadian Charter of Rights and Freedoms.
The principle of the innate human dignity of each person may be seen as fundamental to
all other human rights. Thus Justice Bertha Wilson, the first woman to sit on the
Supreme Court of Canada, wrote: 14
The idea of human dignity finds expression in

almost every right and freedom guaranteed by
the Charter. Individuals are afforded the right
to choose their own religion and their own
philosophy of life, the right to choose with
whom they will associate and how they will
express themselves, the right to choose where
they will live and what occupation they will
pursue.
14.
R. v. Morgentaler, [1988] 1 S.C.R. 30 at 166.
To read Justice Wilson’s words is to understand how important the concept of human
dignity is to a tolerant society. If individuals, by virtue of their innate human dignity,
have the right to choose their own religion and philosophy of life, that choice must be
respected. No individual or group of individuals has the right to impose their beliefs,
practices or choices on another individual.
15.
Aharon Barak, Human Dignity: The Constitutional Value and the Constitutional Right (Cambridge: Cambridge
University Press, 2015) at 107.
To be sure, the right to the choices human dignity affirms is not absolute. Sometimes
human dignity conflicts with other values, requiring us to balance the two.15
How a society defines the core content of human dignity may evolve.16
16.
BVefGe 45, 187 at 229 (1997).
And care must be taken to ensure meaningful and realistic content to the idea of human
dignity, lest it become, as philosopher Arthur Schopenhauer warned, “the shibboleth of
...perplexed and empty-headed moralists ...”17
17.
Quoted in Michael Rosen, Dignity: Its History And Meaning (Cambridge, MA: Harvard University Press, 2012) at 1.
Despite these qualifications, the concept of human dignity – that every person has
innate value and worth and hence the right to make fundamental life choices – remains
the fundamental underpinning of the basic attitude of tolerance in a diverse, multi-
cultural society.
INCLUSIVE INSTITUTIONS AND CULTURAL HABITS
In 2010, His Highness the Aga Khan presented the 10th Annual Lafontaine-Baldwin
Lecture in Toronto. His subject was pluralism. Quoting Adrienne Clarkson in her 2007
Lecture, he cautioned that “we cannot count on the power of ‘love’ to solve our
problems”, and stated that “learning to live with people we may not particularly like ...
will require concerted, deliberate efforts to build social institutions and cultural habits
which take account of difference, which see diversity as an opportunity rather than as a
burden”.18
18.
Lecture by His Highness the Aga Khan: The LaFontaine-Baldwin Lecture (Toronto, Canada) 15 October 2010.
Federal arrangements, laws and courts can help us live together in an ethic of tolerance.
But, the Aga khan counselled, we need to go further.
We need independent educational institutions, he stated. On this front, it is reassuring

that a number of Canadian provinces now require teaching of the world’s major
religions as a mandatory part of the curriculum for public and private schools. It is also
reassuring that “Canada . . . is recognized as a leader in coping with the challenges of a
diverse and polyglot student body” in a recent report of the UN Organization for
Economic Co-operation and Development. 19
19-22.
Maclean’s, May 25, 2015, p.5
We also need inclusive institutions of civil society – institutions that focus on bringing
people of diverse backgrounds together, on bridging divides instead of deepening them.
We need – and fortunately in Canada we possess – an independent press prepared to
report not only on conflict but on the stories that celebrate difference and the
enrichment it brings to our lives. Above, all, we need, in all our institutions, religious
and secular, leaders who understand the richness pluralism brings, and the basic ethic
of tolerance that it requires.
Inclusive institutions are supported by and in turn promote a social mindset that
sustains pluralism. As his Highness put it, “institutional reforms will have lasting
meaning only when there is a social mindset to sustain them.”20-22
He stated:
There is a profound reciprocal relationship
between institutional and cultural variables.
How we think shapes our institutions. And
then our institutions shape us.
He went on:
As societies come to think in pluralistic ways, I

believe they can learn ... [a] lesson from the
Canadian experience, the importance of
resisting both assimilation and
homogenization – the subordination and
dilution of minority cultures on the one hand,
or an attempt to create some new,
transcendent blend of identities, one the other.
THE RULE OF LAW
One of the essential tasks of a multi-cultural society is to maintain respect for the
human dignity of each person and the individual life choices of the person, even where
these choices differ from those of the majority – in a word, to maintain a society where
tolerance is the norm. This cannot be done without the rule of law – a system of laws
backed by an independent judiciary.
In a diverse, multi-cultural society, the law is the guarantor of the right to hold opinions
and follow practices that diverge from the norm. Without the law there is no check on
the power of the majority to check beliefs and practices they do not agree with. The
confidence of the citizen that her human dignity and right to choose to be different will
be respected and enforced through the rule of law is the bedrock upon which civilized
intercourse in a diverse society rests. Fear and hatred of the other in our midst is a
disease that can destroy social peace. The best antidote to this fear is the assurance that
everyone’s basic right to hold their own beliefs and follow their own practices – provided
they do not harm others – is the assurance of protection by the legal system. This
requires that citizens must have access to the legal system, and that the legal system
responds with integrity, even in the face of overweening pressure from the majority that
sees the belief or practice as aberrant and wrong. It also requires commitment to a
culture of legality – a culture that encourages debate about particular decisions, while
maintaining respect for the principles and processes of the law and the Constitution.
Beverly McLachlin, Chief Justice of the Supreme Court of Canada, delivers a speech in
Ottawa on Feb. 5, 2013. (Fred Chartrand/The Canadian Press)
CONCLUSION
Let me conclude. The debate between tolerance and intolerance is one of the great
debates of our times. Canada, like most other countries around the world, is a
pluralistic, multi-cultural nation. It can move forward only by respecting the norm of
tolerance. That does not mean that everything must be tolerated – a civilized society has
no choice but to condemn practices that cause harm to others and injure citizens or
undermine the fabric of peaceful co-existence. But it means the basic rule must be
tolerance. Preserving that tolerance is grounded in respect for the innate human dignity
of each person. It compels us to cultivate and sustain inclusive institutions and
attitudes. And it demands an unwavering commitment to the rule of law.
Living together in the ethic of tolerance is not easy. But it is worth the effort.
This is Exhibit “B” referred to in the Affidavit of Grand Chief

Canada’s Residential Schools:
The Legacy
The Final Report of the
Truth and Reconciliation
Commission of Canada
Volume 5
Canada’s Residential Schools
Volume 5
Canada’s Residential Schools:
The Legacy
The Final Report of the

Truth and Reconciliation
Commission of Canada
Volume 5
Published for the

Truth and Reconciliation Commission
by
McGill-Queen’s University Press
Montreal & Kingston • London • Chicago
This report is in the public domain.
Anyone may, without charge or request for permission, reproduce all or part of this report.
2015
Truth and Reconciliation Commission of Canada
Website: www.trc.ca
ISBN 978-0-7735-4659-2 (v. 5 : bound). ISBN 978-0-7735-4660-8 (v. 5 : paperback).
Printed in Canada on acid-free paper
An index to this volume of the final report is available online. Please visit http://nctr.ca/trc_reports.php
Library and Archives Canada Cataloguing in Publication

Truth and Reconciliation Commission of Canada
[Canada’s residential schools]
Canada’s residential schools : the final report of the Truth and Reconciliation Commission of Canada.
(McGill–Queen’s Native and northern series ; 80–86)

Includes bibliographical references and index.
Contents: v. 1. The history. Part 1, origins to 1939 — The history. Part 2, 1939 to 2000 — v. 2. The Inuit and
northern experience — v. 3. The Métis experience — v. 4. The missing children and unmarked burials
report — v. 5. The legacy — v. 6. Reconciliation
Issued in print and electronic formats.

ISBN 978-0-7735-4649-3 (v. 1, pt. 1 : bound). ISBN 978-0-7735-4650-9 (v. 1, pt. 1 : paperback).
ISBN 978-0-7735-4651-6 (v. 1, pt. 2 : bound). ISBN 978-0-7735-4652-3 (v. 1, pt. 2 : paperback).
ISBN 978-0-7735-9817-1 (v. 1, pt. 1 : ePDF). ISBN 978-0-7735-9818-8 (v.1, pt. 1 : ePUB).
ISBN 978-0-7735-9819-5 (v. 1, pt. 2 : ePDF). ISBN 978-0-7735-9820-1 (v. 1, pt. 2 : ePUB).
ISBN 978-0-7735-9821-8 (v. 2 : ePDF). ISBN 978-0-7735-9822-5 (v. 2 : ePUB).
ISBN 978-0-7735-9829-4 (v. 6 : ePDF). ISBN 978-0-7735-9830-0 (v. 6 : ePUB)
1. Native peoples—Canada—Residential schools. 2. Native peoples—Education—Canada.

3. Native peoples—Canada—Government relations. 4. Native peoples—Canada—Social conditions.
5. Native peoples—Canada—History. I. Title. II. Series: McGill–Queen’s Native and northern series ; 80–86
E96.5.T78 2016 971.004’97 C2015-905971-2

C2015-905972-0
Contents
Introduction.................................................................................................. 3
1. Child welfare: A system in crisis.............................................................. 11
2. The failure to educate............................................................................... 61
3. “I Lost My Talk”: The erosion of language and culture........................... 103
4. An attack on Aboriginal health: The marks and the memories.............. 139
5. A denial of justice..................................................................................... 185
Calls to action............................................................................................... 277
Notes............................................................................................................. 297
Bibliography................................................................................................. 345
Canada’s Residential Schools
Volume 5
Introduction
T
he closing of residential schools did not bring their story to an end. The leg-
acy of the schools continues to this day. It is reflected in the significant edu-
cational, income, and health disparities between Aboriginal people and other
Canadians—disparities that condemn many Aboriginal people to shorter, poorer, and
more troubled lives. The legacy is also reflected in the intense racism some people
harbour against Aboriginal people and the systemic and other forms of discrimination
Aboriginal people regularly experience in Canada. Over a century of cultural genocide
has left most Aboriginal languages on the verge of extinction. The disproportionate
apprehension of Aboriginal children by child welfare agencies and the disproportion-
ate imprisonment and victimization of Aboriginal people are all part of the legacy of
the way that Aboriginal children were treated in residential schools.
Many students were permanently damaged by residential schools. Separated from
their parents, they grew up knowing neither respect nor affection. A school system that
mocked and suppressed their families’ cultures and traditions destroyed their sense
of self-worth. Poorly trained teachers working with an irrelevant curriculum left stu-
dents feeling branded as failures. Children who had been bullied and abused carried
a burden of shame and anger for the rest of their lives. Overwhelmed by this legacy,
many succumbed to despair and depression. Countless lives were lost to alcohol and
drugs. Families were destroyed, children were displaced by the child welfare system.
The Survivors are not the only ones whose lives have been disrupted and scarred
by the residential schools. The legacy has also profoundly affected their partners,
their children, their grandchildren, their extended families, and their communities.
Children who were abused in the schools sometimes went on to abuse others. Some
students developed addictions as a means of coping. Students who were treated and
punished as prisoners in the schools sometimes graduated to real prisons.
These impacts cannot be attributed solely to residential schooling. But they
are clearly linked to the Aboriginal policies of the federal government over the last
150 years. Residential schooling, which sought to remake each new generation of
Aboriginal children, was both central to and an emblematic element of those policies.
4 • Truth & Reconciliation Commission
The beliefs and attitudes that were used to justify the establishment of residential
schools are not things of the past: they continue to animate much of what passes for
Aboriginal policy today. Reconciliation will require more than pious words about the
shortcomings of those who preceded us. It obliges us to both recognize the ways in
which the legacy of residential schools continues to disfigure Canadian life and to
abandon policies and approaches that currently serve to extend that hurtful legacy.
This volume examines the legacy of Canada’s policy of assimilation and the resi-
dential schools it created in five specific areas: child welfare, education, language and
culture, health, and justice.
Child welfare
The federal government and the churches believed that Aboriginal parenting,
language, and culture were harmful to Aboriginal children. Consequently, a central
objective of the residential schools was to separate Aboriginal children from their
parents and communities to “civilize” and Christianize them. For generations, chil-
dren were cut off from their families. At the height of the system in 1953, over 11,000
Aboriginal children were in residential schools.1 The schools were in many ways more
a child welfare system than an educational one. A survey in 1953 suggested that 4,313
of those students were thought to be suffering from “neglect” at home.2 From the
1940s onwards, residential schools increasingly served as orphanages and child wel-
fare facilities. By 1960, the federal government estimated that 50% of the children in
residential schools were there for child-protection reasons.3
The schools were intended to sever the link between Aboriginal children and par-
ents. They did this work only too well. Family connections were permanently broken.
Children exposed to strict and regimented discipline in the schools not only lost their
connections to parents, but also found it difficult to become loving parents.
Child welfare agencies across Canada removed thousands of Aboriginal children
from their families and communities and placed them in non-Aboriginal homes with
little consideration of the need to preserve their culture and identity. Children were
placed in homes in different parts of the country, in the United States, and even over-
seas. The mass adoptions continued between 1960 and 1990.4
Aboriginal children are still being separated from their families and communities
and placed in the care of child welfare agencies. Like the schools, child welfare agen-
cies are underfunded, often culturally inappropriate, and, far too often, put Aboriginal
children in unsafe situations. The child welfare system is the residential school system
of our day.
Introduction • 5
Education
The residential school system failed as an educational system. Those who adminis-
tered the system and many of its teachers assumed that Aboriginal children were unfit
for anything more than a rudimentary elementary or vocational education. The focus
on elementary level and religious training amounted to a self-fulfilling prophecy. Most
students left residential schools unprepared to succeed either in the market economy
or to pursue more traditional activities such as hunting and fishing. The educational
impact of the government’s policy of assimilation was pervasive. Both Aboriginal and
non-Aboriginal children attending public schools received the same message about
Aboriginal inferiority as students in residential schools. This helps explain why even
those Aboriginal children who did not attend a residential school grew up with the
same sense of humiliation and low self-esteem, and why so many Canadians have
such a low opinion of Aboriginal people.
One of the most far-reaching and devastating legacies of residential schools has
been their impact on the educational and economic success of Aboriginal people. The
lack of role models and mentors, insufficient funds for the schools, inadequate teach-
ers, and unsuitable curricula taught in a foreign language all contributed to dismal
success rates. The Truth and Reconciliation Commission of Canada has heard many
examples of students who attended residential school for eight or more years, but left
with nothing more than Grade Three achievement, and sometimes without even the
ability to read. According to Indian Affairs annual reports, in the 1950s only half of
each year’s enrolment made it to Grade Six.5
Poor educational achievement has led to the chronic unemployment or underem-
ployment, poverty, poor housing, substance abuse, family violence, and ill health that
many former students of the schools have suffered as adults.
Governmental failure to meet the educational needs of Aboriginal children con-
tinues to the present day. Government funding is both inadequate and inequitably
distributed. Educational achievement rates continue to be poor. While secondary
school graduation rates for all Aboriginal people have improved since the closure of
the schools, considerable gaps remain with the non-Aboriginal population.
Lower educational attainment for the children of Survivors has severely limited
their employment and earning potential, just as it did for their parents. Aboriginal
people on average have much lower incomes and are more likely to experience unem-
ployment, and are more likely to collect employment insurance and social assistance
benefits than non-Aboriginal people in Canada.6
The income gap is pervasive: non-Aboriginal Canadians earn more than Aboriginal
workers no matter whether they work on reserves, off reserves, in urban, rural, or
remote locations.7 The rate of poverty for Aboriginal children is disturbingly high—
40%, compared to 17% for all children in Canada.8 Overcoming this legacy will require
Aboriginal education systems that meet the needs of Aboriginal students and respect
Aboriginal parents, families, and cultures.
Language and culture

In a study of the impact of residential schools, the Assembly of First Nations noted
in 1994 that
language is necessary to define and maintain a world view. For this reason,
some First Nation Elders to this day will say that knowing or learning the native
language is basic to any deep understanding of a First Nation way of life, to being
a First Nation person. For them, a First Nation world is quite simply not possible
without its own language. For them, the impact of residential school silencing
their language is equivalent to a residential school silencing their world.9
Residential schools were a systematic, government-sponsored attempt to destroy
Aboriginal cultures and languages and to assimilate Aboriginal peoples so that they
no longer existed as distinct peoples. English—and to a far lesser degree French—
were the only languages of instruction allowed in most residential schools.
Students were punished—often severely—for speaking their own languages.
Conrad Burns, whose father attended the Prince Albert school, named this policy for
what it was: “It was a cultural genocide. People were beaten for their language, people
were beaten because … they followed their own ways.”10
The damage affected future generations, as former students found themselves
unable or unwilling to teach their own children Aboriginal languages and cultural
ways. As a result many of the almost ninety surviving Aboriginal languages in Canada
are under serious threat. The United Nations Educational, Scientific and Cultural
Organization (unesco) has found that 70% of Canada’s Aboriginal languages are
endangered.11 In the 2011 census, 14.5% of the Aboriginal population reported that
their first language learned was an Aboriginal language.12 In the previous 2006 cen-
sus, 18% of those who identified as Aboriginal had reported an Aboriginal language
as their first language learned, and, a decade earlier, in the 1996 census, the figure
was 26%. If the preservation of Aboriginal languages does not become a priority both
for governments and for Aboriginal communities, then what the residential schools
failed to accomplish will come about through a process of systematic neglect.
Health
Residential schools endangered the health and well-being of the children who
attended them. Many students succumbed to infectious disease—particularly
Introduction • 7
tuberculosis—at rates far in excess of non-Aboriginal children.13 Children who had

been poorly fed and raised in the unsanitary conditions that characterized most resi-
dential schools were susceptible to a variety of health problems as adults. Many would
later succumb to tuberculosis that they contracted in the schools.14
Sexual and physical abuse, as well as separation from families and communities,
caused lasting trauma for many others. In many cases, former students could find no
alternatives to self-harm.15 The effects of this trauma were often passed on to the chil-
dren of residential school Survivors and sometimes to their grandchildren.
The overall suicide rate among First Nation communities is about twice that of
the total Canadian population. For Inuit, the rate is still higher: six to eleven times
the rate for the general population. Aboriginal youth between the ages of ten and
twenty-nine who are living on reserves are five to six times more likely to die by sui-
cide than non-Aboriginal youth.16
Health disparities of such magnitude have social roots. They are stark evidence of
federal policies that separated Aboriginal people from their traditional lands and live-
lihoods, confining them to cramped and inadequate housing on reserves that lacked
the basic sanitary services. It was from these communities that residential school stu-
dents were recruited and to them, their health further weakened, that they returned.
A comprehensive health care strategy that recognizes the value of traditional healing
practices is desperately needed to help close these gaps in health outcomes.
Justice
Residential schools inflicted profound injustices on Aboriginal people. Aboriginal
parents were forced, often under pressure from the police, to give up their children
to the schools. Children were taken far from their communities to live in frightening
custodial institutions that felt like prisons. The children who attended residential
schools were treated as if they were offenders and were at risk of being physically
and sexually abused.
The Canadian legal system failed to provide justice to Survivors who were abused.
When, in the late 1980s, that system eventually did begin to respond to the abuse, it did
so inadequately and in a way that often re-victimized the Survivors. The Commission
has been able to identify fewer than fifty convictions stemming from abuse at resi-
dential schools, a small fraction of the more than 38,000 claims of sexual and serious
physical abuse that were submitted to the independent adjudication process that was
established to assess and compensate residential school abuse claims.17
In many ways, the residential school experience lies at the root of the current over-
incarceration of Aboriginal people. Traumatized by their school experiences, many
succumbed to addictions and found themselves among the disproportionate number

of Aboriginal people who come into conflict with the law.
Once Aboriginal persons are arrested, prosecuted, and convicted, they are more
likely to be sentenced to prison than non-Aboriginal people. In 2011, Aboriginal peo-
ple made up 4% of the Canadian population, yet they accounted for 28% of admis-
sions to sentenced custody.18 Of those admitted into provincial and territorial custody
in 2011–12, Aboriginal females accounted for 43%, compared to 27% for Aboriginal
males.19 And in the same year, 49% of girls below the age of eighteen admitted to cus-
tody were Aboriginal, compared to 36% of males.20
There is a troubling link between the substance abuse that has plagued many residen-
tial school Survivors and the overincarceration of Aboriginal people. Fetal alcohol spec-
trum disorder (fasd) is a permanent brain injury caused when a woman’s consumption
of alcohol during pregnancy affects her fetus.21 The disabilities associated with fasd
include memory impairments, problems with judgment and abstract reasoning, and
poor adaptive functioning.22 Studies from Canada and the United States suggest that
15% to 20% of prisoners have fasd. A recent Canadian study found that offenders with
fasd had much higher rates of criminal involvement than those without fasd, includ-
ing more juvenile and adult convictions.23 Diagnosing fasd can be a long and costly
process and the lack of a confirmed diagnosis can result in the unjust imprisonment of
Aboriginal people who are living with a disability. In this way, the traumas of residential
school are quite literally passed down from one generation to another.24
As well as being more likely to be involved as offenders with the justice system,
Aboriginal people are 58% more likely than non-Aboriginal people to be the victims
of crime.25 Aboriginal women report being victimized by violent crime at a rate almost
three times higher than non-Aboriginal women—13% of Aboriginal women reported
being victimized by violent crime in 2009.26 The most disturbing aspect of this victim-
ization is the extraordinary number of Aboriginal women and girls who have been
murdered or are reported as missing. A 2014 rcmp report found that, between 1980
and 2012, 1,017 Aboriginal women and girls were killed and 164 were missing. Of
these, 225 these cases remain unsolved.27
Conclusion
The Commission is convinced that genuine reconciliation will not be possible
until the broad legacy of the schools is both understood and addressed. Canada has
acknowledged some aspects of the ongoing legacy and harms of residential schools;
the Supreme Court has recognized that the legacy of residential schools should be
considered when sentencing Aboriginal offenders. While these have been impor-
tant measures, they have not been sufficient to address the grossly disproportionate
Introduction • 9
imprisonment of Aboriginal people, which continues to grow, in part, because of a

lack of adequate funding and support for culturally appropriate alternatives to impris-
onment. There has been an increase in Aboriginal child welfare agencies, but the dis-
proportionate apprehension of Aboriginal children continues to increase because of a
lack of adequate funding for culturally appropriate supports that would allow children
to remain safely with their families.
Many of the individual and collective harms have not yet been addressed, even after
the negotiated out-of-court settlement of the residential school litigation in 2006, and
Canada’s apology in 2008. In fact, some of the damages done by residential schools to
Aboriginal families, languages, education, and health may be perpetuated and even
worsened as a result of current governmental policies. New policies may be based
on a lack of understanding of Aboriginal people similar to that which motivated the
schools. For example, child welfare and health policies may fail to take into account
the importance of community in raising children. We must learn from the failure of
the schools to ensure that the mistakes of the past are not repeated in the future.
Understanding and redressing the legacy of residential schools will benefit all
Canadians. Governments in Canada spend billions of dollars each year responding
to the symptoms of the intergenerational trauma of residential schools. Much of this
money is spent on crisis interventions related to child welfare, family violence, ill
health, and crime. Despite genuine reform efforts, the dramatic overrepresentation
of Aboriginal children in foster care, and among the sick, the injured, and the impris-
oned continues to grow. Only a real commitment to reconciliation and change will
reverse the trends and lay the foundation for a truly just and equitable nation.
* * *
The following chapters include Calls to Action as developed by the Truth and
Reconciliation Commission. The Calls to Action in this volume are numbered accord-
ing to the order in which they appear in Honouring the Truth, Reconciling for the
Future: Summary of the Final Report of the Truth and Reconciliation Commission of
Canada. Also see the Calls to Action in this volume.
Chapter 1
Child welfare: A system in crisis
Introduction
R
esidential schools were an early manifestation of a child welfare policy of
child removal that continues to this day. Since government and the churches
believed that Aboriginal parents were inferior when it came to raising chil-
dren, and could not be relied upon to raise them to be “proper” Canadians, a central
objective of the residential schools was to separate Aboriginal children from their par-
ents and communities to “civilize” and Christianize them.
For generations, children were cut off from their families. At the height of the system
in 1953, just over 11,000 Aboriginal children were in residential schools.1 A 1953 sur-
vey suggested that 4,313 of them were thought to be suffering from “neglect” at home.
The end of the residential school system did not mean that Aboriginal children
were no longer forcibly separated from their families. Child welfare services carried
on where the residential schools left off. More Aboriginal children are removed from
their families today than attended residential schools in any one year. Following the
inquiry into the death of an Aboriginal girl in Manitoba, the Honourable Ted Hughes
concluded that the overrepresentation of Aboriginal children in care in Canada is
“unconscionable” and “a national embarrassment.”2
Why are so many Aboriginal children taken into care? Poverty, family violence,
sexual violence, and substance abuse—conditions that are part of the sad legacy of
residential schools—certainly play a role. The connection between residential schools
and the present-day crisis of the overrepresentation of Aboriginal children in the child
welfare system was painfully obvious to many Survivors who shared their statements
with the Commission. Kay Adams explained that “all these years of growing up in the
dorm I didn’t go home to my family. I wasn’t taught how to love. I wasn’t taught how
to be a family. I knew none of that.”3
Tim McNeil felt the impact of residential schools when his children were older: “I
was a good parent until my kids turned thirteen, and when my kids turned thirteen
then I started parenting them the way that I was when I was in school. So suddenly my
love was gone, my affection was gone, my time was gone. I started treating them the
way I was treated in the dorm. And that was with strict rules, strict discipline, you had
to follow a certain order, there was no love, there was no affection.”4 These Survivors
suffered in residential schools. Their children suffered because of their suffering.
The perception that separation from their families is in the best interests of Aboriginal
children may still be influenced by assumptions about the inferiority of Aboriginal par-
enting. These assumptions seem to be reflected in funding for child welfare services.
Federal funding of on-reserve child welfare has been the subject of prolonged litigation
before the Canadian Human Rights Commission and the Federal Courts since 2007.
Aboriginal groups have long argued that not only is the amount of funding inequita-
ble, but also the funding structure shows a preference for taking Aboriginal children
into care rather than providing supports that would allow them to remain safely with
their parents.5
At five years old, Daniel Big George and his four-year-old sister were taken to a resi-
dential school. He did not see his family for over two years. Reflecting on today’s child
welfare system, Big George observed, “they’re utilizing the [Children’s Aid Society] as
how the residential school system was run.”6 At Commission hearings in Inuvik, Chief
Norma Kassi agreed: “the doors are closed at the Residential Schools but the foster
homes are still existing and our children are still being taken away.”7
More than a century of taking Aboriginal

children from their families
For many years the assimilation of all Aboriginal people was government policy,
and residential schools were one of the tools used to implement that policy. At the
same time, protecting Aboriginal children from their parents was often the stated
reason for forcibly removing children from their homes. Aboriginal parenting was
considered inferior, a prejudice that clearly shows in documents throughout the long
history of residential schools.
In his 1879 report on residential schools, Nicholas Flood Davin wrote that “the chil-
dren should be kept constantly within the circle of civilized conditions.”8 A few years
later, in 1883, according to Indian Commissioner Edgar Dewdney, residential schools
were preferable to day schools for producing workers:
[It is] difficult to make day schools on reserves a success, because the influence
of home associations is stronger than that of the school, and so long as such a
state of things exists I fear that the inherited aversion to labour can never be suc-
cessfully met. By the children being separated from their parents and property
and regularly instructed not only in the rudiments of English language, but also
in trades and agriculture, so that what is taught may not be readily forgotten, I
Child welfare: A system in crisis • 13
can but assure myself that a great end will be attained for the permanent and
lasting benefit of the Indian.9
Over two decades later, in 1915, the principal of the Kuper Island school in British
Columbia wrote that the “only way” to educate Aboriginal children “is to bring them
to an industrial school, where they are completely under the control of their teachers,
and separated from the evil influences of most of their homes.”10
These architects and administrators of the residential school system believed that
Aboriginal children would be much better off away from their parents. Residential
schools were often deliberately built at a distance from reserves to discourage
Aboriginal parents from even visiting their children.11
Prejudice is embedded in policy
Compulsory schooling and school attendance has been in place in Canada since
the 1870s. However, compulsory attendance laws provided that, for non-Aboriginal
children, school attendance was not mandatory if the school was not conveniently
close to the child. Non-Aboriginal children were not required to attend schools where
they could not return to their families each day.12
In 1894, the Indian Act was amended to authorize the government “to secure the
compulsory attendance of children at school.”13 Government officials had already
noted the necessity for family ties to be “severed during the school term.”14 The
Regulations Relating to the Education of Indian Children granted Indian agents and
justices of the peace the power to authorize the apprehension and placement of
Aboriginal children in industrial or boarding schools, if they were satisfied that their
parents or guardians were “unfit or unwilling to provide for the child’s education.”15
Indian agents were authorized to appoint truant officers with “police powers.” A year
later, the acting superintendent general of Indian Affairs asked the Department of
Justice to develop a standard warrant for the removal of Aboriginal children from their
families where “adequate provision is not being and will not be made for the care, or
education or the education and care of the said [child].”16
Twenty years later, in 1914, an Indian Affairs circular was reminding Indian agents
that the government had the power to place children “who are not being properly
cared for or educated” in residential schools. Agents were told that “orphan children
and children neglected by their parents should have the preference.”17 Thus, appre-
hending Aboriginal children, for assimilation purposes or in response to perceived
neglect, became routine over a hundred years ago.
The 1940s and 1950s
Support for residential schools had decreased by the Second World War, and the
federal government started closing residential schools in some parts of the country.
However, in 1943, senior civil servant R. A. Hoey warned that places in residential
schools would still be necessary for “orphans and children from disrupted homes.”18
With fewer places available, the emerging cadre of professional child welfare workers
were to give priority to admitting children considered to be neglected.
In 1947, the Canadian Welfare Council and the Canadian Association of Social
Workers collaborated on a report to a Special Joint Committee of the Senate and the
House of Commons that was examining the Indian Act. The two organizations argued
for the assimilation of Aboriginal peoples to ensure “not only their admission to full
citizenship, but the right and opportunity for them to participate freely with other citi-
zens in all community affairs.”19 The authors noted disparities in the education, health,
and welfare services provided to Aboriginal people. They recommended immediate
reforms to address the gaps. One of their recommendations was to investigate extend-
ing provincial education, health, and welfare services to reserves.
The provinces and territories assumed responsibility for child welfare services on
reserves in the 1950s, facilitated by amendments to the Indian Act in 1951 that allowed
all provincial laws of general applications to apply on reserve.20 At first, the provinces
and territories provided only emergency on-reserve services. With more federal
funding, services expanded to receiving and assessing child protection reports, fam-
ily services, guardianship of children in care, and adoption.21 Funding mechanisms
encouraged the removal of children from their homes because, while the federal gov-
ernment was willing to pay for child-in-care costs, there was considerable resistance
by both federal and provincial governments to support preventive services.22
Even as some residential schools shut down, provincial child welfare authorities
began to apprehend increasing numbers of Aboriginal children. Many were eventu-
ally given up for adoption, often to non-Aboriginal families.
The “Sixties Scoop”
The provincial social workers assigned to reserves assessed child safety and wel-
fare by mainstream cultural standards. They received little or no training in Aboriginal
culture. They were not trained to recognize problems rooted in generations of trauma
related to the residential schools. Instead, they passed judgment on what they consid-
ered bad or neglectful parenting. As a result, beginning in the 1960s, provincial child
welfare workers removed thousands of children from Aboriginal communities. It has
been called the “Sixties Scoop.”23
Aboriginal children were placed in non-Aboriginal homes across Canada, in the

United States, and even overseas, with no attempt to preserve their culture and iden-
tity. The mass adoptions continued between 1960 and 1990.24
The Sixties Scoop children suffered much the same effects as children who were
placed in residential schools. Aboriginal children adopted or placed with white
foster parents were sometimes abused. They suffered from identity confusion, low
self-esteem, addictions, lower levels of educational achievement, and unemploy-
ment.25 They sometimes experienced disparagement and almost always suffered
from dislocation and denial of their Aboriginal identity.
Canada ignores recommendations to support Aboriginal parents
Meanwhile, as Aboriginal children continued to be placed in residential schools

and the mass adoptions of the Sixties Scoop were under way, some officials within
Canada’s Department of Indian Affairs, as well as outside experts, were recommend-
ing the better solution of providing supports for parents.
In 1965, J. R. Tully, superintendent of the Blood Indian Agency, wrote, “the main
reason for the majority of younger children being in Residential School here is because
their parents just cannot afford to properly feed and clothe them for part of the school
year.”26 He suggested that it was not efficient to house a child in residential school for
ten months per year when the parents had economic problems for only four months.
In the absence of “welfare assistance” for the parents, however, he concluded that
there was no practical alternative to placing children in residential schools.
A confidential 1966 report by the Department of Indian Affairs estimated that 75%
of the children in residential schools were “from homes which by reasons of over-
crowding and parental neglect or indifference are considered unfit for school chil-
dren.” Return to the reserve was considered undesirable because “the security that
the child finds in the school is shaken on his return to the reserve.”27 The report noted
that the substantial funds required for residential schooling might have been more
usefully put towards “improving the home and training the parents” to increase “self
support.”28 The report did not result in a policy change, and the money continued to
go to the schools.
In 1967, George Caldwell, a child care specialist with the Canadian Welfare
Council, investigated and reported to the federal government on placements in nine
Saskatchewan residential schools. Caldwell noted that family welfare needs appeared
to be the main reason for placing 60% of the children. Although “neglect” was fre-
quently cited, Caldwell observed a “serious absence of recorded data on the child and
the reason for admission is open to question because of this lack of information.”29 He
recommended that services to assist Aboriginal families should “not be restricted to
the narrow definition of investigating allegations or evidence of neglect of children,

but recognition should be given to prevention of family deterioration, and profes-
sional services given to strengthen and maintain family life.”30
Caldwell, like the authors of the 1966 Indian Affairs report, believed that support
for families would be a better and less drastic alternative to apprehending children
or placing them in residential school. Caldwell’s humane and sensible recommenda-
tions were also not adopted.
Apprehension put children in triple jeopardy
In a 1983 report for the Canadian Council on Social Development, Patrick Johnston
wrote that the child welfare system placed Aboriginal children in “triple jeopardy,”
removed from parents, extended family, and culture:
The effects of apprehension on an individual Native child will often be much
more traumatic than for his non-Native counterpart. Frequently, when the
Native child is taken from his parents, he is also removed from a tightly knit com-
munity of extended family members and neighbours, who may have provided
some support. In addition, he is removed from a unique, distinctive and familiar
culture.31
As the Commission heard from some Sixties Scoop Survivors, the child welfare sys-
tem continued a multigenerational cycle of displacement and alienation. Many chil-
dren lost contact with both their families and their Aboriginal identity forever.
In a 1985 Manitoba public inquiry report, Associate Chief Judge Edwin Kimelman
decried the systematic placement of thousands of Aboriginal children in white homes
outside Manitoba and described the practice as “cultural genocide,” which had “taken
place in a systematic, routine manner.”32 Judge Kimelman continued,
An abysmal lack of sensitivity to children and families was revealed. Families
approached agencies for help and found that what was described as being in the
child’s “best interest” resulted in their families being torn asunder and siblings
separated. Social workers grappled with cultural patterns far different than their
own with no preparation and no opportunity to gain understanding.33
Survivors tell their stories

The residential schools failed to protect Aboriginal children from abuse, but so did
many child welfare agencies. The Commission heard from many Survivors of both
residential schools and the Sixties Scoop.
A Sixties Scoop Survivor placed with a white family was told that her parents were
“the drunken Indians on Main Street.” Her foster father sexually abused her and her
brothers, and her brothers also sexually abused her.34
Tara Picard, whose birth name was Rhonda Eagles, was adopted into a white family
and “was basically told that the First Nations people were really horrible people, and
not to be that way.” She “turned into white, being white, more white than anything.”35
At the age of three, Marci Shapiro was taken from her mother, who had attended
residential school, and adopted into a Montréal family: “There was a huge movement
in the seventies, where they took children from Manitoba and put them into Montréal
Jewish Family Services.” Many of those adoptees “are drug addicts. They’ve had chil-
dren; their children go into care. It’s like the whole cycle’s been perpetuated and it
continues.”36 She is committed to working with her community to help break the cycle.
One former student of the Christie Residential School in British Columbia was also
placed in a number of foster homes. She was abused at the school and by her stepfather
at home. She remarked, “That’s why I’m so against apprehension of our Aboriginal chil-
dren. They should stay with the parents.… Don’t be like us, without our parents, that we
never grew up with, we never really got to know.”37
Another woman who made a statement to the Commission in Alberta was placed
in a foster home with three other children. She explained,
In that foster home there was a pedophile, and I don’t [know] what was happen-
ing to anybody else, but I became his target. The mother used to always send me
to do errands with him. And so every time, he would make me do things to him
and then he would give me candy. Also, in that home there was no hugging of us
foster kids or anything like that. And I carried a great guilt for many, many years,
because sometimes I didn’t want to resist it, I just … But I knew it was very bad.38
One foster child told the Commission of the abuse she suffered in her foster home.
Her Aboriginal identity was constantly disparaged and she was “singled out” because
she was “not as white as the others”: “[They were] adamant about Aboriginal culture
being less than human, living as dirty bush people, eating rats. It made me not want
to be one of those people. And for years, I didn’t know how to be proud of who I was
because I didn’t know who I was.”
This person has now reconnected with her culture and made a great effort to attend
one of the Commission’s gatherings. Her mother, who attended residential schools,
“was led to believe that her mother and her sisters were heathens, living in the bush
… because that’s what the church had told her.”39 However, her mother and her own
daughters remain estranged from their family, their community, and their culture.
Joanne Nimik, the daughter of two residential school Survivors, was apprehended
at age four and adopted by a white family. Until she reconnected with her birth
mother, she had “limited exposure to Aboriginal culture.” She had difficulties growing
up, and when she was eighteen she “went into the bad crowd and started partying and
drinking and drugging.” Only recently has she realized how much residential schools
affected her life. With the help of her family and Aboriginal traditions, she is deter-
mined to “break the cycle”40 in which generations of families are involved with the
child welfare system.
Class actions before courts across the country are seeking accountability and com-
pensation from the federal government for the Sixties Scoop.41 The federal govern-
ment is vigorously fighting these suits. In December 2014, an Ontario court dismissed
the federal government’s attempt to have the Ontario-based class action thrown out.
In allowing the class action to continue to the next stage, the Court observed that “it
is difficult to see a specific interest that could be of more importance to aboriginal
peoples than each person’s essential connection to their aboriginal heritage.”42
Delivery of Aboriginal child welfare services

A patchwork of three hundred provincial and territorial child welfare agencies,
operating in thirteen different jurisdictions, deliver Aboriginal child welfare services
in Canada. The provinces and territories have jurisdiction over child welfare within
their borders, including almost all services provided off reserve. The federal govern-
ment is responsible for funding child welfare services on reserves.
Through its First Nations Child and Family Services Program, Canada has commit-
ted to funding child welfare services on reserves that are culturally appropriate, com-
ply with provincial legislation and standards, and are reasonably comparable with
services provided off reserves in similar circumstances.43 As this section will demon-
strate, that commitment is not being honoured.
The Canadian First Nations child welfare system is a complex array of governance
models: the delegated model, the integrated model, band bylaws, and bilateral and
tripartite agreements.
Delegated model
Delegated delivery is the most common governance model. Provincial govern-

ments delegate responsibility for the delivery of child welfare services to Aboriginal
child and family services agencies.44 These agencies are required to conform to pro-
vincial/territorial laws as a condition for funding.
Ontario’s child welfare system is governed by a unique delegation arrangement
because of an Indian Welfare Agreement that was signed between the Province of
Ontario and Aboriginal Affairs and Northern Development Canada (then named
Department of Indian Affairs) in 1965. The agreement was negotiated without input
from First Nations and provides for the federal government to reimburse Ontario for
93% of the cost of providing child welfare services on reserves in Ontario.
Integrated model
A smaller number of agencies operate under the integrated model in which the
Aboriginal community and the provincial government share governance respon-
sibilities. Manitoba provides the best example of the integrated model in action.
Four regional authorities operate the province’s child welfare agencies: the General
Authority, Métis Authority, First Nations of Northern Manitoba Authority, and First
Nations of Southern Manitoba Authority. This system, first implemented in 2000,
developed as a result of recommendations made by the Manitoba Aboriginal Justice
Inquiry in 1991. The Province of Manitoba, the Manitoba Metis Federation, the
Assembly of Manitoba Chiefs, and Manitoba Keewatinook Ininew Okimowin jointly
developed the model.45
Each regional authority has the right to direct its child and family services agen-
cies, and the Manitoba government is responsible for determining policies and
standards, monitoring compliance, and funding.46 Each authority is mandated to
provide services anywhere in the province.47 As a result, Manitoba is the only prov-
ince where Aboriginal child welfare agencies provide mandated services both on
and off reserve, and First Nations, Inuit, and Métis children and families have access
to culturally appropriate services no matter where they live in Manitoba.48 There
are sixteen First Nations child welfare agencies in Manitoba, including the Child
and Family All Nations Coordinated Response Network. The network is located in
Winnipeg, which has one of the largest urban Aboriginal populations in Canada. It is
the only Aboriginal agency in Canada to serve both Aboriginal and non-Aboriginal
families in a major metropolitan area.49
The General Authority provides services to about 18% of Manitoba’s child welfare
clients, but about 82% of children in care receive services from a First Nation or
Métis authority. This reflects the dramatic overrepresentation of Aboriginal children
in care.50
Self-governance: Band bylaw and tripartite agreements
Two First Nations have developed self-government systems that afford greater con-
trol over child welfare services. The Spallumcheen First Nation in British Columbia
signed an agreement with Canada in 1981 acknowledging the nation’s jurisdictional
control over child welfare services. This First Nation operates under band bylaws
rather than provincial laws and standards.51 The Nisga’a Lisims First Nation signed a
treaty in 1999 that confirms the nation’s right to “make laws with respect to children
and family services on Nisga’a lands.” Those laws must be consistent with provincial
standards. It operates under a tripartite agreement.52
Recent developments in governance
Although Aboriginal child welfare systems governed by delegated and integrated

models apply the same child welfare legislation as their non-Aboriginal counterparts,
there have been significant reforms to child welfare laws across the country since the
1960s.
Today, most child welfare laws include special considerations for Aboriginal
children, families, and communities. Measures include the requirement to notify
Aboriginal bands of court hearings involving Aboriginal children; Aboriginal engage-
ment in service design and delivery; consultation with Aboriginal representatives in
cases involving Aboriginal children; and priority status for kinship care.53
Ontario legislation requires that culturally appropriate services be made avail-
able for Aboriginal children. The government may exempt First Nations child welfare
authorities from any provision in the Child and Family Services Act. Five First Nations
agencies in Ontario have agreements with the provincial government that exempt
them from applying specific aspects of the child welfare legislation.54
Some provinces have implemented Aboriginal-specific practice standards. In
British Columbia, the Aboriginal Operational and Practice Standards manual prior-
itizes child placement within Aboriginal communities and involvement of families
and communities in intervention plans. It also promotes access to cultural ceremo-
nies and information on Aboriginal heritage.55 In New Brunswick, the MicMac and
Maliseet First Nations Services Standards Manual introduced culturally based stan-
dards in 1993.56 The Federation of Saskatchewan Indian Nations has gone further. Its
Indian Child Welfare and Family Support Act exists alongside provincial legislation
and includes standards recognized by the province as equivalent to ministerial poli-
cies, practices, and standards.57
Jurisdictional disputes and litigation
Jurisdictional responsibility for child welfare is intensely contested, with both the
federal government and provincial and territorial governments essentially trying to
shift the responsibility for Aboriginal child services to the other level of government.
The federal government maintains that child and family services are solely within
the jurisdiction of the provinces and territories. To the extent that it provides fund-
ing for such services on reserves, it does so merely at its own discretion. Canada
maintains that any obligation it may have ends at the borders of reserves. The prov-
inces maintain that the federal government has constitutional responsibility for
“Indians” and argue that the federal government has offloaded responsibility to the
provinces to provide services to an increasingly urban, non-reserve population.58
The result is that there are often disputes over which level of government or depart-
ment is responsible for paying costs.
A 2005 survey of twelve First Nations child welfare agencies found that collectively,
the agencies had experienced 393 jurisdictional disputes within the previous year.
Each dispute required an average of 54.25 person hours to resolve, with some dis-
putes taking up to 200 hours of staff time to sort out. The most frequent disputes were
between the federal government’s own departments (36%), between two provincial
departments (27%), and between federal and provincial governments (14%).59
Funding formulas
Directive 20-1: “We had all the incentives wrong”
Beginning in 1988, most First Nations child and family service agencies received
funding through a federal policy called “Directive 20-1.” First Nations had little input
in creating it. Until 2007–08, Directive 20-1 applied in all jurisdictions except Ontario.60
Directive 20-1 has two funding streams. “Operations” funds are intended to cover
the cost of running a child welfare agency, including costs such as salaries and rent.
Operations funding is based on the size of the child population the agency serves.
“Maintenance” funds are intended to cover the full cost of maintaining children in
care outside of their family homes.61
Directive 20-1 does not cover other types of services. Notably, it does not cover pre-
ventive services to support families. Not surprisingly, Directive 20-1 has come under
fire. An evaluation by the Department of Indian and Northern Affairs Canada con-
cluded that “the program’s funding formula, Directive 20-1, has likely been a factor in
increases in the number of children in care and program expenditures because it has
had the effect of steering agencies towards in-care options—foster care, group homes
and institutional care because only these agency costs are fully reimbursed.”62
Failure to provide supports to families that would assist them to maintain custody
of their children could very well be a violation of international law. The Convention on
the Rights of the Child requires states to provide assistance to ensure that the integrity
of Indigenous families and communities is protected.63 Directive 20-1 does not do so.
Canadian officials are well aware of this. In 2011, Michael Wernick, then the deputy
minister for the Department of Indian and Northern Affairs, pointed out the flaws to
the Standing Committee on Public Accounts:
What I think we identified, with the help of the work from the Auditor General,
was that we had the incentives all wrong.… We didn’t really have a funding
formula that provided a lot of resources for prevention. In many cases, early in-
tervention and prevention with the families in the communities means that the
kids can be protected from harm and risk without having to be taken out of the
home and put into care. So children in care is sort of a flawed measure as well for
what we’re trying to get at.64
The Enhanced Prevention Focused Approach
Canada responded to criticism of Directive 20-1 with a new funding formula called
the “Enhanced Prevention Focused Approach.” Operations and maintenance fund-
ing streams still exist, but there is now a third stream for prevention services with the
goal of reducing out-of-home placements. In a further improvement over Directive
20-1, the Enhanced Prevention Focused Approach does not require block funding.
Agencies have the flexibility to shift funds between streams to meet the needs of the
community.65
The new funding formula is being rolled out based on tripartite agreements between
Canada, the provinces, and First Nations child and family services agencies. Tripartite
framework agreements based on the Enhanced Prevention Focused Approach have
been negotiated in Alberta, Manitoba, Nova Scotia, Prince Edward Island, Québec,
and Saskatchewan.66 They have led to significantly increased funding.67 Canada plans
to negotiate agreements in all jurisdictions. In the meantime, Directive 20-1 continues
to be applied in the remaining provinces despite its serious acknowledged flaws.
Shifting money between streams: A shell game
Funding for prevention services is certainly a welcome development, but the new
formula is already raising concerns.
Maintenance funding is based on the actual costs of maintaining children in care
from the year prior. Agencies dealing with an increase in the number of children in
care then face deficits that must be covered by shifting resources from prevention
and operations. The resulting lack of predictability makes it difficult for agencies to
develop and sustain prevention programs.
As with Directive 20-1, operations funding continues to be based on the assump-
tion that 6% of on-reserve children are in care (with the exception of Manitoba, which
assumes 7%).68 Agencies with a higher number of children in care will have fewer
resources for operations and may have to cut prevention services to cover the shortfall.
The auditor general expressed concern about this aspect of the new funding formula:
The new formula does not address the inequities of the existing formula. It still
assumes that a fixed percentage of First Nations children and families need child
welfare services. Agencies with more than 6% of their children in care will con-
tinue to be hard-pressed to provide protection services while developing family
enhancement services. In our view, the funding formula should be more than
a means of distributing the program’s budget; it should take into account the
varying needs of First Nations children and communities.69
The Standing Committee on Public Accounts agreed, noting that “the result of this
approach is that communities that need funding the most, that is, where more than
6% of the children are in care, will continue to be underfunded and will not be able to
provide their children the services they need.”70
Shifting money between program areas: Another shell game
Since 1996, the Department of Indian Affairs and Northern Development (which
became the Department of Aboriginal Affairs and Northern Development in 2011)
has capped annual department funding increases at 2%. But funding for the First
Nations Child and Family Services Program budget has increased significantly, more
than doubling from $193 million in 1997 to $450 million in 2007. These increases were
funded by transferring money from other program areas, such as community infra-
structure and housing.71
Starving community infrastructure and housing of funds is self-defeating and
unsustainable. Neglected community infrastructure and poor housing conditions
contribute to the growing number of child welfare cases that are causing the financial
pressures on the system in the first place.
Will it work?
Shifting the money around would not be as serious a problem if the new funding
approach could achieve the goals of preventing family violence, protecting children,
and reducing the overrepresentation of Aboriginal children in care. It is still early days
for the Enhanced Prevention Focused Approach, but the results of several formal eval-
uations conducted for the Department of Aboriginal Affairs have been, at best, mixed.
A 2010 evaluation by Indian Affairs and Northern Development Canada found that
“the research is inconclusive regarding the extent to which prevention programming
has been effective to date.” The number of First Nations children in care increased
after the new model was introduced. The average number of days in care also went up,
though there were wide variations between agencies. A small number of agencies had
increased prevention spending and also reduced the numbers of children in care, but
the evaluation was unable to determine whether this was a direct result of prevention
activities.72
Based on evaluations, in 2012 Aboriginal Affairs identified a series of issues under-
mining the effectiveness of the Enhanced Prevention Focused Approach: complex
medical needs, the high cost of institutional care, an increase in older children coming
into care, housing shortages and overcrowding, shortages of Aboriginal foster parents,
lack of program supports for parents with addiction or mental health problems, and
poverty.73 Aboriginal Affairs noted that “agencies report that some families are unable
to meet their basic needs (food, fuel for heating, transportation to medical appoint-
ments, etc.) and find themselves unable to care for their children.”74
Because the most significant driver of high child welfare rates in Aboriginal com-
munities is “neglect” that is actually tied to poverty, there are limits to how successful
the new formula can be. The Enhanced Prevention Focused Approach does not put
more money into the hands of Aboriginal families, provide them with safe housing, or
put food on their tables.
Formulas for funding aside, the auditors general of Canada and British Columbia
have concluded that Aboriginal child welfare agencies do not receive adequate fund-
ing to ensure equitable access to a level and quality of services comparable with those
provided to other children.75 The Government of Canada, in meaningful consulta-
tion with Aboriginal communities, should undertake immediate measures to ensure
that Aboriginal child and family service agencies are provided with adequate and
sustainable resources to ensure culturally based services regardless of their place of
residence. Funding arrangements should ensure that Aboriginal agencies and com-
munities have adequate resources to strengthen families so as to minimize the need
for drastic interventions that take Aboriginal children away from their families.
Human rights complaint
There are several examples of the highly charged legal atmosphere surrounding
services to Aboriginal children and families. In 2007, the Assembly of First Nations
and the First Nations Child & Family Caring Society of Canada76 filed a complaint
with the Canadian Human Rights Commission under the Canadian Human Rights
Act, alleging that Canada’s failure to ensure equitable and culturally based child and
family services for First Nations amounted to discrimination on the basis of race and
national ethnic origin.77
Canada disputed the Canadian Human Rights Tribunal’s jurisdiction to review the
complaint and spent more than $3 million on legal proceedings aimed at getting the
case dismissed.78 Canada argued that a discrimination analysis should not be based
on comparing federal levels of funding to those of the provinces and territories. If
accepted, that argument would render the concept of discrimination meaningless
with respect to Aboriginal peoples. The federal government could, with impunity,
deny Aboriginal peoples the quality of services enjoyed by all other groups in Canada
simply by saying that there is no basis for comparison.
In 2011, the tribunal accepted Canada’s arguments and dismissed the human
rights complaint, ruling that the Canadian human rights regime “does not allow a
comparison to be made between two different service providers with two different
service recipients. Federal funding goes to on-reserve First Nations children for child
welfare. Provincial funding goes to all children who live off reserve. These constitute
separate and distinct service providers with separate service recipients. The two can-
not be compared.”79
On judicial review, the Federal Court and the Federal Court of Appeal soundly
rejected this restrictive approach as unreasonable.80 The Federal Court of Appeal
ordered the Canadian Human Rights Tribunal to hear the case.81 In concluding that
the tribunal’s decision to dismiss the case was unreasonable, the court emphasized
that “discrimination is a broad, fact-based inquiry” that requires “going behind the
façade of similarities and differences” and “taking full account of social, political, eco-
nomic and historical factors concerning the group.”82
The Canadian Human Rights Tribunal has been hearing evidence sporadically
since February 2013, although a lengthy adjournment was required when Canada
disclosed an additional 50,000 pages of documents. The hearing was completed in
October 2014. At the time of writing, it is anticipated that the tribunal will publish its
decision in 2015.
The litigation in this case has been particularly prolonged. The federal government’s
aggressive approach aligns awkwardly with its recognition and apology regarding the
ongoing legacy of residential schools in child welfare cases.
Jordan’s Principle
The repercussions of these disputes over jurisdiction can be serious. Aboriginal
children pay the highest price, especially children with complex developmental, men-
tal health, and physical health issues.83
Jordan River Anderson was a member of the Norway House First Nation in
Manitoba. He was born with complex medical needs. Jordan remained in hospital two
years longer than medically necessary while the provincial and federal governments
fought over who would pay for his at-home care. Before the two governments could
come to an agreement, Jordan died, at age five, never having spent a day in a family
home.84
In theory, situations such as Jordan’s should not arise again. On December 12, 2007,
the House of Commons unanimously supported a private member’s motion (M-296)
stating that “the government should immediately adopt a child-first principle, based
on Jordan’s Principle, to resolve jurisdictional disputes involving the care of First
Nations children.”85 According to Jordan’s Principle, the government department that
is first contacted for a service readily available off reserve must pay for it while it is
pursuing reimbursement for the expenses.86
Jordan’s Principle was not passed as legislation. It is merely a statement by
Parliament.87 The Canadian Paediatric Society noted in 2011 that not one province or
territory had implemented a child-first approach to resolving jurisdictional disputes
over services provided to First Nations children and youth.88 Jurisdictional disputes
continue to delay Aboriginal children and families’ access to services.
3) We call upon all levels of government to fully implement Jordan’s Principle.
Jeremy’s case
An Aboriginal family from Pictou Landing, Nova Scotia, went to court in 2013 seek-
ing to enforce Jordan’s Principle so that a disabled child would receive the supports
he required to remain in the family home and avoid institutionalization.89 Both levels
of government took the position that the child was not entitled to the supports his
family had requested. Since both governments denied entitlement, they both took the
position that in fact there was no jurisdictional dispute and Jordan’s Principle did not
apply. The Federal Court concluded that both levels of government were wrong and
that the child was entitled to the services. The court ordered Canada to pay the nec-
essary costs.
The costs for one child had consumed 80% of the six-hundred-member band’s
budget for personal and home care services. The judge stressed that “Parliament has
unanimously endorsed Jordan’s Principle and the government, while not bound by
the House of Commons resolution, has undertaken to implement this important prin-
ciple.”90 The judge also noted that the only other option for Jeremy would be institu-
tionalization and separation from his mother and his community. His mother is the
only person who, at least at times, can understand and communicate with him.
First Nations child and family services agencies

In the early 1980s, Indian Affairs and Northern Development Canada (as it was then
called) began approving the establishment of First Nations child and family service
agencies on reserves on a case-by-case basis. The first were established in Alberta,
Manitoba, and Nova Scotia. Canada now provides funding to 106 Aboriginally con-
trolled agencies. In 2010–11, 9,242 Aboriginal children were outside of the parental
home and in the care of First Nation child and family service agencies, which rep-
resents 5.6% of on-reserve children.91
A few larger Canadian cities (such as Toronto and Vancouver) also have First
Nation child and family service agencies.92 There are none in the territories, where
the same agencies that serve all children provide services to Aboriginal children. In
Yukon, Canada provides funding for these services to the territorial government. The
funding arrangement is slightly different in the Northwest Territories and Nunavut,
where there are territorial transfer agreements with the federal government.
Canada rejected First Nation demands to operate services in accordance with tra-
ditional laws and traditional justice systems. By contrast, in the United States, tribal
courts have played an important role in the child welfare system since 1978.93
Persistent problems
The discouraging news is that, despite the expansion of First Nations child and
family services agencies, the overrepresentation of Aboriginal children in care contin-
ues. Sometimes, the emphasis has seemed to be on simply creating more First Nations
agencies.
There is a lack of vision for a system that can truly serve Aboriginal peoples. The BC
Representative for Children and Youth has had some harsh words on the subject for
the parties involved in child welfare in that province: “There is no clear direction as to
how the Aboriginal child welfare system will be improved; there is no observable logic
between how the current Aboriginal governance and service structure initiatives will
improve services and there is no monitoring of the impact of the various initiatives
undertaken to date.”94
It is also troubling that the ability of First Nations child and family services agen-
cies to develop culturally appropriate services has been constrained by inadequate
funding. Of twelve First Nations agencies surveyed in 2005, 83.4% reported that they
did not receive enough funds to ensure culturally appropriate services.95 This hinders
their capacity to provide effective services and contributes to the continuing overrep-
resentation of Aboriginal children in care.
Overrepresentation of Aboriginal children in care
The data picture is far from complete
Data on Aboriginal children in child welfare care is not collected in a uniform and
accessible manner across the country. Each province and territory has its own child wel-
fare system, with different definitions of terms such as child in care and different methods
for collecting information. Some data collection systems allow for comparison between
Aboriginal and non-Aboriginal children but others do not. In terms of the reasons for
investigations, the grounds for interventions, and the characteristics of children and fam-
ilies who are investigated, the picture across the country is far from complete.
Children may be placed in foster care, in group homes or residential facilities, or
with relatives (often called kinship arrangements). However, whether a child welfare
agency defines the child as being in care depends on factors such as the type of place-
ment, whether it is formal or informal, and whether it is permanent or temporary.
Direct comparisons are difficult, making national statistics ambiguous. Thus, it is a
challenge to compile reliable statistics about the number of Aboriginal children in
care at any given time.
Alarming findings from recent research
The Public Health Agency of Canada, a federal agency designed to promote health
and apply research to health problems, has partnered with some of Canada’s leading
child welfare researchers to develop the Canadian Incidence Study of Reported Child
Abuse and Neglect. The study is developing information about the incidence of child
welfare investigations in Canada, the numbers of children in care, the reasons for
child welfare agency involvement with families, and the types of family stressors that
can lead to child maltreatment.96 So far, the study has analyzed data collected from
selected child welfare agencies across the country in 1998, 2003, and 2008.97
In 2011, for the first time, the study published a First Nations Component, based
on data collected in 2008.98 The First Nations Component is a result of a partnership
between the study’s research team and the First Nations Component advisory com-
mittee, which includes representatives from national and provincial First Nations child
welfare organizations.99 It includes data from 89 provincial/territorial agencies, 22 First
Nations and urban Aboriginal agencies, and 1 Métis agency (on a pilot basis).100
The authors of the 2011 First Nations Component of the Canadian Incidence Study
of Reported Child Abuse and Neglect note that First Nations child welfare agencies
vary enormously. Added to resource limitations, this made it impossible for the
researchers to identify a sample of First Nations agencies that could reliably represent
all such agencies. Thus, the study findings cannot be generalized and can only be said
to apply to children living in the geographic areas served by the sampled agencies.101
Nevertheless, the findings point to vast overrepresentation of Aboriginal children in
care. The study found that investigations involving Aboriginal children resulted in formal
child welfare placements, including foster care, group home, and residential secure treat-
ment (but excluding informal kinship care) at 12.4 times the rate for investigations involv-
ing non-Aboriginal children.102 Placements into informal kinship care occurred at 11.4
times the rate for non-Aboriginal children. Overrepresentation in the latter category may
not be entirely negative if it indicates that child welfare agencies were increasingly respect-
ing the informal kinships structures in Aboriginal communities. Nevertheless, the number
of Aboriginal children in formal care placement was found to be grossly disproportionate.
Statistics Canada’s 2013 National Household Survey provides some further insight.
The survey found that 14,225 Aboriginal children under the age of 14 were in foster care,
representing 3.6% of all Aboriginal children under the age of 14. To put that in perspective,
at the height of the residential school era, 10,112 students were in those schools.103 Only
15,345 non-Aboriginal children were in foster care, representing 0.3% of non-Aboriginal
children.104 Figures from the 2011 Canada Household Survey show that, although
Aboriginal people make up only 4.8% of Canada’s population, Aboriginal children rep-
resent almost half (48.1%) of all children aged 14 and younger in foster care in Canada.105
The percentages vary considerably across the country, but Aboriginal children in
care are grossly overrepresented in all the jurisdictions for which data is available.
Table 1.1 shows stark differences in Ontario, Manitoba, Saskatchewan, Alberta, and
British Columbia:106
Table 1.1
Aboriginal children in care vs. their proportion of provincial child populations
Province Aboriginal children as a % of Aboriginal children as a % of
the total child population children in care
Nova Scotia 6 16
Québec 2 10
Ontario 3 21
Manitoba 23 85
Saskatchewan 25 80
Alberta 9 59
British Columbia 8 52
Source: Extracted from Sinha et al., Kiskisik Awasisak: Remember the Children: Understanding the
Overrepresentation of First Nations Children in the Child Welfare System, 5.
NB: Data for New Brunswick and Canadian territories were not publicly available. Data collection protocols vary
from province to province
Among these provinces, Ontario’s rate of overrepresentation is the most dispro-

portionate, with seven times as many Aboriginal children in care as their proportion
of the population. Statistics are not available for the territories, but the ratios could be
even higher than those for the western provinces given that the North has more recent
experience with residential schools.
International criticism
International law recognizes that children require special care in order to ensure
that they enjoy fundamental human rights and dignity. The preamble of the United
Nations Convention on the Rights of the Child states that to ensure that a child has the
opportunity for “the full and harmonious development of his or her personality, [he or
she] should grow up in a family environment, in an atmosphere of happiness, love and
understanding.” In safe and secure homes, children can be “brought up in the spirit
of the ideas proclaimed in the Charter of the United Nations, and in particular in the
spirit of peace, dignity, tolerance, freedom, equality and solidarity.”
Concern for the “best interests of the child” is a central feature of the Convention
on the Rights of Child and, in particular, must guide decisions about child welfare. In
Commentary 11, the United Nations Committee on the Rights of the Child considered
the application of international children’s rights to Indigenous peoples, and stated
clearly that it is in the best interests of children to be raised in a setting that respects
their ethnic, religious, cultural, and linguistic background.107 Indigenous children
have the right to the preservation of their identity, including their nationality, name,
and family relations. Where a child is illegally deprived of some or all of the elements
of their identity, states must provide assistance to re-establish that identity.108 Parents,
extended families, and communities have rights, responsibilities, and duties when it
comes to raising children, and the Convention requires states to provide assistance
to ensure that the integrity of Indigenous families and communities are protected.
The best interests of the child are the paramount consideration in any alternative care
placement of Indigenous children.109
These international law principles are also firmly entrenched in the Declaration
on the Rights of Indigenous Peoples. The declaration prohibits the forcible removal
of Indigenous children to other groups.110 Indigenous peoples also have the right
to identity and to the preservation of their language and culture.111 These rights are
threatened by child welfare decisions that remove children from their families and
communities without due consideration being given to those issues.
The overrepresentation of Aboriginal children in Canada’s child welfare sys-
tem has not gone unnoticed in the international community. In 2006, the United
Nations Committee on Economic, Social and Cultural Rights noted “with concern
that low-income families, single-mother-led families and Aboriginal and African

Canadian families are overrepresented in families whose children are relinquished
to foster care. The committee is also concerned that women continue to be forced
to relinquish their children into foster care because of inadequate housing.”112 The
committee recommended that, “in accordance with the provisions of article 10 of the
covenant on the protection of families, the federal, provincial and territorial govern-
ments undertake all necessary measures including through financial support, where
necessary, to avoid such relinquishment.”113
In 2012, the UN Committee on the Rights of the Child cited the frequent removal of
children from families as a “first resort” in Canada in cases of neglect, financial hard-
ship, or disability, and decried the frequency with which Aboriginal children were
placed outside their communities.114 Noting that Canada had also failed to act on the
federal auditor general’s findings of inequitable child welfare funding, the committee
concluded that “urgent measures” were needed to address the discriminatory over-
representation of Aboriginal children in out-of-home care.115
The UN committee also urged Canada to “intensify its efforts to render appropriate
assistance to parents and legal guardians in the performance of their child-rearing
responsibilities with timely responses at the local level, including services to parents
who need counselling in child-rearing, and, in the case of Aboriginal … populations,
culturally appropriate services to enable them to fulfil their parental role.”116 The com-
mittee called on Canada to “take immediate steps to ensure that in law and practice,
Aboriginal children have full access to all government services and receive resources
without discrimination.”117 There appears to have been little sense of urgency within
the Government of Canada to respond to these repeated calls to take action.
Why are so many Aboriginal children in

care? The links to residential schools
The research literature and Survivors’ statements to the Commission suggest that
the legacy of residential schools is a significant factor in the overrepresentation of
Aboriginal children in the child welfare system. According to a Saskatchewan study,
there is strong evidence that “the residential school period [was] the beginning of an
intergenerational cycle of neglect and abuse. This cycle is seen as one very important
contributor to the significant over-representation of First Nations and Métis children
and families in child welfare systems in the country today.”118
In Kiskisik Awasisak: Remember the Children, the authors discuss the link between
overrepresentation and the residential schools and mass removals:
Though [the 2008 data] cannot establish how many caregivers of investigated
First Nations children may have experienced direct or intergenerational effects
of the Sixties Scoop or residential schools, the data presented here cannot be
properly interpreted without recognition of the ongoing implications of the
historic pattern of mass removal of First Nations children from their homes and
communities.119
In a 2002–03 survey by the First Nations Centre, 71.5% of residential school Survivors
reported that they had witnessed the abuse of others and had experienced abuse
themselves in the schools.120 In the same survey, 43% of intergenerational Survivors
believed that they were affected by their parents’ experience at residential schools,
and 73.4% reported that their parents were affected by their grandparents’ experience
at residential schools.121
At the Commission’s request, the Indian Residential Schools Adjudication Secretariat
analyzed information from claims submitted through the Independent Assessment
Process (iap) by Survivors of abuse at residential schools.122 In a random sample of 203
files, claimants had a range of lasting effects of abuse:
• Depression or low self-esteem: 94%

• Relationship problems: 90%
• Parenting problems: 42% (more women than men)123
• Substance abuse: 78% (more men than women)
• Sexual issues: 65% (more women than men)124
One-third (33%) of the claimants reported having an encounter with the criminal
justice system (40% of males and 24% of females).125 This is significant because a parent
who has been charged with a crime or has been the victim of a crime may be particularly
vulnerable to child welfare investigations and apprehensions.
A majority of the iap claimants in the sample had received some type of treatment,
but 40% reported that they had none. Of those who sought one or more types of treat-
ment, 32% received mental health therapy, 29% received alcohol treatment, 24% took
part in traditional healing, and 12% received drug treatment.126
No opportunity to learn to be parents
Residential school Survivors carry a heavy burden that profoundly influences their
relationships and their ability to provide secure and safe homes for their families. The
Royal Commission on Aboriginal Peoples concluded that the lack of opportunity to
acquire parenting skills is one of the factors that contributed to the grossly dispropor-
tionate incidence of violence and child apprehension in Aboriginal families.127
Many former residential school students who spoke to the Commission acknowl-
edged the mistakes they made as parents and feel guilt for passing their trauma on to
their own children. Alma Scott of Winnipeg was raped by fellow students and sexually
abused by a headmaster at a residential school. Her experience at residential school
had lasting impacts. She explained,
[As] a direct result of those residential schools, I was a dysfunctional mother.… I
spent twenty years of my life stuck in a bottle in an addiction where I didn’t want
to feel any emotions, and so I numbed out with drugs and with alcohol…. That’s
how I raised my children, that’s what my children saw, and that’s what I saw.128
The intergenerational impact of the residential school experience has left some fam-
ilies without strong role models for parenting. An investment in culturally appropriate
programs in Aboriginal communities has the potential to improve parenting skills and
enable more children to grow up safely in their own families and communities.
5) We call upon the federal, provincial, territorial, and Aboriginal governments to

develop culturally appropriate parenting programs for Aboriginal families.
Disproportionate numbers of investigations,

disproportionate findings of “neglect”
In an analysis of the data gathered for the First Nations Component of the Canadian
Incidence Study of Reported Child Abuse and Neglect, the authors of Kiskisik Awasisak
confirmed that Aboriginal children in the geographic areas studied were significantly
overrepresented as subjects of child maltreatment investigations. In the geographic
areas served by the agencies sampled for this study, the rate of investigations of First
Nations children was 4.2 times the rate of non-Aboriginal investigations.129 The study
also found that allegations were more likely to be “substantiated” in cases involving
Aboriginal children. This was so in all categories of maltreatment, but the difference
was most extreme for “neglect” investigations.130 The investigations substantiated the
allegations of neglect at eight times the rate for the non-Aboriginal population.131
In a further analysis of the First Nation Component data, Aboriginal families were
found to have been investigated for neglect at six times the rate for non-Aboriginal
families. The authors concluded that child welfare caseworkers were more likely to
“substantiate” concerns about neglect when investigating Aboriginal families, even
when compared to non-Aboriginal families experiencing the same kinds of risk fac-
tors (such as poverty, housing instability, domestic violence, etc.).132 For example,
they noted that a finding of substance abuse almost always resulted in a finding of
neglect in the case of Aboriginal parents, but this was not so when the parents were
non-Aboriginal. Concerns about housing were also more likely to substantiate find-
ings of neglect involving non-Aboriginal children. This may reflect implicit assump-
tions that poor housing is more “normal” for Aboriginal families.
In a report for the Child and Youth Services Review, the authors concluded that
“ethno-racial bias on the part of investigating workers” could not be excluded as a
cause of the increased tendency to find neglect in investigations of Aboriginal chil-
dren.133 The authors stressed that findings of neglect account for much of the over-
representation of Aboriginal children in the child welfare system.134 This suggests that
today, as in the residential school era, Aboriginal children are often taken away from
their parents because of assumptions that they will be neglected.
No clear standards for findings of neglect
Very little is known about how child protection workers identify cases of neglect.135
In an analysis of supervisory neglect cases from the 2008 Canadian Incidence Study
of Reported Child Abuse and Neglect, the researchers found that only 2% of cases
resulted in injuries. They observed that “in the absence of visible signs of harm and
established standards for adequate supervision of children, a question emerges on
… the extent to which those take into account a variety of specific circumstances or
cultural and social class differences and norms affecting ‘acceptable’ patterns of child
care.”136 Moreover, “differences in family practices, in particular cultural difference,
rather than clear evidence of harm or potential harm, may be driving some child wel-
fare investigations.”137 The authors point out that providing family supports and pre-
vention services may be a better response to supervisory concerns.138 As noted earlier,
however, similar recommendations have largely gone unheeded to date.
Social workers and others who conduct child welfare investigations need educa-
tion and training about the history and impacts of residential schools. They should
also be trained to assess the potential within Aboriginal communities and families to
provide more appropriate solutions to family healing.
Poverty and other risk factors
An analysis of the First Nations Component of the Canadian Incidence Study of

Reported Child Abuse and Neglect confirms that poverty and social stressors are
major factors in child welfare investigations involving Aboriginal families. Aboriginal
parents were more likely to experience a host of serious risk factors, including domes-
tic violence, alcohol abuse, lack of social supports, drug or solvent abuse, and a his-
tory of living in foster care or group homes.139
In cases of maltreatment investigations, poverty was much more prevalent in

Aboriginal families. They were more likely to rely on income supports such as social
assistance (49%) than non-Aboriginal parents (26%).140 The researchers suggest that
the high rate of Aboriginal child welfare investigations reflect “challenges linked
with poverty.”141 It follows that reducing social assistance to Aboriginal parents may
increase child welfare apprehensions. The direct connection between Aboriginal
poverty and high child welfare apprehensions has been known for half a century.
Yet Aboriginal children are still being taken away from their parents because their
parents are poor.
First Nations represent ninety-six of the one hundred most disadvantaged com-
munities in Canada.142 Reserve communities have very limited emergency housing,
food security, wellness and addictions services, supports for families, and recreation
services. More research is needed, but the evidence suggests that the disproportion-
ate number of Aboriginal children taken from their parents for “neglect” is tied to poor
funding for their schools and health care services as well as other factors related to the
legacy of residential schools.
True neglect is undoubtedly a threat to a child’s health and well-being. However,
the Commission is deeply concerned that the concept of neglect may be used to
target Aboriginal families for child apprehensions. To eliminate any systemic dis-
crimination and unconscious bias as a legacy of residential schools, it is clear that
neglect investigations and outcomes should be assessed and monitored based on
clear evaluation criteria.
For over a hundred years, Canadian law has, in various ways, continued to autho-
rize government officials to take Aboriginal children away from their parents. The
federal government funds child welfare services on reserves, but provincial laws are
generally applied. Provincial and territorial child welfare laws continue to allow offi-
cials to apprehend Aboriginal children who are deemed to need protection. Parental
rights can be curtailed or even ended if a judge determines that it is in the best inter-
ests of the children.143
Withdrawal from the child welfare field is not possible. That would leave many
Aboriginal children vulnerable. However, without action to reduce the number of
Aboriginal children taken from their families, the child welfare system itself will take
the place of residential schools in doing damage to them. As adults, the children taken
into care in the years to come will place high demands on social assistance and the
health and justice systems. They will struggle economically and socially. They may
pass damage on to their own children.
1) We call upon the federal, provincial, territorial, and Aboriginal governments to com-
mit to reducing the number of Aboriginal children in care by:
i. Monitoring and assessing neglect investigations.
ii. Providing adequate resources to enable Aboriginal communities and child

welfare organizations to keep Aboriginal families together where it is safe to
do so, and to keep children in culturally appropriate environments, regardless
of where they reside.
iii. Ensuring that social workers and others who conduct child welfare investi-
gations are properly educated and trained about the history and impacts of
residential schools.
iv. Ensuring that social workers and others who conduct child welfare investi-
gations are properly educated and trained about the potential for Aboriginal
communities and families to provide more appropriate solutions to fam-
ily healing.
v. Requiring that all child welfare decision makers consider the impact of the
residential school experience on children and their caregivers.
2) We call upon the federal government, in collaboration with the provinces and
territories, to prepare and publish annual reports on the number of Aboriginal
children (First Nations, Inuit, and Métis) who are in care, compared with non-
Aboriginal children, as well as the reasons for apprehension, the total spending
on preventive and care services by child welfare agencies, and the effectiveness
of various interventions.
Deaths of Aboriginal children in care

It is very difficult to get a clear picture of Aboriginal child welfare across the coun-
try, but information about deaths of Aboriginal children in care is even more fragmen-
tary. Where province-specific statistics are available, they are very troubling. In some
parts of the country, Aboriginal children who come into contact with child welfare
authorities are more likely to die than their non-Aboriginal counterparts.
In January 2014, the Edmonton Journal published a series of articles about deaths
in Alberta’s child welfare system. Alberta had never publicly reported on deaths of
children in care. The newspaper’s investigation revealed that Aboriginal children
accounted for 78% of children who died in foster care between 1999 and 2013.144
Aboriginal children are a small minority but represent 59% of children in care in
Alberta. Yet the number of Aboriginal child deaths in care is even more disproportion-
ate than the number of them in care in the first place. Of the seventy-four Aboriginal
child deaths recorded in foster care, thirteen were due to accidents, twelve committed
suicide, and ten were the victims of homicide.145
Forty-five of these Aboriginal children died while in the care of a provincial child
welfare agency and twenty-nine died in the care of an on-reserve First Nations child and
family service agency. Since First Nations agencies care for only a fraction of the
children (27% in 2012–13) Aboriginal children are much more likely to die if they are
in care on reserve. According to reporter Darcy Henton, this statistic “starkly high-
lights the federal/provincial funding disparity that gives off-reserve aboriginal chil-
dren more services and more support.”146
In the outcry following the Edmonton Journal’s revelations, the Alberta Centre for
Child, Family and Community Research obtained more information about child wel-
fare deaths from the provincial government. Their analysis showed that “Aboriginal
children were much more likely than non-Aboriginal children to enter the interven-
tion system, and had higher rates of mortality than non-Aboriginal children once they
were in the system.”147
By contrast, in British Columbia, a review covering the period between 1997 and
2005 found that Aboriginal children and youth represented 34% of children in care
and 36% of the deaths.148 While this roughly equal figure is not cause to celebrate,
it illustrates that it is difficult to generalize about the scope of the problem across
the country.
In Ontario, under a joint directive from the Coroner’s Office and the Ministry of
Children and Youth Services, children’s aid societies report child deaths when the
child or family was involved with child welfare in the year prior to the death. There
are approximately one hundred such deaths in Ontario each year, representing about
8% of all child deaths in Ontario.149 The Coroner’s Office’s Paediatric Death Review
Committee chooses a subset of these cases for more extensive review, generally
excluding cases in which the death was due to expected or uncomplicated natural
causes. In 2012, 29% of the reviewed cases involved Aboriginal children.150 (Twenty-
one per cent of children in care in Ontario are Aboriginal.)151 The committee found
that in many of the Aboriginal cases, there were issues related to the child welfare
agency’s capacity to meet ministry requirements. A strained relationship between
child welfare agencies and local First Nations communities was also identified as a
problem.152
Death is only the most extreme example of harm coming to a child. This sample
of experiences from different provinces strongly suggests that Aboriginal children in
care specifically, disproportionately, and on a widespread basis throughout the coun-
try, continue to be deprived of services they require and protections they deserve.
The death of Phoenix Sinclair
Phoenix Sinclair was a healthy baby girl born to Aboriginal teenage parents in
Manitoba. Both parents had troubled pasts, and because of their own history as foster
children, they intensely mistrusted the child welfare system. Phoenix was taken into
care twice during her five years of life. She was twice returned to her family, with lit-
tle support, on either occasion. The caseworkers assigned to her changed frequently.
They had little face-to-face contact with the family or with Phoenix herself.
At least thirteen times, Winnipeg Child and Family Services received notices of
concern about Phoenix’s safety and well-being. In 2005, three months after the last
notice, her mother and her mother’s partner killed her. Her death went undiscovered
for nine months.153
A commission of inquiry examined Phoenix’s life, the services she received through
Winnipeg Child and Family Services, and Manitoba’s child welfare system generally.
Former Saskatchewan judge Ted Hughes led the inquiry. He found that child welfare
workers lacked awareness of the reasons families came into contact with the child
welfare system and the steps caseworkers should take to support them. In Phoenix’s
case, caseworkers repeatedly closed her file, with minimal investigation, because they
concluded that Phoenix was not in danger in the short-term. They failed to consider
her long-term risk.154
Reporting on the inquiry in 2014, Justice Hughes noted that new practices had been
put in place in recent years to identify families that needed help earlier, to assess a
family’s needs and strengths, and to provide services to enable them to keep their chil-
dren safely at home. However, Justice Hughes also found that many of the services and
supports families needed were still missing.155 He endorsed a “prevention” approach
that provides essential services to all children, accessible without the need to come
into contact with a child welfare agency first.156 This approach would draw on many
resources within Aboriginal communities and support parents and families in a cul-
turally appropriate way. Social workers would need better training in this scenario,
including education on the legacy of residential schools.
Justice Hughes pointed out that the child welfare system alone cannot solve the
child welfare problem. Nor can it address the fact that over 80% of children in care
in Manitoba are Aboriginal, which he called a “national embarrassment.” He wrote
that Aboriginal children are overrepresented in the child welfare system because they
live in “far worse circumstances than other children,” for reasons that are “rooted in
the legacy of colonization and residential schools, the conditions on reserves, cultural
dislocation and loss of identity.”157 Observing that the child welfare system was doing
a poor job of connecting families with the supports that are available to them, Justice
Hughes acknowledged that the system could do little to alleviate poverty or the under-
lying causes of substance abuse, family violence, and sexual abuse.
Justice Hughes called for a collaborative approach: “Working with parents and
harnessing the collective resources of child welfare and other provincial government
departments, other levels of government, and the province’s many community-based
organizations, can make a difference to vulnerable families.”158 Central to such a col-
laboration would be the inclusion of Aboriginal governments, communities and com-
munity organizations, and families.
Following Phoenix Sinclair’s death, the Manitoba Office of the Children’s Advo-
cate conducted a “child death review” of the deaths of all children, from January 2004
to May 2006, who were in receipt of child welfare services within one year of their
death. Of the 145 deaths in the period, 99 files were available for review. The review
concluded that no child died as a direct result of a breakdown in the provision of
child welfare services, but there was a “pattern of difficulties that may have led to the
death of the child.” Many cases revealed a lack of appropriate community services,
or if services did exist, they were difficult to access or coordinate.159 Of the child
deaths included in the study, 76% were Aboriginal or Métis [sic] and 24% were non-
Aboriginal. The authors point out that “these figures closely follow the breakdown of
children involved in the child welfare system, but given the fact that Aboriginal peo-
ple comprise 14% of the total population, it appears that Aboriginal, including Métis
children, are overrepresented in both the child welfare system and the deaths of
children in general.” Deaths by suicide appeared to be driving the higher mortality
rates for Aboriginal children.160 Eleven of the twelve suicides included in the study
were Aboriginal children. Half of these deaths occurred while the children were in
foster care.161
Deaths at the hands of others occurred with terrible frequency. Eighteen of the
ninety-nine deaths reviewed were homicides. Aboriginal children accounted for four-
teen of those deaths. Seven of the eighteen homicides involved children who, like
Phoenix, were under the age of five. All of them were killed by a parent or caregiver,
whether Aboriginal or non-Aboriginal. The killers of the older children were generally
people outside the child’s family. The review noted that “the majority of these chil-
dren were living in homes with a very high level of risk to the children, but none had
received a formal risk and/or safety assessment conducted when they first came into
contact with a child welfare agency or when they were moved or returned to their
family.”162 Authorities most often reported high-risk children as “absent without leave”
when they went missing.163
The Inuit experience with child welfare

Almost 60,000 Inuit people live in Canada.164 Inuit also live throughout the circum-
polar Arctic region, including parts of the United States (Alaska), Russia, and Denmark
(Greenland). Three-quarters of Canadian Inuit live in the traditional homeland known as

Inuit Nunangat. Inuit Nunangat consists of four regions: Nunatsiavut in Newfoundland
and Labrador, Nunavik in Northern Québec, Nunavut Territory, and Inuvialuit in the
Northwest Territories. The Inuit have traditionally occupied these areas, but the regions
are not fully autonomous self-governing entities. Of the approximately 16,000 Inuit peo-
ple who live outside Inuit Nunangat, 37.5% live in large urban centres such as Ottawa
and Montréal. The Inuit population is one of the youngest and fastest growing in Canada.
About 40% of Inuit in Nunavik and Nunavut are under the age of 15.165
After the federal government forced Inuit people to move off the land and into
permanent settlements in the 1950s, Inuit communities made significant attempts
to regain self-determination and follow Inuit Qaujimajatuqangit (Inuit traditional
knowledge). Traditional knowledge is grounded in principles for living a good life,
including working for the common good, respecting all living things, maintaining har-
mony and balance, and planning and preparing for the future.166
Inuit communities are not organized by reserve or band systems like First Nations
communities. Instead, they work within municipal and legislative models. The rela-
tively new territory of Nunavut has the largest Inuit population and has incorporated
Inuit traditional knowledge into all aspects of its formal governance, management,
and operational structures. This has both successes and limitations.167 Each Inuit
region of Inuit Nunangat has gained increased control of the administration of social
services, including child and family services. All regions struggle to build capacity to
deliver these services, including the particular challenge of developing child welfare
services that are culturally appropriate and take into account traditional Inuit prac-
tices of childrearing.168
Traditional Inuit parenting
Traditional Inuit parenting is based on kinship relationships and cultural and spir-
itual beliefs. Inuit believe that a newborn named after a deceased relative takes pos-
session of that relative’s soul or spirit, and this is reflected in the parents’ relationship
with the child.169 According to the national Inuit women’s association, Pauktuutit, it
“would not be considered appropriate ... to tell a child what to do, as this would be the
equivalent of ordering an elder or another adult about, thus violating an important
social rule in Inuit culture.”170
Ignorance of this aspect of Inuit culture caused many non-Aboriginal people,
including residential school administrators and child welfare officials, to make cul-
turally biased judgments. They often saw Inuit parents as extremely permissive and
indifferent to discipline.171 At the residential schools, in contrast, teachers attempted
to control a child’s behaviour through corporal punishment and other harsh disciplin-
ary measures distasteful to Inuit parents.
Inuit custom adoption
In Inuit custom adoptions, the children have knowledge of and access to their birth
parents. Traditionally, Inuit grandparents were integral in helping to raise their grand-
children, as well as orphaned or neglected children, through custom adoption. Inuit
researcher Heather Ochalski points out that, traditionally, “many grandparents adopted
their biological grandchildren. They often took orphaned children in as their own and
called them panik (daughter) or irnik (son) … Sometimes they took them in briefly to
help the biological parents that were nearly starving and returned them to their parents
when they were back on their feet.”172
Residential schools and child welfare apprehensions eroded custom adoption
practices, along with many other values and traditions of Inuit culture. Because they
found Inuit names difficult to pronounce and spell, non-Aboriginal officials changed
names to accord with Christian traditions. They imposed the European tradition of
naming women and girls after the male head of the household, which devalued tradi-
tional kinship ties and imposed unfamiliar belief that females were inferior. From the
1940s to the early 1970s, the federal government assigned numbered disks as a nam-
ing system for Inuit, or “Eskimos” as the government and others called them. Despite
the pressures, many Inuit continued to name their children after their ancestors and
maintain traditional beliefs about naming practices.173
Inuit communities get residential schools
The residential school system was fully operational in the rest of Canada by the
time the federal government extended it to the Eastern Arctic in 1955. Until then, the
government had largely ignored the Inuit.
The Inuit began moving closer to trading posts and trapping non-traditional ani-
mals to benefit from the fur trade, but poverty and the loss of a way of life was too often
the result.174 American officials witnessed these tragedies from their vantage point
along the Distant Early Warning (dew) Line sites spread across the Arctic Inuit home-
land. The international criticism that followed prompted the Canadian government to
establish residential schools for Inuit children on so-called humanitarian grounds.175
The Indian Act was amended in 1951 to state that “the race of aborigines commonly
referred to as Eskimos” was not entitled to the legal rights and benefits defined for
Indians. This legal status did not protect Inuit children from being forced to attend
residential schools.176
Most Inuit parents did not want this compulsory school system and tried to prevent
their children from attending or returning to the residential schools and day schools.
Researcher David King reports that the Family Allowance program, introduced in 1944
for families with children aged sixteen and under, encouraged school attendance. The
government did not have an official policy of denying Family Allowance payments
to families who refused to send their children to residential school, but it was federal
policy to withhold these payments if students were not attending either residential or
day school.177
There was a significant increase in the number of Inuit students attending day and
residential schools between 1956 and 1963. During that time, attendance rose from
201 to 1,173 in the Eastern Arctic. In the Western Arctic, attendance rose from 1,755
to 3,341.178
As at the residential schools in the South, students were separated from their
cultural practices and teachings. Inuit Elders were not allowed to be part of the
education system in their traditional role as cultural teachers. Inuit children attend-
ing residential schools were expected to behave like Qallunaat (white people) in
their communication, dress, and eating habits. The traditional diet was considered
unhealthy because meat and fish were eaten raw. Inuit children were stripped of
their Inuit name, family, language, and culture, and subjected to verbal, psycholog-
ical, physical, and sexual abuse.179
Without their cultural teachings, Inuit children who attended the residential
schools lacked the knowledge and tools to raise their own children in traditional ways.
The cumulative effect of these experiences continues to affect Inuit communities and
families, and it is within this context that contemporary Canadian Inuit child welfare
issues must be addressed.
From residential schools to child welfare in Inuit communities
The systemic abuse and breakdown of the culture and traditions that supported the
health and well-being of Inuit families had far-reaching effects in Inuit Nunangat, pro-
foundly changing family relationships. Anthropologist Nelson Graburn wrote that the
vast majority of historical descriptions “bear little evidence of any kind of child abuse
among the [Inuit] peoples.”180 But the residential schools deprived Inuit children of
the opportunity to learn how to parent in traditional ways and left many students with
the lifelong effects of trauma.
When residential school Survivors became parents, some modelled the harsh dis-
cipline and abusive punishments they had been subjected to as children. Today’s
Inuit children, like First Nations and Métis children in other regions of the country,
now bear the burden of the intergenerational trauma of the residential school era.
Physical and emotional abuse suffered during childhood, loss of culture, overcrowded
housing, and widespread drug and alcohol addiction all contribute to the prevalence
of child abuse.181
Conditions for too many Inuit children include low educational outcomes, poverty,
food insecurity, exposure to communicable diseases, poor health, family violence,
intergenerational trauma, the loss of coping strategies, and epidemic suicide rates.182
In many Inuit communities, healthy food is very expensive. A single char sells for
$99.53; a head of lettuce for more than $28; and four tomatoes for $8.20.183
Isolation, addictions, and a lack of resources and services can make it very difficult
for Inuit parents to provide safe and healthy environments for their children, which
increases the prospects of child welfare apprehension. The child welfare system in
Inuit Nunangat is unable to deal with these challenges effectively.
Since the Inuit homeland is spread out over several territories and provinces, child
welfare services depend largely on where an Inuit family lives. There are no Inuit-
specific (or even Aboriginal-specific) child protection agencies in the North, although
most of the child welfare laws include requirements to take the particular needs of
Aboriginal children into account. Unlike the southern regions, child welfare services
tend not to be specialized. Instead, child protection is often simply one of many
responsibilities of local health and social service centres that must also deliver other
types of supports and programs. For example, in addition to child and family services,
social workers often also provide services to the elderly and people with disabilities.184
Northwest Territories
In the Northwest Territories (nwt), the Department of Health and Social Services
is responsible for the delivery of child and family services, including providing for the
protection and well-being of children and youth through setting standards and ensur-
ing compliance with policy and legislation. These services are currently delivered
through six regional health and social services authorities and the Tlicho Community
Services Agency (established under the Tlicho Land Claims and Self-Government
Agreement). There are approximately seventy-five frontline workers and supervisors
assigned to child protection duties across the Northwest Territories.
In an effort to improve service delivery, effective April 1, 2016, a new Northwest
Territories Health and Social Services Authority will be established, which will replace
the six existing regional authorities and work with the Tlicho Community Services
Agency. Regional advisory councils will provide leadership and guidance to local
program delivery to ensure that services remain culturally responsive. In the future,
Aboriginal governments in the nwt may choose to exercise jurisdiction over child and
family services.185
Child welfare legislation requires that the child’s cultural, linguistic, and spiritual
or religious upbringing be considered. In addition, the child’s Aboriginal community
must be notified of any application for a child protection court order. There is also a
provision for Aboriginal community councils and Aboriginal non-profits to form child
and family services committees. These committees can participate in case planning
for Aboriginal children and families. The Aboriginal Custom Adoption Recognition Act
allows for the privately arranged adoption of children in a manner that respects cul-
tural traditions.186
The rate of child welfare investigations is very high. The 2003 Canadian Incidence
Study of Reported Child Abuse and Neglect found a rate of 141.48 child maltreat-
ment investigations per 1,000 children.187 Although this was not further broken
down by Aboriginal identity, it is safe to assume that Inuit children would be deeply
affected given that more than half of the population of the Northwest Territories is
Aboriginal.188 By comparison, the investigation rate for all of Canada was only 38.33
per 1,000.189 In general, the Northwest Territories mirrored other trends identified
in the Canadian Incidence Study of Reported Child Abuse and Neglect, with the
top three categories of substantiated child maltreatment being neglect, exposure to
domestic violence, and physical abuse. However, the rate of neglect investigations
in the Northwest Territories was very high: 51% as compared with the national rate
of 30%.190
Nunavut
In Nunavut, where Inuit represent the large majority of the permanent population,
there are no distinct Aboriginal or Inuit child welfare agencies. However, the territorial
government has made a commitment to integrate Inuit social values into all programs
and services. The Department of Health and Social Services is responsible for the
delivery of all health and social services, including child welfare services. Community
social workers provide a range of programs in addition to child protection, including
early intervention and support to families, adoption services, and family violence pre-
vention.191 As in the Northwest Territories, Aboriginal community councils and non
-profits can form child and family services committees to participate in case planning
for Aboriginal children and families. As with many territorial government laws and
policies modelled on those in the Northwest Territories when Nunavut was created in
1999, Nunavut also has an Aboriginal Custom Adoption Recognition Act, which allows
for private adoptions of Inuit children in a manner that respects cultural traditions.192
There are no treatment facilities for mental health problems or addictions

in Nunavut.193 Individuals who need such services must travel to facilities in
Saskatchewan, Alberta, or Ontario.
Lack of services within Nunavut has also posed a serious challenge for child pro-
tection. A recent social services review concluded that there is a perception that too
many Inuit children have been placed outside the territory, leading to distrust of the
system and a concern by Inuit that their cultures and values are not being respected.194
Newfoundland and Labrador
In Newfoundland and Labrador, there are no delegated Aboriginal child and

family service agencies. Aboriginal families receive child welfare services from the
regional health authorities. The Labrador-Grenfell Regional Health Authority serves
Inuit families.195 The province’s child welfare legislation recognizes the importance
of respecting and preserving the cultural heritage of children, as well as the respon-
sibility of the community and the extended family to support the safety, health, and
well-being of children. Social workers use these cultural concepts in case planning
for Aboriginal children. To enhance child and family service delivery in Aboriginal
communities, the health authorities employ community members as community
services workers. They assist social workers in providing culturally appropriate sup-
ports to Aboriginal families.196
Nunavik
In Nunavik, Northern Québec, the Nunavik Regional Board of Health and Social
Services is responsible for providing child protection services for Inuit families. The
board covers two regions: Ungava Bay and Hudson Bay. Each region has a health cen-
tre that is responsible for health services, social services, a child and youth protection
centre, a short-term hospital, a long-term residential care centre, and a rehabilita-
tion centre for troubled youth. A board of directors oversees the regional board, and
includes representation from each of the communities, the two local health centres
and the Kativik Regional Government.197 A director of youth protection reports to each
of the health centres. These directors are responsible for applying child welfare legis-
lation, recruiting foster families, and acting as provincial director for the purposes of
the Youth Criminal Justice Act.198 Clearly, child protection is only one of many signifi-
cant tasks.
Inuit custom adoptions are not only permitted, but are frequent in Nunavik. One-
quarter of the children born between 2000 and 2004 have been adopted.199 However,
concerns have been raised about the process of custom adoption in Nunavik. There
are reports of some families forcing mothers to give up children for adoption. Some
adoptions have proceeded in circumstances in which the adoptive family is known to
be inadequate. If difficulties arise, the child may end up being adopted repeatedly.200
Following complaints about inadequate child welfare services in Nunavik,
Québec’s Commission des droits de la personne et des droits de la jeunesse launched
an investigation. The commission’s report, released in 2007, found that Inuit fami-
lies in Nunavik are facing intense stressors and change, and that the child protection
services are not meeting the challenge. The commission described the organizations
as operating “in continual crisis mode.”201 There are not enough staff members and
social workers to cover the vast geography and remote locations of Nunavik.202 The
lack of frontline social services and of preventive programs for children under eigh-
teen is a deficiency that significantly undermines the effectiveness of child protection
in Nunavik.
The commission concluded that the fundamental rights of children and young
people in Nunavik had been infringed, “in particular the right to personal inviolabil-
ity, to the safeguard of their dignity, and to the protection, security and attention that
their parents or the persons acting in their stead are capable of providing.”203 Slight
improvements were reported in 2010, but the commission said the Nunavik system
remained fragile and precarious.204
Gaps in services throughout the Inuit homeland
Regardless of where an Inuit family lives, they are likely to experience gaps in ser-
vices, high numbers of child protection cases, difficulties with custom adoption and
foster care, tensions between Inuit cultural values and the mandates and approaches
of the agencies serving them, and inadequate prevention services.205
The shortage of social service workers is a significant problem. For example, the
auditor general has found that in Nunavut, one-third of its community social service
workers positions were unfilled. The Department of Health and Social Services was not
meeting its key responsibilities for the protection and well-being of children, youth,
and their families. Safety checks of foster and adoptive homes were not done rou-
tinely, nor were complete annual compliance reviews of child protection files being
completed. These failures to meet legislative requirements placed children at risk. The
department could not accurately track the status of children in care or understand
their changing needs.206 The government of Nunavut took these criticisms seriously
and is taking steps to implement the auditor general’s recommendations.207
Social workers who serve Inuit communities need more than simply an academic
degree. They must understand the cultural needs and traditional practices of the
communities in which they work. However, the Nunavut Law Review Commission
(Maligarnit Qimirrujiit) reported that it is challenging for the social service system to
deal with the custom adoption practice.208 Nunavut continues to try to raise awareness
and understanding of the Inuit way of life among those who make policies and work
in child welfare. According to a report published by the National Aboriginal Health
Organization, “traditional Inuit practices, such as custom adoption, [are] essential
to improving family and child security. Formal support for kinship relationships and
extended family and community responsibility for children can create healthy family
environments for all Inuit children.”209
Urban Inuit families and children also have difficulty accessing culturally appropri-
ate services, with only a handful of agencies in the South offering programs for Inuit
children and families. Promising approaches to adapting traditional practices to life in
the city can be found at the Ottawa Inuit Children’s Centre, Ottawa’s Tungasuvvingat
Inuit (a counselling and resource centre), the Manitoba Urban Inuit Association (pro-
viding culturally relevant services and helping Inuit peoples with the transition from
the North to urban settings), and the Association of Montreal Inuit (a community
organization for Inuit peoples). These non-profit organizations are working with Inuit
families and child welfare agencies, providing cultural linkages, and promoting safe
environments for healthy child development and family stability.
The Métis experience with child welfare

Métis histories and experiences differ from those of other Aboriginal peoples in
Canada in terms of their territories, relationship to the land, political institutions, and
legal status. The Métis emerged as a distinct nation in the eighteenth and nineteenth
centuries, and their historic homeland includes Manitoba, Saskatchewan, Alberta,
and parts of Ontario, British Columbia, the Northwest Territories, and the northern
United States.210
The Métis population in Canada is growing and increased by 16.3% between 2006
and 2011. The Métis now account for an estimated 32.3% of the total Aboriginal pop-
ulation and 1.4% of the Canadian population. Michif is the Métis language, spoken by
an estimated 940 Métis in Canada. Many Métis people also speak Cree or other First
Nation languages as well as French and/or English.211
Métis are defined through their identification with ancestors who lived in the his-
toric Métis nation, and through their way of life, culture, language, and relationship
to the land, rather than solely by bloodlines.212 The Métis National Council says that a
Métis is “a person who self-identifies as Métis, is distinct from other Aboriginal peoples,
is of historic Métis Nation Ancestry, and who is accepted by the Métis Nation.”213
Métis peoples have diverse cultural practices and different traditions of childrear-
ing, which evolved from a variety of First Nation and European influences. However,
Métis identity is intrinsically linked with and influenced by the extended family, which
is the basic unit of Métis society. The residential schools challenged these familial
connections, with far-reaching consequences.
Fighting to be heard: Métis children in residential school
Originally, the federal government mandated residential schools to admit

“Indian” children exclusively, although many Métis children attended these institu-
tions unofficially. In 1913, the government policy to exclude Métis children from res-
idential schools was reversed. As reported by the Royal Commission on Aboriginal
Peoples, “they registered children from every Aboriginal culture—Indian, Inuit,
and Métis children too—though the federal government assumed no constitutional
responsibility for Métis people. While Métis children would be invisible, rarely men-
tioned in the records, they were nevertheless there and were treated the same as all
the children were.”214
Rates of admittance and attendance of Métis students ranged widely across geo-
graphical locations, communities, and even within families. At some schools, such
as St. Paul de Métis in Alberta, Métis children were in the majority.215 Before the
Commission began gathering statements from Survivors, Tricia Logan was one of the
only researchers to collect stories, memories, and oral histories from Métis Survivors
of residential schools. Survivors frequently told her of their experiences as outsiders
in “Indian schools.”216
The more “Indian” a Métis child appeared, the more likely that he or she would
be forced into a residential school. As a report for the Aboriginal Healing Foundation
described it, “the closer the government thought the Métis were to First Nation com-
munities, in a geographical or societal sense, the lower class of person they were
thought to be. This lower class had priority over other Métis when being considered
for admission to residential schools to ensure that the outcasts and menaces of soci-
ety, living like Indians, were civilized.”217 School admittance was thus based on the
perceived inferiority of children who presented as “Aboriginal” and were therefore in
greater need of intervention.
With only a half-day of instruction at many schools, it was not unheard of for Métis
children to attend schools for a decade or more yet receive nothing more than a Grade
Two education.218 As the Métis Nation of Alberta has observed, “There has been some
documentation to suggest that the churches considered Métis to be half-white and
therefore they were already half-civilized. This apparently justified offering less edu-
cation to Métis students. Their labour went to financially support the school since
much of what was produced in the farm programs was sold to business interests to
support the schools and not used to feed the children.”219
The intergenerational impacts of Métis experiences in residential and day schools
include the loss of parenting skills, the inability to express feelings, and the loss of
language and culture. Elmer Ghostkeeper, a Métis Elder from Alberta has eloquently
expressed the impact of the residential school experience:
Love is the greatest emotion in Métis families and this love for each other was
greatly impacted by residential schools. Our ways of being as families were also
affected. Our family life included fishing, hunting, and family activities such as
learning language, berry picking, social time, baby caring traditions, and rites of
passage. Our children were enslaved through the residential school system and
lost those connections to our culture. 220
Métis Elder Deborah Dyck recounted her story of attending Cranberry Portage
school in Manitoba as a day student. Both of her parents taught at the school and
tried to show kindness in the harsh environment. She recalled that “the residential
setting was totally different than what Native kids were used to, it didn’t have the
aunty relationships…. As a people, the Métis had to be so resilient and ever chang-
ing to live with an environment that was ever changing and moving. We were made
stronger by this.”221
Métis cultural consultant Tom McCallum, who attended residential school in
Saskatchewan, reflected on parenting and residential schools:
The most important thing is to keep children in touch with their family. They
need to understand where they come from and experience love—they need love!
Healthy, beautiful, love-filled family interactions were destroyed or attacked in
the child welfare/residential school experience.… All parents sang to their chil-
dren. Each child had a special song that was their song…. I’d walk into the house
and my mom would be there and would start singing my song to me. She did this
even when I was older. That’s how we got nicknames…. They would always come
from your song. We never called each other by our given names.222
The loss of culture and family relationships continues to reverberate, and poses
challenges for today’s child welfare system.
Métis children and child welfare
Richard Cardinal was seventeen years old when he hanged himself in 1984. From
the age of four until his death, this Métis boy lived in twenty-eight different child
welfare placements across Alberta, including sixteen foster homes and twelve group
homes, shelters, and locked facilities.223 His diary documents his experience and his
deep longing to be reunited with his family: “I kept telling myself that this was all a bad
dream that I would wake up soon with Charlie and Linda and the rest of my family in
our home in Fort Chipewyan but in reality I knew that I wouldn’t wake and that this
was real and not just a bad dream.” 224 His tragic story brought public attention to the
experience of many Aboriginal children in foster care.
Researcher Deborah Canada found that the Sixties Scoop had a profound impact
on Métis in Manitoba, where “between 1971 and 1981, 70% to 80% of Manitoba’s First
Nation and Métis adoptions were made into non-Native homes.”225 Robert Doucette
was a Sixties Scoop child. He recalled being told that his mooshum (grandfather), who
attended residential school, was “quite mad” when Doucette was taken away at only
four months old. His mooshum “was throwing rocks at the car and swearing at them
in all the languages that he knew he could speak, Michif, Cree, Dene, French and
English. I think he probably swore at them in each language, but he was powerless to
stop them.”
Doucette was adopted into a family with five other Métis foster children. His fos-
ter father had to fight with the school in Prince Albert to allow him to use his birth
name of Doucette. He faced much racism in Prince Albert. Despite being an excellent
hockey player who was offered a tryout with a Junior A team, he turned to individ-
ual sports like track and field where he had more control over how he was treated.
Doucette recalled how he was “a brown white guy” until he began to study his culture
as an adult. His sister in his foster home was not as lucky and took her own life while in
a penitentiary in Kingston, Ontario. He recalled “how sad” it was that her birth father
only saw his daughter when she was born and when she was buried.
Doucette told the Commission, “We have to deal with our own internal racism
amongst ourselves, because there are a lot of people from the Sixties Scoop that are
trying to make their way back, that are being abused by our own people, because they
just don’t want to believe that they are who they say they are.”226
As is the case with the number of Métis children in child welfare, the number
of Métis children adopted out in the Sixties Scoop can only be estimated. Reliable
numbers are not available because Métis identity is inconsistently recorded. Métis
children may not self-identify or even be aware of their Métis heritage. A lack of
knowledge and training leads some social workers to misidentify Métis children as
Aboriginal. Estimates of the number of Métis children in care are likely conservative
and researchers are often unable to track the progress and outcomes of Métis children
involved with child and family services.227
The First Nations Component of the Canadian Incidence Study of Reported Child
Abuse and Neglect was not able to generate separate estimates of Métis child mal-
treatment investigations because there were not enough investigations of Métis chil-
dren in the data to be statistically reliable.228 Data is likewise scarce provincially. In
British Columbia, the Ministry of Children and Family Development reported that of
the 4,642 Aboriginal children in care in 2009, just over 650 (14%) were identified as
Métis.229 The provincial auditor in Manitoba reported an increase in the number of
Métis children in care between the fiscal year 2009–10 and 2010–11, from 797 to 908.230
But this appears to be the extent of concrete information. Clearly, there is a gaping
hole in terms of knowledge about the experience of Métis children and child welfare;
accurate and up-to-date research is vitally needed.
Jurisdiction for providing services to Métis children
Without information, the distinct needs of Métis families cannot be met. A

pan-Aboriginal approach is not appropriate. A Métis child’s identity development
“can be compromised in cross-cultural care if they are immersed in the domi-
nant culture.”231 Métis peoples have traditional concepts of connectedness and
kinship relationships that can form the basis for positive and effective child welfare
interventions. Culturally appropriate supports from extended family can permit
children to remain in their homes and communities.232
The development of Métis-specific child welfare institutions is in its infancy. The
federal government does not provide funding for these services, taking the position
that it is not responsible for Métis peoples, or indeed for any Aboriginal peoples who
do not live on reserves. The government fought for twelve years to stop litigation aimed
at obtaining a legal ruling on federal jurisdictional obligations with respect to Métis
and “non-status Indians.” In April 2014, the Federal Court of Appeal ruled in Daniels
v. Canada that Métis are included as “Indians” within the meaning of the Constitution
Act, 1867, which would mean that the federal government does indeed bear responsi-
bility for Métis peoples.233 The Federal Court of Appeal dismissed a lower court’s find-
ing that “non-status Indians” also fall within federal jurisdiction.234 Both sides have
appealed to the Supreme Court. It is anticipated that the Supreme Court will hear the
case in 2015.235 In the meantime, Métis children rely upon provincial child welfare
agencies that, for the most part, are not designed to meet their unique needs.
There are some exceptions. The most developed Métis child welfare system is
in Manitoba, where the first Métis child and family service agency in Canada was
opened in 2000 as a result of an agreement between the province and the Manitoba
Metis Federation.236 Today, Métis peoples in Manitoba requiring child and family ser-
vices receive culturally appropriate services from the Métis Child and Family Services
Authority, delivered by the Métis Child, Family and Community Services and the
Michif Child and Family Services Agency. The creation of this Métis-specific child
welfare authority may lead to the more accurate identification of Métis children in
care over time.
In Alberta, the province funds municipalities as well as Métis settlements for

Métis child welfare services,237 such as the Metis Child and Family Services Society
in Edmonton and the Métis Calgary Family Services Society. In British Columbia, five
Métis child and family service agencies deliver services while a non-profit organiza-
tion, the Métis Commission for Children and Families, consults with the provincial
government.238
Little progress has been made in Ontario, but the Métis Nation of Ontario has made
recommendations to the provincial government to better adapt child welfare laws to
the needs of its community. The Nation has recommended amendments to the Child
and Family Services Act to allow for Métis-run child and family services. It has also
suggested changes to the collection of data to identify Métis children in care, and bet-
ter training for social workers to work effectively and respectfully with Métis families.
As of spring 2015, these recommendations have not been implemented.239
Inequitable access to the kinds of health and healing services that can prevent the
need for child welfare interventions further undermines the effectiveness of child
welfare services. Health disparities, high unemployment, inadequate housing, and
educational issues need to be addressed to ensure that Métis children have the best
chance for a happy and healthy life.240
Métis Elder Leanne Laberge from British Columbia stressed the importance of tak-
ing every opportunity to take the Métis spirit into spaces where Métis people need to
be represented.241 In spite of the geographical differences of Métis peoples in Canada,
Métis peoples are an extended family. In upholding the extended family, the role of
Métis women will be critical, since “women are the teachers” who keep family infor-
mation, stories, inspire the work ethic, and “look after the spiritual needs and knowl-
edge of the family.”242
Métis who were involved with residential schools or the child welfare system will
need supports to ensure that they can reconnect with their traditions and “to recover
what has been stolen in terms of their family stories, their cultural identity, and their
ancestral pride.”243 It is not only the children taken who require such supports—the
parents, extended families, and communities have also suffered.
The Government of Canada should not let unresolved jurisdictional disputes stand
in the way accepting its responsibilities. Helping Métis people reconnect with their
ancestral ties “means helping families to find and reconnect with those who have
been taken, those lost in the foster care system, those taken to Europe by adoption,
those lying in unmarked graves away from home.”244
Addressing the child welfare crisis

Child welfare institutions in Canada are failing First Nations, Métis, and Inuit chil-
dren. All of these groups are being disproportionately investigated and then placed in
child welfare care. Many of the conditions that result in disproportionate Aboriginal
involvement in the child welfare system are related to the intractable legacies of resi-
dential schools including poverty, addictions, and domestic and sexual violence.
Mary Anne Clarke was married to a residential school Survivor. She told the
Commission that she worries that child and family services are
carrying on some of the same tragedies that kids[went]through [in]the residen-
tial schools. I’m a [Child and Family Services] worker myself, and I know what
it’s like to be in a position to apprehend children. But there’s got to be a better
way than having the community decimated by it. There’s got to be a way to keep,
strengthen the community, putting the supports and services that they need so
that they don’t get removed from the community.
She suggests that we move away from “band-aid solutions” and learn from the
experience of the residential schools:
If anything that the school situation has taught us, it’s to listen. And I think we
need to do the same for the ones who are victims of [Child and Family Services].
And I say victims. I know [Child and Family Services] has helped some people,
I’m not saying that, but there’s a lot of victims out there, too. And the system is
not adequate. And if we listen to the people who have been affected, I do believe
we find our answers.245
Child apprehension is not a step that child welfare officials take lightly. Yet, for
most agencies, it is the only means they have to be funded for providing services. More
resources devoted to a wide range of services could help prevent the need for criti-
cal interventions. As residential school Survivor Shirley Morris told the Commission,
“You look at all these kind of problems and you see even some of our child services
like an extension of the residential school system. How they’re taking our children
away instead of working with the parents and offering them help, and maybe even
respite care. Because of the stress, they never learned to be parents, especially when
they’re having kids [at] sixteen, seventeen, eighteen. They don’t know how to look
after kids.”246
Important steps have been taken to shift control over Aboriginal child welfare to
Aboriginal peoples. But without the necessary funding and tools, Aboriginal child
welfare agencies have been unable to significantly reduce the number of children in
out-of-home care. More Aboriginal children continue to be placed in foster care each
year than attended residential school in any one year. This is the most compelling evi-
dence of the harmful and continuing legacy of residential schools.
The governments of Canada will need to address Aboriginal child poverty, includ-
ing matters of housing, water, sanitation, food security, family violence, addictions,
and education inequities and outcomes. Child welfare reform is essential, and the
crisis of Aboriginal overrepresentation in child welfare cannot be addressed without
interventions that also target its contributing causes.
Lessons from the US Indian Child Welfare Act
The United States experienced a similar crisis of dramatic overrepresentation of

Aboriginal children in care. Congress enacted the Indian Child Welfare Act in 1978
in response. Four years of hearings confirmed that “many state and county social
service agencies and workers, with the approval and backing of many state courts
and some federal Bureau of Indian Affairs officials, had engaged in the systematic,
automatic, and across-the-board removal of Indian children from Indian families
and into non-Indian families and communities.”247 Between 25% and 35% of all
Indigenous children were removed from their families. About 90% were placed in
non-Indigenous homes.248
Professor Lorie M. Graham wrote that the legislative studies and hearings leading
to the passage of the Act “revealed how deeply ingrained the assimilative attitudes of
the past had become in our society. The cultural values and social norms of Native
American families—particularly indigenous child-rearing practices—were viewed
institutionally as the antithesis of a modern-day ‘civilized’ society.”249 Professor
Graham explained how the Act attempted to counter those attitudes and affirm the
legitimacy and the importance of Indigenous families. She recognized that “no law
could dictate a change in the attitudes of social workers, educators and judges regard-
ing indigenous culture.” However, a law could “minimize the effects of those lingering
attitudes by setting minimum standards and procedures for the future placement of
Native American children outside the home.”250
The American law now in force governs any custody proceeding involving the ter-
mination of parental rights, the implementation of foster care, or the adoption of a
Native American child. Tribal courts have exclusive jurisdiction over custody pro-
ceedings involving Native American children living on a reservation. Tribal courts
also have concurrent and presumptive jurisdiction over child custody cases where the
child lives outside of a reservation.251
Where a state court has jurisdiction over a case involving an Indigenous child, the
Act provides for minimum procedural guarantees, including notice to both the par-
ents and the Indian tribe if a state agency is petitioning for foster care or the termina-
tion of parent rights. Parents have the right to court-appointed counsel. State agencies
have to prove “beyond a reasonable doubt ... that the continued custody of the child by
the parent or Indian custodian is likely to result in serious emotional or physical dam-
age to the child,” which is a higher standard than that applied in custody proceedings
involving non-Indigenous children.252 The state agency must also call the testimony of
“qualified expert witnesses” before parental rights can be terminated. To be qualified,
the expert must have “particularized knowledge regarding Indian culture.”253
If the court orders a placement, it must give preference to the Indian child’s
extended family or, failing that, another tribal community placement.254 Child welfare
agencies must prove that “active efforts” have been made to prevent the breakup of
the family before a court can order foster care or termination of parental rights.255
The system in the United States is far from perfect. Critics have argued that state
courts have simply used creative legal arguments to get around the provisions of
the Act.256 In 2013, three families and two tribes, the Oglala Sioux and the Rosebud
Sioux, filed a class action lawsuit alleging that the State of Minnesota had repeatedly
removed children from their homes without due process.257 As in Canada, high rates of
poverty, unemployment, crime, and substance use have contributed to the apprehen-
sion of Indigenous children, and even a reformed child welfare system can do little to
alleviate these problems.258
Nonetheless, after thirty years, the Indian Child Welfare Act has achieved a number
of positive results, including greater tribal authority over the placement of Indigenous
children as well as the expansion of family preservation programs. Indigenous chil-
dren are still removed from their homes in disproportionately high numbers, but the
rate of overrepresentation has decreased. The rate of placement with non-Indigenous
caregivers has also decreased.259
A number of Canadian jurisdictions have similar presumptions built into their leg-
islation, such as the need to respect the integrity of Aboriginal families, the impor-
tance of cultural continuity, and the benefits of kinship care. However, the American
model has one key difference: it places judicial control over child welfare in the hands
of tribal courts.
To begin to address the national Aboriginal child welfare crisis, reform is essen-
tial. A key part of that reform is greater consistency in the regulatory framework that
guides the work of child welfare authorities. That framework must acknowledge the
central role of Aboriginal agencies in decision making about child welfare matters.
As Aboriginal justice systems evolve, they too will come to play a part in determining
child apprehension and custody matters. Establishing national standards is the first
step towards developing greater consistency in decision making and ensuring that
overrepresentation is reduced and that culturally appropriate placements become
the norm.
4) We call upon the federal government to enact Aboriginal child welfare legislation
that establishes national standards for Aboriginal child apprehension and custody
cases and includes principles that:
i. Affirm the right of Aboriginal governments to establish and maintain their
own child welfare agencies.
ii. Require all child welfare agencies and courts to take into account in their
decision making the residential school legacy.
iii. Establish, as an important priority, a requirement that placements of Aboriginal
children into temporary and permanent care be culturally appropriate.
The Touchstones of Hope approach to child welfare reform
In October 2005, Cindy Blackstock and colleagues presented a report titled

Reconciliation in Child Welfare: Touchstones of Hope for Indigenous Children, Youth
and Families to an audience at Reconciliation: Looking Back, Reaching Forward—
Indigenous Peoples and Child Welfare, a conference held in Niagara Falls, Ontario.
The report provides some helpful guidelines to consider in approaching child wel-
fare reform:
• Recognize the past, and current, multigenerational and multidimensional

impacts of colonization on Indigenous children, youth, and families;
• Honour those who suffered the loss of their family relationships and identities
as a consequence of child welfare decisions, and those who have kept family
relationships strong despite all odds;
• Respect those who have worked, and continue to work, to build and develop
culturally based services and policies;
• Affirm that all Indigenous children and youth have the right to family (nuclear
and extended), safety, and well-being, and to be able to identify with, and thrive
as, a member of their culture of origin.
Further, it is expected that the path to reconciliation in child welfare will
• Acknowledge the mistakes of the past, and establish a child welfare profes-
sion based on non-discriminatory values, social justice, and fundamental
human rights;
• Set a foundation of open communication that affirms and supports Indigenous

families and communities as the best caregivers for Indigenous children
and youth;
• Respect the intrinsic right of Indigenous children, youth, and families to define
their own cultural identity;
• Improve the quality of, and access to, services for all children, youth, and fami-
lies to free the potential of each person;
• Build a united and mutually respectful system of child welfare capable of
responding to the needs of all children and youth;
• Strengthen the ability of the child welfare profession to learn, ensuring past mis-
takes do not become tomorrow’s destiny.260
The document sets out five principles (self-determination, holistic response,

respect for culture and language, structural interventions, and non-discrimination),
framed within a four-phase process of reconciliation (truth telling, acknowledging,
restoring, and relating). It includes tools to assist Aboriginal communities to clearly
document their vision of healthy children and families and to work with Aboriginal
and non-Aboriginal community members, professionals, and other stakeholders to
implement the measures needed to achieve that vision. Touchstones of Hope seeks to
stimulate a process for community-specific, community-driven plans for child safety.
However, communities must have the resources and powers necessary to implement
their own creative community solutions to the child welfare crisis.261
An independent evaluation of the implementation of the Touchstones of Hope prin-
ciples in Northern British Columbia suggests that it has been very effective in shifting
the relationship between First Nations and mainstream child welfare providers to one
based on a shared vision and a commitment to better support First Nation families.262
Promising program innovations

A number of promising and innovative Canadian programs have been devel-
oped. They are subject to Aboriginal control and inspired by First Nations wisdom
and practices.
Nishwnawbe-Aski’s Talking Together Program
Nishnawbe-Aski Legal Services in Thunder Bay, Ontario, launched the Talking

Together Program (TTP) in 2001 as an alternative to court proceedings in child protec-
tion matters. Talking circles bring together families, social service workers, and Elders
to explore creative solutions in a non-judgmental environment. Their solutions are

then implemented as the plan of care for the child.
The participation of families and community members is the cornerstone of the
program. Rather than the usual, often ineffective addiction and anger management
treatment options, TTP allows for more innovative solutions for the care of children.
In 2005, 135 children remained in their home communities following involvement
with TTP. The next year even more, 218, remained in their community.263 In some
areas, TTP has been so effective that it has evolved into a prevention program rather
than a crisis intervention service. This means the program is able to address concerns
early so that child protection services do not have to become involved.
Manitoba’s Meenoostahtan Minisiwin

First Nations Family Justice Program
The Meenoostahtan Minisiwin First Nations Family Justice Program in Manitoba

was developed by a mandated Aboriginal child protection agency. The program
brings families, community members, and service providers together to achieve long-
term protection of children by getting at the roots of the family’s concerns. The process
is based on Aboriginal traditions of peacemaking, and all participants must be fully
informed volunteers. Since 2000, the program has served approximately two hundred
families each year.
A 2004 evaluation indicated very high levels of participant satisfaction. Participants
said that their voices were heard, there was positive and open communication, and
it was a safe and comfortable environment for families. The evaluation found that
“95% of referring agents stated that the program was valuable to their First Nation
community.”264
Aboriginal Legal Service of Toronto’s Giiwedin Anang Council
This talking circle program involves volunteers from Toronto’s Aboriginal commu-
nity, including an Elder and an auntie for each talking circle. The talking circle may
also include a representative from the child’s community. The program provides a safe
and culturally relevant place for families, children, and child welfare officials to come
together to develop a plan that will meet the needs of the child.
Talking circles can take place before or after apprehension. After apprehension, the
program requires the consent of at least one parent as well as Native Child and Family
Services of Toronto, the mandated child protection agency for Aboriginal families in
Toronto. Children over twelve years of age may participate in the talking circle. An
auntie from the council will also meet with the child and represent the child’s interests
in the circle.
A council hearing cannot usurp the role of the courts in determining the best inter-
ests of the child. However, a council hearing may arrive at a plan for the child more
quickly, and with greater participation from the parties.
Rene Timleck has acted as an auntie in the council. At one time, her own chil-
dren were taken into care by the Children’s Aid Society. Her own experiences help
her “understand the fear the parents feel in their dealings with Native Child and
Family Services,” which has “the power to take or keep their children away.” She also
understands “the responsibility that the agency’s workers feel in keeping the children
safe.”265 Timleck described the circle as “a process that helps to heal families while
protecting children.” She continued,
Much is revealed in a day-long hearing. Everyone involved comes closer to the
truth than when they are in a courtroom. There is less chance of losing sight
of the real issues in the Council process. In court proceedings, it is often how
knowledgeable the lawyers are and who presents their case the most eloquently,
rather than the real issues at hand—whether it be criminal or family proceed-
ings. The council process allows for the problem to be dealt with on a more
personal level, with the people involved being a part of the process. I believe that
such councils could be a very effective tool in assisting people of any culture and,
therefore, in all society.266
Timleck believes that the collective plans formulated in the circles can “allow for
more people to be involved in the safekeeping of children in their communities.…
With the Council, decisions are made by a collective, so the onus of responsibility is
spread out amongst several people” rather than placed on a single judge.267
Another recent innovative approach to child protection cases is one that has been
used with Indigenous families in Australia called the Signs of Safety approach.268 Signs
of Safety is a child protection model that focuses on partnerships with parents and chil-
dren to stabilize and strengthen families. Some Aboriginal agencies in Manitoba have
started studying this approach to whether it might be useful in a Manitoba context.
A move toward more community participation in child welfare matters and pro-
grams that draw on Aboriginal traditions and wisdom is encouraging. However,
although Aboriginal programs may be better able to draw on kinship and commu-
nity resources than court-based child welfare proceedings, it is important to recog-
nize that most Aboriginal communities have limited resources. Such programs are
resource intensive and require stable funding. Like all programs involving children,
they should also be carefully evaluated.
Community programs are important and inspiring, but the ultimate solution to
the child welfare crisis must lie in better child welfare decision making and cultur-
ally appropriate support of families, together with broader reform to address poverty,
addiction, mental health, and family violence issues, which are themselves part of the
Conclusion
The legacy of Canada’s colonial past, including the residential school system, can-
not be simply willed to an end. We must ensure that Aboriginal parents, families, and
communities have the resources they need to overcome the trauma of how they have
been treated in residential schools and in broader society. The story of Canada’s child
welfare institutions and Aboriginal peoples suggest that the lessons of the residen-
tial schools have not yet been learned. A renewed approach to child welfare, based
upon the Touchstone of Hope principles of self-determination, holistic response,
respect for culture and language, structural interventions, and non-discrimination,
can be a starting point to reversing the harmful legacy of the residential schools upon
Aboriginal children and bringing about reconciliation.
Recognizing and prioritizing actions to redress the present and growing crisis of
Aboriginal overrepresentation in the Canadian child welfare system will be a test of
the political will and courage of the parties to the residential schools settlement agree-
ment, and ultimately all Canadians.
Chapter 2
The failure to educate
The darkness of ignorance is in me, from the residential

school experience.
—Howard Stacy Jones, former Kuper Island student1
Introduction
Given all the damage caused by the residential schools—the physical and mental
abuse, the loss of culture and language, the forced separation of families—it is a bitter
irony that one of the schools’ greatest failings was the very quality of the schooling
they provided.
Many principals and teachers had low expectations of their students. Wikwemikong,
Ontario, principal R. Baudin wrote in 1883, “What we may reasonably expect from the
generality of children, is certainly not to make great scholars of them. Good and moral
as they may be, they lack great mental capacity.” He did not think it wise to expect
them to “be equal in every respect to their white brethren.”2 In preparing a 1928 report
on the Anglican school at Onion Lake, a Saskatchewan government school inspector
expressed his belief that “in arithmetic abstract ideas develop slowly in the Indian
child.”3 Some thought it was a risky matter to give the students too much education.
Mount Elgin principal S. R. McVitty wrote in 1928, “classroom work is an important
part of our training, but not by any means the most important.” He added, “In the case
of the Indian ‘a little learning is a dangerous thing.’”4
Given these attitudes it is not surprising to discover that the schools failed as edu-
cational institutions. Many Aboriginal students who attended residential schools were
so ill-served there that they later struggled to succeed, either in furthering their edu-
cation, or in the market economy, or in more traditional activities such as hunting and
fishing. They were, as the Survivor John Tootoosis famously observed, “left hanging”
between two worlds.5
Theirs is a story of marginalization and lost opportunity. The residential schools
graduated few role models and mentors. The poor-quality education led people into
chronic unemployment or underemployment. Beyond that, it led to levels of poverty,
poor housing, substance abuse, family violence, and ill health. Although educational
success rates are slowly improving, the fact remains that Aboriginal people still have
lower educational and economic achievements than other Canadians. This is the leg-
acy of residential schools.6
Non-Aboriginal Canadians have also been disadvantaged by educational systems
that taught them that Aboriginal people were ‘heathens’ or ‘savages.’ Even today, those
same systems routinely neglect the history and experiences of Aboriginal Canadians
altogether.
This chapter is grounded in the understanding that education is a fundamen-
tal human and Aboriginal right, guaranteed in Treaties, international law, and
the Canadian Charter of Rights and Freedoms. In particular, the United Nations
Declaration on the Rights of Indigenous Peoples states that “Indigenous peoples have
the right to establish and control their educational systems and institutions providing
education in their own languages, in a manner appropriate to their cultural methods
of teaching and learning.”7 These rights, however, have never been fully honoured.
The first part of this chapter examines the educational and income gaps that sep-
arate Aboriginal people and other Canadians and identifies the links between these
outcomes and the residential school system. The second part of the chapter outlines
the current crisis in Aboriginal education and how it continues the patterns of chronic
underfunding and misunderstanding of Aboriginal people that characterized the
residential schools. The third part of this chapter will focus on the recent history of
Aboriginal educational reform. It will review how numerous task forces and parlia-
mentary committees have recognized that the educational system is failing Aboriginal
children and that the underfunding of First Nations schools on reserves is particularly
acute. It will then examine how the federal government responded to these wide-
spread calls for reform. The last part of this chapter will discuss a number of reform
strategies for Aboriginal education that build on existing successes, and can ensure
that the mistakes of the residential school era are not repeated.
The long reach of the residential schools:

Educational and income gaps
Canada’s residential schools provided little education. Because successive gov-
ernments considered Aboriginal people inferior, the schools offered only the most
rudimentary education. As a result, generations of Aboriginal people ended up in the
bottom ranks of Canadian society.
The failure to educate • 63
A history of inadequate education
As educational institutions, residential schools were failures, and regularly judged

as such. In 1923, former Regina industrial school principal R. B. Heron delivered a
paper to a meeting of the Regina Presbytery of the Presbyterian Church that was highly
critical of the residential school system. He said that parents generally were anxious
to have their children educated, but they complained that their children “are not kept
regularly in the class-room; that they are kept out at work that produces revenue for
the School; that when they return to the Reserves they have not enough education to
enable them to transact ordinary business—scarcely enough to enable them to write
a legible letter.”8 The schools’ success rate did not improve. From 1940–41 to 1959–60,
41.3% of each year’s residential school Grade One enrolment was not promoted to
Grade Two.9 Just over half of those who were in Grade Two would get to Grade Six.10
Much of what went on in the classroom was simply repetitious drill. A 1915 report
on the Roman Catholic school on the Blood Reserve in Alberta noted, “The children’s
work was merely memory work and did not appear to be developing any deductive
power, altogether too parrot like and lacking expression.”11 A 1932 inspector’s report
from the Grayson, Saskatchewan, school suggests there had been little change: “The
teaching as I saw it today was merely a question of memorizing and repeating a mass
of, to the children, ‘meaningless’ facts.”12
In the minds of some principals, religious training was the most valuable training the
schools provided. In 1903, Brandon, Manitoba, principal T. Ferrier wrote that “while
it is very important that the Indian child should be educated, it is of more importance
that he should build up a good clean character.” Such a heavy emphasis was required,
in Ferrier’s opinion, to “counteract the evil tendencies of the Indian nature.”13 The staff
handbook for the Presbyterian school in Kenora in the 1940s stated it was expected
that, upon leaving the school, most students would “return to the Indian Reserves
from which they had come.” Given this future, staff members were told that “the best
preparation we can give them is to teach them the Christian way of life.”14
Before the Second World War, many schools followed a system that saw the chil-
dren doing farm and domestic work for half of each day. This work schedule signifi-
cantly limited their classroom and study time.
When the students were in school, the classrooms were often severely over-
crowded. At the Qu’Appelle school in 1911, Sister McGurk had seventy-five girls in
her junior classroom. The inspector of Roman Catholic schools reported to Ottawa
that this was an “almost impossible” situation.15 In 1915, two teachers were respon-
sible for 120 students at the Coqualeetza Institute in Chilliwack, British Columbia.16
In 1928, there were sixty students in the junior classroom at the Port Alberni, British
Columbia, school.17
The Indian Affairs schools branch maintained that the principals and the staff were
“appointed by the church authorities, subject to the approval of the Department as
to qualifications.”18 In reality, the churches hired staff and the government then auto-
matically approved their selections.19 The churches placed a greater priority on reli-
gious commitment than on teaching ability.20 Because the pay was so low, many of the
teachers lacked any qualification to teach.21 In 1908, Indian Affairs inspector F. H. Paget
reported that, at the Battleford school, “frequent changes in the staff at this school has
not been to its advantage.” The problem lay not with the principal, but with the fact
that “more profitable employment is available in the District and, furthermore, the
salaries paid are not as high as are paid in other public institutions.”22 When a British
Columbia Indian agent recommended that schools be required to hire only qualified
staff, he was told by his superior, British Columbia Indian Superintendent A. W. Vowell,
that such a requirement would result in the churches’ applying for “larger grants.”
And, as Vowell understood it, Indian Affairs “is not at present disposed to entertain
requests for increased grants to Indian boarding and industrial schools.”23 In 1955, 55
(23%) of the 241 teachers in residential schools directly employed by Indian Affairs
had no teacher’s certificate.24 In 1969, Indian Affairs reported it was still paying its
teachers less than they could make in provincial schools. “As a result, there are about
the same number of unqualified teachers, some 140, in federal schools [residential
and non-residential] now, as ten years ago.”25
Since the 1920s, Indian Affairs required residential schools to adopt provincial
curricula.26 The department also asked provincial governments to have their school
inspectors inspect Indian Affairs schools.27 The wisdom of this practice had been
questioned during the hearings of the Special Joint Committee of the Senate and
House of Commons inquiry into the Indian Act in the 1940s. Andrew Moore, a sec-
ondary school inspector for the Province of Manitoba, told the committee members
that Indian Affairs took full responsibility for all aspects of First Nations education,
including curriculum.28 He said provincial education departments, including the one
he worked for, were “not organized or not interested in Indian schools.”29
The decision to leave curriculum to provincial education departments meant that
Aboriginal students were subjected to an education that demeaned their history,
ignored their current situation, and did not even recognize them or their families as
citizens. This was one of the reasons for the growing Aboriginal hostility to the Indian
Affairs integration policy. An examination of the treatment of Aboriginal people in
provincially approved textbooks reveals a serious and deep-rooted problem. In
response to a 1956 recommendation that textbooks be developed that were relevant
to Aboriginal students, Indian Affairs official R. F. Davey commented, “The prepara-
tion of school texts is an extremely difficult matter.” It was his opinion that “there are
other needs which can be met more easily and should be undertaken first.”30 In the
following years, assessments of public-school textbooks showed that they continued
to perpetuate racist stereotypes of Aboriginal people.31 A 1968 survey pointed out that
in some books, the word squaw was being used to describe Aboriginal women, and
the word redskins used to describe Aboriginal people.32
Despite the many challenges they faced, some of the children of the residential
schools were able to enjoy subsequent success, sometimes as teachers or mission-
aries themselves. However, many left the schools without adequate skills and with
an aversion to education. Myrna Kaminawaish went to the Fort Alexander residential
school. She remarked, “Learning became very hard for me because I associated learn-
ing with being beat or, you know. So learning was very terrifying for me.”33 As a result,
she attained only a Grade-Three education.
Paul Kaludjau attended school in Chesterfield Inlet on the Hudson Bay coast. He
recalled how his father used to call him and his fellow students “educated bums”
because, as he said,
I knew nothing about survival on the land, because everybody was dependent
on harvesting from the land and everything else. And during that time when we
went to school, when we learned how to speak English, it labeled us as a little
bit separate from the family now, because we knew something they didn’t know
in the speaking of the language.… You weren’t close to the community anymore
because you were not a skilled hunter anymore.34
As with many of the residential school students, Kaludjau’s experience only
strengthened his commitment to his family’s ways of living: “I tried really hard to
become that skillful hunter after that, and because someone was labeling you as a not
very skillful hunter because of your education. But for me, that made me more aggres-
sive in trying to make sure that I lived up to their expectations, and it helped me more
to become stronger myself.”
Walter Russell Jones attended the Port Alberni residential school. He recalled a stu-
dent there asking,
“Can I go to grade 12?” And that supervisor said, “You don’t need to go that far,”
he says. He says, “Your people are never going to get education to be a profes-
sional worker, and it doesn’t matter what lawyer, or doctor, or electrician, or any-
thing, that a person has to go to school for.” He says, “You’re going to be working
jobs that the white man don’t want to do.”35
Too often the residential school system is regarded as a relic of the past. However,
the last residential school closed in the mid-1990s. Forty-seven per cent of on-reserve
residents between the ages of fifty and fifty-nine attended residential schools.36 The
Northern territories have the largest proportion of children whose parents attended
residential schools (38%).37
A legacy of abuse
In 1895, when commenting on the physical abuse of students by the staff of the
Red Deer school, Indian agent D. L. Clink noted the disciplinary measures used by
one teacher “would not be tolerated in a white school for a single day in any part of
Canada.”38 In the coming years, others would comment on the excessive discipline
employed in the schools.39 Despite this, Indian Affairs failed to develop and imple-
ment comprehensive and consistent directives, and to monitor for effective and
appropriate discipline. By so doing, it sent the message that there were no real limits
or consequences to what could be done to Aboriginal children within the walls of a
residential school.
In their mission to ‘civilize’ and Christianize, the school staff relied on corporal
punishment to discipline their students. That punishment often crossed the line into
physical abuse. Although it is employed much less frequently now, corporal punish-
ment is still legally permissible in schools and elsewhere under Canadian law. Section
43 of the Criminal Code reads, “Every schoolteacher, parent or person standing in the
place of a parent is justified in using force by way of correction toward a pupil or child,
as the case may be, who is under his care, if the force does not exceed what is reason-
able under the circumstances.” The Commission believes that corporal punishment is
a relic of a discredited past and has no place in Canadian schools or homes.
6) We call upon the Government of Canada to repeal section 43 of the Criminal Code
of Canada.
The abuse that characterized life at the schools was not conducive to learning any-
thing other than fear and self-hatred. Patricia Brooks recalled that at the Shubenacadie,
Nova Scotia, residential school, “the way the teachers spoke to us every day, that we
weren’t even native, we were just like, they were talking about somebody else; so you’d
just kind of disassociated yourself from the fact that the native people, it was you. But
they never said anything encouraging about native people.”40 Thus, many students left
the school filled with self-loathing and loathing of their own family and community.
They also often left with a profound distrust of education.
Successes and failures

Most students left residential schools as soon as they could. A 2010 study of
Aboriginal parents and children living off reserve found that among those who did not
complete high school, 36% had attended residential school, while 28% had not.41 Only
7% of the parents who attended residential school obtained a university degree, com-
pared to 10% for those Aboriginal parents who had never attended these institutions.42
These findings are consistent with findings of a random sample of 203 files pulled
from the Independent Assessment Process (iap), a dispute resolution process that is
available to those who suffered sexual or severe physical abuse at residential school.
Twenty-three per cent of the claimants in the sample did not identify any specific
level of school completion, suggesting a low level of achievement. Of those report-
ing a level of educational attainment, 13% said they attained less than a Grade-Seven
education, 28% attained Grade Seven to Nine, 28% completed Grade Ten to Twelve,
and 11% received a ged (a high school equivalency diploma).43 According to the 2011
National Household Survey, among Aboriginal people aged 25 to 64, 28.9% had “no
certificate, diploma or degree,” while the proportion for non-Aboriginal people in the
same age group was 12.1%.44 The residential school Survivors in the iap sample appear
to have completed high school at a much lower rate than the national averages for
both Aboriginal and non-Aboriginal people generally.
Only 20% of the former residential school students captured by the iap study
had completed a college certificate/diploma or university degree. This level of post-
secondary education is far below the educational attainment amongst Aboriginal
people generally (48.4%) and even further below the non-Aboriginal population
(64.7%).45
Some students, however, were able to succeed despite their negative experiences at
residential school. Violet Rupp failed Grade Nine at the Assiniboia residential school after
she had been sexually assaulted by a staff member. She explained to the Commission,
I always had to watch my back ’cause I’d see him once in awhile and he’d be
look, staring at me, you know, just be avoiding him all over the place, all over the
residence. I was scared to meet him in the hallways; I was scared to go out, out
of my dorm. I was scared that, you know, he might try to do something worse;
but I didn’t tell anyone because I felt ashamed and I was afraid. And I was afraid
that nobody would believe me.… But after that though I, I had that determina-
tion to be strong and just to continue. I wanted to prove myself that I can, I can
succeed even though, you know, I was violated. And I went on, went on. I went to
university. I have, I went on and got married, I have four children. And it seems
to me I’m always, you know, making my sure my girls are, you know, are ok. I’m
always phoning them, asking them if they’re ok. So I just, you know went, went
to school and got my Bachelor of Education degrees, my two Master’s degrees; I
never gave up.46
Esther Lachinette-Diabo became a teacher after attending the Spanish residential
school. She noted,
I’m thankful that I was in there, in the school, in that system because I did be-
come educated.… The boarding school used to have public speaking contests,
and so I aspired to become a public speaker. I’ve learned to speak English really,
really well, and I learned to speak loud and clear. So, I think that part that I did
receive an education. But as far as family connections, that was all lost.47
The income gap

The failures of the residential school system had an impact well beyond the child-
hood of the students. It adversely affected the kinds of jobs and earnings they could
obtain as adults. Darryl Siah, attended residential school in Mission, BC. He was
homeless when he provided the Commission with his statement in May 2011. He told
the Commission how he valued education but became uncomfortable with it as a
result of his experiences at residential schools:
And as long as you … do your homework and stuff, and you’ll get a real good
education, and … make something out of yourself. You’ll be a lawyer or a doctor,
or nurse, or you name it, you can do it if you always go right through the whole
school, right. Now, I probably could have been something, too, if I went all the
way. I didn’t want to. I didn’t feel comfortable being there.48
In the sample of iap claimants, 55% reported working as “physical labourers,” fol-
lowed by 56% who identified as “casual workers.”49 The iap statistics reflect a far greater
reliance on “lower-skilled” labour than the Canadian labour market as a whole.
According to the 2011 National Household Survey, only 11% of Canadian workers are
employed in jobs that do not require secondary school completion or higher.50
The residential school litigation and subsequent settlement did little to address
these aspects of the residential school legacy. The Common Experience Payments
went to individuals, not communities. Although there was a promise that any residual
amounts could later be allocated to educational purposes, the settlement has done
little to overcome the educational barriers that the children and grandchildren of res-
idential school Survivors still face. Their lives have also been impacted by the poor
education experienced by their parents and the resulting high levels of poverty and
family breakdown. As a result, poor educational attainment, low rates of employment,
and high rates of poverty persist as the continuing legacies of residential schools for
this next generation.
It should be noted that while successful iap applicants have been awarded on aver-
age $115,000, this is compensation for the sexual and serious physical abuse they
endured. It is not compensation for the poor education they received and its related
loss of economic opportunity.
The intergenerational impact

The barriers that residential school Survivors faced after leaving school have had
serious repercussions for their children. Factors such as parents’ educational lev-
els and household income are powerful predictors of the school success of their
children.51
While there are few studies that focus specifically on the children of residential school
Survivors, some data is starting to be gathered. One study found that on-reserve First
Nations youth aged twelve to seventeen are more likely to report having learning prob-
lems at school and having had to repeat a grade if one or both of their parents attended
residential school.52
Another study found that Aboriginal children living off reserve whose parents
attended residential school are less likely to be doing well at school, compared to
Aboriginal children whose parents did not attend these institutions.53 In addition, for-
mer residential school students are less likely to have incomes in the highest 20%,
and are more likely to report experiencing food insecurity. All three of these factors—
parental residential school experience, household income level, and food security—
combine to impede success in school for their children.54
The study also found that students who spoke an Aboriginal language at school
were more likely to be doing well in school, a further indication that the denial of lan-
guage rights at residential schools contributed to difficulty in school for the children
of Survivors.55
While secondary and post-secondary graduation rates for Aboriginal people have
improved since the closure of the schools, considerable gaps remain when com-
pared to the non-Aboriginal population. The 2012 Aboriginal Peoples Survey showed
that 72% of First Nations people living off reserve, 42% of Inuit, and 77% of Métis
aged 18 to 44 had a high school diploma or equivalent. These figures are similar to
those from the 2006 Aboriginal Peoples Survey. In comparison, the 2011 National
Household Survey revealed that 89% of the non-Aboriginal population had at least a
high school diploma.56
The result is that access to post-secondary education is not an option for the major-
ity of Inuit young people or for First Nations youth living on reserve.57 In 2006, only
2.9% of First Nations people living on reserve had completed a university education,
compared to 18.1% of the general Canadian population.58 The federal auditor general
commented, “In 2004, we noted that at existing rates, it would take 28 years for First
Nations communities to reach the national average. More recent trends suggest that
the time needed may be still longer.”59 Given the youthful demographics of Aboriginal
communities, there is an urgent need for change.
According to the 2012 Aboriginal Peoples Survey, 43% of off-reserve First Nations
people, 26% of Inuit, and 47% of Métis aged 18 to 44 had post-secondary credentials
(i.e., a certificate, diploma, or degree above the high school level). According to the
National Household Survey, the corresponding figure for the non-Aboriginal popula-
tion in 2011 was 64%.60
Most of the gains in high school completion rates have been led by Aboriginal
women.61 Completion rates at the secondary level are higher for Aboriginal women
than for Aboriginal men, although they are still below the Canadian average.62 Again,
it is young Aboriginal women who are driving most of the increases in Aboriginal
post-secondary attendance.63 More research is needed to explain the achievement
gaps between Aboriginal men and women.
The connection between residential schools and lower than average educational
and economic attainments is particularly evident in data that shows that residential
school Survivors have less income than other Aboriginal people, and that their chil-
dren have more difficulty in school.
Aboriginal people have a lower median after-tax income; are more likely to experi-
ence unemployment; and are more likely to collect employment insurance and social
assistance.64 In 2010, the employment participation rate for Aboriginal workers was 75%
compared with 86.7% for their non-Aboriginal counterparts. This 11.7 percentage-point
gap reflects an increase in the disparity between Aboriginal and non-Aboriginal workers
over the course of the economic downturn that began in 2008.65 These statistics cover all
Aboriginal groups, with their own variations.
Aboriginal people also have earnings well below their non-Aboriginal counterparts.
The median income for Aboriginal peoples in 2006 was 30% lower than the median
income for non-Aboriginal workers ($18,962 vs. $27,097).66 Earnings are highly influ-
enced by educational attainment. Aboriginal adults aged 18 to 44 who have finished
high school are more likely to be employed than those who did not have a diploma.
Among off-reserve First Nations people, 72% who finished high school were employed,
while only 47% of those who did not finish had jobs. Among Inuit, 71% who completed
high school were employed, while 44% of those who did not finish had jobs. For Métis,
the figures were 80% versus 61%. While men in the general population usually have
higher rates of employment than women, this was not the case among First Nations
people living off reserve, Inuit, and Métis who had completed high school. For all
three groups, female completers were as likely to be employed as their male counter-
parts. In terms of earnings, among First Nations people living off reserve and Métis,
the median employment income ranges for completers were $10,000 higher than for
leavers. Among Inuit, the difference in median employment income between compl-
eters and leavers was $20,000.67
The income gap between Aboriginal and non-Aboriginal people closes almost
completely when Aboriginal people attain a university diploma, which, as noted
above, they do at a far lower rate.68
Not surprisingly, the child poverty rate for Aboriginal children is very high—40%,
compared to 17% for all children in Canada.69 These statistics cannot be explained
away simply on the basis that many Aboriginal people live in rural communities.
These children are living with the economic and educational legacy of the residential
schools.
Aboriginal Canadians earn less than non-Aboriginal workers regardless of
whether they work on or off reserve, in urban, rural, or remote locations.70 The pro-
portion of Aboriginal adults living below the poverty line71 is also much higher than
those of non-Aboriginal adults, with differences ranging from 7.8% for adult men
aged 65 or older, to 22.5% for adult women aged 65 or more. The depth of poverty is
also much greater, with Aboriginal people having an average income that’s further
below the poverty line on average than that of non-Aboriginal adults.72
Even with the opportunities that flow from Aboriginal rights settlements, many
Aboriginal adults are not fully able to take advantage of those benefits. For example,
with land-rights negotiations finalized in the four northern Inuit regions, residents are
increasingly looking for opportunities to work within government to implement these
final agreements. The Government of Nunavut has stated a goal of hiring beneficia-
ries of the Nunavut Land Claim Agreement (Inuit peoples) to match their proportion
of the total Nunavut population. However, while in 2007, Inuit made up 85% of the
Nunavut population, they comprised only 50% of the total public service workforce
with the majority of those (92%) employed in administrative support positions. The
majority of the higher paying positions were filled by non-Inuit workers.73 Former
Justice Thomas Berger, in his 2006 evaluation report on the implementation of the
Nunavut Land Claims Agreement, noted that Inuit employment in the government of
Nunavut was “achieved early on, and has not been improved upon for the simple rea-
son that only a few Inuit are qualified for the executive, management and professional
positions that make up the middle and upper echelons of the public service.”74
Low education rates have an ongoing impact on the economic well-being of the
North in general because of the social consequences associated with high unem-
ployment, greater numbers of young people caught in the justice system, and more
health-related issues linked to poverty.75
Aboriginal people also experience the feminization of poverty. Despite the
fact that Aboriginal women are more likely to complete high school and attend
post-secondary school, they report lower median household after-tax income than
Aboriginal men.76 Aboriginal women over the age of 65 are much more likely to
live in poverty than Aboriginal men in the same age group (53.4% vs. 37.4%).77 The
unemployment rate for Aboriginal women was almost double that of non-Aboriginal
women in 2006 (13.5% vs. 6.4%).78 These markers all suggest a population suffering
significant inequality and social exclusion.
The Treaties
Aboriginal peoples have always expressed a commitment to education for their
children. Such hopes are reflected in the language of the early Treaties. For example,
Treaties 1 and 2 included a commitment by “Her Majesty” to “maintain a school in
each reserve hereby made, whenever the Indians of the reserve shall desire it.” Treaty
6 reads as follows: “Her Majesty agrees to maintain schools for instruction in such
reserves hereby made, as to her Government of the Dominion of Canada may seem
advisable, whenever the Indians of the reserve shall desire it.” Other Treaties, such
as Treaty 10, protected the right to education by way of agreements to pay teachers’
salaries. Thus, access to education was an essential element of the early Treaties, cap-
turing a desire by First Nations to foster the capacity to adapt to the changing world.79
Although the federal government does provide basic educational funding for First
Nations communities, promises made in the Treaties have never been fully kept.80
Without control over their own education, the educational system has more often
than not been alien to Aboriginal people, both within the residential school system,
and in the public system.
International rights to education

The right to education is recognized in a number of international human rights
documents, including the International Covenant on Economic, Social and Cultural
Rights (article 13), the Convention on the Rights of the Child (articles 28 and 29), and
the United Nations Declaration on the Rights of Indigenous Peoples (article 14). The
right to fair wages, equal remuneration for work of equal value, social security, and
an adequate standard of living are listed in the International Covenant on Economic,
Social and Cultural Rights (see articles 6 to 11) and are also guaranteed in the United
Nations Declaration on the Rights of Indigenous Peoples (article 17). The International
Covenant on Economic, Social and Cultural Rights (articles 6 and 7) provides for the
right to work, the opportunity to earn a living, and the right to just and favourable
work conditions.
Fulfilling the promise of the UN Declaration on the Rights of Indigenous Peoples will
be key to overcoming the legacy of the residential schools. The “expert mechanism”
established by the UN to provide advice on the Declaration on the Rights of Indigenous
Peoples observed that Indigenous peoples have been subjected to monolithic main-
stream education systems that eroded traditional ways of life and languages, imposed
foreign belief systems, and institutionalized discriminatory attitudes. In the face of
these violations, “it is the responsibility of States to address and undo past wrongs
to reform mainstream education systems.”81 Not only has a right to education been
recognized in international law, but so has the right to correction of the wrongs that
result when that right has been breached.
The right to education is connected to the fulfillment of other basic human rights.
In a commentary on the Convention on the Rights of the Child, the Committee on the
Rights of the Child observed,
Quality education enables indigenous children to exercise and enjoy economic,
social and cultural rights for their personal benefit as well as for the benefit of
their community. Furthermore, it strengthens children’s ability to exercise their
civil rights in order to influence political policy processes for improved pro-
tection of human rights. Thus, the implementation of the right to education of
indigenous children is an essential means of achieving individual empowerment
and self-determination of indigenous peoples.82
In 2009, the employment rate for Aboriginal youth was 45.1%, compared to 55.6%
for their non-Aboriginal counterparts. The employment gap is growing despite
increased educational attainment for Aboriginal peoples.83
A number of residential school Survivors have put a human face on these trends
in educational and income inequality. Laverne Victor attended the Kamloops, British
Columbia, school. She explained,
I didn’t do well in school. I didn’t like school. And nobody knew why, and I
couldn’t, nobody would listen to me or understand me, so I just kept it all to
myself, and that’s probably when I started blocking everything. It was at the age
of nine and ten was when I started blocking everything out of my, my mind, be-
cause nobody would, nobody would believe me, and nobody would listen to me.
Beyond her own experiences, Victor fears for her children:
They don’t feel like they fit and belong, but the, they need the better education, so
they need to go to the public schools. I’ve been stressing, they’re … trying to bring
our, our native culture into the schools, but something I’ve noticed is that they’re
only bringing it into the schools for the natives. It’s not for the non-natives to learn.
She stressed that all people need to learn about Aboriginal languages and cultures
and that “everybody needs to be taught who we are, why we do what we do, and that
natives are not just a bunch of drunken Indian bums that live on welfare.”84
Australia’s “Close the Gap” commitments

In the wake of its apology in 2008 to Indigenous people for its assimilationist pol-
icies, Australia committed to closing the educational and employment gaps between
its Indigenous and non-Indigenous populations. Australia’s commitments include
• ensuring access to early childhood education for all Indigenous four-year-olds

in remote communities by 2013;
• halving the gap in reading, writing, and numeracy achievements for children
by 2018;
• halving the gap for Indigenous students aged twenty to twenty-four in Year 12
attainment or equivalent attainment rates by 2020; and
• halving the gap in employment outcomes between Indigenous and other
Australians by 2018.85
In a detailed report in 2015 on closing the gap, the Australian prime minister
acknowledged that most of these targets would not be met. However, access to
early childhood education has improved, with 85% of Indigenous four-year-olds in
remote communities enrolled. Nationally, the proportion of Indigenous twenty- to
twenty-four-year-olds who had achieved Year 12 or equivalent increased from 45.4%
in 2008 to 58.5% in 2012–13.86 In the Commission’s view, failure that is both mea-
sureable and public is far preferable to governmental silence. It is especially striking
that Australia has made progress on a commitment to early childhood education for
four-year-old Aboriginal children while Canada has made no similar commitment.
Current proposals for First Nations educational reform in Canada only address edu-
cation from six years of age, despite widespread evidence of the importance and
benefits of early childhood education.
7) We call upon the federal government to develop with Aboriginal groups a joint
strategy to eliminate educational and employment gaps between Aboriginal and
non-Aboriginal Canadians.
Aboriginal education in crisis

Aboriginal education in Canada is a complicated mix of policies and funding mod-
els from various levels of government, Aboriginal and non-Aboriginal. The federal
government funds schools on reserve, with the actual operation of those schools often
delegated to the local First Nation. Aboriginal children who live off reserve are edu-
cated through the provincial or territorial school systems.
Finally, there are some educational systems completely run and managed by
First Nations through self-government and other types of tripartite agreements. The
jurisdictional complexities in these different education systems create challenges for
effective reform.
Integration or assimilation
By 1945, the Indian Affairs residential school system, having been starved for fund-
ing for fifteen years, was on the verge of collapse.87 Not only was the existing Indian
Affairs education system lacking money and resources, but there were also no school
facilities of any sort for 42% of the school-aged First Nations children.88 Having con-
cluded that it was far too expensive to provide residential schooling to these students,
Indian Affairs began to look for alternatives. One was to expand the number of Indian
Affairs day schools. From 1945–46 to 1954–55, the number of First Nations students
in Indian Affairs day schools increased from 9,532 to 17,947.89 In 1949, the Special
Joint Committee of the Senate and House of Commons Appointed to Examine and
Consider the Indian Act recommended “that wherever and whenever possible Indian
children should be educated in association with other children.”90 In 1951, the Indian
Act was amended to allow the federal government to enter into agreements with
provincial governments and school boards to have First Nations students educated
in provincially run public schools.91 By 1960, the number of students attending such
schools (9,479) was roughly equal to the number living in residential schools (9,471).92
The transfer of First Nations students into the public school system was described as
“integration.” By then, the overall policy goal was to restrict the education being given
in Indian Affairs schools to the lower grades. Therefore, it was expected that during
the course of their schooling, at least half of the students then in Indian Affairs schools
would transfer to a ‘non-Indian’ school.93
The integration policy was opposed by some of the church organizations. Roman
Catholic church officials argued that residential schooling was preferable for
three reasons:
1. Teachers in public schools were not prepared to deal with Aboriginal students.
2. Students in public schools often expressed racist attitudes towards Aboriginal
students.
3. Aboriginal students felt acute embarrassment over their impoverished condi-
tions, particularly in terms of the quality of the clothing they wore and the food
they ate.94
These were all issues that students and parents raised as well.95 Annie Wesley told
the Commission about the time she spent in residential school in Kenora:
The results were devastating. Many quit school all together. I was sent to an
all girls’ residential school in Pembroke, Ontario, and I ended up alone again,
because the other native students were so lonely they went home. At the white
school, we were not welcome by the other students. We were outcasts in this
white residential school. 96
Dorothy Ross recalled being called “squaws, a dirty Indian” in the public school she
attended in Sioux Lookout, Ontario.97 Shirley Leon told the Commission,
I was one of the first students from the Okanagan band that was integrated in the
1950s, into the public schools … We had horrific experiences because we were
the savages, we were taunted. Our hair was pulled, our clothing torn, and we hid
wherever we could, and didn’t want to go to school. So, those kinds of stories are,
are just as traumatic as what happened at residential school.
Leon told the Commission that “when we took social studies, it was ‘the damned
Indians, the drunken Indian, the savages,’ and it’s no wonder we skipped school, we
dropped out of school, and didn’t want to be there.”98 She subsequently obtained her
high school equivalency in the same year that one of her daughter’s graduated from
high school.
The abdication of federal responsibility for providing a proper education system
and the necessary funding can only be viewed as a continuation of the government’s
long-term policy of assimilation. The First Nations Education Council, Nishnawbe
Aski Nation, and the Federation of Saskatchewan Indian Nations take the position
that “the fully documented chronic underfunding of our education system is among
the many strategies or tactics currently being used to force our integration into the
provincial system which is better funded than the First Nations system.”99 Not only
are provincial schools better funded by the provincial governments that established
and oversee them, but the federal government also funds them at a much higher per-
student rate than they do on-reserve schools. Underfunding of on-reserve schools has
meant that all too often First Nations children, as they did with residential schools,
have to leave their families and communities to attend schools far away. It is diffi-
cult for the Commission to accept that such an approach, including separation from
family and community and eventual assimilation into non-Aboriginal society, can
honestly be seen to be in the best interest of Aboriginal children.
Today, 40% of students living on reserve attend schools that fall under provin-
cial jurisdiction (particularly those pursuing a high school education).100 Provincial
and territorial schools are the only option for Métis students, for other Indigenous
children without recognized status, and for those First Nations children who do not
live on reserves. Their educational outcomes are not significantly better than those
who attend First Nation schools on reserve.101 The Royal Commission on Aboriginal
Peoples (rcap) observed that the highest drop-out rate for Aboriginal students came
as they entered high school, often away from their home communities, and when
they may have their “first direct experience with the attitudes of the mainstream
society,” including “racist attitudes and behaviour.”102 rcap recommended inno-

vative approaches that could facilitate distance learning and keep children in their
home communities.
Educating First Nations children on reserves
As the Senate Standing Committee on Aboriginal Peoples noted in 2011, “First

Nations education is in crisis.”103 In some reserve communities, First Nations children
do not even have an actual school building.104
There are approximately 72,000 students attending 518 First Nation schools.105
Despite those numbers, many children must still leave their homes and families
behind if they wish to obtain an education, particularly at the high school level. As
was the case with many residential school students, some First Nations students do
not return home from provincial schools. In Ontario, an inquest has been called to
examine the deaths of seven First Nations students who died between 2000 and 2011
while boarding in Thunder Bay to attend high school.106
In 1969, Indian Affairs Minister Jean Chrétien introduced a white paper propos-
ing an end to the Indian Act and an end to the special legal relationship between
Aboriginal peoples and the Canadian state. He proposed it as an exercise in equality.
However, Aboriginal leaders quickly rejected the document as an abrogation of their
Treaty rights. The federal government withdrew the white paper and proclaimed its
commitment to the concept of “Indian Control of Indian Education.”107
However, the interpretation of ‘Indian control’ put forward by the Government of
Canada bore little resemblance to the vision held by First Nations people. The govern-
ment’s version of Indian control meant the devolution of federal education programs
to First Nations, without the benefit of adequate funding or statutory authority.108
Indeed, when devolution began, it was designed to occur without any additional
expense. This meant that schools, which were already substandard compared to
provincial norms, were handed over to the First Nation bands to run, without giving
the bands the means to operate them effectively. Authors Jerry Paquette and Gérald
Fallon wrote,
thrust into the world with no program or administrative infrastructure whatso-
ever, and no resources to create such infrastructure … these communities found
themselves completely alone and bereft of any means to develop the capacity
to administer their schools coherently—much less in a way that would adapt
provincial curricula to ensure “cultural continuity and development.”109
Thus, devolution delivered nothing more than the illusion of control.
The Aboriginal scholar Andrea Bear Nicholas notes that local decisions are heav-
ily constrained by the party holding the purse strings—the federal department of
Aboriginal Affairs and Northern Development. Most band-operated schools are

forced to accept provincial curricula and assessment standards, teacher certification,
and—with the exception of Québec and parts of the North—the use of English as the
language of instruction.110 As a result, the curriculum for the majority of First Nation
schools is virtually identical to that found in the provincial and territorial schools.111
Consequently, the current situation is not significantly different from the residential
school era, when Aboriginal communities had no say in the content and language of
their children’s schooling.
As Verna Kirkness points out, the current system bears no relationship to tradi-
tional modes of teaching that taught
knowledge necessary for daily living. Boys and girls were taught at an early age to
observe and utilize, to cope with and respect their environment. Independence
and self-reliance were valued concepts handed down to the young. Through
observation and practice, children learned the art of hunting, trapping, fishing,
farming, food gathering, child rearing, building shelters. They learned whatever
their particular environment offered through experiential learning.112
The funding of First Nations schools was inadequate from the start. The for-
mula under which they were funded was last updated in 1996, and does not take
into account the range of basic and contemporary education components needed
to deliver a quality education in the twenty-first century, such as information and
communication technologies, sports and recreation, language proficiency, school
operating costs, student data management systems, and library services.113 Worse
still, after 1996, funding increases for First Nation education were capped at 2% for
nearly a decade.114 The original 2% annual increase was initially put in place as an
assurance that Aboriginal funding would be guaranteed 2% increases even while
other government departments were being cut back drastically. However the 2% cap
was retained even when increased spending in other government departments
was permitted. In recent years, the modest growth in funding has been insufficient
to keep pace with rising costs and the significant increases in the Aboriginal stu-
dent population.115
There is a lack of information and transparency on the funding inequities that exist
between federally and provincially funded schools. Even though Aboriginal Affairs
has committed to funding a First Nation education system that is comparable to the
provincial schools, an internal audit found that the department does not collect the
information required to confirm whether or not this goal is being met. The collection
of accurate, consistent, relevant, and accessible information is important if we are to
measure and close gaps between Aboriginal and non-Aboriginal peoples that are in
part a legacy of the residential schools.
A 2012 evaluation (commissioned by the federal government) found that

Saskatchewan stood out as a province in which the provincial school boards receive
significantly more funding per student (the actual difference was not identified in the
report). In the other regions, evaluators with Aboriginal Affairs determined there was
either no difference in funding, or that First Nation schools appeared to receive more
than non-Aboriginal public schools.116
However, the Aboriginal Affairs consultants delved deeper, examining the funding
provided to provincial school boards with fewer than 1,000 students—which are more
directly comparable to First Nation schools. This comparison revealed a marked ineq-
uity in funding. For example, in Ontario, the smaller school boards receive approx-
imately $17,000 per student, while First Nations schools receive under $10,000. In
Québec, smaller school boards receive approximately $12,000 per student, while
First Nation schools receive approximately $8,000. Manitoba was the only province in
which funding per student for First Nations schools exceeded the funding per student
for small provincial school boards.117
In Canada v. Mohawks of the Bay of Quinte First Nation, Ontario’s First Nations
argue that the funding policies discriminate against larger First Nations because
they receive considerably less per capita than smaller First Nations.118 The view of the
Commission is that funding should be measured equitably, with comparably sized
and located provincial schools.
The underfunding of schools on reserve violates legal Treaty obligations and con-
tinues the legacy of discriminatory neglect and underfunding seen in the residen-
tial schools. Even the funding that is available is unstable and short term, with First
Nations schools having to re-apply with each funding cycle.119 This makes long-term
planning next to impossible.
Capital costs
Funding shortfalls extend to capital expenditures for First Nations school buildings
as well. There are at least one hundred schools that are in such poor condition that
they are considered unsafe, with no plan in place to either repair or replace them.120
For example, the school in North Caribou Lake in Northern Ontario is plagued by
black mould. The outside walls of the building are so weak that they move when
pushed. Large-scale repairs are necessary but are not possible with the funds pro-
vided by Aboriginal Affairs.121
The Office of the Parliamentary Budget Officer noted that, in 2009–10, capital
expenditures were “under-funded by about $169 million in the best case, and $189
million in the worst-case scenario.”122
First Nations children attending provincial schools
Provincial education systems are built around a school board structure (often called
second-level structures). School boards determine the number, size, and location
of schools. They build, equip, maintain, supervise, and furnish schools and provide
student transportation. These boards provide education programs, such as special
education, prepare annual budgets, hire teachers and other staff, and organize pro-
fessional development. The boards ensure schools abide by the standards established
in provincial education laws. By comparison, First Nations educational organizations
operate in relative isolation.123
Provincial schools are also governed by their ministries of education. These minis-
tries set education policy, determine school curricula, approve texts, establish student
standards, determine teacher qualifications, and set classroom size, as well as invest
in research and analysis to measure the achievement of students.
Most First Nations do not have a comparable level of governance, although there
are examples of First Nations working together to form education authorities and
regional management organizations. There are positive examples emerging in
Saskatchewan, with tribal councils establishing “second-level” services and regional
management organizations.124 In Québec, the Cree School Board was established
under the 1975 James Bay and Northern Quebec Agreement.125 Cree language and
culture are at the basis of the curriculum, which is designed and controlled by the
Cree—including setting a Cree school calendar that allows Cree youth to partici-
pate in traditional hunting and fishing. It provides education services to primary,
secondary, and post-secondary students.126 But even with a modern agreement, the
Cree School Board has had difficulty with funding and the board had to go to court
to ensure that it was an equal participant in establishing the funding formula that
would apply to their own schools.127
There are also examples of First Nations political organizations working to provide
similar supports in some areas.128 But none have the capacity, or the mandate or, most
importantly, the funding to match even a tiny portion of what a provincial or territorial
ministry of education has.129
The education inequity continues when Aboriginal parents send their children
to provincially run schools. First Nations are obliged to pay fees to school boards so
that their children can attend public schools. The First Nations then receive money
from the federal government to cover those fees. However, Ottawa does not take into
account any increases in provincial student fees so the First Nations often have to pay
the difference. Table 2.1 demonstrates the gap between federal funding and the rates
that the band has to pay to send student to local school boards.
Table 2.1. Tuition fees for Timiskaming First Nation students vs. federal funding, 2010
Provincial tuition fees charged for Band school rates paid by
First Nation students attending Aboriginal Affairs
provincial schools
School Board Elementary Secondary Elementary Secondary
Northeastern Catholic $12,796 N/A $4,951 N/A
School District of Ontario
District Ontario North $11,584 $12,552 $4,951 $5,579
East
Conseil catholique $12,280 $14,528 $4,951 $5,579
Grandes-Rivières Ontario
Source: FNEC, NAN, and FSIN, Report on Priority Actions in View of Improving First Nations Education, 42.
As the table demonstrates, the Timiskaming First Nation must pay between $11,584
to $12,796 for each child they send off reserve to attend a provincial public or Catholic
elementary school. Yet they receive less than half that amount from Aboriginal Affairs
(just $4,951) for the funding of each student’s education.
First Nations struggle to ensure their children receive even an adequate education.
They do so “with tenuous authority and without any specific funding to enable their
systems to provide second-and-third level services comparable to those offered by
provincial/territorial systems.”130
The Senate Standing Committee on Aboriginal Peoples found that the absence of
adequate funding supports is “among the key factors that contribute to the unaccept-
able gap in educational attainment rates between First Nations students and their
Canadian counterparts; a gap that is unlikely to substantially improve unless this edu-
cational infrastructure deficit is addressed.”131
8) We call upon the federal government to eliminate the discrepancy in federal

education funding for First Nations children being educated on reserves and those
First Nations children being educated off reserves.
9) We call upon the federal government to prepare and publish annual reports
comparing funding for the education of First Nations children on and off reserves,
as well as educational and income attainments of Aboriginal peoples in Canada
compared with non-Aboriginal people.
Meeting learning needs of Aboriginal students

Aboriginal students in many cases have diverse and unique needs that mean sim-
ply providing identical funding to a provincial school system is not sufficient. The need
for the schools to teach Aboriginal language and culture is one example of such needs.
Hundreds of Survivors have told the Commission that the incorporation of Aboriginal
culture and language into the life of First Nation schools and communities is essential
to overcoming the impact of the residential schools.
Provincial education systems must better accommodate Aboriginal children espe-
cially given the growth of urban Aboriginal populations. A 2013 study by the educa-
tion advocacy group People for Education indicates that, while over 90% of schools
in Ontario have Aboriginal students, and while 82% of Aboriginal children in Ontario
attend provincial schools, “51% of elementary schools and 41% of secondary schools
offer no Aboriginal education programs or opportunities, such as professional devel-
opment or cultural support programs.”132 Native studies scholar Leroy Little Bear notes
that language, songs, stories, and ceremonies are the repositories of knowledge. He
states that “knowledge, from an Indigenous perspective, is the relationships one has
to ‘all my relations,’” which he says includes “everything in creation.”133 These elements
are generally not evident in the provincial and territorial education systems. In spite
of efforts to be more inclusive of Aboriginal learners, public schools are not Aboriginal
places of learning.
Although efforts are being made, such as the development of the Common
Curriculum Framework for Aboriginal Language and Culture Programs in the west-
ern provinces,134 in general provincial, federal, and territorial governments have not
committed the necessary resources to accomplish the task.135
The Canadian Heritage department’s Task Force on Aboriginal Languages and
Culture has identified immersion and bilingual programming as the preferred method
for providing language education. But it noted in 2005 that very few such programs are
available to First Nations, Inuit, or Métis students due to lack of support from school
boards or other educational authorities, limited funding, and lack of teachers and
materials.136
Elementary schools with higher proportions of Aboriginal students are also half as
likely to have specialist physical education, health, or music teachers. Studies show
that 59% of First Nations and Métis high school students are in applied courses (as
opposed to academic courses) compared to a 30% provincial average.137 In other
words, the legacy of low expectations for Aboriginal children manifested in the resi-
dential school era continues today.
Ontario has taken steps to improve the educational experience of Aboriginal
students, to work with Aboriginal leaders and organizations to improve education
outcomes for Aboriginal students, and to develop curriculum that more accurately
reflects Aboriginal issues and history.138 Support documents have been developed for
teaching seven Aboriginal languages, and Aboriginal language courses are available
as an alternative to French as a second language. Curriculum policy documents have
been developed for teaching Native studies in Grades Nine through Twelve. 139
The province has established a baseline from the 2011–12 year from which it
will be able to more accurately measure whether outcomes for Aboriginal students
improve.140 The baseline shows that First Nation, Métis, and Inuit students are not
achieving at the same level as all Ontario students. For example, Grade Three and
Six reading scores show gaps ranging from 5 to 33 percentage points between the
numbers of First Nation, Métis, and Inuit students and the numbers of English- and
French-language students achieving at or above the provincial standard; Grade
Three and Six writing scores show gaps ranging from 8 to 35 percentage points;
Grade Three and Six mathematics scores show First Nation, Métis, and Inuit stu-
dent results ranging from 6 to 51 percentage points below all English- and French-
language student results; Grade Nine mathematics results indicate a gap of up to 19
percentage points. The percentage of First Nation, Métis, and Inuit students accu-
mulating 8 or more credits in their Grade Nine year ranges from 10 to 24 percentage
points below the provincial average.141
This baseline data is critical for measuring successes and failures as Ontario con-
tinues to work with Aboriginal communities to improve the quality of education pro-
vided to Aboriginal students in the provincial schools and serves as a good model for
other provinces and territories.
Early childhood education
The Royal Commission on Aboriginal Peoples stressed the importance of early

childhood education, stating that “Aboriginal parents and educators consistently
press for holistic programs that address the physical, intellectual, social, emotional,
and spiritual development of children.” The report went on to say, “This priority should
guide the design and operation of all early childhood programs.”142 It also noted that
early childhood programs were excellent vehicles for parental involvement and for
use of Aboriginal languages, and recommended that they should be delivered in a way
that maximizes Aboriginal control and parental involvement.143
Despite some increases in funding and availability of childcare spaces after the
rcap recommendations, Aboriginal families continue to suffer from a general lack
of early childhood education. Based on 2011 data, the Assembly of First Nations
(afn) reported that 78% of children aged 0 to 5 do not have access to licensed
day care.144
rcap also emphasized that parents play a key role in preparing their children to
participate in two worlds.145 The Royal Commission recommended that all schools
serving Aboriginal children should adopt policies that welcome the involvement of
Aboriginal parents, Elders, and families in the life of the school.146 It recognized that
this would require not only Aboriginal control of schools where possible, but also
that provincial and territorial governments work more closely with Aboriginal peo-
ple to develop “innovative curricula that reflect Aboriginal cultures and community
realities,”147 which would also encourage the teaching and preservation of Aboriginal
languages.148
Since 1995, Health Canada has run the Aboriginal Head Start program, claiming to
support over 9,000 children in 300 different programs in First Nations communities on
reserve.149 However a 2012 evaluation done for the Public Health Agency of Canada
reported that there were only 4,640 spaces for children aged 0 to 6 in these programs.
Furthermore, there are almost 48,000 Aboriginal children aged 3 to 5 living off reserve.
The report noted this vast underservicing despite the higher needs of Aboriginal chil-
dren who
• are overrepresented in the child welfare system;

• experience higher levels of moderate and severe food insecurity (33%) than
non-Aboriginal populations (9%);
• are twice as likely to experience poverty as the general Canadian population;
and
• are two to three times more likely than non-Aboriginal Canadians to be raised
by young, single parents.
The evaluation also reported that it found “no evidence of systematic coordination
between the Public Health Agency and other federal departments delivering similar
programs, namely Aboriginal Affairs and Northern Development Canada, as well as
Human Resources and Skills Development Canada.”150
Although some provinces are moving towards full-day kindergarten for five- and
even four-year-olds, others are not. In provinces and territories such as Alberta,
Saskatchewan, and the Northwest Territories that leave such decisions to individual
school divisions, it seems unlikely that full-day programs will be extended to school
districts with high Aboriginal populations.151 Given the young demographics of First
Nations communities, it is particularly disappointing that neither the federal govern-
ment’s 2013 Blueprint for Legislation nor its proposed First Nations Education Act fea-
tured a commitment to early childhood education.
12) We call upon the federal, provincial, territorial, and Aboriginal governments
to develop culturally appropriate early childhood education programs for
Aboriginal families.
Special education
Federal funding for special education is particularly problematic when com-

pared with provincial schools. Aboriginal Affairs consultants were told of a number
of examples in which on-reserve students who are ineligible for “High-Cost Special
Education” support through Aboriginal Affairs criteria on reserve would be qualified
if they lived in the adjacent provincial school district.152
The Mississaugas of the New Credit First Nation are pursuing a human rights com-
plaint arguing that Canada’s special education funding discriminates against First
Nations. The Mississaugas lodged the complaint when Aboriginal Affairs refused to pay
for the special education supports required by two children with Down’s syndrome.
Because of their special needs, the two children must attend a provincial school, as
the services they require are not available on reserve. The provincial school charges a
fee of over $80,000 per year for the education supports these students require. Canada
has refused to cover the cost, saying that the First Nation should pay for the costs out
of their existing special needs budget. However, the Mississaugas entire budget for all
its students with special needs is $165,000 per year, and these funds are already allo-
cated for other children with different types of special needs. The complaint argues
that First Nations children are not guaranteed the same level of special education ser-
vices as non-First Nations children.153 This complaint is currently being reviewed by
the Canadian Human Rights Commission.
This and other similar cases fit into a growing and very disturbing pattern of
Aboriginal people having to take the government to court to argue for a basic
Aboriginal right to equal education. Unfortunately, Aboriginal children and commu-
nities often pay the price for the delay.
Post-secondary education
Post-secondary education should be seen as an opportunity to increase the sup-
ply of skilled Aboriginal personnel needed by Aboriginal communities to develop
and manage their own institutions. Increased access to post-secondary education is
essential if the income and employment gap between Aboriginal people and other
Canadians is to be closed. However, post-secondary education for Aboriginal learners
is inadequate and inaccessible for many. From 1876 until 1927, the federal minister of
Indian Affairs had the right to strip First Nations individuals of their Indian Act status
if they were
admitted to the Degree of Doctor of Medicine, or to any other degree by any Uni-
versity of Learning, or who may be admitted in any Province of the Dominion to
practice law either as an Advocate or as a Barrister or Counsellor or Solicitor or
Attorney or to be a Notary Public, or who may enter Holy Orders or who may be
licensed by any denomination of Christians as a Minister of the Gospel.154
Access to post-secondary education remains problematic. Only 8.7% of First Nations
people, 5.1% of Inuit, and 11.7% of Métis have a university degree, according to the
2011 census.155 Yet, as noted earlier in this chapter, where Aboriginal students have the
opportunity to complete a university education, the income gap with non-Aboriginal
Canadians virtually disappears.
Some of the Survivors who spoke to the Commission recounted difficulty in obtain-
ing a higher education. Jennie Thomas attended the Kuper Island, British Columbia,
school and went on to graduate from the University of Victoria with a bachelor of
social work and child welfare specialization. She explained,
I was pretty much the only native woman in the class with the class of young,
white girls that just got out of high school by the looks of it, and it was, that’s who
were, that’s who my peers were or my cohorts. So, all through my academic life
at, you know, I was definitely the older woman in the class, the only native in the
class. So, that really took some getting used to. But I’ve always known that I was
gonna, if I started something, I was gonna finish it. So a lot of my experiences
have, have—whether I like it or not—are based on my experience as a child at
Kuper Island Residential School.156
Velma Jackson attended residential school in Saddle Lake, Alberta. She used the
settlement money from her Common Experience Payment to study at university:
I applied to Frog Lake band for them to pay for my education, and they said, “Oh,
no, you have no money, your money ran out.” He said, “You’ve exhausted all
your resources,” is what I was told. So out of the $13,000 I got, most of it went to
educating myself, to try and get a Cree language instructor diploma. So, I spent
most of my, my money on that.157
If access to post-secondary education is to be improved, clearly increasing second-
ary school completion rates is an important step. But even for those who qualify for a
university program, there are significant obstacles.
The First Nations Education Council estimated in 2007 that there was a backlog of
over 10,000 First Nations students waiting for post-secondary funding, with more than
$200 million required to erase that backlog and meet current demands.158
There are no universities in the Northwest Territories, Nunavut, or Yukon. This
poses a serious barrier to Inuit and other Northern Indigenous peoples trying to
obtain a degree.159 Southern universities and colleges are poorly equipped to provide
the cultural and language instruction that northern students need if they wish to work
within their communities. This helps explain why the Inuit and Northern First Nations
have lower rates of post-secondary education than southern First Nations and Métis
peoples. There are, however, some promising developments. For example, the First
Nations University of Canada, the Saskatchewan Indian Institute of Technologies,
and the Saskatchewan Indian Cultural College are important institutions that support
the language, culture, history, and education of some First Nations.160 Thomas Chase,
of Royal Roads University, told the Senate Committee on Social Affairs, Science and
Technology that the First Nations University of Canada played a critical role because
it was a “safe place for people who are coming in from tiny, Northern Aboriginal com-
munities that may have only 100, 200 or 300 people … To be in an institution that
is built around their culture, in which they see similar faces—the artwork, even the
cuisine in the cafeteria reflects their own ways of life—is an important way to ensure
that they complete their post-secondary education.” The Senate Committee noted
that there is evidence that Indigenous institutions have a higher graduation rate than
non-targeted institutions.161
As of 2007, there were approximately ten thousand students attending forty-five
Aboriginal post-secondary institutions.162 Many of these institutions are technical
campuses, such as the Ogwehoweh Skills and Trades Training Centre in Ohsweken,
Ontario, which offers welding, automotive, and construction training, or Yellowquill
College in Winnipeg, which offers diplomas in Aboriginal business management or a
certificate in community health.163 However, most such institutes do not offer degree
programs. Many of their certificates and diplomas are not recognized by univer-
sities. Many of these institutions also suffer from significant underfunding, receiving
only 56% of the necessary operating costs through Canada’s Indian Studies Support
Program.164 Further, the Indian Studies Support Program provides project funding
only, not day-to-day operational funding. As Aboriginal institutions do not have
access, generally speaking, to provincial funding available to other colleges and uni-
versities, they must find alternative funding sources.165
11) We call upon the federal government to provide adequate funding to end the
backlog of First Nations students seeking a post-secondary education.
Métis education
Even though Canada’s Métis people have equal protection under section 35 of
the Constitution, jurisdictional disputes between the federal and provincial govern-
ments continue to be a major obstacle in ensuring that the Métis have control over the
education of their young people.166 A recent ruling of the Federal Court of Appeal in
Daniels v. Canada declared that Métis are included as ‘Indians’ within the meaning of
the Constitution Act, 1867, which may well mean recognition that Métis are entitled to
many of the same rights as other Aboriginal peoples in Canada. The Supreme Court
agreed to hear this case in November 2014; as of July 2015, the case is still before the
court.
At present, though, Métis children are largely educated in public or Catholic school
systems in which school boards are not specifically held accountable for the unique
educational needs of Métis children.167
The Métis national organization, the Métis National Council, recommended the
following measures to address the shortcomings in Métis education:
• Establishment of an integrated Métis early childhood system that is funded at

a level that will provide administrative capacity, maximize benefits for Métis
children and families, and promote Métis language, culture, responsibilities,
and values.
• Establishment of Métis provincial education commissions accountable to the
Métis National Council to work with provincial education authorities, includ-
ing school boards, to develop Métis curricula and establish a Métis Education
Active Measures Program to improve the quality of education and to improve
educational outcomes.168
The Truth and Reconciliation Commission endorses these directions advocated by
the Métis National Council.
Inuit education
Unlike the system for First Nation students living on reserve, most Inuit education
is delivered through public school systems. Education in the Inuit Nunangat (Inuit
homeland) is managed by four public systems operating across two provinces and two
territories. Although developing a single education system in Inuit Nunangat would
not be appropriate given regional, historical, and jurisdictional differences, Inuit lead-
ers in all the regions have united in a call for an education system that cultivates their
languages and reflects the Inuit worldview, culture, and history.169
Only 42% of Inuit have a high school diploma or equivalent.170 Mary Simon, the
chairperson of the National Committee on Inuit Education and former head of the
national Inuit organization Inuit Tapiriit Kanatami, described the Inuit educational
system as “the greatest social policy challenge of our time.”171
In 2008, the Inuit Tapiriit Kanatami hosted the first National Summit on Inuit
Education. The summit resulted in the establishment of a National Committee on
Inuit Education, tasked with developing a national strategy for Inuit education. The
committee produced a national strategy in 2011 with ten core recommendations
designed to provide support for children to stay in school.
1. Mobilize parents
2. Develop leaders in Inuit education
3. Increase the number of bilingual educators and programs
4. Invest in the early years
5. Strengthen Kindergarten to Grade Twelve by investing in Inuit-centred

curriculum and language resources
6. Improve services to students who require additional support
7. Increase success in post-secondary education
8. Establish a university in Inuit Nunangat
9. Establish a standardized Inuit language writing system
10. Measure and assessing success172
One of the greatest problems is the lack of supports both within and outside the
education system. Inuit educators have long recognized that it is important to begin
working with children as early as possible, but the North lacks quality daycare and
pre-school spaces.173 The Inuit Nunangat also lacks services for those children with
additional barriers to learning. For example, most schools do not have the resources
to work with children with behavioural or mental health problems. Schools lack liter-
acy and math programs, breakfast programs, or alternative discipline programs. A dis-
proportionately high number of parents in the North (where residential schools were
among the last to close in the country) are Survivors or intergenerational Survivors.
Services to support struggling parents are also lacking, such as drug and alcohol pro-
grams and mental health counselling.
The National Committee on Inuit Education identified some of the goals that Inuit
peoples share when it comes to education:
• Inuit want education to be delivered by Inuit educators, through quality bilin-

gual programs based on Inuit-centred curriculum.
• The education system should inspire young Inuit to stay in school longer and
advance the process of restoring confidence lost during the residential school
experience.
Success will mean equipping young Inuit with the skills and knowledge they need
to contribute to, and benefit from, the emerging economic and civic opportunities in
Canada’s northern regions.174
Canada attempts education reform

For far too long, the education provisions of the Indian Act served as the only stat-
utory basis for First Nations schools. These same provisions were key in the establish-
ment of the residential schools. A new legislative approach to education is required,
one that ensures adequate funding and true local control.
Three reports recommending reform
There is no shortage of good advice when it comes to finding reforms that could
improve Aboriginal education. In 2011–12, three different reports were released on First
Nations education; all of them made credible recommendations. All agreed on two core
points: that sustainable funding and greater Aboriginal control of education are both
absolutely necessary.
The first report, in 2011, was published by the Senate Standing Committee on
Aboriginal Peoples. The committee held twenty-eight public meetings, heard from
over ninety witnesses, visited schools, and convened a round table of education prac-
titioners.175 The committee put its conclusions bluntly:
Currently, every First Nation community is left on their own to try to develop and
deliver a range of educational services to their students. First Nations schools
operate without any statutory recognition and authority to do so. Federal policy
to guide efforts in this regard is, at best, ad hoc and piecemeal. The department
requires First Nations to educate their students at levels comparable to provin-
cial and territorial jurisdictions, and yet provides them no meaningful supports
by which to do so.176
The standing committee’s key recommendation was a call for the formalization of
an Aboriginal education system in legislation, to be developed in consultation with
First Nations people. Such legislation would explicitly recognize the authority of
First Nations for on-reserve elementary and secondary education and establish First
Nations–controlled second- and third-level education structures (similar to provin-
cial school boards and ministries of education).177
The committee also recommended that education funding address factors such as
demographics, remoteness, and the need for language preservation and revitalization
programs.178 The principle underlying all the recommendations was that the federal
government’s role should be to enable First Nations to create and adopt viable edu-
cation systems “while acknowledging that primary responsibility for education rests
with First Nations.”179
The second report in 2011 was released by a national panel that was launched
jointly by the national chief of the Assembly of First Nations, and the federal minister
of Aboriginal affairs.180 Like the Senate committee, the National Panel on First Nation
Elementary and Secondary Education for Students on Reserve recommended the cre-
ation of a statute that would set out rights and responsibilities for Aboriginal educa-
tion. The panel argued that any education statute must enshrine every First Nations
child’s right to their culture, language, and identity, regardless of whether they attend
a First Nations or provincial school. The panel recommended that the proposed legis-
lation include operational and capital statutory funding that would be needs-based,
predictable, sustainable, and used specifically for education purposes. The panel also
suggested that additional funding be allocated to provincial schools for the direct
benefit of First Nations students enrolled in them.181 It recommended that a clause be
included in the statute ensuring that the legislation did not derogate from Treaty or
other Aboriginal rights.182
Like the Senate committee, the National Panel emphasized the need for second-
and third-level education structures and supports while maintaining First Nation
control of First Nation education. The panel made a specific recommendation for the
“third tier”: a National Commission for First Nation Education, which would be cre-
ated prior to the legislation and would oversee its development.
The second tier would be made up of First Nation Education Organizations,
which would fulfill the role now filled by school boards in provincial systems and
allow for economies of scale to support the delivery of quality education to First
Nation learners. 183
At the same time as the National Panel began its work, three First Nations orga-
nizations launched their own review. The First Nations Education Council (fnec)
(Québec), Nishnawbe Aski Nation (nan) (Northern Ontario), and the Federation of
Saskatchewan Indian Nations (fsin) came together out of concern that the National
Panel’s work might not properly respect Treaty rights or recognize international
law.184 In their own 2011 report, titled Report on Priority Actions in View of Improving
First Nations Education, the three organizations were less supportive of a legislative
approach. They warned that the development of any legislation could only be done
with the consent of Aboriginal peoples. They emphasized that Canada has a constitu-
tional obligation to ensure that First Nations peoples have access to educational ser-
vices of at least equivalent quality to those provided in the public school system. At a
minimum, they emphasized, this will require a significant infusion of money.185 They
also advocated for greater transparency and accountability to First Nations commu-
nities by all parties delivering education—First Nations, provincial schools, and the
federal government.
While not in complete agreement, a consistent and significant thread connected
all three reports—the need for a complete restructuring based on principles of
self-government, a culturally relevant curriculum, stable funding, and honouring of
the treaties. Aboriginal peoples themselves must lead and control the process of change.
The Senate Committee and the National Panel reports both recommended the cre-
ation of a First Nations Education Act. The National Panel called for the federal govern-
ment and First Nations to co-create a child-centred First Nation Education Act. The Act
would not only recognize First Nations legislative jurisdiction but also empower First
Nations to enact laws for the management and administration of First Nations schools.
They agreed that the Act would not abrogate or derogate existing Aboriginal or Treaty
rights. While establishing clear governance objectives, responsibilities and accountabil-
ity, policies and procedures, and while defining the responsibilities and powers of the
various components of a First Nation education system, the Act would have to acknowl-
edge the rights of the child to a quality education regardless of whether they are enrolled
in a First Nations or provincial/territorial school system. Although developed for First
Nations on-reserve education, the principles developed by the National Panel could
also apply with appropriate modification to off-reserve, Inuit, and Métis populations.
Aboriginal-controlled education today is widely regarded as the best tool to counter the
historical use of education in residential schools as a means to assimilate and demean
Aboriginal peoples.
Canada’s proposed First Nations Education Act
Canada’s initial response to these reports was heavy-handed and reminiscent

of some of the same attitudes towards Aboriginal people that inspired residential
schools. In December 2012, Aboriginal Affairs began a consultation process for the
establishment of a First Nations Education Act. After a series of meetings across the
country with some First Nation leadership, education practitioners, and community
members, and after organizing an online survey, Canada released its Blueprint for
Legislation on July 12, 2013.186 The proposal included a few different models that First
Nations could choose from:
• Community-operated schools
• Delegation to a First Nation Education Authority (an amalgamation of schools,
like a school board)
• Agreements with a provincial school board to: (a) operate the First Nation
school on reserve; or (b) allow students who live on reserve to attend provincial
off-reserve schools 187
The Blueprint was a far cry from the joint development process advocated by the
National Panel on Education and the Senate Standing Committee.
It provided no commitment to ensuring K–12 services would be available within a
community. Rather, if a First Nation school offered education up to a certain grade,
the legislation would require that school to have a transition plan for students moving
into a provincial school.188 The Blueprint did not address early childhood education,
such as Junior Kindergarten, despite the widely recognized importance of its potential
to help redress the Aboriginal child welfare crisis. While the Blueprint acknowledged
Treaty rights, it made no specific commitment to ensure that Canada would meet its
obligations under international law or preserve existing education rights found in the
Treaties.
The federal government’s Blueprint approach sent the message that it knew better
than First Nations what was best for their children. This attitude was so reminiscent
of the residential school era that it triggered substantial resistance from First Nations.
In October 2013 the government followed its Blueprint with its proposed First
Nations Education Act. Under this proposed legislation, First Nation schools would
have requirements for curriculum and graduation, student assessment and report-
ing, safety, daily operations, teaching supports, materials and equipment, compliance
and enforcement, finance and accounting, human resources, and information tech-
nology. The Act would have legislated attendance requirements similar to provincial
requirements, with all students between the ages of six and sixteen required to be
registered in and attending school. Each school would be required to file an annual
“student success plan.”189
While it might be difficult to argue with such standards, there was nothing in the
Act that addressed the financial ability of First Nation schools to meet or enforce such
requirements. It provided no guarantee of increased or stable funding of First Nations
schools. There was no assurance of equity in the distribution of resources to educate
First Nations children in First Nations schools or in provincial or private schools. It
also provided a mandatory structure where First Nations must have both a “Director
of Education”190 and a “school inspector.”191 This was a one-size-fits-all approach that
failed to recognize the diversity of First Nations.
The First Nations Education Act contemplated paternalistic and punitive actions
whereby the minister of Aboriginal Affairs and Northern Development could essen-
tially take over First Nations schools for non-compliance with provisions in the Act.
Special administrators could be appointed by the minister for open-ended periods of
time and against the wishes of the First Nation affected.192 The minister of Aboriginal
Affairs would also have unfettered discretion in creating regulations regarding report-
ing, human resources, and schooling requirements, including all matters required
under the Act.193 Such an approach did not renounce the colonial legacy of the resi-
dential schools: it continued them.
The Government of Canada defended the proposed legislation, saying that its goal
was to provide better education outcomes for First Nation students.194 But that goal is the
same one that the government has consistently failed to meet for many years. Given the
legacy of residential schools and the history of Aboriginal education, First Nations had
little reason to trust that Canada would now fund First Nations education in a sustain-
able and appropriate way on the basis of policy alone, and without the corresponding
force of law.
Furthermore, neither the Blueprint nor the proposed First Nations Education
Act made any commitment to language revitalization or culturally tailored educa-
tion. Instead, there was a mention that the curriculum may include instruction in
Aboriginal culture and languages, and that there would have to be consultation with
community committees on such matters.
The Commission has heard from thousands of Survivors about the loss of Aboriginal
languages and culture in the residential schools, about their struggles to reconnect
in later years with their languages and traditions, and about the great healing and
redemptive value that such connections have had for them and their families. The fre-
quency and conviction of these statements from Survivors and many of their descen-
dants across all Indigenous communities within Canada make it abundantly clear
that Aboriginal languages and cultures deserve much better treatment than what was
contemplated in the proposed First Nations Education Act.
The Government of Canada’s proposed First Nations Education Act, fit into the dis-
turbing pattern of matters getting worse, not better, since the settlement of the res-
idential school litigation and Canada’s apology. The UN special rapporteur on the
rights of Indigenous peoples, James Anaya, observed in October 2013,
I urge the Government not to rush forward with this legislation, but to re-initiate
discussions with aboriginal leaders to develop a process, and ultimately a bill,
that addresses aboriginal concerns and incorporates aboriginal viewpoints on
this fundamental issue. An equally important measure for improving educa-
tional outcomes, and one that could be implemented relatively quickly, is to
ensure that funding delivered to aboriginal authorities for education per student
is at least equivalent to that available in the provincial educational systems.195
The First Nations Control of First Nations Education Act
Matters improved somewhat with an announcement in February 2014 of an agree-

ment between the Government of Canada and the Assembly of First Nations on a
partnership to develop the First Nations Control of First Nations Education Act. This
act differed significantly from the First Nations Education Act in that it did promise
sustainable funding and instruction in Aboriginal culture and languages. The agree-
ment accepted the case for change and reform as made by the three reports examined
earlier in this chapter.
The bill would establish minimum education standards on reserve, consistent with
provincial standards off reserve. For example, the legislation would require that First
Nation schools teach a core curriculum that meets or exceeds provincial standards,
that students meet minimum attendance requirements, that teachers are properly cer-
tified, and that First Nation schools award widely recognized diplomas or degrees.196
The agreement’s commitments to sustainable funding was accompanied by alloca-
tions in the federal budget of February 2014 of over $2 billion in new funding to reserve
schools. It promised to replace the long-standing 2% cap on annual increases with a
4.5% annual increase and $1.25 billion in new core funding from 2016–17 to 2018–19.
In addition, $500 million over seven years was committed to improving school infra-
structure, and $160 million over four years to an enhanced education fund.197
However, a number of Aboriginal leaders questioned the new act. They felt that
it could threaten Treaty obligations and erode Aboriginal rights. Consequently, in
May of 2014, at a meeting of the Assembly of First Nations, Aboriginal leaders voted
to reject the proposed legislation. National Chief Shawn A-in-chut Atleo subsequently
resigned and the Government of Canada announced that it was putting the legislation
on hold.
This disagreement underscores the seriousness of this issue to Aboriginal leaders,
and it highlights just how much work remains to be done. This particular disagree-
ment is also a reminder of the deep levels of distrust that have built up over the years.
In this instance, history is not helpful. The legacy of the residential schools and
the years of underfunded education have given many Aboriginal parents and leaders
considerable opportunity to question the commitment and sincerity of any and all
government proposals.
The tainted legacy of the Indian Act that forced Aboriginal parents to send their
children to residential schools must be fully and finally set aside. The Government of
Canada must end its pattern of underfunded and culturally and linguistically inap-
propriate Aboriginal education, which began with the residential schools.
The Commission is well aware how much work remains to be done. The process of
consultation is essential. Any legislation and its accompanying proposals for funding
must recognize that the contemporary needs of Aboriginal children, for at least the
short and mid-term, are greater than for children in the general population, in large
part because of the legacy of the government’s own policies of assimilation.
Even without the legacy of residential schools, the challenges of providing qual-
ity education for remote, diverse, and small communities are immense. The federal
government must, as the Assembly of First Nations itself recognized, work in part-
nership not only with the afn but also with individual Aboriginal communities to
ensure that the mistakes of the residential school era, as well as the more recent
mistakes of the heavy-handed 2013 Blueprint and proposed First Nations Education
Act are not repeated.
10) We call upon the federal government to draft new Aboriginal education legislation
with the full participation and informed consent of Aboriginal peoples. The new
legislation would include a commitment to sufficient funding and would incorpo-
rate the following principles:
i. Providing sufficient funding to close identified educational achievement gaps

within one generation.
ii. Improving education attainment levels and success rates.
iii. Developing culturally appropriate curricula.
iv. Protecting the right to Aboriginal languages, including the teaching of
Aboriginal languages as credit courses.
v. Enabling parental and community responsibility, control, and accountability,
similar to what parents enjoy in public school systems.
vi. Enabling parents to fully participate in the education of their children.
vii. Respecting and honouring Treaty relationships.
Overcoming the education legacy of residential schools
Supportive governance structures
Both the National Panel and the Standing Senate Committee recognized the need for
additional governance structures to support Aboriginal education. The National Panel
recommended the establishment of an independent National Commission for First
Nations Education. The commission would replace the current role played by the fed-
eral Department of Aboriginal Affairs and Northern Development. It would be responsi-
ble for developing and implementing education goals, national curricula, standards and
testing criteria, education policies, and funding allocation policies, much like provincial
ministries of education. The commission would set standards for culturally appropriate
education as well as professional standards for teachers and principals. Additionally,
the commission would develop performance measurement and accountability. The
National Panel also recommended the development of regional First Nation Education
Organizations to facilitate the establishment of education services.
The February 2014 agreement between the federal government and the Assembly
of First Nations made no mention of structures that may be necessary to support
reserve schools, especially in remote and small communities.
Funding
The proposed First Nations Control of First Nations Education Act included a
commitment that “the Government of Canada will provide First Nations education
systems with a stable, predictable and sustainable funding model for First Nations
education.”198 This was an important step forward, but it remains to be seen whether
agreement can be reached on legal measures to make this commitment real. Too
many programs that are necessary to redress the legacy of residential schools are vul-
nerable to the vagaries of governmental funding. The federal government has in many
different contexts been attracted to a formal equality approach that fails to recognize
the distinct and higher needs of Aboriginal students stemming in part from the legacy
of residential schools and compounded by the isolation and high operating costs in so
many remote Indigenous communities.
Aboriginal control of Aboriginal education

There have been some important recent developments that show the promise and
the potential of Aboriginal self-determination in designing and developing education
programs and systems.
New governance models
Across the North, Inuit education is on the cusp of significant transformation

with some of the most promising models for self-governing education coming out
of Northern communities. The Kativik School Board (established by the 1975 James
Bay and Northern Quebec Agreement in Nunavik) has exclusive education jurisdic-
tion in fourteen Inuit villages.199 In addition to educating children, the board runs a
training program for Inuit teachers, an upgrading program for non-Inuit teachers,
adult education, and a research department.200 The board also arranges and super-
vises post-secondary education for students studying in the South. The board designs
its own curriculum, determines its own school calendar and languages of instruction,
and trains its own teachers.
When Nunavut was founded in 1999, it passed education and language laws to pro-
tect the right to a culturally relevant curriculum. The Consolidation of Inuit Languages
Protection Act guarantees the right to Inuit language instruction in Nunavut’s school
system.201 Nunavut’s Education Act establishes a right to a bilingual education with the
Inuit language, and makes Inuit knowledge the foundation of the education system.202
Teaching Aboriginal languages in schools is one of the best ways to ensure respect and
interest in culturally appropriate learning.
In 2006 in Labrador, the Nunatsiavut land claims settlement set the stage for the
Nunatsiavut government’s gradual takeover of the delivery of education.203 Several
promising practices have included parents as contributors and collaborators in
curriculum-based Inuit camps, heritage fairs, and breakfast programs. This is a signifi-
cant break from the practices of the residential schools. In the Northwest Territories,
Inuit educators and Elders have developed some specialized curricula.204
However, these significant changes have not come without obstacles. Some regions
have a greater capacity to develop the necessary resources than others. A shortage
of bilingual educators is one of the greatest barriers to expanding bilingual educa-
tion in Inuit schools.205 There is also a lack of teaching and reading materials in
Inuit languages.
Place-based learning
Based on the reports of the Aboriginal Learning Knowledge Centre (created by

the Canadian Council on Learning) and the National Committee on Inuit Education,
there is a need to recognize and strengthen place-based learning within classrooms
that serve Aboriginal students.206
Place-based education is a philosophy that anchors the student’s lessons in the
cultures, the land, the history, and the stories of their communities. These connec-
tions are emphasized in every subject from the study of language to mathematics to
social studies and science.
Such an approach allows Elders to play a role in Aboriginal education. Academically
qualified teachers can work with Elders and other Aboriginal instructors to find cul-
turally enriched ways to meet the standardized learning outcomes.
Marie Battiste is a Mi’kmaq scholar and director of the Aboriginal Education
Research Centre at the University of Saskatchewan. She notes that reconciling First
Nation peoples to their own knowledge “should be a restorative feature of educa-

tion for the future of First Nations.”207 Place-based learning can also be a source for
all forms of Indigenous knowledge, including Indigenous science, which Professor
Battiste describes as “a dynamic, living process watching, listening, connecting,
responding and renewing. Indigenous science embodies a holistic view of the world
in which all human, animal, and plant life are perceived as being connected, related
and interdependent.”208
Leroy Little Bear notes that “it is not enough to only know about places, its history
or narrative, but a learner must experience them both physically and emotionally,
achieved through rituals, and visitations.”209 In the view of the Commission, rooting
learning in a local context is an important step towards effective education.
Negotiated agreements
A growing number of self-government agreements negotiated between First

Nations and federal and provincial governments contain education jurisdiction com-
ponents, including Sechelt (1986), Nisga’a (2000), Tlicho (2005), Tsawwassen (2009),
Maa-nulth First Nations (2011), and the Yale First Nation (2013). However, many First
Nations with such self-government agreements have chosen not to exercise that juris-
diction because of the lack of support for the elements of a system of education.210
The other emerging trend has been towards the negotiation of tripartite agree-
ments. In 1998, eleven Mi’kmaq First Nations concluded the first tripartite agreement
providing for the transfer of education to local control.211 Under the agreement, the
education sections of the Indian Act—provisions that once forced Aboriginal parents
to send their children to residential school—cease to apply to the participating com-
munities. The agreement also provides that First Nation laws regarding education
on reserves prevail over provincial education laws. The Mi’kmaq schools under this
agreement have been pioneers in programs designed to preserve and draw on the
wisdom of the Mi’kmaq language and have become important cultural centres for the
whole community.212
In 2006 the Government of Canada, British Columbia, and the First Nations
Education Steering Committee signed the Education Jurisdiction Framework
Agreement, which put in place a process to transfer jurisdiction over on-reserve
education to participating First Nations in British Columbia.213 The First Nations
Jurisdiction over Education in British Columbia Act gives effect to the framework
agreement.214
Those First Nations in British Columbia that wish to participate can negotiate
individual education agreements that transfer education authority to the partici-
pating and/or self-governing First Nations. Once a jurisdiction agreement has been
ratified, participating First Nations assume responsibility for providing educational

services from Kindergarten to Grade Twelve on reserves. The agreement also estab-
lished a First Nations Education Authority to support First Nations in exercising
education jurisdiction in three key areas: teacher certification, school certification,
and the establishment of curriculum and examination standards. First Nations can
co-manage educational services with the Authority, or delegate their jurisdiction
entirely to the Authority.215
Apart from these approaches, other tripartite agreements have been negotiated in
four provinces (Manitoba, New Brunswick, Alberta, and Prince Edward Island) and
there is a sub-regional agreement with the Saskatoon Tribal Council.216 Canada states
that the seven tripartite education agreements (which include the BC and Nova Scotia
agreements referred to above) cover “58% of eligible First Nation communities.”217
However, unlike the agreements concluded in BC and Nova Scotia, the agreements
negotiated through the Education Partnership Program are not legally binding and
do not involve a transfer of jurisdiction. Instead, the agreements are focused on pro-
moting collaborative relationships between the parties and committing to develop-
ing strategies to improve educational outcomes for First Nations students who attend
both band-operated schools and provincial schools.218
There are also promising examples of Aboriginal peoples working within the pub-
lic education systems to better meet the needs of Aboriginal students. The Mi’kmaq
Kina’matnewey (Nova Scotia) and the Ahkwesahsne Mohawk Board of Education
(Ontario) have established agreements that require the public education system to be
more reflective of Aboriginal culture, values, and language.219
In 1999, the First Nation Education Steering Committee (BC) engaged Canada,
the province, and the BC Teachers’ Federation in discussions aimed at improving
school success for Aboriginal learners. The memorandum of understanding that
was eventually signed in BC set the foundation for the creation of local enhance-
ment agreements requiring public schools to provide strong programs on the cul-
ture of local Aboriginal peoples.220
These developments are promising, but there is also reason to be cautious. The
Senate Standing Committee on Aboriginal Peoples observed that while these partner-
ship agreements have some benefits, witnesses who testified before the committee
argued they are not a lasting solution to the education challenges facing First Nations.
Legislation developed in genuine partnership with First Nations to ensure Aboriginal
control over education and adequate funding for the great challenges left by residen-
tial schools is still necessary.221
Meanwhile, as in other legacy areas such as child welfare and health, these edu-
cation developments are taking place on a piecemeal basis, agreement by agree-
ment across the country. Aboriginal peoples have neither the resources nor the time
required to negotiate and renegotiate such temporary agreements. Significant and
durable change, which honours the Treaties and Aboriginal peoples’ rights to self-
determination, must happen much more quickly to ensure that today’s children are
not left behind.
Non-Aboriginal students
The Commission hosted more than 14,000 Aboriginal and non-Aboriginal
high school students at special Education Days aimed at familiarizing them with
Canada’s residential school history, and allowing them to hear first-hand from
Survivors. Non-Aboriginal students have been among the most vocal, and indeed,
at times, outraged, in saying that someone should have taught them about all of this
a long time ago. Young people have told the Commission that they want to learn
the whole truth about our country—that this has helped them better understand
why things are the way they are, in their homes, in their communities, on the streets
of our country, and in their schools. This Commission wholeheartedly agrees with
them. Better integration of Canadian history affecting Aboriginal peoples, as well as
Aboriginal peoples’ own perspectives, history, and languages in the public school
curriculum, will assist non-Aboriginal children as well as Aboriginal children.
The Commission has received encouraging replies from ministries of education in
a number of provinces, including Alberta, Manitoba, and New Brunswick, about their
determination to include Aboriginal experiences in the curriculum from Kindergarten
to Grade Twelve. Such curriculum changes are already in place in the territories.
In Ontario, enrolment in Aboriginal languages and Native studies programs in
public schools has increased from 5,343 students in 2007 to 19,345 students in 2012
with the assistance of targeted funding.222 Some provinces, such as Saskatchewan,
have focused on education about residential schools. This is a positive development,
but there is need to examine other aspects of Aboriginal history and culture—and to
recognize the benefits of examining these other aspects.
Conclusion
Residential schools failed miserably in their mission to provide Aboriginal children
with a decent education. Although a few graduates of the schools went on to play lead-
ership roles, the vast majority of students suffered from poor education and were often
permanently estranged from continuing their education. This should not be surprising.
The education they experienced in residential schools was a violation of their rights. It
was an instrument of assimilation and limitation, and a belittlement of their personal
and collective Indigenous identities, cultures, and languages.
One of the most tragic legacies of the residential schools is the significant edu-
cation and income gap separating Aboriginal people from other Canadians. The
Commission believes that this gap must be closed. The best way to close the gap is to
monitor it accurately and to report on its standing, and to invest in the education of
Aboriginal children.
The inadequate funding of First Nations schools on reserves remains a national dis-
grace. Those classrooms today bear a shameful resemblance to the residential schools.
There must be stable and adequate funding of Aboriginal education. The funding has
to be adequate to address the challenge of erasing the legacy of residential schools as
well as other needs faced by Aboriginal people. In addition to fair and adequate fund-
ing, there is also a need to maximize Aboriginal control over Aboriginal education,
and to facilitate instruction in Aboriginal cultures and languages.
Only with all these educational measures in place will there be a realistic prospect
of reconciliation on the basis of equality and respect—principles so lacking in the res-
idential school era.
Chapter 3
“I Lost My Talk”: The erosion

of language and culture
Embodied in Aboriginal languages is our unique relationship to

the Creator, our attitudes, beliefs, values and the fundamental
notion of what is truth … Language is the principal means by
which culture is accumulated, shared and transmitted from gener-
ation to generation. The key to identity and retention of culture is
one’s ancestral language.
—Elder Eli Taylor, Sioux Valley First Nation1
Introduction
F
or over a hundred years, Canada’s residential schools took Aboriginal children
away from their parents, their families, and their communities for the purpose
of destroying their connection to their traditional cultures and languages. The
intent, as acknowledged by Prime Minister Stephen Harper in his historic apology on
June 8, 2008, was to “kill the Indian in the child.” Exercising harsh and often humilia-
ting forms of discipline, punishment, and deprivation, those in charge of the schools
repeatedly told the children that their language and their culture was worthless and
evil—in the words of Canada’s first prime minister, “savage.”
The churches and the Canadian government believed that Aboriginal children
should live their lives in Euro-Canadian cultures, speaking only English or, to a much
lesser extent, French. To this end, they generally prohibited the use of Aboriginal lan-
guages both in classrooms and in the daily life of the students. Students who spoke
their native language outside the classroom were often punished or ridiculed.
Indian Affairs appears to have had no other policy on the use of language in the
schools beyond its requirement that English and French were to be the only two lan-
guages of instruction and the only two languages to be taught in the schools.2 The gov-
ernment simply thought the languages were disappearing and would be of no interest
or value to Aboriginal children in the future.
The schools were left to improvise their own policies. Those policies and their
enforcement varied significantly. At the Anglican school at Moose Factory, Ontario,
Billy Diamond, who went on to serve for many years as chief of the Grand Council
of the Crees of Québec, recalled that in the 1950s, the punishment for speaking Cree
was having one’s mouth washed out with soap.3 Jane Willis, who attended residen-
tial school in the 1940s and 1950s, recalled how the opening message from the prin-
cipal at the Anglican school in Fort George, Québec, stressed that from then on, the
students were to speak English in the school, since they were there to learn new
ways. In practice, students refused to abide by this rule. They avoided punishment
by refusing to speak Cree or English when the teachers were around, and speaking
Cree among themselves.4 When Isabelle Knockwood’s mother first took her to the
Shubenacadie school in Nova Scotia, they encountered a young Aboriginal girl in
the school parlour. When Knockwood’s mother began to speak to her in Mi’kmaq,
the girl responded, shyly, in English. It was then explained to Mrs. Knockwood that it
was not permitted to speak Mi’kmaq in the school.5 According to Albert Canadien, at
Fort Providence in the Northwest Territories in the 1950s, once students had learned
a little English, they were forbidden to speak Slavey (Dene).6 Raphael Ironstand
wrote in his memoirs how, shortly after he entered the Pine Creek, Manitoba,
school in the 1950s, a number of girls had their heads shaved: “Even though they
wore scarves and toques to hide their heads, the tears were streaming down their
faces. They were so embarrassed, they kept their heads bowed and eyes looking at
the floor. It turned out that their crime had been speaking their native dialect to each
other.”7 When James Roberts became the first Aboriginal administrator of the Prince
Albert, Saskatchewan, residence in 1973, he remarked that when he had attended
the school as a boy, he had not liked the fact that he and his fellow students “were
not allowed to speak their own native language.”8 These examples make it clear that
in schools across Canada, children were told that it violated school policy to speak
their own language.
The rejection of Aboriginal languages and cultures—the belief systems, values,
laws, spiritual ceremonies, and ways of life of Aboriginal people—was based on two
distinct and separate principles: first, the European belief that Aboriginal people had
no culture and were ‘savages’ living in a state of nature; and second, the belief that the
distinctive Aboriginal race needed to be eliminated so that they would be no different
from other Canadians.
While the children taken to the schools tried to retain as much of their languages
and cultures as they could, the multigenerational battle waged against them was
too hard to resist. While initially Survivors could return to communities where their
languages and cultures were still alive and vibrant, with each successive genera-
tion of Survivors, there was a greater weakening of community cultural and linguis-
tic strength. More often than not, the schools prevailed. Aboriginal students were
The erosion of language and culture • 105
forced to abandon their languages and cultural practices. They became alienated
from their families, their communities, and ultimately from themselves. This dam-
age was passed down through the generations, as former students found them-
selves unable or unwilling to teach their own children Aboriginal languages and
cultural ways.
Many of the residential school Survivors who spoke to the Truth and Reconcil-
iation Commission have stressed the pain caused to them from this loss of their
very identity. It is their stories that have guided the work of the Commission. In the
words of Elder Shirley Williams, “Language and culture cannot be separate from
each other—if they are, the language only becomes a tool, a thing … Our language
and culture are our identity and tell us who we are, where we came from and where
we are going.”9
In this chapter, the Survivors explain how the loss of languages led to a loss of
identity and ultimately brought Aboriginal people face to face with the destruction
of their cultures. The loss of identity cast children into a state of confusion over what
was right and good in their lives.
The chapter examines the current threats to the survival of Aboriginal languages,
and looks at why the loss of Aboriginal language, identity, and culture is so important
to non-Aboriginal Canadians. It will also examine the failure of the Canadian gov-
ernment to support the preservation of Aboriginal languages despite their protected
status under the Constitution and international agreements. The final part of this
chapter will address what has been done and what still needs to be done to preserve
Aboriginal languages and cultures.
In our Calls to Action, the Commission will assert that a multi-pronged approach
to Aboriginal language preservation—if implemented, honourably resourced, and
sustained—can begin the promise of reconciliation with Survivors and their families,
people who, through numerous generations, still bear the scars and the losses of the
Loss of language and culture

The punishment of speaking Mi’kmaq began on our first day at
school, but the punishment has continued all our lives as we try to
piece together who we are and what the world means to us with a
language many of us had to re-learn as adults.
—Isabelle Knockwood,
Survivor of Shubenacadie Residential School10
I lost my talk
The talk you took away.
When I was a little girl
At Shubenacadie School.
—Rita Joe, Survivor of Shubenacadie Residential School,

“I Lost My Talk”11
Thousands of children were moved into residential schools at a very young age.
When Nellie Trapper went to Horden Hall in Moose Factory, Ontario, she was six years
old. She recalled, “I just followed everybody around ’cause I didn’t understand what
they were telling me to do; just followed the crowd … There was a lot of stuff that I got
in trouble for, and I didn’t know why ’cause I didn’t understand what they were telling
me to do, or, because I only spoke Cree.”12
Life in residential schools was both confusing and frightening. Greg Rainville was
sent to the Qu’Appelle, Saskatchewan, school. He remembered,
I was punished because the nuns would get frustrated with you when they talk to
you in French and English, and you’re not knowing what they’re talking about,
and you’re pulled around by the ear, and whatnot, and slapped on the back of
the head, and stuff like that. And I didn’t know what I was doing wrong. No mat-
ter what, I tried to do good, but I couldn’t understand what they were saying, and
they couldn’t understand what I was saying, but I was punished.13
When the children had their languages stripped from them, they not only lost
the ability to communicate with one another, they were forced to question if what
they knew, and if what they had been taught since birth had any value at all. John
Tootoosis, who attended the Delmas, Saskatchewan, school, said that for Aboriginal
children, the residential school experience was
like being put between two walls in a room and left hanging in the middle. On
one side are all the things he learned from his people and their way of life that
was being wiped out, and on the other side are the white man’s ways which he
could never fully understand since he never had the right amount of education
and could not be part of it. There he is, hanging in the middle of two cultures and
he is not a white man and he is not an Indian.14
According to social anthropologist Wade Davis, culture “is not decoration or arti-
fice, the songs we sing or even the prayers we chant. It is a blanket of comfort that
gives meaning to lives.”15 This section examines some of the devastating effects of
taking away that “blanket of comfort” of Aboriginal cultures and languages from the
children who attended residential schools, and the intergenerational effects of such
deprivations.
The statements of the Survivors are our best guide to understanding what was lost,
or stolen, or deemed “evil” in the residential school system. The culture that the chil-
dren were forced to abandon covered everything from the basics of food and clothing
and family to their essential understanding of home and history to the most sacred—
their stories and their spirituality.
Mary Siemans explained the connection between language and culture:
Our Dogrib language … identifies us as a people in a unique culture within the
land we occupy. Our language holds our culture, our perspective, our history,
and our inheritance. What type of people we are, where we came from, what
land we claim, and all our legends are based on the language we speak. Our
culture depends on our language, because it contains the unique words that de-
scribe our way of life. It describes name places for every part of our land that our
ancestors travelled on … Rules which govern our lives bring stability to our com-
munities, and our feast days, which bring people together, are all inter-related
within our language. Losing our language will not only weaken us as a people
but will diminish our way of life because it depend so much on our language.16
Doris Young speaking at the Commission’s National Event in Saskatoon,
Saskatchewan remembers the way students were forced to dress:
They took away our clothes, and gave us clothes that, that everybody else [wore],
we all looked alike, our hair was all the same, cut us into bangs, and, and straight
short, straight hair up to our ears. And there was our shoes, they took away our
moccasins, and gave us shoes, which I was not, I was just a baby, I had, didn’t
actually wear shoes; we wore moccasins.17
Martin Nicholas was sent to school with new, handmade clothing. A “buckskin
jacket, beaded with fringes … My mom did beautiful work, and I was really proud of
my clothes.” But the moccasins, pants, and jacket she made were taken from him on
his first day at school and never returned. He recalled, “that was the only one time I
wore them.”18
The Survivors shared many painful memories about the way their culture was
stripped away from them. Sarah McLeod spoke at the community hearing in Kamloops,
British Columbia, about the residential school attack on Aboriginal spirituality:
When I got here I was so proud of my totem pole ... and I showed it to the nun. I
said, “Look what I got for my birthday. I really like my totem.” She went, “Ah!” She
said, “You throw that away. Throw it away right now. Put it in the garbage right
now.” I looked at her. I said, “But that’s my birthday present.” “No, that’s no good.
That’s the devil seeing that totem pole. It’s out. Devil, can’t you see all the devil
in there? You throw it away right now!” And she made me throw it in the garbage,
and it was, I didn’t know, I said to myself, “Oh, my gosh. All this time I was, I was
hugging this devil?” You know I didn’t know that.... I never forgot it. I still, deep
in my heart, I still think it’s always something that I shouldn’t have thrown away.
It’s just how much they, they tried to take culture away from us.19
Going beyond the condemnation of childhood basics like food and clothing the
students were further encouraged to adopt the racist attitudes of the schools. Archie
Hyacinthe recalled his time at the St. Mary’s Residential School in Kenora, Ontario:
The sad part of it was, we used to watch cowboys and Indian movies on TV, black
and white TV. We would be cheering for the cowboys, you know. Here we were
saying to the Indians because “they’re losers,” you know. See, this is what the
school did to you. They taught you how to be, you know, turn against your own
people, your own culture.20
The Commission heard time and again the wrenching memories of children who
found that they couldn’t even go home anymore. Mary Courchene spoke at the com-
munity hearing in Pine Creek, Manitoba, of how she felt when she returned to her
parents’ home after a year in residential school:
I looked at my dad, I looked at my mom, I looked at my dad again. You know
what? I hated them. I just absolutely hated my own parents. Not because I
thought they abandoned me; I hated their brown faces. I hated them because
they were Indians … This is what we were told everyday; “You savage. Your an-
cestors are no good.”21
Hubert Nanacowop attended Our Lady of the Snows School in Berens River,
Manitoba. He recalled, “I always thought being an Indian was just like being next to a
pig, and that’s the way they used to call us. And I couldn’t talk, talk my own language,
which is Anishinaabe ... We had all kinds of troubles with that.”22
Richard Kaiyogana, Sr., attended the Coppermine tent hostel in the Northwest
Territories. He told the Commission, “Okay, why not think like a white man? Talk like
a white man? Eat like a white man … so I don’t have to get strapped anymore.”23
Agnes Mills spoke to the Commission at a sharing circle in Inuvik, Northwest
Territories. She explained,
And one of the things that residential school did for me, I really regret, is it made
me ashamed of who I was … And I wanted to be white so bad, and the worst
thing I ever did was I was ashamed of my mother, that honourable woman, be-
cause she couldn’t speak English, she never went to school, and they told us that
we used to go home to her on Saturdays, and they told us that we couldn’t talk
Gwich’in to her and, and she couldn’t, like couldn’t communicate. And my sister
was the one that had the nerve to tell her. “We can’t talk Loucheux to you, they
told us not to.”24
Betsy Olson remembers how hard it was for her family to welcome her home: “Mom
had to buy white man’s food to feed me ’cause I couldn’t eat our, our way of eating
back home. I couldn’t eat soup. I couldn’t eat fish. I couldn’t eat bannock. Couldn’t eat
nothing … Mom had to get extra money to try and buy extra food just for me.”25
Eva Lepage is an Inuk woman who attended the Churchill Vocational Centre in
Manitoba. She spoke to the Commission at the Atlantic National Event:
I was not accepted by white people because of my colour. My own people did not
accept me either… I’ve been hurt a lot by, by white people but I also been hurt a
lot by my own people because people hurting so much they hurt each other, and
they don’t see it. I’m not in my community either. For thirty years I live where I
didn’t grow up, so all my family relatives are not, never hardly are around me.26
Roy Thunder and his friends at the Shingwauk Residential School in Sault Ste.
Marie had to, quite literally, battle for their identities. He remembered, “Reserve kids
... were making fun of us ’cause we were talking English ... There were times, too ... they
wanted to fight us ... because they thought we were, you know, white kids.”27
Sabina Hunter grew up in Goose Bay: “At eighteen I left Labrador with no intention
of coming back … When I lived outside people thought I was Oriental and so I would
use that. I would take advantage of that. I didn’t want to be Inuk. And during that time
I drank a lot. I was not a person to be proud of.”28
Rosemary Paul spoke to the Commission in Halifax, Nova Scotia: “They made fun
of me because I couldn’t speak Mi’kmaq and to this day I still try to fit in and I still, like,
consider myself an outsider. I mean, I can still go to my reserve and everybody, you
know, hugs and kisses me, but I still consider myself an outsider.”29
Professor Lorena Sekwan Fontaine is from the Sagkeeng First Nation in Manitoba.
She explained,
My stepfather said he never spoke Cree to me partially because of the shame he
felt. At first he never articulated the source of the shame, but a few years ago he
said it was a result of his residential school experiences. He often spoke to me
with a heavy heart, saying, “there are so many things I cannot express to you in
English because there are only Cree words to describe what I am feeling.”30
Henry “Curly” Ruck told the Commission that his mother attended the Elkhorn
Residential School in Manitoba and consequently had a very limited understanding
of Aboriginal culture:
She phoned me one day and asked me if she could come over. It was on a Sun-
day morning.… But I told her I couldn’t do it that Sunday because we were going
to a sweat. And all she said to me was, “What?” I said, “We’re going to a sweat.”
She says, “What’s that?” And I said, “A sweat lodge. We’re going to go sit in a
sweat lodge.” And she said, “What the hell is that?” That’s why to me … she lost
everything. She lost her culture. She lost everything. That residential school took
everything away from her.31
Listening to the voices of the Survivors, it is difficult to measure how much was lost
when their languages and cultures were so systematically and savagely suppressed.
Many Survivors and their descendants have a huge sense of loss and either a sense
of anger or sadness about their loss. Such Survivors lead the cultural and language
revitalization movements that are happening across the country. Others, who have
accepted and embraced the Christian doctrines imposed on them at the schools,
reject the value of the traditions and languages of their own people. These Survivors
sometimes actively fight against cultural revitalization. Tension and turmoil often
result between these groups when they exist in the same community. This friction too
needs to be seen as one of the legacies of residential schools.
Language, culture, and health

Culture and language are closely connected not only to a sense of self but also to
physical well-being. Positive cultural identity has been linked to resilience and good
mental health among minorities. Cultural loss has been recognized as a significant
determinant of health in the Aboriginal community.32
In its 2010 review of the health of Aboriginal languages in BC, the First People’s
Heritage, Language and Cultures Council concluded,
The loss of language is directly related to the troubling health issues many First
Nations are facing today. Knowledge of one’s language is related to physical,
mental and spiritual health. It is an expression of ways of life, ways of thinking,
and cultural understanding. Language revitalization plays a vital role in commu-
nity growth, healing, education, development, strong families and reconnection
to the past. A healthy language means healthy individuals, healthy communities,
and contributing members to society.33
The First Nations–controlled Regional Longitudinal Health Survey has concluded
that “the closer a people are to their Nation’s ‘roots’ and their spiritual beliefs and
practices, the higher the levels of health and self-esteem found within that commu-
nity.”34 The attack on Aboriginal languages and cultures at residential schools was also
an attack on the very health of Aboriginal students. The connection between wellness
and culture will be discussed at greater length in the next chapter on health.
In the 1990 Standing Committee on Aboriginal Affairs report titled “You Took My
Talk”: Aboriginal Literacy and Empowerment, Sala Padlayat, director of the Salluit
Adult Education Centre, eloquently describes the relationship between mother
tongue literacy and self-esteem. She explains,
I truly believe that my strength, my feeling of self-worth as an Inuk is in part
because I had access to a form of communication, our written language, that
is uniquely our own.… Not all of our young people are as fortunate to have the
support I received from my family. When alien ways are pressed on them, they
cannot differentiate between what is real and what is superficial, what is essen-
tial and what in reality is trivial. They are confused, lost, bitter, because they feel
abandoned.35
Positive cultural identity has the power to protect as well as to heal. Strikingly,
researchers in BC found that significantly lower suicide rates are correlated with
those bands in which a majority of members have a conversational knowledge of an
Aboriginal language. Correlation does not imply causation, but the researchers con-
cluded “that indigenous language use, as a marker of cultural persistence, is a strong
predictor of health and well being in Canada’s Aboriginal communities.”36 There is
also evidence that the use of an Aboriginal language at home is positively associated
with the success of children living off reserve at school.37 Survivors who struggle with
addictions, mental health issues, and imprisonment can benefit from greater engage-
ment with Aboriginal languages and culture. Recognizing the connection between
culture and health, the Royal Commission on Aboriginal Peoples (rcap) observed,
“it is often the most distressed and alienated Aboriginal people who find the greatest
healing power in the reaffirmation (or rediscovery) of their cultures and spirituality.”38
Aboriginal languages at risk

In 1994, an Assembly of First Nations study of the impact of residential schools
noted that “language is necessary to define and maintain a world view. For this rea-
son, some First Nation Elders to this day will say that knowing or learning a native lan-
guage is basic to any deep understanding of a First Nations way of life, to being a First
Nation person. For them, a First Nation world is quite simply not possible without its
own language.”39 This same report quoted Bernie Francis, a Mi’kmaq linguistic con-
sultant, who stated, “the greatest part of our spirituality is embedded in our language.
That is why it was attacked with such vigor.”40
The Royal Commission on Aboriginal Peoples similarly noted the connection
between Aboriginal languages and what it called a “distinctive world view,” rooted in
the stories of ancestors and the environment:
For Aboriginal people, the threat that their languages could disappear is more
than the prospect that they will have to acquire new instruments for commu-
nicating their daily needs and building a sense of community. It is a threat that
their distinctive worldview, the wisdom of their ancestors and their ways of
being human could be lost as well. And, as they point out, if the languages of this
continent are lost, there is nowhere else they can be heard again.41
rcap added that Aboriginal languages are a “tangible emblem of group identity”
that can provide “the individual a sense of security and continuity with the past ...
Maintenance of the language and group identity has both a social-emotional and a
spiritual purpose.”42
The deep cultural and spiritual significance of Aboriginal languages was also
reflected in some of the first principles that guided an important 2005 Task Force on
Aboriginal Languages. The task force included speakers of the Michif, Secwepemc,
Mohawk, Inuktitut, Cree, Plains Cree, Swampy Cree, Saulteaux, Ojibway, and
Algonquin, and drew on a Circle of Experts. The task force articulated its core princi-
ples thusly:
We believe First Nation, Inuit and Métis languages embody the past and the
future. To enter into a relationship with our ancestors we must speak our
languages and by doing so we honour their spirits. However, we also adapt our
languages to new environments, new situations and new technologies.43
Aboriginal languages have survived. But only barely. Very few Aboriginal languages
are in good health today. The largest and “most viable” languages are Inuktitut, Cree,
and Ojibway, but all Aboriginal languages spoken in Canada are considered vulner-
able to extinction.44 In 1998, the Assembly of First Nations declared a state of emer-
gency regarding First Nation languages, and called on Canada to act immediately to
recognize, officially and legally, the First Nation languages of Canada, and to make a
commitment to provide the resources necessary to reverse First Nation language loss
and prevent their extinction.45 That call was never answered. Since that time, things
have become critically worse. In the 2011 census, only 14.5% of the Aboriginal popu-
lation reported that their first language learned was an Aboriginal language.46 In the
previous census in 2006, 19% of those who identified as Aboriginal had reported an
Aboriginal language as their first language learned, and a decade earlier, in the 1996
census, the figure was 26%. Although some of this decline may reflect the growth in
the number of people now identifying as Aboriginal, especially off reserve, the rapid
decline in those who learn an Aboriginal language as a first language is dramatic
and significant.
In the 2006 census, 21% of those who reported an Aboriginal identity also reported
the ability to conduct a conversation in an Aboriginal language; in the 2011 census,
this proportion declined to 17.2%, a drop of 4% in just five years.47 Again, some of this
decline may be explained by the growth in the overall Aboriginal population, but there
are plenty of consistent, disturbing signs that Aboriginal languages are in danger of
disappearing completely.
There remains great diversity in language use among Canada’s Aboriginal peoples.
Fewer than 5% of Métis people speak an Aboriginal language, although about 50%
report that keeping, learning, or relearning their language is important to them. Some
of the languages spoken by Métis people, such as Cree and Ojibway, are in good health,
but others, such as Michif, are spoken by fewer than one thousand people.48
Nearly two-thirds of Inuit speak their own language, compared to 22.4% of First
Nations people. Although the Inuit have the highest percentage of Indigenous lan-
guage speakers, there are signs of decline there as well. In the 2011 census, 63.3% of
their population spoke an Inuit language, down from 68.8% in the 2006 census.
There are also striking regional differences, with much lower rates of language use
by Inuit in urban areas as well as in the western, Inuvialuit region of the Northwest
Territories, where church-run residential schooling, commercial whaling, and fur
trading had more than a century-long history.49
Constitutional guarantees
Canada prides itself on its official bilingualism and is admired internationally for
this policy. Yet there is no comparable policy of official trilingualism to equitably hon-
our and encompass the mother tongues of the country’s third founders, the Aboriginal
peoples of Canada.
The Supreme Court of Canada has interpreted section 35 of the Canadian
Constitution (which recognizes Aboriginal and Treaty Rights) as protecting those
Aboriginal rights that “were integral to the distinctive culture of the specific aboriginal
group” prior to European contact.50 There can be no doubt that Aboriginal languages
and cultural practices fall within the scope of such constitutional protections.51 The
practice of Aboriginal languages was a pre-existing, distinctive, and continuous prac-
tice that should be recognized as an existing Aboriginal right under section 35(1) of
the Constitution Act, 1982.52
In the words of Supreme Court of Canada Chief Justice Beverley McLachlin in the
case R v. Mitchell, “European settlement did not terminate the interests of aborigi-
nal peoples arising from their historical occupation and use of the land. To the con-
trary, aboriginal interests and customary laws were presumed to survive the assertion
of sovereignty, and were absorbed into the common law as rights.”53 As a result,
Aboriginal language rights continue to exist as part of the Aboriginal rights protected
within Canada’s guiding law, the Canadian Constitution. They have survived unless,
as Chief Justice McLachlin wrote in R. v. Mitchell, “(1) they were incompatible with the
Crown’s assertion of sovereignty, (2) they were surrendered voluntarily via the treaty
process, or (3) the government extinguished them.”54 Because Aboriginal languages do
not threaten the Crown’s assertion of sovereignty, and were not surrendered through
Treaties, and were not extinguished by the government, the rights to these language
practices, customs, and traditions continue to this day.
It can also be argued that because Treaty talks were conducted in both English and
Aboriginal languages, both parties assumed that they would continue to communi-
cate in a similar manner. Given that Aboriginal peoples owned the land by virtue of
their historic use and occupancy, and exercised governance powers prior to European
arrival, Treaties should be fairly understood as a grant of rights from First Nations to the
Crown, leaving First Nations to still hold any and all rights not granted to the Crown,
including language rights.55 This obviously leaves broad grounds for Aboriginal lan-
guage rights to be recognized and affirmed within section 35(1) of the Constitution.
The Supreme Court of Canada, in the course of interpreting French and English
minority language rights under the Canadian Charter of Rights and Freedoms, has
clearly stressed the importance of language as part of culture. The Court has written,
Language is so intimately related to the form and content of expression that
there cannot be true freedom of expression by means of language if one is pro-
hibited from using the language of one’s choice. Language is not merely a means
or medium of expression; it colours the content and meaning of expression. It is
a means by which a people may express its cultural identity. It is also the means
by which one expresses one’s personal identity and sense of individuality. 56
Finally, section 22 of the Canadian Charter of Rights and Freedoms provides that
the recognition of French and English language rights in the Charter does not take
away “from any legal or customary right or privilege acquired or enjoyed either before
or after the coming into force of this Charter with respect to any language that is not
English or French.”57 This section of the Charter provides support for the idea that
Aboriginal language litigation could be successful under section 35 of the Constitution
Act, 1982.
In interpreting Aboriginal and treaty rights under section 35(1) of the Constitution
Act, 1982, the Supreme Court of Canada has stressed the relation of those rights to
the preservation of distinct Aboriginal cultures.58 The Commission is convinced that
Aboriginal languages are an integral part of Aboriginal culture, no less than English
and French languages are to those cultures, in that they help define how Aboriginal
peoples govern and educate themselves and relate to their environment.
13) We call upon the federal government to acknowledge that Aboriginal rights
include Aboriginal language rights.
Preserving Aboriginal languages

The residential school system was based primarily on the racist belief in the supe-
riority of settlers and the inferiority of Aboriginal cultures. Yet, despite the frequent
use of various forms of punishment, students resisted attempts to prohibit their use
of Aboriginal languages in many ways. In 1887, Reverend T. Clarke of the Battleford
Industrial School complained that “We have experienced a great difficulty in inducing
the boys and girls to speak English among themselves in every day life.”59 In 1938, an
inspector of the Sandy Bay school was still complaining that students “will only learn
English by using it, and using it as continuously as possible,” including in the play-
grounds and at meals.60
Canadian anthropologist Diamond Jenness, in a 1962 lecture at Waterloo Lutheran
University, lamented “that very few of our Canadian Eskimos have acquired more
than the feeblest smattering of English,” and he observed that they would be unable to
cope in the South “unless we appoint ourselves their guardians and watch over them
during the first months or year of their sojourn” while they mastered English.61 These
assimilationist views did not go unchallenged, but they remained dominant in the
administration of the residential schools.62
The Royal Commission on Aboriginal Peoples
In 1996, the Royal Commission on Aboriginal Peoples stressed the importance of

allowing Aboriginal nations to take steps in accordance with their own conditions and
priorities to preserve Aboriginal languages. rcap also stressed that, in part because of
the residential school experience, both the Government of Canada and the churches
had an obligation to engage in “restorative justice.” The report also stated that
“Aboriginal languages have been undermined by government action ... [and] because
churches have played a critical part in the destruction of languages, we consider that
practical support for the restoration of the languages would be a highly appropriate
reconciliatory gesture.”63 rcap recommended the creation of an Aboriginal languages
foundation that would be endowed with a total of $100 million. The foundation board
would have a majority of First Nations, Inuit, and Métis members, and would “sup-
port language initiatives undertaken or endorsed by Aboriginal nations and their
communities.”64
The initial reaction to rcap’s language recommendations was positive. In Gathering
Strength, the Government of Canada’s response to the rcap, the government commit-
ted to working with Aboriginal people to establish programs to preserve, protect, and
teach Aboriginal languages.65 A new approach to language preservation was launched
in 1998.66
Aboriginal Languages Initiative (ali)
The long-term goal of the program was to increase the number of Aboriginal
language speakers, with an emphasis on language acquisition and retention in
the home.67 Starting in 1998, funding of $5 million per year was administered by
the Assembly of First Nations, the Métis National Council, and the Inuit Tapiriit
Kanatami.68 Leaving aside the adequacy of the dollar amounts, this approach rec-
ognized that a government-controlled approach did not respect the diversity of
Canada’s Aboriginal peoples, especially given the diversity of Aboriginal languages.
The approach also respected rcap’s view that language policy should be a key com-
ponent of Aboriginal self-determination. It would mean that the Aboriginal orga-
nizations, although funded by Canada, would themselves be responsible and held
accountable by their members for the ways they devoted resources to the urgent
task of language preservation.
Unfortunately, Canada no longer pursues such a nation-to-nation approach. The
present approach is based on federal administration of heritage subsidies. In 2006,
the federal government declined to use the $160 million that had been set aside for
the creation of an Aboriginal Languages and Culture Centre and a national language
strategy.69 Instead, the government committed $5 million per year “permanent fund-
ing” for the Aboriginal Languages Initiative.70 Aboriginal language initiatives are now
delivered by the Department of Canadian Heritage on a project-by-project basis. The
heritage subsidy approach suggests that Aboriginal languages will, at best, be pre-
served with other relics of the past.
Even if one were to set aside the significant reduction in funding, it is important
to understand that the Aboriginal Language Initiative made matters much worse. It
is a program of government-administered subsidies. It is not based on the notion of
respectful nation-to-nation relations between Canada and Aboriginal peoples; nor
does it trust Aboriginal people to make decisions for themselves about how to allo-
cate those few resources and how to administer programs. Evaluations have identi-
fied gaps in funding, especially for Métis people, urban, and non-status First Nations
people, and urban Inuit.71 These groups include many former students of residential
schools and their children and grandchildren.
The Aboriginal Language Initiative budget remains $5 million per year, just as it was
more than seventeen years ago in 1998 when the program was initiated. Given infla-
tion, this funding has dramatically decreased in real terms.72 In 2013–14, this budget
was used for eighty projects, which were funded by way of “contribution agreements”
with national, provincial, and regional Aboriginal organizations. ali funding is avail-
able for programs that are designed and delivered by Aboriginal people, but only on a
short-term project basis.73 The Aboriginal Languages Initiative is financially unfit for
its purpose, and structurally flawed.
Apart from the Aboriginal Languages Initiative, the only other significant programs
for language preservation are the Canada–Territorial Language Accords ($4.1 mil-
lion annual budget). These support territorial government-directed Aboriginal lan-
guage services and community projects in Nunavut and the Northwest Territories.
In Yukon, Canada provides $5 million for language revitalization and preservation
projects through transfer agreements with ten of the eleven self-governing Yukon First
Nations.74 This follows rcap’s recommended approach that language policy should be
included as a matter of self-government wherever possible. However, Yukon receives
more money than the nwt and Nunavut combined, even though Yukon has a smaller
Aboriginal population.
Thus, Canada spends roughly $14 million annually across Canada for the preser-
vation and revitalization of Aboriginal languages, through the Aboriginal Languages
Initiative, Territorial Accords, and transfer agreements. By way of comparison, the
Official Languages Program for English and French spent over $350 million in 2013–
14 for the promotion of linguistic duality and the development of official-language
minority communities across Canada.75
Over the last several years, Aboriginal programming within the Department of
Canadian Heritage has become smaller and less prominent. There were once fifteen
different Aboriginal programs managed independently, but they were all consoli-
dated into the Aboriginal Peoples’ Program in 2005.76 Since then a significant portion
of such programs were transferred to the oversight of the Department of Aboriginal
Affairs and Northern Development.77 In April 2012, Canadian Heritage dispensed
with its Aboriginal Affairs Branch altogether and moved the remaining ten Aboriginal
programs (including ali) into the Citizen Participation Branch.78
The profile of the Aboriginal Peoples’ Program has become increasingly dimin-
ished in recent years. This is a betrayal of prior commitments, including commitments
that were presented as part of Canada’s response to both the residential school litiga-
tion and settlement. The preservation of Aboriginal languages should not be a part of
the Canadian Department of Heritage. Such an approach does little credit to Canada’s
legal and moral duties towards Aboriginal peoples, and does little to make reparations
for the forced assimilation of Aboriginal people in residential schools.
The Commission concludes that since the settlement of the residential school litiga-
tion in 2006, federal government policy has done little to repair the losses of Aboriginal
languages and culture; in fact, the consolidations and cutbacks are a betrayal of the
residential school Survivors. The consequent failure to protect increasingly fragile
Aboriginal languages renders hollow Canada’s 2008 apology.
The Commission concludes that the Government of Canada must abandon its
tightly controlled model of program-based heritage subsidies, and instead provide
sustainable resources to recognize that the Indigenous peoples of Canada have
language rights tied to their protected Aboriginal rights, including their rights to
self-determination.
A federal Aboriginal Languages Act
The Truth and Reconciliation Commission believes that federal legislation is nec-
essary for the government to recognize its constitutional obligations with respect to
Aboriginal languages. The Commission is well aware that such legislation in itself will
not be sufficient to revitalize Aboriginal languages, yet there is a danger that such leg-
islation may be presented or viewed as sufficient. An Aboriginal Languages Act could
takes steps to create and facilitate conditions within Aboriginal communities that
would enable them to develop the types of necessary language initiatives discussed
in other parts of this chapter. To ensure that such steps were taken, Parliament could
create requirements enforceable in a legal forum such as a tribunal or before a com-
mission, which would give force to these initiatives. Parliament could restrict the dis-
tribution of federal funds based on the condition that Aboriginal language initiatives
are developed and supported by local communities.
There are precedents for such federal legislation. In 1990, the United States Congress
enacted the Native American Languages Act.79 Section 101 provided that “the status of
the cultures and languages of Native Americans is unique and the United States has
the responsibility to act together with Native Americans to ensure the survival of these
unique cultures and languages.” It also recognized that “the traditional languages of
native Americans are an integral part of their cultures and identities and form the
basic medium for the transmission, and thus survival, of Native American cultures,
literatures, histories, religions, political institutions, and values.” It recognized that the
“lack of clear, comprehensive, and consistent Federal policy on treatment of Native
American languages … has often resulted in acts of suppression and extermination of
Native American languages and cultures.”80
The 1990 Native American Languages Act also declared in section 104 that it was
“the policy of the United States to preserve, protect, and promote the rights and free-
dom of Native Americans to use, practice, and develop Native American languages,”
including placing Indigenous languages “where appropriate” in school curricula and
allowing exceptions to teacher certification programs where they would “hinder the
employment of qualified teachers who teach in Native American languages, and to
encourage State and territorial governments to make similar exceptions.”81
A Canadian version of this act, borrowing from Canada’s Official Languages Act,
could also establish a commissioner of Aboriginal languages. The commissioner would
be appointed through a process determined in consultation with Aboriginal groups.
The commissioner would have the power to report on and draw attention to the health
of Canada’s Aboriginal languages, to provide guidance to Aboriginal communities in
the preservation of their languages, and to educate non-Aboriginal Canadians about
Aboriginal languages. This is not an original concept. New Zealand’s Mãori Languages
Act creates a commission with such powers related to the promotion of that Indigenous
language.82
The auditor general of Canada has written about the federal government’s failure to
create clarity about the service levels First Nations receive. In his 2011 status report, he
wrote, “It is not always evident whether the federal government is committed to pro-
viding services on reserves of the same range and quality as those provided to other
communities across Canada.”83 In fact, First Nations receive significantly fewer dollars
per capita than non-Aboriginal groups when it comes to basic government services. The
auditor general has also asserted that First Nations cannot effectively plan and control
the delivery of their services because the federal government has not created a legisla-
tive base to hold itself accountable in dealing with Aboriginal peoples. He wrote,
Therefore, for First Nations members living on reserves, there is no legislation
supporting programs in important areas such as education, health, and drinking
water. Instead, the federal government has developed programs and services
for First Nations on the basis of policy. As a result, the services delivered under
these programs are not always well defined and there is confusion about federal
responsibility for funding them adequately.84
The auditor general’s findings exemplify the need for the certainty of federal
legislation to ensure the effectiveness of remedial and ongoing action on Aborigi-
nal languages.
Provincial and territorial initiatives
Some provinces and territories in Canada have made progress through legislation
and other measures that focus on the official status of Aboriginal languages within
their jurisdictions. First Nation and Inuit languages in the Northwest Territories85 and
Nunavut86 have been designated as official languages. Nunavut has an Inuit Language
Protection Act (2008) that includes a legal statement of the inherent right of the Inuit
in Nunavut to use their language.87 Since 2002, Yukon legislation has recognized the
importance of Yukon Aboriginal languages and expresses a wish to take appropriate
measures to “preserve, develop and enhance” those languages.88
British Columbia has legislation providing for a First Peoples’ Language, Heritage
and Culture Council, tasked with providing support and distributing funds to heritage
and arts organizations.89 An accompanying regulation recognizes thirty-four distinct
First Peoples’ languages.90 Several provinces have legislation that formally recognizes
First Nation languages but with no concurring obligation to protect or promote such
languages. For example, the 2010 Manitoba Aboriginal Languages Recognition Act
recognizes that the languages of Cree, Dakota, Dene, Inuktitut, Michif, Ojibway, and
Oji-Cree are “the Aboriginal languages spoken and used in Manitoba,” but it does not
legislate official language status or obligate the province to take steps to protect and
promote these languages.91
In Québec, Aboriginal children are exempted from French-language educational
service requirements in order to permit them to receive instruction in their own lan-
guages.92 The preamble of the Charter of the French Language recognizes the rights
of “Amerinds [sic] and the Inuit of Québec, the first inhabitants of this land, to pre-
serve and develop their original language and culture.”93 The official languages of
instruction for schools under the jurisdiction of the Cree (Cree School Board) and
Inuit (Kativik School Board) are Cree and Inuktitut, respectively. In addition, “Indian
reserves” are not subject to the requirements of the Charter of the French Language.94
None of the other provinces have any legislation officially addressing the status of
Aboriginal languages.
The Commission concludes that the Government of Canada should establish
a framework for a new commitment to respecting, preserving, and strengthening
Aboriginal languages by enacting an Aboriginal Languages Act that is similar to the
Native American Languages Act enacted by the US Congress. The Act should recog-
nize that residential schools were part of a forced policy of linguistic assimilation,
and affirm both Aboriginal and Treaty rights and the UN Declaration on the Rights of
Indigenous Peoples.
14) We call upon the federal government to enact an Aboriginal Languages Act that
incorporates the following principles:
i. Aboriginal languages are a fundamental and valued element of Canadian
culture and society, and there is an urgency to preserve them.
ii. Aboriginal language rights are reinforced by the Treaties.
iii. The federal government has a responsibility to provide sufficient funds for
Aboriginal-language revitalization and preservation.
iv. The preservation, revitalization, and strengthening of Aboriginal languages
and cultures are best managed by Aboriginal people and communities.
v. Funding for Aboriginal language initiatives must reflect the diversity of
15) We call upon the federal government to appoint, in consultation with Aboriginal
groups, an Aboriginal Languages Commissioner. The commissioner should help
promote Aboriginal languages and report on the adequacy of federal funding of
Aboriginal-languages initiatives.
Redressing the harms

Canadian governments and the churches that ran residential schools have special
obligations to assist in the retention of Aboriginal languages because of their past
shared policies of forced assimilation. The United Church’s 1986 apology acknowl-
edged the church’s responsibility for harm caused by forced assimilation: “We
imposed our civilization as a condition for accepting the gospel. We tried to make
you be like us and in so doing we helped to destroy the vision that made you what you
were. As a result you, and we, are poorer and the image of the Creator in us is twisted,
blurred, and we are not what we are meant by God to be.”95
The Presbyterian Church’s 1994 apology sought forgiveness for the church’s com-
plicity in banning “some important spiritual practices through which Aboriginal
peoples experienced the presence of the creator God” as well as for other practices
that lead to “the loss of cultural identity and the loss of a secure sense of self” for
former students.96
During a private meeting at the Vatican in 2009, Pope Benedict XVI expressed “sor-
row” to a delegation from the Assembly of First Nations over the abuse and “deplor-
able” treatment that Aboriginal students suffered at residential schools run by the
Roman Catholic Church, but he did not address the loss of language and culture.97
No formal and public apology has been made on behalf of the Catholic Church as
an organization, although some individual Catholic organizations have made apol-
ogies, such as the Missionary Oblates of Mary Immaculate, which apologized for its
role in attempts to “assimilate aboriginal peoples” through residential schools.98 In
one example of a particular diocese accepting responsibility, Bishop Murray Chatlain
of the Roman Catholic Diocese of Mackenzie-Fort Smith in the Northwest Territories
acknowledged in 2009 that “We participated in a system that sought to strip away
aboriginal language and culture.”99
It is important that the churches that ran the residential schools recognize that the
purpose of the schools was assimilation and that language and cultural loss was one
of the most damaging features of residential schools, and of similar policies of assim-
ilation pursued in other schools. At the same time, apologies can only be a meaning-
ful prelude to reconciliation if tangible steps are taken by the churches to help repair
the damage they caused. This is particularly necessary given that residential school
Survivors have not succeeded in obtaining compensation for lost language and cul-
ture through the courts.
The legal pursuit of compensation
Residential school Survivors have insisted that claims for loss of language and
culture be a part of their many lawsuits against the Government of Canada and the
churches. Both the government and the churches have aggressively opposed such
claims. Even if the law recognized that Aboriginal language and culture loss was some-
thing that could be valued, the government and the churches argued that Survivors
had waited too long to make their claims.
Claims about loss of language and culture were important for many Survivors. One
former student at the Duck Lake, Saskatchewan, school alleged in a lawsuit that he was
forcibly removed from his people, punished for speaking Cree, and prohibited from
engaging in Aboriginal dancing, cultural, or religious activities. The Saskatchewan
Court of Appeal dismissed his claim on the basis that he had not sued public author-
ities within one year after leaving school, and that his allegations did not amount to a
breach of fiduciary duty or trust.100
Frederick Lee Barney sued the United Church and the Government of Canada in
one early case that went to the Supreme Court of Canada. He recovered damages for
being sexually assaulted but not for loss of language and culture, despite his powerful
testimony, in which he explained,
I was deprived of the love and guidance of my parents and siblings for five years.
I lost my Native language and Aboriginal culture and was removed from my
family roots. The enormity of the loss of both my culture and my connection with
my family feels overwhelming and the effects irreversible. I lost my identity as a
Native person. I live with a sense of not knowing who I am and how I should be
in the world. I lost the friendship and support of my friends and community. I
suffered a loss of self-esteem.... I’m angry about my loss of culture … It’s sicken-
ing. It was obvious the tremendous effect it has had on me as a person and yes, I
get angry as hell.101
The trial judge in that case held that the federal government and the United Church
did not engage in a breach of trust or a breach of fiduciary duty because they were
candid and not dishonest about their plan to assimilate Aboriginal people.102 The
Canadian legal system did not hear Survivors when they said in the lawsuits that the
treatment of Aboriginal languages and cultures in the schools was wrong and the lan-
guage and culture that was lost was valuable.
The Common Experience Payments (cep) arising from the Settlement Agreement
provided recognition of an individual’s loss of language and culture for those who
could establish that they attended listed residential schools. Such payments, however,
ignored the collective and intergenerational harms that have struck at the very core
of Aboriginal identity. It is essential to understand, based on almost every statement
the Commission received from almost seven thousand Survivors from every region of
this country, that all of these losses are interconnected. These statements tell of dev-
astating cumulative damage to Survivors, children, and grandchildren. This damage
has also contributed to contemporary realities that add up to a significant financial,
social, and reputational cost to Canada. It is not at all clear to this Commission why
Aboriginal language and culture loss could not be recognized in Canadian courts.
The 2005 federal Task Force on Aboriginal Languages warned that the govern-
ment’s past policies towards Aboriginal languages, most notably the policies used in
residential schools, could be viewed as a violation of Aboriginal and Treaty rights as
well as the fiduciary duties that government had with respect to the children taken,
and to Aboriginal people generally. The Task Force concluded,
In our view, forcibly removing language and culture from individual First Na-
tion, Inuit and Métis people is tantamount to a breach of Aboriginal and Treaty
rights, as well as a breach of the Crown’s fiduciary duty, and should therefore
be compensable. It is also our view that Canada’s refusal to compensate indi-
viduals who continue to suffer the devastating effects of their loss of connec-
tion to their communities and their languages, cultures and spiritual beliefs,
fails to uphold the honour of the Crown. Further, this refusal has the effect of
appearing to relegate First Nation, Inuit and Métis languages to the position of
subjugated languages that can be forcibly removed from the memories of the
people who spoke them, with impunity. Canada has taken the view that, while
language is the collective right of a community or language group, compensa-
tion for loss of language will be a programmatic response to communities and
language groups. We believe Canada’s position to be fundamentally wrong.
Government funding of First Nation, Inuit and Métis languages must be made
on the basis of their constitutional status and should not be viewed as arising
as part of the compensation for legitimate claims for damages that arise from
wrongs committed against many individuals.103
The Task Force found that the revitalization and preservation of First Nations lan-
guages must be done by First Nations themselves. Canada has a duty to provide the
resources necessary to restore First Nation, Inuit, and Métis languages and cultures.
The essential value of Aboriginal cultures was again emphasized in a 2014 ruling
in Ontario. In Brown v. Attorney General of Canada, a class action has been “certi-
fied” (and thus permitted to proceed) relating to the large-scale removal of Aboriginal
children by child welfare authorities between 1965 and 1984. In refusing the federal
government’s attempt to have the case thrown out, the Ontario Superior Court recog-
nized that the case raises important issues about connection to culture and the harm
of separation from one’s Aboriginal heritage:
Here we are not dealing with just one aspect of that culture. Here we are dealing
with a person’s connection to that culture as a whole. It is difficult to see a spe-
cific interest that could be of more importance to aboriginal peoples than each
person’s essential connection to their aboriginal heritage. In addition, on this

point, the importance of aboriginal rights cannot be disputed.104
United Nations Declaration on the Rights of Indigenous Peoples
The United Nations Declaration on the Rights of Indigenous Peoples makes one
of the most powerful and persuasive cases for governments to make reparations for
forced assimilation. It recognizes Aboriginal languages as a vital part of Indigenous
cultural rights. During the same time period that Canada supported and endorsed
this important international declaration, it has backtracked on promises of increased
funding for Aboriginal languages, and has treated Aboriginal languages as a minor
part of a larger governmental portfolio devoted to all matters of Canadian heritage.
Many provisions in the UN Declaration make clear that Canada has obligations to
change course and to provide redress for its past policies.
Article 8 of the declaration recognizes that “Indigenous peoples and individuals
have the right not to be subjected to forced assimilation or destruction of their cul-
ture.” Article 8(2) then provides that “states shall provide effective mechanisms for
prevention of and redress for any form of forced assimilation or integration.” As sug-
gested throughout this volume, residential schools constituted a most pernicious form
of “forced assimilation.” The linguistic policies pursued in the schools are among the
worst forms of forced assimilation. Even if the modest payments of compensation to
individuals in the form of the Common Experience Payment are seen as a form of indi-
vidual reparation, Canada has not taken the kinds of steps that would be necessary to
reverse the collective loss of language and culture that was the intended consequence
of the residential schools. In the absence of such steps, redress has not occurred.
Article 13(1) of the UN Declaration recognizes that “Indigenous peoples have the
right to revitalize, use, develop and transmit to future generations their histories, lan-
guages, oral traditions, philosophies, writing systems and literatures, and to designate
and retain their own names for communities, places and persons.” Article 14(1) sim-
ilarly provides that “Indigenous peoples have the right to establish and control their
educational systems and institutions providing education in their own languages, in
a manner appropriate to their cultural methods of teaching and learning,” and article
14(3) makes such rights real by providing that “States shall, in conjunction with indig-
enous peoples, take effective measures, in order for indigenous individuals, particu-
larly children, including those living outside their communities, to have access, when
possible, to an education in their own culture and provided in their own language.”
Article 16 provides that Indigenous peoples “have the right to establish their own
media in their own languages and to have access to all forms of non-indigenous media
without discrimination” and that states “shall take effective measures to ensure that
State-owned media duly reflect indigenous cultural diversity.”
Article 19 is a critical provision in the declaration because it requires Canada to
consult and cooperate in good faith with Indigenous peoples in order to obtain their
consent prior to implementing legislative or administrative measures that may affect
them. As a result, Canada cannot impose solutions upon Aboriginal peoples, but must
work with Aboriginal peoples to implement its international obligations.105
Finally, it is difficult to reconcile the refusal of courts to acknowledge the loss of lan-
guage and culture as being compensable with the very important principle that such
acts could constitute acts of genocide an acknowledged crime against a racial group
in breach of the UN Convention on Genocide.106
This Commission has found that the actions of the federal government in attacking
and attempting to destroy Aboriginal cultures and languages, not only in residential
schools but in Aboriginal communities through ceremonial prohibitions in the Indian
Act, amounted to cultural genocide. The term cultural genocide is not found in the
UN Convention on Genocide, and an analysis of the evolution of the Convention prior
to its adoption by the United Nations shows that inclusion of the term was rejected.
Nonetheless, while the term genocide generally refers to the physical destruction of
members of a racialized group, the Convention contains provisions that appear to
contemplate criteria other than immediate physical destruction. For example, article
2 of the Convention states,
In the present Convention, genocide means any of the following acts committed
with intent to destroy, in whole or in part, a national, ethnical, racial or religious
group, as such:
(a) Killing members of the group;
(b) Causing serious bodily or mental harm to members of the group;
(c) Deliberately inflicting on the group conditions of life calculated to bring

about its physical destruction in whole or in part;
(d) Imposing measures intended to prevent births within the group;

(e) Forcibly transferring children of the group to another group.
Clearly, articles 2(d) and 2(e) do not require that the victims themselves be
“destroyed” but that the measures taken against them be intended to result in the
destruction of the “national, ethnical, racial or religious group, as such.”
The forcible sterilization of women and girls for the purpose of preventing their
group from repopulating itself would be an act of genocide, even though the indi-
vidual female victim would be allowed to live. The forcible removal of children from
their racial community in order to be indoctrinated into another racial community

and thereby “destroy” their original group would likewise be an act of genocide, even
though the children themselves continued to live as members of the new group.
It is the Commission’s view that if Canada were to attempt to do today what it did in
the nineteenth century through residential schools, it could face severe international
consequences.
It seems logical to conclude that Canada’s actions in forcibly transferring Aboriginal
children from their racial group to another in order to eliminate or destroy their cul-
tures and languages—and therefore their racial group—could at least amount to a
legal wrong cognizable in Canadian law because of Canada’s acceptance of it as a legal
wrong in international law. No court has so held; nor as a Commission can we make a
definitive finding on the point. The way does seem clear, however, for such legal rec-
ognition to be made at some point in the future.
The Commission concludes that the Aboriginal peoples of Canada have language
rights tied to their rights under Canadian constitutional law, their rights under inter-
national law, and their legitimate claims to collective reparation for forced assimila-
tion in the residential schools.
The Commission calls for a new approach from the Canadian government, an
approach that must restore the right of Aboriginal communities to pursue the lan-
guage and cultural initiatives that best reflect their own circumstances. This should
be done, wherever possible, on a nation-to-nation basis, along the lines of the Yukon
model where the government provides language funding to self-governing nations. A
pan-Aboriginal approach is inappropriate given the diversity of Canada’s Aboriginal
communities, their relative access to supportive resources, and the differences in the
current health of the Aboriginal languages used in Canada.
The importance of Aboriginal languages and

culture to non-Aboriginal Canadians
The neglect of Aboriginal languages affects all Canadians. It impedes the ability of
non-Aboriginal Canadians to understand and to appreciate the linguistic and cultural
diversity that is part of a shared history. The language and culture of all Canadians is
infused with the words and the history of Aboriginal peoples. Too easily people forget that
proper names such as Québec and Saskatchewan and everyday words such as chipmunk
(Odawa) and moose (Ojibway) are gifts from Aboriginal people and their ancestors.
However, there is much more for non-Aboriginal Canadians in a broader apprecia-
tion of the value of Aboriginal languages. For example, the Anishinaabe word sabawaa
is used to describe a time in the Ontario spring when cold and warm air masses inter-
mingle and cause fine mists to rise over the earth. The snows melt and the waters start to
flow at this time. The Anishinaabe word for forgiveness is a related word: aabaweweni-
maa. It describes a process in which we loosen our thoughts towards others and let rela-
tionships flow more easily, becoming warmer towards each other.107 Other Aboriginal
languages throughout Canada hold similar examples of wisdom and beauty.
Non-Aboriginal Canadians should also care about the damage done to Aboriginal
languages and cultures because their government has apologized to Aboriginal peoples
on their behalf. Canada’s 2008 apology for residential schools recognized explicitly that
the schools were based on a “policy of assimilation” that “caused great harm, and has
no place in our country.” It specifically recognized that the schools “had a lasting and
damaging impact on Aboriginal culture, heritage and language.”108
There can be no real prospect for reconciliation if that apology is not seen as sin-
cere and accompanied with a commitment to address the wrongs that prompted the
apology in the first place. Those who have stolen something valuable cannot expect
their apology to be believable and acceptable without the return of what was stolen,
or a mutually agreeable level of compensation. In the case of residential schools, the
apology is a moral commitment on the part of the Government of Canada to support
the health of Aboriginal cultures and languages.
Reclaiming names
As a result of the residential school experience, many Aboriginal people lost their
language and lost touch with their culture. Many also suffered a loss of a different
sort. It was common for residential school officials to give students new names. At the
Aklavik Anglican school in the Northwest Territories, a young Inuit girl named Masak
was called Alice—she would not hear her old name until she returned home.109 At
the Qu’Appelle school in Saskatchewan, Ochankuga’he (Path Maker) became Daniel
Kennedy, named for the biblical Daniel, and Adélard Standing Buffalo was named for
Adélard Langevin, the archbishop of St. Boniface.110 Survivors and their families who
have sought to reclaim the names that were taken from them in residential schools
have found the process to be both expensive and time consuming. The Commission
believes that measures should be put in place to reduce the burden placed on those
who seek to reclaim this significant portion of their heritage.
17) We call upon all levels of government to enable residential school Survivors and
their families to reclaim names changed by the residential school system by waiv-
ing administrative costs for a period of five years for the name-change process
and the revision of official identity documents, such as birth certificates, pass-
ports, driver’s licenses, health cards, status cards, and social insurance numbers.
The way forward
Aboriginal knowledge
Residential school Survivors do not need reports or studies to tell them that recov-
ering their stolen cultures can assist them on their healing journey. They know this
from their own experiences. Isabelle Knockwood, who attended the Shubenacadie
school in Nova Scotia, writes of recovering spirituality: “Many of us have returned to
a traditional path as the source of our strength … Some of us have come to realize
that we were abused not only physically but spiritually. For us, the Native Way with
its Sacred Circle and respect for all living things is a means of healing that abuse.”111
The Commission heard many stories from Survivors about their early experiences
with Aboriginal language and how learning language connected them to family and
to place. Paul Stanley talked about this connection at the Commission’s community
hearing in Deroche, British Columbia:
When you’re in bed with papa, and he tells you about your first story, and it’s
about how the chipmunk got his stripes, and it was so funny to me, you know
that I asked him every night to say it again, you know, and, and, and these things
helped, too. And if I didn’t know a word, he’d let me know ... And so that’s how
language is taught at home, in my place ... And it’s not by a desk or anything like
that, which is okay, you know, other systems work anyway, but that’s how we
started, so that was my life, you know, like to learn the language, and maybe a bit
of culture.112
Esther Lachinette-Diabo, echoed that sentiment in Thunder Bay, Ontario:
I feel free to be able to speak in Ojibway, and I talk about the culture because I
experienced it when I was a kid. I’ve seen my grandparents; I’ve seen my uncles;
and I’ve seen medicine people come to our community, our trapline, and do
their ceremonies. I can talk about those from first-hand experience.113
Matilda Lampe vividly remembers the day her younger sister first spoke to her
father in Inuktitut at their home in Labrador:
At our supper table dad, Doris said to dad, “qanuivit?” [How are you?] Oh my
God everybody just, like we all got quiet like this; just myself and Doris and my
mom and dad. My dad put his food down; he got up and oh my God that was the
best ever. My dad, my dad got up off his chair and went over to Doris; me and my
mom were just looking at each other like, like myself like, thinking for the worst.
She’s going to be hit; she’s going to be smacked something.
That was the best supper ever. My dad got up and went over to Doris and
hugged her; first time ever and he actually took her, hugged her. He sat down
and looked at Doris, nakummiik [thank you] … oh my God, that was the best
ever … Doris picked up few, few words like, not hard words but easy. My dad got
comfortable with her after; took him long time, almost a year.114
Case studies
The Aboriginal cultures and languages that were damaged are actually even more
precious today; for as battered and broken as they are, they hold the seeds for rejuve-
nation. The Survivors know that the recovery of language and culture was and remains
critical for their own individual healing and for the health of Aboriginal families and
communities in the future. Many of the Survivors explained to the Commission how
they reconnected with Aboriginal languages and cultures as the most powerful and
restorative part of their very difficult healing journeys.
Many remedies to the loss of language and culture have already been tested by
different Aboriginal peoples across the country. These solutions, however, need sup-
port and nourishment from governments and churches, and support has not been
forthcoming.
British Columbia
British Columbia has the greatest diversity of Aboriginal languages, having 27 of

the 86 Aboriginal languages spoken in Canada, according to unesco. However, it
accounts for only 7% of the country’s Aboriginal mother-tongue population because
of the small speaker population.115 The 2011 census reported that BC is home to 30
different Aboriginal languages but that most of those languages have less than 1,000
people each.
For example, there are 925 recorded speakers of Gitksan, and 675 recorded speak-
ers of Shuswap.116 British Columba has some of the smallest and most endangered
Aboriginal mother-tongue populations, including the Salish family (3,700), the
Tsimshian family (2,400), the Wakashan family (1,200), Kutenai isolate (155), Haida
isolate (130), and Tlingit (90).117 In 2001, second-language learners accounted for over
half the speakers of Tlingit, Haida, and smaller Salish languages.118
A 2010 study by the First Peoples’ Heritage, Language and Cultures Council
observed that the teaching of First Nations languages in schools in BC is “too limited
to have any great effect” and has predicted that most fluent speakers of Aboriginal
languages in BC may be gone by as early as 2016.119
The Sto:lo Nation is one of many British Columbia First Nations that is taking steps
to revitalize and preserve its languages. The Sto:lo Nation spans the Fraser Valley and
is comprised of eleven member First Nations: Aitchelitz, Le’qamel, Matsqui, Popkum,
Skawahlook, Skowkale, Shxwha:y, Squiala, Sumas, Tzeachten, Yakweakwioose. The

total population of these First Nations is about 2,094.
Halq’eméylem is the traditional language of the territory. With fewer than five flu-
ent speakers of the language, it is considered very close to extinction. In the face of this
risk of extinction, numerous steps are being taken to preserve the language in both
the short and long term. For example, Seabird Island runs a Halq’emeylem Preschool
Language Nest, which is a preschool modelled after a family home where young chil-
dren are immersed in their language and culture. The children learn Halq’emeylem
from fluent speakers and Elders while doing daily activities. The Language Nest takes
a multigenerational approach, with parents encouraged to volunteer in the preschool
and then continue to use the language at home.
The Sto:lo Nation Language Program has also developed an intensive immersion
program. The program runs for fifty weeks and has a goal of developing highly fluent
speakers of Halq’eméylem. An extensive language archive as well as language teach-
ing materials are available on FirstVoices.com. The Sto:lo First Nation has been work-
ing together and at great odds to preserve their language. Nonetheless, the work is far
from finished and much more must be done to ensure that Halq’emeylem is not lost.120
Inuit languages
As late as 1949 only 111 Inuit were receiving full-time schooling in the North. Twelve
were attending a federal day school in Kuujjuaq (Fort Chimo) in Northern Québec, 8
at the Anglican residential school at Fort George, Québec, and 91 at the two residential
schools in Aklavik, Northwest Territories.121 Due to the uneven rate of development of
the system, the Inuit and Inuvialuit in the Western Artic were pulled into the residen-
tial school system much earlier. Many of the communities where Inuktitut language
survives are in the east (Nunavut) or above the Arctic Circle. It was not until the late
1950s, when a system of hostels and day schools was established across the North,
that Inuit children began attending residential schools in significant numbers.122 By
February 1959, 1,165 Inuit children were receiving full-time schooling in the North.123
Consequently, Inuit people were not spared the attacks on Aboriginal language and
culture that characterized residential schools elsewhere. As early as 1968 social sci-
entists were noting how Inuit children educated at residential school were forced to
“play two different games”—one involving English and white ways at school, and the
other in Inuktitut and involving Inuit ways at home.124 Willy Carpenter grew up in
Tuktoyuktuk, Northwest Terrorities. He remembered,
We tried to speak our own language; we’d get scolding and punishment of
some kind. I lost my language for a good two to three years. And I came back;
I couldn’t hardly understand my mom, when she spoke to me in Inuvialuktun.
But in time we got together speaking, I got it all back; and up to today I speak
it. I could speak it really good. I got right back to it. I didn’t want to forget that ...
Why did they treat us the way they did? Maybe they thought we were animals or
something. I can’t understand that.125
Through the efforts of people like Willy Carpenter, Inuit languages have persisted.
Inuktitut is one of the largest and most viable Aboriginal languages in Canada.126
Although Inuktitut remains strong, its use has declined.127 According to the 2011
census, just over 34,000 Inuit, or 63.7% of the total, reported Inuktitut as their mother
tongue, down from 68% in 1996.128 Also of concern is the fact that the proportion is
declining for Inuit who speak Inuktitut most often at home. In 2006, about 25,500 Inuit,
50% of the total, reported Inuktitut as the language most often spoken at home, down
from 58% in 1996.129 The percentage of Inuit who reported that they spoke Inuktitut
well enough to carry on a conversation is also declining, down to 63.3% from 69% in
2006 and 72% in 1996.130
Language fluency varies across Inuit Nunangat (consisting of the four regions of
the Inuit homeland). Close to 100% of Inuit living in Nunavik (Northern Québec) can
converse in an Inuit language. In Nunavut, nearly 90% can do so. However, fluency is
much lower in Nunatsiavut (northern coastal Labrador) (24.9%) and in the Inuvialuit
region of the Northwest Territories (20.1%). Outside Inuit Nunangat, only 10% of Inuit
report speaking an Inuit language well enough to conduct a conversation.131
The large majority of Inuit adults in each region stated that it was very or somewhat
important for them to keep, learn, or relearn Inuktitut. Nine in every ten Inuit parents
stated it was very or somewhat important for their children to speak and understand
Inuktitut.132 Inuit youth report a desire to increase access to learning, hearing, and
using Inuktitut. Furthermore, these youth think governmental initiatives should facil-
itate, not replace, home and community-based efforts.133
Some of the health of Inuktitut can no doubt be attributed to the resources that have
been devoted to its survival. Fifteen per cent of all language funding provided through
Heritage Canada’s Aboriginal Language Initiative is devoted to Inuktitut.134 As well,
programmers with the Canadian Broadcasting Corporation’s Northern Service radio
and television have worked to expand their programming in Aboriginal languages in
recent years. However, those advances are also threatened by repeated funding cuts.
Inuktitut is designated an official language in Nunavut.135 Also in Nunavut, efforts
have been made to ensure that Inuktitut is integrated into political, economic, and
social life. Nunavut formally recognizes by statute the inherent right of the Inuit in
Nunavut to use their language. The Inuit Language Protection Act guarantees, among
other things, the right to Inuit language instruction in Nunavut’s school system and
the right to work in the Inuit language in territorial government institutions. It also
specifies that governments, municipalities, community organizations, and businesses
can use the Inuit language in reception and customer services, on signs, posters, and
advertising, for essential, household, residential, and hospitality services, and in

municipal services concerning public safety and welfare.136 Rights can be important
in protecting fragile languages, but they must also be rooted in a healthy language that
is used in daily life if they are not simply to be a symbolic reaffirmation of languages
that may only appear to be healthy and protected.
Nunavut’s Education Act establishes a right to a bilingual education with the Inuit
language, with the goal of producing graduates who are able to use both languages
competently in academic and other contexts. The Act provides for several different
models of bilingual instruction, with the ultimate decision about which model will
be used to be made with community consultation, and to be subject to review every
five years. The minister of education is responsible for ensuring that the education
program supports the use, development, and revitalization of the Inuit language.137
However, underlying this institutional support for Inuktitut is the fact that intergen-
erational mother-tongue language transmission continues to be the foundation for
language retention in the territory.138 In Nunavut, 83% reported an Inuktitut mother
tongue.139 Thus, many Inuit children enter school already speaking their language,
which makes it easier to implement language instruction in the primary grades.140
Other elements of the overall strategy that have supported the maintenance of
Inuktitut include
• documentation of the language and the stories of the Elders;

• Inuktitut radio and television programming;
• widespread teaching of literacy skills and use of Inuktitut in the print media;
• the training and utilization of Inuit teachers;
• production of Inuktitut language materials;
• cultural-based activities for children on the land and in school; and
• a variety of community-based projects aimed at promoting and strengthening
the use of the language in the home and community.
Additionally, the Nunavut Arctic College offers a certificate program for Inuktitut
interpreters; and the Bathurst Mandate (Nunavut’s blueprint for Indigenous
self-government) set a goal of having Inuktitut as the working language of the
Nunavut government by 2020.141 Inuktitut also has the advantage of being a vital lan-
guage in several jurisdictions. Therefore, the exchange of educational materials, and
collaboration in the development of them, is an important option not available to
other communities.
This multi-pronged approach recognizes that languages must be supported if they

are to survive and thrive. Despite the fact that Inuktitut is an official language of the
territory of Nunavut, the funding available to support the language is far inferior to the
funding for French-language services in Nunavut. The federal government provides
support to the small minority of francophones in Nunavut in the amount of approxi-
mately $4,000 per individual annually. In contrast, funding to support Inuit language
initiatives is estimated at $44 per Inuk per year.142 Although Inuktitut is healthier
than most Aboriginal languages, and language policy at the territorial level is robust,
Canada could do much more to promote such languages, especially in a region that
only the Inuit can claim is truly their homeland.
The Commission finds that the preservation and revitalization of Aboriginal lan-
guages is a necessary and constructive reparation for the attack on Aboriginal languages
and cultures in the residential schools and in Canadian society. It also concludes that
retention of Aboriginal languages could provide Canada with vital social capital to
enrich our understandings of the environment, health, culture, justice, and governance.
The Commission finds that there is a willingness and ability among Aboriginal
people to undertake the rewarding work of learning Aboriginal languages. The
Commission recognizes that there are enormous differences in the current use of
Aboriginal languages among Inuit, First Nations, and Métis, and geographically
within those groups. It is clear to the Commission that a one-size-fits-all approach to
language will not work.
Community-based responses
There is a need for Canada’s Aboriginal peoples to pursue their own language poli-
cies in a way that is appropriate for their own distinct situations. rcap outlined a very
practical approach to preserving and strengthening Aboriginal language, proposing
an eight-stage process for language revitalization, with use of languages in govern-
ment as only the seventh and eighth phases. It emphasized the importance of the
communities themselves reconstructing language, mobilizing older fluent speakers,
restoring intergenerational transmission through families and community.
The stories, the songs, the languages that we learn from our families as children
influence how we go on to live in the world. This nurturing role in the transmission
of beliefs was taken from Aboriginal parents when their children were forced into
residential schools. That role must be restored and honoured. The Commission has
been convinced by the testimonials from Survivors, as well as by the social science
evidence, that the best way to restore Aboriginal languages and cultures is by ensuring
that families and communities are the focal point for learning.
There are many possible models and no one size will fit all. As rcap recognized, the
best way to revitalize and preserve culture, including language, is to ensure that it is
part of everyday life and passed on to children from a young age. As a teacher with the
Secwepemc First Nation observed,
Our children need the opportunity to hear our languages so that they can go to
sleep with our language, they could hear their grandfather speaking the lan-
guage, they could hear their grandmother speaking the language, they could
hear and dream in the language. And I think, too, I have a belief that when we are
in our sweats [sacred ceremonial lodges], if we’re going to meet our ancestors
wouldn’t it be beautiful to be conversing in the language as the Creator has gifted
us? … Our children will be going to those levels, too, because they’ll be going and
meeting our ancestors and be able to understand and make sure our messages
and our teachings are not lost.143
However, very few Aboriginal families and communities are in a position to be
able to employ effective measures for language preservation. This is especially the
case as fluent speakers become elderly and are not being replaced by younger gener-
ations. Loss of language will also challenge the ability of communities to impart cul-
tural knowledge.
Yet many Aboriginal people are rising to the challenge. In the face of great odds, we
are witnessing an upsurge in innovative community-based and community-controlled
initiatives to revitalize and preserve culture and language. These initiatives include local
development of language classes in schools; language preservation through writing and
audio and video recordings; Aboriginal media on radio, TV, and the Internet; as well as
cultural classes and immersion programs. These initiatives must be permitted to flour-
ish and grow, with the choice about how to go about this important work ultimately
belonging to the communities themselves. The TRC has been able to encourage and
witness some of these efforts through our role in recommending funding for proposed
commemoration projects.
Language nests
‘Language nests’ provide one interesting model that has been used with success
internationally. The nests have been adopted by a number of Aboriginal communities
here in Canada. They can ensure that language and culture are part of the everyday life
of children from a young age, even if their parents are not fluent speakers. There are dif-
ferent models but, generally, preschool children as young as six weeks of age spend their
days immersed in their Aboriginal language and culture in a home-like environment.
Ideally, children then transition to an immersion school available in the community.
There are a number of language nests in British Columbia and the Northwest
Territories.144 Some began simply because one or two individuals in the community
took the initiative and made it happen. As one administrator from a BC language
nest observed,
People can walk in and say, “Wow, this is easy”… because all we’re doing is
inviting children over to grandma’s house and speaking the language all day and
playing with them. There’s no mystery to that…. We go down to the lake and we
play with logs and we put rocks on logs and we make those into canoes, we go
out into the fields and we play with the flowers and we make flower wreaths and
stuff … We don’t need to overcomplicate it. I think that’s what people tend to
do. They overcomplicate the whole thing. We forget that children need love and
nurturing, they need positive reinforcement, they need acceptance, they need to
be safe, they need healthy food, there’s real basics that we need to do, we don’t
need to worry about too many other things. In a nutshell, that’s what I think a
language nest is.145
The language nests do more than simply teach language. They also ensure that chil-
dren learn about their cultures, beliefs, practices, and songs. Traditional drumming
and dancing are often incorporated, and one community introduced the practice of
using traditional names for the children. Interviews conducted as part of a study of
language nests in BC suggest that children who participated “better appreciated their
history, identity, and traditions.”146
In addition to inspiring children, language nests can also assist parents. They
can learn the language from their children as they come home and talk about what
they have learned. The children then become teachers themselves and valuable
resources for the community. The community itself may find that connections
are made, especially with Elders and others who must be fluent in the language in
order to run language nests; these connections also provide social and linguistic
capital that will assist the community. In one community, the first children who
went through the language nest and then K–7 immersion have now graduated from
high school and work at the immersion school as curriculum developers. One of the
teachers reported that she has conferred with these past graduates (who are now
young adults) on certain words or concepts that she does not know. She respectfully
referred to them as her “little Elders.”147
Unfortunately, the barriers and obstacles to developing such programs can seem
enormous. An evaluation in the Northwest Territories identified many hurdles: a lack
of administrative capacity, staffing challenges, a lack of fluent speakers, low or no
wages, lack of core funding, lack of space, licensing requirements, and the lack of cur-
riculum and materials.148 Again, these challenges underline the importance of giving
Aboriginal communities the powers and the funding they need.
Aboriginal languages as second languages

Although Aboriginal languages are best preserved when they are learned in the
home as a first language,149 both the state of Aboriginal languages in Canada and the
desire of many to reconnect with their cultures suggest that more support should be
given to learning Aboriginal languages as a second language.
To begin with, many mother-tongue populations are aging beyond childbearing
years; and second, for most children the ideal family and community conditions
for mother-tongue transmission are becoming the exception rather than the norm.
Demographic data show that the children most likely to learn an Aboriginal lan-
guage as a second language are from linguistically mixed families and live in urban
areas.150 Approximately 22% of Aboriginal people who reported to the 2011 National
Household Survey that they could conduct a conversation in an Aboriginal language
had learned it as a second language. That proportion varied from 35.3% for Métis to
23.1% for First Nations people to 10.2% for Inuit.151
There is also a demand among Aboriginal people for such language training.
According to the 2001 Aboriginal Peoples Survey, parents of 60% of Aboriginal chil-
dren in non-reserve areas believed it was very important or somewhat important for
their children to speak and understand an Aboriginal language.
The survey report also notes that in Saskatchewan, 65% of Aboriginal adults and
63% of Aboriginal youth aged fifteen to twenty-four living off-reserve considered it
important to know their language; in Yukon, 78% of adults and 76% of youth consid-
ered it important.152
The Commission urges all parties to the Settlement Agreement to support com-
munity-based approaches to language retention as recommended by rcap. This may
require innovative approaches to the use of Elders and others as teachers and the use
of language nests and immersion programs. Schools should be flexible and respon-
sive in their attempts to encourage the teaching of Aboriginal languages.
As a way of preserving Aboriginal languages and building broader support for
national reconciliation, language instruction should be extended through post-sec-
ondary institutions. This would allow Aboriginal-language speakers to develop greater
proficiency while at the same time institutionalizing language instruction in an aca-
demic context.
16) We call upon post-secondary institutions to create university and college degree
and diploma programs in Aboriginal languages.
Conclusion
The fragile state of almost all Aboriginal languages in Canada is a damaging legacy
of residential schools. Although the schools contributed greatly to the decline, so too
did the federal day schools and public schools, which made no room for Aboriginal
languages or cultural expression. The repressive policies used against Aboriginal lan-
guages and cultures in all schools, and in Canadian society generally, were based on
the view that Aboriginal languages and cultures were primitive, savage, and inferior.
It is especially regrettable that the Canadian government did not follow through
in 2006 on earlier funding commitments with respect to Aboriginal languages. Those
actions are a significant barrier to reconciliation. Canada’s policies on Aboriginal lan-
guages are neither fiscally nor structurally sound. Funding for Aboriginal language
initiatives has not increased since 1998. Canada has pursued a paternalistic policy of
heritage subsidies. These are a direct rejection of rcap’s recommendation that poli-
cies designed to preserve language respect the inherent rights of Aboriginal people.
The churches, which ran so many of the schools, simply asserted that Christianity
was superior to the spirituality, values, and ceremonies of Aboriginal systems. The fed-
eral government and the churches need to make collective reparation for the damage
they have done to Aboriginal languages and cultures. In particular, the Government
of Canada should, as recommended by rcap, approach the funding of Aboriginal
languages on a nation-to-nation basis that recognizes that language policy is a core
element of Aboriginal self-determination. Such an approach should also recognize
the great diversity of Aboriginal peoples within Canada, and the different needs of
different communities.
The Commission would also like to emphasize that these obligations are affirmed
in the Canadian Constitution and in numerous legal precedents. Canada is also a sig-
natory to the UN Declaration on the Rights of Indigenous Peoples, a document that
clearly sets out obligations that the Government of Canada has to make reparations for
past policies, and to address the current policy and funding failures and inadequacies.
While the Commission heard many painful stories about the direct and intergen-
erational harm caused by the loss of language and culture, the Commissioners were
heartened by the many stories we heard of resistance, resilience, and recovery. We are
convinced that reconnection with Aboriginal languages and cultures will have impor-
tant healing effects. Such initiatives will also increase the social and intellectual capi-
tal of Canada by preserving Aboriginal languages.
As the 2005 Task Force on Aboriginal Languages and Cultures noted, the ultimate
responsibility lies with Aboriginal people:
Canada cannot speak our languages for us. Canada cannot restore them. And
Canada cannot promote them among our peoples. We must take our rightful po-
sitions as the first and most appropriate teachers of our languages and cultures.
We must begin by speaking our own languages to our children in our homes
and communities and we must do it daily. We cannot delegate this task to our
schools or leave it for the next generation.153
At the same time, non-Aboriginal people, as represented by the Government of
Canada and the churches, have moral and legal responsibilities to help repair the lin-
guistic and cultural damages caused by their failed attempts at forced assimilation in
the schools.
The recommendations of this Commission are intended to provide a guide as to
how these obligations can be discharged. We hope they honourably reflect and reaf-
firm what Survivors have told us about the vital importance of maintaining Aboriginal
languages and cultures. As Survivor Sabrina Williams so eloquently puts it,
All things that are attached to language: it’s family connections; it’s oral history;
it’s traditions; it’s ways of being; it’s ways of knowing; it’s medicine; it’s song; it’s
dance; it’s memory; it’s everything, including the land. Because when I listen to
people speak our language I can hear where, start to hear where it might have
come from. So, to me … that’s another act of reconciliation—is to be able to pro-
vide that support so we can reclaim our languages.154
Chapter 4
An attack on Aboriginal health:

The marks and the memories
Introduction
Thousands of Aboriginal children died in residential schools. They were killed by
relentless waves of epidemics—tuberculosis and a host of other infectious diseases—
that swept repeatedly through the institutions. Those children did not have to die. The
spread of disease was fed and facilitated by crowded living conditions at the schools,
along with a lethal combination of substandard sanitation, poor nutrition, and an
appallingly low quality of medical care.
Health care services that might have been made available were often denied
or caught in bureaucratic tangles between different levels of government and the
churches. Prevailing attitudes of those ultimately responsible for the schools reflects
coldness, indifference, and neglect that borders on the criminal, if it does not actually
cross the line.
Not all students died of disease. Some students died from exposure when they
attempted to run away from the schools. Some young children took their own lives
rather than face another day in institutions where they lived in such despair. The stu-
dents were also denied access to medical professionals who might have been available
or willing to treat them. In one of the darkest stains on the history of Canada, docu-
ments show that the care of Aboriginal children in residential schools was deemed
less necessary than that given to white children.
Students in residential schools were powerless to take any of their own healing
measures. They were refused access to traditional foods and Aboriginal healers who
might have helped them. Their families and communities were routinely excluded
from decisions related to their care.
While many thousands of Aboriginal students took their injuries and infectious
diseases back to their homes and communities, those were not the only burdens
they carried. They also brought with them, as lessons from their schoolmasters and
mistresses, the permanent scars of racism—lessons that taught them, in their most
impressionable years, that they, and their parents and their ancestors, were subhu-
man. Aside from the physical and mental damage these students bore, they were the
first to bear what was to become a multigenerational affliction, one that would affect
the ability of Aboriginal peoples to embrace their languages, their cultures, and their
trusted traditional healing practices. In this way, the residential school system was an
attack on the health of generations of Aboriginal peoples, an attack first made visi-
ble by the physical scars of sickness and abuse, but also one that continues to punish
Aboriginal peoples with a legacy of marginalized lives, addiction, mental health, poor
housing, and suicide.
Ruby Firth shared her story with the Commission. She attended the Stringer Hall
Anglican hostel, a residence for students in Inuvik, nwt. In her years there, she suf-
fered seven different bouts of pneumonia, causing permanent damage to her respira-
tory system. She explained,
I’ve got chronic bronchitis today. Every winter I get pneumonia like two or three
times and I’m on two puffers ’cause when I was in Stringer Hall Residential
School they used to put us in these little skinny red coats that weren’t even warm
enough for winter. And we used to have to walk across the street to go to school
... My lungs are 50%, both my lungs are 50% scarred from having pneumonia
seven times in res. That’s always going to be there, it’s never going to go away.
Firth’s medical records also show that she had numerous broken bones resulting
from different instances of the physical abuse she suffered there. Today, she suffers
from Post Traumatic Stress Disorder (ptsd):
I didn’t do this to myself. They did it to me, yet they still fall short of what I need.
I’m still in need; I’m still in poverty; I’m still in a third world country. I still hurt
and they’re still standing by and not doing nothing about it … I don’t even make
eye contact with no white person. No white person will ever make eye contact
with me again; that’s how much they hurt my nation … If you raise a voice to me,
“Ruby!” I’ll cry. And so I try to avoid all that. I stay on my medication and stay
with my family. If I go outside the circle much, people affect me and I don’t like
that so I don’t go out; and that’s what residential school did to me … It was all
directly put on me by the Canadian Government, through the queen who, who
hired the churches to assimilate and I didn’t do none of that.1
Ruby Firth is just one, of the many thousands of residential school Survivors who
carries the marks, the memories, and the lasting effects of poor health care in the res-
idential school system. The suffering of so many has also had a telling impact on sub-
sequent generations, and that’s the subject of this chapter.
The residential schools are closed. A number of them have been destroyed. Yet the
legacy of those schools continues to infect the health of Aboriginal people today. This
chapter begins by briefly reviewing the multiplicity of abuses, injuries, and diseases
An attack on Aboriginal health • 141
that residential school life inflicted on students and their families. It will then look at
what is known about the health of Aboriginal people today, surveying a broad range
of health indicators, including life expectancy, infant mortality, fetal alcohol spec-
trum disorder, hiv/aids, mental health, food and housing insecurity, addiction, and
suicide.
The chapter then examines the failure of the federal government to fulfill its role in
improving the health of Aboriginal people in general, Survivors, and intergenerational
Survivors in particular. The chapter will also look at what is needed now and in the
future to improve the health of Aboriginal Canadians. It will highlight programs and
institutions that are working to bridge the health gap that exists between Aboriginal
and non-Aboriginal people.
By tracing this “trail of death and disease”2 back to the residential schools, the
chapter will show how inequities continue today in the unconscionable political and
societal acceptance of dramatically higher death, illness, suicide, and accident rates
among Aboriginal peoples. It is critical that this acceptance come to an end, and soon,
for it is only in good health that people will find the strength to face the truths and the
opportunities for reconciliation that lie ahead.
Aboriginal health in residential schools

The exceedingly high death rate for Aboriginal children in residential schools was
never a secret. In 1906, it was publicly denounced by Dr. P. H. Bryce, then chief med-
ical officer of the Department of Indian Affairs. He wrote in his annual report that
“the Indian population of Canada has a mortality rate of more than double that of the
whole population, and in some provinces more than three times.”3 His report made
national headlines, and the popular Saturday Night magazine concluded, “Even war
seldom shows as large a percentage of fatalities as does the educational system we
have imposed on our Indian wards.”4
Infectious disease
Tuberculosis was the prevalent cause of death. Bryce described a cycle of disease
in which infants and children were infected at home and sent to residential schools,
where they infected other children. The children infected in the schools were “sent
home when too ill to remain at school, or because of being a danger to the other schol-
ars, and have conveyed the disease to houses previously free.”5 In 1907 Bryce published
a damning report on the conditions at prairie boarding schools. In an age when fresh
air was seen as being central to the successful treatment of tuberculosis, he concluded
that, with only a few exceptions, the ventilation at the schools was “extremely inade-
quate.”6 He found the school staff and even physicians “inclined to question or min-
imize the dangers of infection from scrofulous or consumptive pupils [scrofula and
consumption were alternate names for types of tuberculosis] and nothing less than
peremptory instructions as to how to deal with cases of disease existing in the schools
will eliminate this ever-present danger of infection.”7
Dr. Bryce gave the principals a questionnaire to complete regarding the health con-
dition of their former students. The responses from fifteen schools revealed that “of a
total of 1,537 pupils reported upon nearly 25 per cent are dead, of one school with an
absolutely accurate statement, 69 per cent of ex-pupils are dead, and that everywhere
the almost invariable cause of death given is tuberculosis.” He drew particular atten-
tion to the fate of the thirty-one students who had been discharged from the File Hills
school: nine were in good health, and twenty-two were dead.8
Though Dr. Bryce was later removed from his position, he continued to denounce
the Department of Indian Affairs’ inaction as a “national crime.” The senior govern-
ment officials who dismissed Dr. Bryce’s analysis went so far as to blame the Aboriginal
students for their own high death rate, one of them noting in 1914 the “well known
predisposition of Indians to tuberculosis.”9
Aboriginal children were taken from their homes and sent to residential schools in
part because of beliefs “that Aboriginal parents were negligent parents and especially
that unassimilated Native women made poor mothers.”10 Yet the absurdity of this con-
clusion is now made clear by statistics that show it was the schools themselves where
the children faced the greatest threats to their lives.
Unsafe buildings
For Aboriginal children, the relocation to residential schools was generally no

healthier than their homes had been on the reserves. In 1897, Indian Affairs official
Martin Benson reported that the industrial schools in Manitoba and the North-West
Territories had been “hurriedly constructed of poor materials, badly laid out, with-
out due provision for lighting, heating or ventilation.” In addition, drainage was poor,
and water and fuel supplies were inadequate.11 Conditions were not any better in the
church-built boarding schools. In 1904, Indian Commissioner David Laird echoed
Benson’s comments when he wrote that the sites for the boarding schools on the
Prairies seemed “to have been selected without proper regard for either water-supply
or drainage. I need not mention any school in particular, but I have urged improve-
ment in several cases in regard to fire-protection.”12
Students’ health depended on clean water, good sanitation, and adequate ventila-
tion. But little was done to improve the poor living conditions that were identified at the
beginning of the twentieth century. In 1940, R. A. Hoey, who had served as the Indian
Affairs superintendent of welfare and training since 1936, wrote a lengthy assessment
of the condition of the existing residential schools. He concluded that many schools
were “in a somewhat dilapidated condition” and had “become acute fire hazards.”
He laid responsibility for the “condition of our schools, generally,” upon their “faulty
construction.” This construction, he said, had failed to meet “the minimum standards
in the construction of public buildings, particularly institutions for the education of
children.”13 By 1940, the government had concluded that future policy should con-
centrate on the expansion of day schools for First Nations children. As a result, many
of the existing residential school buildings were allowed to continue to deteriorate. A
1967 brief from the National Association of Principals and Administrators of Indian
Residences, which included principals of both Catholic and Protestant schools, con-
cluded, “In the years that the Churches have been involved in the administration of
the schools, there has been a steady deterioration in essential services. Year after year,
complaints, demands and requests for improvements have, in the main, fallen upon
deaf ears.”14
The badly built and poorly maintained schools constituted serious fire hazards.
Defective firefighting equipment exacerbated the risk, and schools were fitted with
inadequate and dangerous fire escapes. Lack of access to safe fire escapes led to high
death tolls in fires at the Beauval and Cross Lake schools.15
The Truth and Reconciliation Commission of Canada has determined that at least
53 schools were destroyed by fire. There were at least 170 additional recorded fires. At
least 40 students died in residential school fires.16 The harsh discipline and jail-like
nature of life in the schools meant that many students sought to run away. To prevent
this, many schools deliberately ignored government instructions in relation to fire
drills and fire escapes. These were not problems only of the late nineteenth or early
twentieth centuries. Well into the twentieth century, recommendations for improve-
ments went unheeded, and dangerous and forbidden practices were widespread and
entrenched. In the interests of cost containment, the Canadian government placed
the lives of students and staff at risk for 130 years.
The schools often lacked adequate facilities for the treatment of sick children. In
1893, Indian Affairs inspector T. P. Wadsworth reported that at the Qu’Appelle school,
the “want of an infirmary is still very much felt.”17 Those infirmaries that existed were
often primitive. On an 1891 visit to the Battleford school, Indian Commissioner Hayter
Reed concluded that the hospital ward was in such poor shape that they had been
obliged to move the children in it to the staff sitting room. According to Reed, “The
noise, as well as the bad smells, come from the lavatory underneath.”18
Nutrition
The students often received food that was not only completely foreign to them but
also lacking in the basic nutrition they needed to stay healthy. Sometimes, it was the
food itself that made them sick. Paul Stanley and his brother attended residential
school in Cranbrook, British Columbia. He recalled,
My brother, who had left by the time I just got started, he was 13 years old, he
found, apparently found a mouse in his soup. So, he wasn’t going to eat it. And of
course, who’s going to eat that? And the Brother says, “You eat what’s in front of
you,” and that kind of stuff. And they wouldn’t, no, he wouldn’t budge, and they
went and got the principal, Father Kelly, you know, came down, and, “Come on,
you eat,” you know. They were gonna make him eat, just take the mouse out, and
let him eat the rest kind of, and he wouldn’t take it.19
According to Eleanor Brass, the dinners at the File Hills, Saskatchewan, school con-
sisted “of watery soup with no flavour, and never any meat.” One winter, it seemed
to her that they ate fish every day.20 In fair weather, the boys would trap gophers and
squirrels, and roast them over open fires to supplement their meagre diets.21 Mary
John, who attended the Fraser Lake, British Columbia, school, recalled that the meals
were dull and monotonous: a regular diet of porridge interspersed with boiled barley
and beans, and bread covered with lard. Weeks might go by without any fish or meat;
sugar and jam were reserved for special occasions.22
In 1942, the federal government issued Canada’s Official Food Rules, an early ver-
sion of the Canada Food Guide.23 Inspectors quickly discovered that residential school
diets did not measure up to the Food Rules.24
A survey of six schools from across the country conducted after the Second World
War revealed significant nutritional problems in the schools, including disturbingly
high incidents of low hemoglobin, rickets, vitamin deficiencies, decaying teeth,
inflamed gums, low body weight, and low blood pressure.25 In a later survey of dietary
practices at thirty-eight schools, inspections found that “no school was doing a good
feeding job.”26 It was not until the late 1950s that the federal government adopted a
residential school food allowance calculated to provide a diet deemed “fully adequate
nutritionally.”27 Even with the increase in funding, schools still had difficulty providing
students with adequate meals.
The dietary regime at the residential schools was also part of the assimilation strat-
egy. David Charleson attended the Christie residential school in British Columbia in
the 1960s. He was “introduced to a diet that didn’t agree to me.” He contrasted the
foods he ate at residential school to the “fish, seals, and all the seafood that was avail-
able right on the edge of our, I call it our, my fridge. Nothing ever went bad in my
fridge. It was always fresh.” However, he and the other students were not allowed to
collect their own food. When they did, they were accused of stealing. For him, food at
the residential school was associated with abuse. He recalled one meal in which the
nuns force-fed him cabbage, a vegetable that was completely alien to him:
They forced me to eat it, and I’d puke it up, and put it back in my mouth, and
they’d hold my mouth shut, and one hold, holding my nose. And I know they
used to pinch my ears really hard to make me … open up my mouth, and they’d
put it back in there, and push it shut, and one holding my chin and making
me chew it, and the other one holding my nose, so I would swallow. I couldn’t
breathe. That’s the … way I ate it.28
David Charleson does not eat cabbage to this day.
Physical and sexual abuse
The full extent of the abuse that occurred in the schools is only now coming to light.
As of January 31, 2015, the Independent Assessment Process (iap), established under
the Indian Residential Schools Settlement Agreement (irssa) had received 37,951
claims for injuries resulting from physical and sexual abuse at residential schools.
The iap is a mechanism to compensate former students for sexual and physical abuse
experienced at the schools and the harms that arose from the assaults. By the end of
2014, the iap had resolved 30,939 of those claims, awarding $2.7 billion in compen-
sation.29 The number of claims for compensation for abuse is equivalent to approxi-
mately 48% of the number of former students who were eligible to make such claims.
This number does not include those former students who died prior to May 2005.
In a survey conducted by the First Nations Centre, Survivors reported experienc-
ing one or more of the following types of abuse in the schools: sexual abuse (32.6%),
physical abuse (69.2%), and verbal or emotional abuse (79.3%). The majority (71.5%)
reported that they had witnessed the abuse of others.30
Physical abuse and sexual abuse often were intertwined. Jean Pierre Bellemare,
who attended the Amos, Québec, school, spoke for many students when he told the
Commission that he had been subjected to “physical violence, verbal violence, touch-
ings, everything that comes with it.”31 Andrew Yellowback was “sexually, physically,
emotionally, and mentally abused” at the Cross Lake, Manitoba, school for eight
years.32 There was no single pattern of abuse: students of both sexes reported assaults
from staff members of both the opposite sex and the same sex as themselves.33
First-year students, traumatized by separation from their parents and the harsh
and alien regime of the school, were particularly vulnerable to abusive staff members
who sought to win their trust through what initially appeared to be simple kindness.
In some cases, this might involve little more than extra treats from the school canteen.
This favouritism, however, was often the prelude to a sexual assault that left the stu-
dent scared and confused.34
Many students spoke of having been raped at school.35 These were moments of ter-
ror. Josephine Sutherland was cornered by one of the lay brothers in the Fort Albany
school garage: “I couldn’t call for help, I couldn’t. And he did awful things to me.”36
Other students recalled being assaulted in the church confessional.37
The effects of sexual abuse can be long lasting, with ongoing effects of fear, anger,
low self-esteem, depression, sexual difficulties, substance abuse, dissociative symp-
toms, and ptsd.38 Anita Lenoir told the Commission that when she was twenty-five
years old she started getting “really bad anxiety attacks … but I didn’t know what they
were. When I was getting them, I just thought I was going crazy. I couldn’t eat for days.
I got hospitalized because of dehydration.” After some reading and counselling she
related these attacks to sexual abuse while in residential school. Although she has
overcome her anxiety attacks, the sexual abuse still affects her: “I can’t be sexual. I
can’t be romantic. You know I just, because it just destroyed so much of me.”39
Paul Kaludjau, who was sexually abused during his first year at residential school,
stated, “it doesn’t matter, their names don’t matter anymore. But you live with that
all of your life. You take it with you, even when you climb a few mountains some-
times, you feel good, you come crashing down again.” He recalled that when he left the
school, “I was like a raging bull, I was so angry, didn’t know where to turn my anger
except inward. I became an alcoholic. Didn’t know how to raise my family.” Although
it took him until seventy years of age to reach this stage, he ended his comments by
stating, “I’m trying really hard because I think it is important, trying to reach a stage in
my life where I don’t want to pass my anger on anymore.”40
Inadequate and punitive care
Doris Young attended the Elkhorn residential school in Manitoba. She explained,
I faced illnesses alone, like chicken pox, measles, mumps, you know. I remem-
ber sitting on a rad one evening when I could hardly swallow, and my ears were
sore, and my head was sore, and I sat on this rad, and I cried on, it seemed like
I cried all night. Anyway, I was by myself. I might have been in what they call an
infirmary. I don’t really know. But that memory remains with me. When I’m sick
… I feel like I should have nobody around me, so it’s hard for me to ask for help
when I’m not feeling well.41
Shirley Waskewitch recalled a terrible experience that followed when she faked a
toothache in order to escape an abusive teacher in a classroom. One of the nuns in
the infirmary, who “never did anything kind,” took matters into her own hands when
a dentist was unavailable and pulled out a perfectly healthy tooth with a set of pliers
as punishment:
She sat me down on a little stool in the infirmary, and she took out some kind
of a pliers-type instrument. It looked like pliers, and said, “Where is it?” I said,
“Over here, up here, my last tooth on the upper right.” And so she put the pliers
in there, and she proceeded to pull and twist at my neck sideways, and she
twisted this way, and my jaw was cracking, and she twisted, put her hand on
my head here, and pulled more, and she’s just going back and forth to try and
wedge it out. And I had all these noises in my ear, and my jaw was cracking … It
was for a while, took a while to get that tooth out, that she just pulled it out, and,
and she’s ja-ja-ja, “You go to your classroom,” she said to me, and she just sent
me back in the classroom. I don’t remember if she put gauze, or just kind of put
gauze in there, or just threw it in my mouth and just send me back to the class-
room. I had to suffer like that with all the pain. I knew she did it as punishment
because I lied. She wanted to show me … that I could be scared for the rest of my
life, and she did succeed in that.42
Doctors providing care in the residential schools were paid at a significantly lower
rate than they were when caring for non-Aboriginal patients.43 This low pay under-
mined access to qualified care, at times leaving the care of sick children to untrained
or incompetent individuals. Rose Marie Prosper recalled how, when she accidentally
cut her head at Shubenacadie residential school in Nova Scotia, “all they did was put
a cold pack on my forehead. No doctor’s visit or nothing … And today, the cut is still
visible; the scar is still visible.”44
As an excerpt from a 1934 letter to the Department of Indian Affairs Medical Branch
makes clear, in some cases access to medical care depended upon the religious
denomination of the school. A “field matron” was stationed at the Protestant mission
at Ahousaht, British Columbia, and was expected to provide basic health care to the
nearby Catholic residential school. As the letter’s author Victor Rassier explained,
The fact of the matter is she has always confined her ministrations to the one
school and the one reserve. It should be added furthermore that the present
matron has made herself quite undesirable for work amongst the Catholic tribes
because of her proselytizing propensities; an objection that very likely should
always continue in the event a single matron were appointed to serve the two
residential schools and the reservations.45
Gender roles
Aboriginal girls were trained to perform domestic work. These enforced gender
roles undermined the role of women in many Aboriginal communities and broke
extended family relationships that had been central to the organization of many
Aboriginal communities.
Residential schools also challenged the boys’ sense of their own masculinity. Many
suffered physical and sexual abuse and other forms of humiliation. The Aboriginal
Healing Foundation has noted that men were less willing to participate in its healing
initiatives than women, and observed that “it is often difficult for men to admit to
having been sexually abused because being a victim is contrary to the widely held ste-
reotype of manliness.”46 Charles Cardinal told the Commission how he and his brother
became exceptionally close in residential school when they realized that “nobody else
is gonna help us, so we’ll have to stick together.” He recalled how in 1992 his brother
killed himself after saying “he wanted to escape.” Cardinal stated that he had been
told, “‘you’re not a man, man don’t cry.’ I’m crying for him right now. But I’ll see him,
I’ll see him. And I’ll be the one who’s crying now. I sure do miss him.”47
Two-spirited people
Aboriginal people traditionally celebrated people who were gay or transgender as

gifted, as being the recipients of “two-spirits.” The residential schools had particular
impacts upon two-spirited people, who faced numerous attacks on their identities.48
One two-spirited Survivor explained that few of the two-spirited students that were
at the Hobbema, Alberta, school have lived to tell their stories. Some “went to the
streets,” and “most of them died very early,” at least two to suicide. He stated, “I’ve
heard through the years that the residential school made people homosexual …
Nothing could be further from the truth. Residential school made institutional homo-
sexuals; true. But it did not create who we are as two-spirited people. ’Cause that—
who we are—was there way before we went in.” He also commented on what he saw as
the particular vulnerability of two-spirited people in residential schools: “You might
as well put a woman into a man’s prison. You’re left as a target ... For me to survive
to, to be sixty-two, it’s a miracle for me.… But for the first ten years after leaving that
school, it was, there was a lot of things that went on, and I never went home.”49
acknowledge that the current state of Aboriginal health in Canada is a direct
result of previous Canadian government policies, including residential schools,
and to recognize and implement the health-care rights of Aboriginal people as
identified in international law, constitutional law, and under the Treaties.
The health of Aboriginal people today

That the residential school system was an assault on the health of Aboriginal peo-
ple is not a matter for debate. The catalogues of injury, infection, and death are a mat-
ter of public record. The Survivors present powerful evidence of the injuries to health
they suffered, and the ongoing effects those injuries and illnesses had on subsequent
generations. There is no question that Aboriginal Canadians live today with significant
generational effects passed on by their forbearers.
A 2015 discussion paper from the Wellesley Institute titled “First Peoples, Second
Class Treatment: The Role of Racism in the Health and Well-Being of Indigenous
Peoples in Canada” details the research that links health and the effects of historical
and systematic racism. As the publication argues, “The devastating health dispar-
ities experienced by Indigenous peoples in Canada underscore the need for com-
prehensive anti-racism efforts to address systemic and structural racism, as well
as the development of services, programming and interventions that recognize the
impacts of racism on Indigenous peoples’ health and well-being and assist them in
dealing with it.”50
Ken Ward told the Commission that his and his brother’s early days at the Blue
Quills residential school in Alberta were “like a honeymoon for us, because we look
white. Oh, we were the darlings of the res school, and, you know the nuns and the
priest, you know, they welcomed us, and they thought we were white, there’ll be no
problem, you know.” The “honeymoon” ended when he was sexually abused in the
school. He recalled,
I was hardcore. I was a hardcore kid at using drugs at thirteen, suicidal big time
… Years later I found out that, you know, both parents went through the res
school. My mom went through St. Albert, up by Poundmaker’s Lodge there … I
can’t remember where my father went. But it was acknowledged that they went
through it … A lot of the anger was more to me, simply because maybe I’m the
one who’s at fault, or maybe I, I’m bringing it on, like that blame, you know,
maybe you deserve it. So, I carried a lot of guilt, a lot of shame, a lot of blame as a
child.51
After leaving Blue Quills, Ward was placed in a series of foster and group homes.
He explained, “I drank bleach, I drank Comet, I wanted, in the receiving home for
the weekend, I wanted to burn out, you know, what was inside. I survived, like, I was
rushed to the hospital. They pumped me out.” He felt like he couldn’t “compete with
the world, and I just want to surrender, and go, let it go.” He continued,
So, I became a street, street person, homeless guy for, you know, a few years, in
Vancouver here, Calgary, Edmonton, Saskatoon, you know, just hung around
the street families, and I felt okay within. Simply, I can score my drugs easier and
stuff like that…. Get me high, or get me drunk, and I’ll sleep with ya, you know.
It was my way of couch surfing, but it’s a place to get high and just go ahead …
I started pumping needles in my arms … at around the age of 22, and then my
drugs of choice were cocaine, mescaline mostly.… But the, the use of needles
was quite, was quite heavy then, and I did share it with my older sister. We used
to share it, right…. I have a sister, who went through school, and now she’s HIV
positive, as well as I am, that’s how I got infected. That was, for me, at the age of
32. So us older ones went through the mill, the alcohol, the abuse that’s hap-
pened within themselves, but I didn’t really understand where theirs were com-
ing from, eh, until those whole about the res school, it started coming out. I’m
54 now, I knew back then that we had to talk about HIV, because being a former
user, I knew that this sickness was gonna hit our people big time, and plus we’re
heavily addicted in many ways.
Ken Ward has participated in education and sharing circles about HIV prevention:
“I work in the prisons as well … We have a lot of our own people in there, too, whether
it’s safe to do this in the prison or not, but … that’s a big chunk of our lost brothers and
sister out there.”52
Mortality rates
One of the most significant measures of the health of a society is its infant mortal-
ity rate.53 There are major deficiencies in the statistical information about Aboriginal
infant mortality rates, and, in particular, there is virtually no information for Métis
or non-status Aboriginal peoples.54 However, the data that is available confirms
that First Nations and Inuit infant mortality rates range from 1.7 to over 4 times the
non-Aboriginal rate. These elevated rates are most pronounced for “post-neonatal”
children (aged 28 days to 1 year), from causes such as congenital conditions, sud-
den infant death syndrome, and infections. Aboriginal peoples disproportionately
experience all of these infant health issues.55
Increased mortality rates continue into adulthood. The mortality rate amongst
Inuit children and teenagers is extraordinarily high. From 2004 to 2008, the “age-
specific mortality rate” at ages 1 to 19 in Inuit Nunangat (the four regions comprising
the traditional Inuit homeland) was 188.0 deaths per 100,000 person-years, compared
to only 35.3 deaths per 100,000 in the rest of Canada.56 While there have been improve-
ments over the last several decades, the life expectancy for First Nations, Métis, and
Inuit remains well below that of the total Canadian population.57
Even accounting for infant mortality, Aboriginal people in Canada do not live as
long as non-Aboriginal people. A 2011 Statistics Canada study found that Canadian
women tracked from the 1991 to 2006 census could expect, at 25 years of age, to
live 57.9 more years and Canadian men could expect to live another 52.6 years. By
comparison, female registered Indians could expect to live 51.1 more years; female
non-status Indians 53.3 years; and Métis women 52.5 years. For registered Indian
men, the figures were 46.9 years, 48.1 years for non-status Indians, and 48.5 years for
Métis men.58 To be sure, some of the reduced life expectancy overlaps with the lower
life expectancy of lower income groups, but the results are disturbing nevertheless.
Injury rates
Serious injury rates for Aboriginal peoples are far above the Canadian average.59
For First Nations children, there is a correlation between injury rates and whether the
child’s mother or father attended a residential school.60 In Inuit Nunangat, injuries
are the largest contributor to mortality of children and teenagers, accounting for 64%
of deaths (as compared to 36% in the rest of Canada).61 One study of Calgarians, for
example, found that Aboriginal people suffered severe trauma at a rate of 257.2 per
100,000 compared to the non-Aboriginal rate of 68.8 per 100,000, with the leading
causes of trauma being traffic accidents, assaults, and suicide.62
Ida Ralph attended McIntosh residential school in Ontario. She remembered that
she and her sister were going to be adopted but
that’s when my sister had her accident, and she was gone for the next two, two
and a half years maybe. I don’t know why it took that long for her to get healed
up. Today she’s not with us today because she got murdered in Calgary in 1983.
She was into drugs, really heavy into drugs. She left behind three children to
adoption. And I never heard from niece, my two nieces and nephew.63
Suicide
The overall suicide rate among First Nation communities is staggering. Forty per
cent of deaths amongst young Inuit are suicides, as compared to 8% in the rest of
the population.64 Aboriginal youth between the ages of 10 and 29, who are living on
reserves are 5 to 6 times more likely to die by suicide than non-Aboriginal youth. The
risk decreases with age, and, after age 70, the rate among First Nations peoples drops
below the rate for the general population.65
Many of the Survivors and their family members who spoke with the Commission
drew a direct link between their residential school experience and suicide. Katherine
Copenace attended the Roman Catholic school in Kenora, Ontario. She remarked,
They used to say we were proud and spiritual people, what happened to that?
What happened to that thing that proud and spiritual? … When I got older, I had
thoughts of suicide, inflicting pain on myself, which I did. I used to slash my
arms, pierce my arms, my body and I destroyed myself with alcohol, which the
government introduced of course.66
Maurice Marceau attended the Spanish, Ontario residential school where he was
physically and sexually abused. His first suicide attempt came after he watched the
film The Boys of St. Vincent on television, which is about the abuse of children at an
orphanage modelled on Mt. Cashel in Newfoundland. He explained,
That was my first time I tried to kill myself. I overdosed on, on pills and stuff
like that, and I was rushed to the hospital, and they pumped my stomach out.
Apparently it took five orderlies to subdue me, so they could tie me to a table
and pump my stomach out, because I wanted to die, I didn’t know why, but I
wanted to die, and it took five guys bigger than me to subdue me.… I ingested
40 Tylenols for supper, yeah, and then I woke up the next morning at 7 o’clock, I
was puking yellow bile. It looked like egg yolk. And, and I was passing blood out
of my back, back end, like my liver, or my organs were, I was bleeding, you know
… I was in a lot of pain, and from that pain, that’s, that’s, well God was talking to
me, you know, you can’t do this anymore. So after that, I went to the hospital,
and I saw a psychiatrist, and I, I see a psychologist every week to, to, to deal with
my emotional being, you know, and, and I’m learning, and thank God I’m learn-
ing. And I hope to progress to a point where I, I’ve been thinking of marriage,
and I’m 62 years old, and I’m thinking of marriage again, you know.67
Tanya Tungilik is the daughter of Marius Tungilik, who was one of the first Survivors
from Chesterfield Inlet to speak publicly about sexual and physical abuse he suffered
at the school. She told the Commission about a difficult life at home:
A lot of my cousins had committed suicide, and I find that it’s almost more
acceptable nowadays as a way out, to commit suicide. It’s almost, yeah, it’s too
accepted. I had attempted three different times, because I felt hopeless, and that
there was no way out. But I would think about my son, and my mom, and my
dad, and how it would affect them, and I couldn’t, I couldn’t do it. But I remem-
ber the first time I ever thought about suicide was when I was in grade six. I was
so young.… And I know a lot of the social problems today with Inuit, like alcohol-
ism, and physical abuse, sexual abuse, discipline for children. It, it comes from
the experiences at the residential school.68
Alcohol and drug use are frequently connected to Aboriginal suicides. One study of
thirty suicides of adult Aboriginal people in Québec found that all but two individuals
had a history of alcohol abuse, and twenty-three also used drugs. Seven of the suicides
were incarcerated at the time of their death.69
However, general patterns can hide both enormous variations across communi-
ties as well as persistent problems. For example, the number of suicides increased
dramatically in Nishnawbe Aski Nation communities in Northern Ontario between
1986 and 1995. At the same time, other First Nations have shown steady or even falling
rates. In BC, the overall suicide rate has declined among First Nations peoples, but
this decline is due to lower rates of suicide among young women; in fact, suicide rates
among young First Nations men have remained high.70 In general, though, amongst
Aboriginal peoples, suicide attempts are more frequent among women than men,
while the rate of “successful” attempts is higher among men than women. This gen-
der difference, however, is not as pronounced as that seen in the general population.71
Addiction
Due in large part to the residential schools, Aboriginal peoples in Canada are
more likely to have experienced the types of risk factors associated with addictions.
Florence Horassi attended school in Fort Providence, Northwest Territories. She told
the Commission about her struggles with alcoholism:
I was, I was caught in between two worlds, like, I’m, I’m not a white person,
I’m Indian, and yet I come back home, no, you’re a white person. You live
like them, you act like them, you talk like them, go live with them … I learned
fear, fear of the unknown … I went to treatment centre a couple of times, one
for a follow-up. I must have been through about five, six, seven psychiatrists,
psychologists, mental health worker, ’cause everything was a lie to me. When
they say alcoholism kills, it’s a disease, it’s sickness, it’s gonna kill you … That’s
when they were gonna take my kids away, ’cause I was drinking. I drank over
20 years…. My kids were going to be taken away. The police came in, the nurse
came in, the Superintendent Social Services came in, they said there was help.
I thought they were lying to me. I told them, “Keep them, at least they’ll be bet-
ter off than being with me, ’cause I drink all the time.” They said there was help.
“We’re gonna help you.” So, I went to treatment centre. So, later on, I went to
training for community addictions training with Nechi Institute. I’m complet-
ing my training. Got my certificate.72
Although many Survivors have spoken with the Commission about their struggles
with addictions, they have also provided the Commission with much information to
contextualize addictions as a coping response to the way they were treated at residen-
tial school. A number of multigenerational Survivors told the Commission about turn-
ing to drugs and alcohol to cope with the scars of residential school. While this might
seem to conform to negative stereotypes about Aboriginal peoples and alcohol use,
it actually obscures a very complex picture. For example, the First Nations Regional
Longitudinal Health Survey found that, compared to the general population, a higher
percentage of Aboriginal people don’t drink at all.73
Addictions and drug use places people at risk of multiple harms, including greater
risk of violence. A recent study of young Aboriginal women who used drugs in
Vancouver and Prince George between 2003 and 2010 found that those with a par-
ent who attended a residential school were at twice the risk of sexual assault over the
study period.74
Fetal Alcohol Spectrum Disorder
A tragic number of those who became dependent on alcohol have been pregnant
mothers. The result has been an alarmingly high rate of fetal alcohol spectrum dis-
order (fasd) in Aboriginal communities, sometimes cited as another legacy of the
residential schools. Permanent brain injury caused by fasd, as well as a lack of sup-
port, has created challenges for many Indigenous children, too often leading to poor
performance in school, disordered lives, and conflict within families and eventu-
ally with the law. There are no known research studies that specifically examine the
ways in which residential school experiences contributed to the current rates of fasd
and alcohol-related birth effects (arbe) amongst Aboriginal people. Nonetheless,
researcher Caroline Tait, in a lengthy review of the literature, concludes that the res-
idential school system contributed to high rates of alcohol abuse among those who
previously attended the schools, and among significant numbers of parents and
community members who had their children removed from their care because of the
school system.75 The most significant risk factors cited are the many faces of poverty,
including poor housing, lack of sewage disposal and potable water, poor access to
health services, and lack of adequate nutritious food.76
A man who attended residential school in Ontario told the Commission about his
son, who was born with fasd. The man had overcome a history of abuse and alcohol
use, and spoke of his belief that his son would also find a place for himself with the
love and support of his family and community and his cultural traditions:
I brought him to the Sundance, I brought him to a lot of ceremonies … But he,
he had, he hasn’t been sober, and he’s been living on the street, and he became
a street person, and he is a street person now … I was a victim, I’m not a victim
anymore. I don’t have the anger there. I don’t have the thoughts about revenge....
My son’s suffering now. I know it’s part of that legacy. I can’t explain it exactly,
but I have to have faith in him, too, just like I have faith in myself. He’ll succeed
somehow, somehow. He’s got the same spirit, same kind of spirit as you and I
have, I know that. Even with the brain damage, he’s gonna be all right. He’s got a
lot of love in, in him.77
Tait notes that women at risk for having a child with fasd have generally poor health
and are likely to suffer from one or more alcohol-related illnesses. They are also more
likely to die within a very short period of time of giving birth if they do not receive
treatment for their health problems. She writes, “While a great deal of concern, which
at times is expressed as outrage, has occurred in Canada over the birth of children
with fas/arbes, (Fetal Alcohol Spectrum/Alcohol-Related Birth Effects) there has
been far less concern (and even less outrage) over young women, many of whom are
Aboriginal, dying of alcohol-related illnesses or accidents. As with fas/arbes, these
illnesses/accidents are one-hundred per cent preventable.”78
HIV/AIDS
In 1992, Chief Edward John observed that the harmful legacy of residential schools
was “like a disease ripping through our communities.”79 The disease metaphor was,
unfortunately, prophetic. Aboriginal people are disproportionately represented
among Canadians living with hiv/aids.80 One study of 1,064 Aboriginal people living
with hiv/aids, conducted between 2010 and 2012, found that 30% were residential
school Survivors.81 In another study, most of the Survivors and descendants reported
that their physical and mental health had been affected by residential schools, as
reflected in their problems with addictions, low self-esteem, and poor parenting skills.
One respondent explained, “I can live with the disease, but the ‘mental’ damage from
residential school is a very serious disease.”82 Other studies of hiv/aids have had sim-
ilar results.83 Aboriginal drug users in Vancouver have elevated hiv incidence when
compared to non-Aboriginal drug users.84
Mental health
Leona Bird attended the Prince Albert, Saskatchewan, school. She received a set-
tlement for being sexually abused in residential schools but she says it did little to
alleviate the long lasting effects on her and her family. She explained,
I’m still the same. There’s just barely, hardly any time that I can say that I was
truly, truly happy. My wedding day was just like another day, no fun … I can’t
take back what I’ve done in my lifetime. I was forever being charged with assault,
sent to jail 18 months at a time … Yeah, I’m suffering from depression.85
Physical and sexual abuse at residential schools had profound intergenerational
effects. Case studies conducted by the Aboriginal Healing Foundation suggest that
more than 50% of community members needed healing from the effects of residen-
tial schools.86 Many former students told the Commission that they were denied the
opportunity to learn nurturing parenting skills and they replicated the strict and
uncaring discipline that they experienced at school. The lack of positive strategies for
dealing with interpersonal conflict may have led to high rates of family breakdown
and problems that youth carry with them into their adult lives.87
Anne Thomas describes herself as “third generation residential school Survivor”:

We did not belong to our families, we belonged to the government … I faced
a life of rejection. I faced a life of betrayal. I faced a sense of not belonging to
my parents, to my family, to my community … Sex, drinking, rebellion, hatred,
anger, resentment, bitterness, hostility, chip on my shoulder were my pre-teen
years, I had to show people they can’t push me around now. ’Cause if you do, I’m
going to flip out on you.
She has since been diagnosed with a bipolar condition, which she links directly to
her years as residential school: “I started having my own little getaway in my mind.”88
Displacement
Angus Havioyak was sent from his home in Inuvik to Alberta for medical treatment:
“I was in the hospital, 1962, I believe, ’cause I had TB, that was in Edmonton—Camsell
Hospital—they used to call it. I was there for two years. At that time, I, I didn’t know
about my parents. I didn’t know I had brothers and sisters. In our family, I had about,
there’s 10 of us.”89
The hospital that Havioyak and many other Northerners were and still are sent to is
more than a thousand kilometers from home, well beyond the possibility of any regu-
lar family visits, both in distance and in cost.
Mabel Brown told the Commission at Inuvik how she saw disturbing parallels
between her treatment in Northern residential schools and today’s lack of adequate
treatment facilities close to home:
They did away with all the treatment centres. They used to have one here called
Delta House, and it’s no longer, it’s called the homeless shelter now. And they
did away with two treatment centres in Yellowknife. Really beautiful places that
people used to go and … and there’s just that one in Hay River, it’s just always
waiting, people waiting to get in there too; so people have to go south.
She recalled, when her grandson needed treatment,
We didn’t want to send him down south; down to another province. We want
him to stay in our home province and not, and yeah. And they, they let me escort
him down to Regina then I came back; he ran away. He ran to Regina. And so I,
I told his dad and his dad just burst out crying. And we’re, we’re helpless; he’s
way, just like, just like what they took us away to residential schools; away from
our own homes. Same thing.90
Most Inuit communities access primary health care services through nursing sta-
tions, so most Inuit patients must travel to regional centers or southern cities to con-
sult medical specialists, have operations, and deliver babies. In general, services are
delivered within a Western model of medicine.91 In an echo of Inuit experience with

southern education, many Inuit report that medical transfers to the south can be iso-
lating and demoralizing experiences, because they are separated from their families
and home communities during a time when they are most in need of support.
There are also significant service gaps, particularly in remote locations.92 Most com-
munities have limited availability of physical health services and virtually no special-
ized mental health service. Care is provided mainly by primary care clinicians (nurse
practitioners) or community workers, supplemented by a rotation of occasional visit-
ing physicians.93
Off-reserve Aboriginal peoples are caught in a different and difficult position.
They are frequently in urban centres, far from family and home, where their access to
Western medicine and doctors is limited to the emergency room at a hospital. They also
face challenges in finding ways to access Aboriginal health practices. The Aboriginal
Healing Foundation found that three out of ten urban Aboriginal people said it was
somewhat or very difficult to access traditional healing practices.94 Inuit, Métis, and
First Nations people living off reserves were significantly less likely to have seen or
talked to a family doctor, but were significantly more likely to have seen or talked to a
nurse, than non-Aboriginal people. The difference was particularly marked for Inuit,
where 55% of Inuit saw or talked to a doctor and 64% saw or talked to a nurse, com-
pared to 77% and 11% of non-Aboriginal respondents, respectively.95 The Aboriginal
Healing Foundation noted that Les services parajudiciares autochtones du Québec
has reported, “Our greatest challenge is the fact that clients come from afar in many
cases, which means that their families also are far away. We believe very strongly in
re-establishing ties with family, but geographical distances make this more difficult.”96
Food insecurity
In January 2013 Statistics Canada reported that “Food insecurity was more com-
mon among the three Aboriginal groups, with the highest rate among Inuit at 27%,
four times the proportion of 7% for non-Aboriginal people.”97 Another recent study
found that, in 2011, off-reserve Aboriginal households in Canada were about twice as
likely as other Canadian households to be food insecure.98
A 2011 study of Aboriginal households found that those without food security “were
more likely to report poor general health (36% versus 21%) and poor mental health
(21% versus 10%), life dissatisfaction (28% versus 13%), a very weak sense of commu-
nity belonging (20% versus 11%), high stress (43% versus 21%), and cigarette smoking
(64% versus 46%).”99 Also, First Nations people aged 45 and over had nearly twice the
rate of diabetes compared with the non-Aboriginal population (19% versus 11%).100
The Commission cites these reports simply as a reminder of the need to contextualize
health indicators by explaining the circumstances behind them, and the need to avoid
stereotypes that blame Aboriginal people for their own ill health.
Link is clear
The social determinants of health are complex. It is not always possible to chart
health impacts that are tied directly to the intergenerational impacts of the residen-
tial schools as opposed to other factors. However, it is indisputable that many of the
recognized social determinants of health—income, education, employment, social
status, working and living conditions, health practices, coping skills, and childhood
development—were themselves impacted by attendance at residential school.101 As
a result, there can be no doubt that residential schools have had a lasting impact on
the health of former students, their families and their communities. And whatever the
cause, negative social and health conditions pose a serious obstacle to healing the
wounds left by the residential schools.
The Wellesley Institute study of racism and its effect on the health of Aboriginal
Canadians concludes with a sentiment that speaks to the need for change:
We as Indigenous peoples must be the authors of our own stories. It is necessary
to interrupting the racism that reduces our humanity, erases our histories, dis-
counts our health knowledge and practices, and attributes our health disparities
and social ills to individual and collective deficits instead of hundreds of years
of violence, marginalization and exclusion. The stories shared here describe the
ways in which racism has shaped the lives of generations of Indigenous peoples
and contributed towards our contemporary health disparities. It is time for
stories of change: change in how we imagine, develop, implement and evaluate
health policies, services and education, change in how we talk about racism
and history in this country. This is fundamental to shifting what is imagined and
understood about our histories, our ways of knowing and being, our present
and our future, and to ensuring the health and well-being of our peoples for this
generation and generations to come.102
Recent failures of government action

The Commission notes with profound regret that the Canadian government has
moved backwards on issues of Aboriginal health since the settlement of the residen-
tial school litigation in 2006 and the prime minister’s apology in 2008. In cutting off
funding to a number of Aboriginal health organizations, the Government of Canada
has acted as if all the deep wounds of residential schools have been healed, when it is
clear to the Commission that they have not. This is a short-sighted approach that will
increase the suffering of Aboriginal people and, in the end, will likely require more
costly crisis interventions. The government’s cutting of funding to Aboriginal health
organizations is seen by many as mean-spirited, and a barrier to reconciliation. It
suggests that there has been little change in the disrespect for both Aboriginal health
and traditional medicine that was characteristic of the schools over a hundred years
ago. The decision to stop funding Aboriginal healing programs is made all the more
incomprehensible when compared to the lapsed funding of almost one billion dollars
reported by aandc in recent fiscal years.103
The Aboriginal Healing Foundation and the Indian

Residential Schools Resolution Health Support Program
The Aboriginal Healing Foundation (ahf) was an important source of knowledge

and funding for the revitalization of Aboriginal healing practices designed specifi-
cally to address the legacy of the residential schools. The ahf’s mandate was explicitly
intergenerational, and the Foundation was “committed to addressing the legacy of
abuse in all its forms and manifestations, direct, indirect and intergenerational, by
building on the strengths and resilience of Aboriginal peoples.”104
A 2009 study, commissioned by Indian and Northern Affairs Canada, found that
“ahf healing programs at the community level are effective in facilitating healing at
the individual level, and are beginning to show healing at the family and community
level.”105 In light of the ahf’s finding that it takes approximately ten years of continuous
healing efforts before a community is securely established in healing from intergener-
ational residential school trauma and that “the healing has just begun,” the evaluation
results “strongly support the case for continued need for these programs, due to the
complex needs and long-term nature of the healing process.”106
The Government of Canada funded the Foundation for fourteen years, between
1998 and 2012. The last five years of funding were provided as part of the Indian
Residential Schools Settlement process. However, with the conclusion of its formal
settlement obligation, Canada has since refused to contribute any additional funds.
As of March 31, 2010, 135 community-based healing initiatives were no longer receiv-
ing ahf support.107 A report of the Standing Committee on Aboriginal Affairs and
Northern Development recommended the continuation of the ahf for at least a fur-
ther three years.108 It was ignored. The foundation exhausted its funding. In 2012, based
on repeated statements from Survivors at trc hearings that the healing work in their
communities had barely begun, the Commission’s Interim Report recommended that
there was an urgent need for the Government of Canada to meet immediately with the
Aboriginal Healing Foundation to restore its funding for healing initiatives.109
The ahf itself has been allowed to lapse, despite the evidence of valuable work it
was doing with Survivors and Aboriginal communities to address the adverse health
legacies of the schools in a holistic and culturally appropriate manner. The end of the
Foundation means that an important source of funding for further healing that is still
clearly needed, and the knowledge about best practices for Aboriginal healing, have
been lost.110
The Government of Canada takes the position that its Indian Residential Schools
Resolution Health Support Program (irsrhs) provides access to sufficient mental
health, transportation services, and emotional support services for former Indian
residential school students. Eligible clients include former students taking part in
the Independent Assessment Process and their families, former students receiving
Common Experience Payments (cep) and their families, and those participating in
Truth and Reconciliation and commemoration events.111 The program administers a
national twenty-four-hour toll free Indian Residential School Crisis Line and provides
funding to local Aboriginal organizations for the provision of mental health services.
This includes the services of Elders and/or traditional healers.112
A story told by a participant at the Shingwauk school reunion in Sault Ste. Marie
demonstrated how frightening it can be for those reaching out for help for the first time:
So I called that number, the crisis line. And I talked to the worker on the other
crisis line and I told her about what my situation was. But she kept asking me,
“Where are you? What, where, what, what location are you? What street are you
calling me from?” … So I hang up on her. I thought maybe she’s going to call the
cops on me or somebody; or she’s going to call 911 the way she sounded like she
was going to report me.
Ultimately, his experience was a positive one. When he called back a second time,
he was comforted when the person on the other end of the line told him, “You’re not
the only one.”113
As important as this program may be, it is completely inadequate to the task. Unlike
the Aboriginal Healing Foundation, irsrhs services are limited to former students
and their immediate family members. It is only available to individuals taking part
in one of the cep or iap compensation processes and/or Truth and Reconciliation
Commission events. Unlike the ahf, the irsrhs is not Aboriginal-operated and does
not operate independently of federal government.114
The Standing Committee on Aboriginal Affairs found that, in contrast to the irsrhs
program, the ahf projects allowed for more holistic, culturally relevant, community-
level health and wellness interventions (e.g., healing circles, traditional healing therapy,
land-based and sweat lodge retreats). In testimony to the Committee, Kathy Langlois
of Health Canada advised that, under the irsrhs program, the department would not
“be able to go as far as the community-based types of approaches that the Healing
Foundation had.” Similarly, Aideen Nabigon, a director general in the Department of
Aboriginal Affairs and Northern Development, stated that “The Aboriginal Healing
Foundation provided things ... that we aren’t going to be in a position to fund.” Jacob
Gearheard, executive director of the Ilisaqsivik Society in Clyde River, Nunavut, stated
that community members on Baffin Island who had been offered a range of culturally
sensitive healing programs must now call a 1-800 number in Whitehorse, Yukon, three
time zones away. They are not given the name of a person to call, and there is no guar-
antee that they can be served in the Inuktitut language. He added, “For Clyde River
members a help line in Whitehorse is almost the same as nothing.”115
The irsrhs cannot carry on the work of the ahf without a complete transformation
of its mandate and structure. Indeed, the Standing Committee on Aboriginal Affairs
review in 2010 stated categorically that the irsrhs, while “technically proficient,” is
no substitute for the “real, innovative, transformational work that communities have
been developing through their community projects.”116
Jackie Fletcher’s father, siblings, aunts, and uncles all attended residential school
and she also did for a short time. She noted,
Since the Aboriginal Healing Foundation got their dollars, and there was a lot of
workshops being offered in different places, I, I would attend every workshop. I
was just soaking them up, like, you know I just wanted to be there. I still, I’m still
like that. When I hear anything like this happening, I want to be there…. Because
every time I go somewhere, I learn something new every time ... And it’s, it’s, I’ve
been working on this, on my own personal healing now.117
It must be said that throughout the work of the Truth and Reconciliation
Commission, Health Canada has offered important integrated support to Survivors
of residential schools and their families, often by drawing on cultural and spiritual
resources and wisdom from within Aboriginal communities. High quality, integrated
mental health and cultural support teams were available to support those who took
part in our activities. The Commission acknowledges and honours those who have
provided this health support. One of the Commission’s interim recommendations
was designed to ensure that such workers, particularly those specially trained and
with proven performance as resolution health support workers and cultural support
workers, received recognition and accreditation for their valuable work and demand-
ing experiences.118
At the same time however, Health Canada’s individualistic approach and its focus
on providing support for Survivors who are in acute distress, rather than a strategy
and commitment for longer-term continuous support for the wider community, fails
to address the legacy of the residential schools. It discounts the potential for holistic
community interventions that can benefit many Aboriginal people on a day-to-day
basis regardless of their direct connection with residential schools.
Helen Doyle is the daughter of a residential school Survivor and works with many
Survivors. She has warned that dealing with the trauma of the experience “takes a
lifetime to do it. It’s not something that can be done in eight weeks, 10 sessions, 12
sessions, and you know, which is how … Health Canada puts it … That’s annoying too
for survivors.”119
National Aboriginal Health Organization
In addition to allowing the important work of the Aboriginal Healing Foundation

to lapse, the Government of Canada has cut the $5 million in annual funding that the
National Aboriginal Health Organization (naho) received. As of June 30, 2012, this
important organization, like the Aboriginal Healing Foundation, closed its doors.
This cut in the 2012 budget for the purpose of saving $5 million each year strikes
the Commission as especially mean-spirited and unnecessary, particularly given the
ongoing work at that time of the Commission and other processes established by the
Settlement Agreement.
For over twelve years, naho has employed thirty specialists in Aboriginal health
and issued over two hundred publications about Aboriginal health, including thirteen
issues of the Journal of Aboriginal Health.120 The available evidence suggests that there
is not enough research on Aboriginal health.121 The Commission is deeply disappointed
with these cuts. It believes that they constitute serious barriers to reconciliation.
Cuts to other Aboriginal organizations
In late March 2012, Canada abruptly terminated funding for several other key
Aboriginal organizations: the First Nations Statistical Institute, Pauktuutit Inuit
Women of Canada, and the National Centre for First Nations Governance. The cut-
ting of the annual $5-million budget of the First Nations Statistical Institute is espe-
cially short-sighted given the importance of accurate data to measure progress in
redressing the legacy of residential schools. The National Centre for First Nations
Governance provided important capacity building for Aboriginal self-determination.
The Pauktuutit Inuit Women of Canada has been working since 1984 in a broad range
of health and violence matters relating to Inuit women, including human trafficking,
fetal alcohol effects, and violence against women.122 It has wide regional representa-
tion in the North and is a respected voice for Inuit women.
The Common Experience Payment
Common Experience Payments (cep) were the modest compensation payments

given to former residential school students according to a prescribed formula based
on years of attendance at schools approved by the Settlement Agreement. The whole
process of claiming and receiving redress for the residential school experience has
added its own new element of harm.
The daughter of one residential school Survivor described the harsh impact that
the settlement process had upon her aunt:
We went to visit her because we were out visiting my aunts and uncles here
in Regina. It came up in discussion when they were first starting to negotiate
the [residential school] settlement and they were wanting to put money in the
healing fund. We were having this conversation and I don’t know how it started
but she said, “I don’t want healing, I don’t want any of that. They can take their
money. They can’t heal me. They can never give me back what they did to me.”
She was angry. She said, “I can’t hug my kids, I couldn’t be the mother to my
children and I blame all of that on residential school. No amount of healing is
going to fix me.” It was really emotional and that was just the highlights of it. It
was more of a half hour cathartic experience with my aunt and my cousin sitting
there, listening to her and it was really hard knowing that there’s a lot of survivors
out there and they’re not going to heal.123
The Aboriginal Healing Foundation conducted an evaluation of the effects of
claiming or receiving the cep on 281 First Nations, Inuit, and Métis residential school
Survivors across Canada. Forty per cent of the respondents found the cep process dif-
ficult or challenging; a third found that the process triggered negative emotions and
flashbacks; and 20% said that the long wait caused anxiety. Although a quarter of the
respondents felt that the process contributed to healing, half stated that receiving
compensation made no difference to their well-being, and 20% experienced the pro-
cess as a step backwards often because it left them bitter and angry. One participant
commented that the application “brought up the memories ... I had a panic attack. I
ended up in the hospital ... Just to realize that, yes it was true, it did really happen.”124
Unsafe living conditions
While issues such as poor quality housing and water are not direct legacies of resi-
dential schools, substandard community infrastructure increases the health burden,
and consequently increases the challenges of addressing the legacy of the residential
schools. Communities, families, and individuals that are in crisis cannot heal. For this
reason, we make specific note of the shameful state of community infrastructure in

many Aboriginal communities.
Water
As part of Canada’s 2014 Economic Action Plan, the federal government announced
an investment of $323.4 million to be spent over two years to build and renovate water
and wastewater infrastructure on reserves.125 This money is on top of the approxi-
mately $2.5 billion it has spent since 2006 on First Nations water and wastewater infra-
structure through Aboriginal Affairs and Northern Development Canada’s Capital
Facilities and Maintenance Program, the First Nations Water and Wastewater Action
Plan, and Canada’s Economic Action Plan.126
Sadly, even these additional funds come nowhere near what is required to ensure
all First Nations have access to safe drinking water, as the government’s own con-
sultant stated in 2011. This serves as a measure not only of the urgent work that
needs to be done today, but also of the extent to which services and facilities in
the past have been substandard, or allowed to deteriorate without adequate main-
tenance. An April 2011 report on a survey of water systems in First Nations com-
munities found that 39% are categorized as “high overall risk” with a further 34%
categorized as “medium overall risk.” In terms of wastewater systems, 14% are cat-
egorized as “high overall risk” with a further 51% categorized as “medium overall
risk.” This did not include the twelve First Nation communities (2%) with no active
infrastructure. The report commissioned by the Government of Canada estimates
that the cost of upgrades to meet standards is over a billion dollars (not including
new service connection costs).127 Thus, the money currently allocated is known to be
utterly inadequate. As of August 31, 2013, there were 178 water systems in 122 First
Nation communities under a drinking water advisory.128
In 2013, the Government of Canada passed the Safe Drinking Water for First
Nations Act, a highly controversial piece of legislation that allows the government
to enact regulations governing drinking water and waste treatment in First Nations
communities.129 Before it passed, the Senate Committee on Aboriginal Peoples raised
serious concerns about its implications for Aboriginal and Treaty rights.130 The Senate
committee urged the Government of Canada to ensure that the development of water
safety regulations be based on meaningful consultation with First Nations.131
A 2013 evaluation found that the First Nations Water and Wastewater Action
Plan “may not address the more pervasive issues and a shift to longer-term plan-
ning is needed.”132 A serious investment in training and operational support is what
is required to provide a safe drinking water supply, more so than complex equip-
ment. It recommended, among other things, that First Nations and Health Canada
develop a long-term strategy for investments in water and wastewater infrastruc-

ture and maintenance in order to address the pervasive and longstanding issues of
water and infrastructure quality and maintenance and that regulations ensuing from
the Safe Drinking Water for First Nations Act are developed with the engagement of
First Nations.
Housing
A 2007 study by the House of Commons Standing Committee on Aboriginal Affairs

and Northern Development found that estimates of on-reserve housing shortages
ranged between 20,000 and 87,000, with the estimated shortfall growing annually by
over 2,000 units. Inuit communities, particularly in Nunavut and Nunavik, are also
affected by growing shortages. Mould contamination in existing units remains a sig-
nificant problem. One in five Aboriginal dwellings across Canada is in need of major
repairs, compared to one in ten for Canada as a whole.133
The government claims that, under Canada’s Economic Action Plan, “nearly 500
First Nations communities across Canada benefitted from the Government’s $400 mil-
lion investment to support the construction of new on-reserve housing, renovate exist-
ing social housing units and for other complementary housing activities.”134 However,
part of the Government of Canada’s strategy has been to fund “market-based” housing
on reserves, through its First Nations Market Housing Fund, which relies on the free
market to build affordable housing.135 This could be seen as a threat to principles of
communal ownership of land.
Despite these efforts, in 2014 the United Nations special rapporteur on the rights of
Indigenous peoples described the housing situations in Inuit and First Nations com-
munities as having reached a “crisis level.”136 These weaknesses in community infra-
structure remain a significant obstacle to community health and wellness. The health
legacy of residential schools cannot be overcome while such conditions remain too
often the norm.
Disparities in health outcomes
The Commission is concerned that too many Canadians still fail to fully under-
stand the harmful legacy of residential schools and similar assimilation policies on
Aboriginal health and wellness. In the absence of such understanding, there is a ten-
dency to blame Aboriginal people for their poor health and lack of services. Even
Statistics Canada’s most recent reports on Aboriginal health focus on smoking, obe-
sity, and drinking with little attempt to contextualize these factors.137 There is a need
for greater understanding of how the direct and intergenerational effects of residential
schools have often produced trauma and self-hatred that lead too many Aboriginal
people to engage in destructive behavior from suicide to smoking. Addictions in par-
ticular have contributed to the shockingly high rates of both incarceration and crime
victimization.
There is a clear need to embrace a holistic approach to Aboriginal health—an
approach that recognizes that health is inextricably connected with families, commu-
nity, culture, language, justice, and poverty.
The persistent health gaps between Aboriginal and non-Aboriginal people in
Canada can be measured by the continued and disproportionate impact of poverty
and poverty-related diseases, including tuberculosis, a disease that was believed to be
eradicated and that has killed so many Aboriginal people in the past, including many
children.138 In 2010, the Globe and Mail reported that the tuberculosis rate among
status Indians was thirty-one times the rate of those of non-Aboriginal Canadians.
It drew parallels with Dr. Bryce’s unheeded warnings a hundred years earlier about
tuberculosis epidemics in the residential schools.139 These health outcomes would
not be tolerated if they afflicted non-Aboriginal Canadians, but, more importantly,
these health disparities between Aboriginal and non-Aboriginal Canadians need to
be researched and explained and contextualized. Otherwise, the work of reconcilia-
tion becomes significantly more difficult.
Statistical shortfalls
Recent restrictions on the national census and the methods of reporting used by
Health Canada and Statistics Canada are making it more difficult to monitor health
for Aboriginal people. Even before such restrictions, researchers were unable to prop-
erly estimate basic health indicators, such as life expectancy at birth for Canada’s
Inuit population, because of a lack of Aboriginal identifiers on death registrations
and could only make educated guesses based on findings from areas with large Inuit
populations.140
Much of the best information about the comparative health outcomes between
Aboriginal and non-Aboriginal Canadians is incomplete and becoming outdated. It
is difficult to determine whether the health gap has widened or narrowed. The lack of
up-to-date information means that these issues attract less public, media, and polit-
ical attention.
By contrast, the Australian government has set itself a series of health-related tar-
gets as a part of the apology issued by Australian Prime Minister Kevin Rudd in 2008.
There is agreement on baseline health indicators so progress can easily be measured
on health, education, and employment outcomes.141 Australian targets include
• close the gap in life expectancy by 2031;

• halve the gap in mortality rates for Indigenous children under five by 2018.
There has been a 35% decrease in the gap in child death rates since 1998,
although much more will need to be done if the goal is to be met by 2018;
• halve the gap in reading, writing, and numeracy achievements for children
by 2018;
• halve the gap for Indigenous students in Year 12 (or equivalent) attainment rates
by 2020; and
• halve the gap in employment outcomes between Indigenous and other
Australians by 2018.142
Setting such targets ensures that government must monitor indicators of health
and is accountable for failing to meet targets. Of course, the Australian example also
demonstrates that setting targets is not sufficient without committing the necessary
resources to achieve them. The 2015 annual report shows that Australia has made lit-
tle progress on many of its goals.
No comparable and measurable commitments were made when Prime Minister
Stephen Harper delivered his 2008 apology for residential schools. In fact, the
Canadian government has cut health grants to the Native Women’s Association of
Canada, the Métis National Council, the Congress of Aboriginal Peoples, the National
Indian and Inuit Community Health Representatives Organization, and Inuit Tapiriit
Kanatami.143 These organizations have been committed to models of research in which
Aboriginal communities have ownership, control, access, and possession. Their loss
would significantly limit the development of accurate information about health issues
and solutions for Aboriginal peoples. The cancellation of Canada’s long-form census
and the Aboriginal Children’s Survey has further contributed to undermining access
to accurate research and information.144
These drastic and sudden cuts have led some to conclude that the Government of
Canada is “deliberately undermining capacity to generate accurate Aboriginal health
data and circulating discredited health data so as to downplay the severity of the
Aboriginal health crisis in Canada.”145 Dr. Janet Smylie, a professor of family medicine
and research scientist, argues that the infant mortality rate on Aboriginal reserves as
published by the Public Health Agency of Canada underestimates the rate by as much
as 60%.146 Organizations that could have supplied correct information have been gutted.
19) We call upon the federal government, in consultation with Aboriginal peoples,
to establish measurable goals to identify and close the gaps in health outcomes
between Aboriginal and non-Aboriginal communities, and to publish annual
progress reports and assess long-term trends. Such efforts would focus on indi-
cators such as: infant mortality, maternal health, suicide, mental health, addic-
tions, life expectancy, birth rates, infant and child health issues, chronic diseases,
illness and injury incidence, and the availability of appropriate health services.
Weaknesses in existing agreements
It may seem promising that for many years federal policy towards Aboriginal health
has emphasized the language of community control. The Government of Canada per-
mits community control over health services in three main ways: the Health Transfer
Policy, the Integrated Model, and self-government agreements. However, each of
these models has significant limitations.
The Health Transfer Policy, initiated in 1989, provides opportunities to individual
communities and tribal councils to have increased local responsibility in the planning
and delivery of community-based health services, as well as some regionally based
programs.147 However, the programs over which communities may exercise local con-
trol are those established and governed by the First Nations and Inuit Health Branch
of Health Canada. In addition, most on-reserve health facilities receive funding for
only a limited number of health promotion and prevention services.148 Also, not all
Aboriginal peoples are eligible. Only First Nations communities south of the sixtieth
parallel and Inuit in Labrador are eligible for funding under this policy.149
The “integrated model,” created in 1994, was designed to broaden opportunities
for control to communities that were deemed “too small” to successfully manage
transfers. Like the transfer policy, communities participating in the integrated model
choose from a list of programs and sign a three- to five-year agreement for community
administration.
Communities can also negotiate a self-government agreement. For example, the
James Bay and Northern Quebec Agreement created health care structures managed
by Aboriginal authorities but linked to the provincial health care system. The Nisga’a
Agreement in British Columbia and the Labrador Inuit Association Agreement are tri-
partite agreements that include provisions for self-administration of health services.
In the Yukon, the Carcross/Tagish First Nations Programs and Services Agreement
Respecting the Indian and Inuit Affairs Program and the First Nations and Inuit
Health Branch of the Government of Canada (2003) transfers responsibility for health
and other services to the First Nation.150 Although not a self-government agreement,
the Athabasca Health Authority in Saskatchewan is another example of an Aboriginal
health authority that is an extension of a provincial health care system, providing care
to two First Nations and three Métis communities.151
The First Nations and Inuit Health Branch funds over thirty separate Aboriginal
health programs, one quarter of which cannot be included in integrated, transfer or
self-government agreements. An additional problem is that these programs receive
“project-based funding,” so community health activities survive or fail based on the
availability of funds, rather than by a true reflection of community priorities.
The danger when the federal government uses the language of ‘self-government’
and ‘community control’ is that it can mask offloading of services to communities
without adequate resources. Indeed, as the above descriptions suggest, Canada’s
vision of community control has typically entailed the transfer of administrative
responsibility for existing health-related programs, thus absolving the government of
responsibility for Aboriginal health. At best, Canada’s policy of ‘community control’
has resulted in a patchwork of Aboriginal-specific legislation, policies, and provisions,
with significant gaps.152
The latest model to emerge is the “tripartite health agreement.” British Columbia
is the only province to establish a framework through which agencies mandated by
First Nation governments, organizations, and communities deliver health services
operating under provincial jurisdiction. The Tripartite Framework Agreement on First
Nation Health Governance, completed in October 2011, sets out a commitment to
establish a First Nations Health Authority. Federal funding for existing federal health
programs, and responsibility for First Nations health program design and delivery,
will be transferred to the new Authority.153 Ultimately, the Authority is expected to
replace the Non-Insured Health Benefit Program (which covers the cost of prescrip-
tion drugs, dental and vision coverage, medical equipment, and some other services)
with its own program serving “Status Indians” in British Columbia, as well as poten-
tially taking over other provincial programs.154
The agreement commits to a health system in which all First Nations in the prov-
ince have access to quality health services comparable to those available to “other
Canadians living in similar geographic locations.”155 This may seem to be a laudable
goal, but it ignores the higher health needs of Aboriginal people, which are in part
related to the legacy of the residential schools. There is a danger that the goal of “com-
parable” services may be an example of formal equality that, by failing to accommo-
date the higher health needs of Aboriginal people, may fail to achieve substantive
equality or equal health outcomes.
The tripartite model could have the advantage of preventing jurisdictional issues
from acting as a barrier to the development of Aboriginal-controlled health care.
However, it is too early to tell whether the BC agreement will result in a genuine trans-
formation of health care services under Aboriginal control.
Métis health promotion, prevention, and protection services and programs are
in the very early beginning stages. Neither the federal nor the provincial govern-
ments have assumed responsibility for providing health services to Métis people,
or developed a policy or strategy for addressing Métis health needs. National and
provincial/territorial Métis organizations lack sustained funding for health pro-
grams, and there is little progress in the devolution of Métis health funding to Métis
organizations.156
The only exception for Métis peoples is in the Northwest Territories, where the ter-
ritory provides Métis with access to a program that is equivalent to the federal govern-
ment’s Non-Insured Health Benefits program.157 However, even for Métis people in
the Northwest Territories, significant gaps remain.
The federal government has been fighting for many years to stop litigation aimed at
obtaining a legal ruling on federal jurisdictional obligations. In April 2014, the Federal
Court of Appeal ruled in Daniels v. Canada that Métis are included as ‘Indians’ within
the meaning of the Constitution Act, 1867, which would mean that the federal govern-
ment does indeed bear responsibility for Métis peoples.158 The Federal Court of Appeal
dismissed a lower court’s finding that “non-status Indians” also fall within federal
jurisdiction.159 Both sides have appealed to the Supreme Court. It is anticipated that
the Supreme Court will hear the case in the fall of 2015. In the meantime, Aboriginal
peoples living off reserves continue to live in a no-man’s land when it comes to health
services.
20) In order to address the jurisdictional disputes concerning Aboriginal people who
do not reside on reserves, we call upon the federal government to recognize,
respect, and address the distinct health needs of the Métis, Inuit, and off-reserve
Aboriginal peoples.
The way forward

Our Calls to Action for future improvements to Aboriginal health involve a two-
track strategy. The first track will be to give Aboriginal communities the resources
and freedom that they require to take responsibility for their own health and well-
ness through the development of health and wellness centres. At the same time,
the Commission will also recommend that improvements be made to the existing
Western-based health care system so that it can treat Aboriginal people better. This is
particularly important with respect to urban Aboriginal populations.
One of the main purposes of all of the Commission’s recommendations is to ensure
that the harms that residential schools perpetuated on Aboriginal people are not
being perpetuated again in a new form.
Aboriginal healing practices
A belief shared among many Inuit, Métis, and First Nation people is that a sacred
connection exists among people, the earth, and everything within and around it.
Activities such as “on-the-land” or “bush” healing camps can allow participants to
experience the healing power of the natural world. Holistic approaches to health and
well-being can also include sweat lodges, cedar baths, smudging, and other spiritual
ceremonies, depending upon the particular beliefs and customs of each Aboriginal
community. Seasonal ceremonies, communal meals, potlatches, medicine walks,
powwows, qulliq lighting, feasts and giveaways, Métis réveillons, and Inuit community
celebrations are all activities that promote healing through positive relationships.160
There are many successful examples of Aboriginal health practices. The Sulsila
Lelum Healing Centre Society in Vancouver has medicine-making workshops, a
supply of remedies on hand for dispensing, a garden with natural medicinal plants,
and a pond with running water. The Surrey Aboriginal Cultural Society reported that
one of their best practices is on-the-land camps. The Aboriginal Health and Wellness
Centre included on-the-land retreats in their men’s program. Native Child and Family
Services of Toronto holds a one-week healing camp in summer, and pipe ceremonies
and sweats are conducted outside of the city.161
Aboriginal health practices and beliefs are diverse. The term healing has different
meanings for different individuals and communities. However, a holistic approach to
health is common to many Aboriginal cultures and is also more and more supported
by what is referred to as Western medicine.
Aboriginal healing centres
The Aboriginal Healing Foundation once supported twelve healing centres across
the country. Many of the Survivors who participated in the work of the Truth and
Reconciliation Commission acknowledged that the ahf–supported health initiatives
helped them heal enough to be able to come forward and talk about their childhood
school experiences and their consequences on their lives. For these centres to con-
tinue their healing and, in some cases, life-saving work, they need to find alternatives
to replace the ahf funding, which has now ended.162
In Ontario, through its Aboriginal Healing and Wellness Strategy, the provincial
government has established a network of programs, including ten Aboriginal Health
Access Centres and six healing lodges.163 These and similar programs are, however, an
exception—not the norm—across the country.164
The Aboriginal Healing Centres involve a range of services from mainstream health
care to traditional practices, all under community ownership and control. Such an
approach has the power to improve the lives of all community members.
Aboriginal approach to addiction
The experience of addiction treatments for Aboriginal people has shown that the
most effective treatments are those that are grounded in the “wisdom of traditional
Inuit, Métis, and First Nation teachings about a holistic approach to a healthy life.”165
These types of approaches involve “not just the mind and body of the addicted person,
but his or her emotions, spirit, relationships and identity; not just the individual, but
his or her family, friends and community; and not just change in the use of addictive
substances, but change in fundamental patterns of living.”166 In a 2007 report prepared
for the Aboriginal Healing Foundation, Deborah Chansonneuve identified the “ten
characteristics of an Aboriginal approach to addictions”:
1. An Aboriginal approach identifies and addresses the underlying causes

of addictive behaviours unique to the historical experiences of Aboriginal
people in Canada.
2. The wisdom of Aboriginal cultures and spirituality is at the very heart of

healing and recovery.
3. The relationship among suffering, resilience, experiential knowledge, and

spiritual growth is acknowledged and honoured.
4. The interconnectedness among individuals, families, and communities is

strengthened.
5. The differing pace at which individuals, families, and communities move
through the stages of healing is understood and respected.
6. Healing encompasses a range of traditional and contemporary activities

with an equally valued role for everyone in the circle of care.
7. Community health and community development are inseparable.
8. Culture is healing.
9. Legacy education is healing.
10. Healing is a lifelong journey of growth and change.167

Suicide prevention
A report on suicide among Aboriginal people in Canada, written for the Aboriginal
Healing Foundation, concluded that the most successful suicide prevention program
is one that adopts a “community wellness” promotion strategy—and thus the report’s
recommendations are useful beyond the goal of suicide prevention. The authors sug-
gested the following general guidelines for a community wellness/suicide preven-
tion strategy:
1. Programs should be locally initiated, owned and accountable, and em-

bodying the norms and values of Aboriginal culture. Although it is crucial
to develop local solutions rather than those imposed by external agencies,
useful help from the latter should not be rejected when a meaningful part-
nership can be negotiated.
2. Suicide prevention should be the responsibility of the entire community,

requiring community support and solidarity among family, religious,
political, or other groups. Given the importance of community, there is a
need for close collaboration among health, education, other community
services, and local government …
3. A focus on children and young people (up to their late twenties) is crucial,
and this implies involvement of the family and the community.
4. The problem of suicide must be addressed from many perspectives, en-

compassing biological, psychological, socio-cultural, and spiritual dimen-
sions of health and well-being.
5. Programs that are long-term in focus should be developed along with

“crisis” responses. A comprehensive approach to the problem of suicide
should be integrated within larger programs of health promotion, family
life education, community and cultural development, and political em-
powerment.
6. Evaluation of the impact of prevention strategies is essential. While a
program’s continued existence is often taken as an indicator of its success,
it is always important to examine the workings of a program and its wider
impact to detect any unforeseen or harmful effects.
7. Training of community mental health workers in individual and family

counselling (particularly for grief ), appropriate social intervention, and
community development methods is essential.168
Michael Chandler and Christopher Lalonde have done research in BC Aboriginal

communities to identify factors that are associated with lower suicide rates there. They
found that in over half the communities studied, there were no known suicides during
the targeted five-year period, while the remainder of the communities experienced
rates of youth suicide five hundred to eight hundred times the national average.169
The researchers found that “at least in the case of BC, those bands in which a major-
ity of members reported a conversational knowledge of an Aboriginal language also
experienced low to absent youth suicide rates. By contrast, those bands in which less
than half of the members reported conversational knowledge suicide rates were six
times greater.”170 The study’s authors concluded that “Altogether these results demon-
strate that indigenous language use, as a marker of cultural persistence, is a strong
predictor of health and well-being in Canada’s Aboriginal communities.”171
21) We call upon the federal government to provide sustainable funding for existing
and new Aboriginal healing centres to address the physical, mental, emotional,
and spiritual harms caused by residential schools, and to ensure that the funding
of healing centres in Nunavut and the Northwest Territories is a priority.
22) We call upon those who can effect change within the Canadian health-care system
to recognize the value of Aboriginal healing practices and use them in the treat-
ment of Aboriginal patients in collaboration with Aboriginal healers and Elders
where requested by Aboriginal patients.
Facing racism within the health care system
When looking for examples of racism towards Aboriginal peoples in the health
care system, one need look no further than the shameful circumstances surround-
ing the death of Brian Lloyd Sinclair, the Aboriginal man who died after waiting
thirty-four hours in the emergency room of the Winnipeg Health Sciences Center in
September 2008. Speaking on the subject, Madeleine Keteskwew Dion Stout observed,
“Shockingly, the staff said Mr. Sinclair didn’t ask for help. But it just makes you think
… what do we look like to others? Do we look like a person even? Do we look like a
people? Especially when both our legs are missing and we’re sitting in a wheelchair,
and we’re vomiting all over ourselves and on the floor? Clearly we as a people aren’t
even looked at as human beings.”172 While an inquest report into his death did not
seriously consider the role of racism in the treatment he received (or failed to receive),
it noted evidence that a number of “incorrect assumptions” and stereotypes were
made about Mr. Sinclair, including that he was “sleeping off his intoxication,” that
he was “homeless” and just “seeking shelter.” Judge Timothy Preston concluded that
Mr. Sinclair “did not have to die.”173 His recommendations included the use of Elders
in hospitals, Aboriginal discharge planners, and ongoing cultural safety training for
health care workers.174
The Health Council of Canada has noted that providers must be made familiar
with the long history of discrimination and colonialism, and that Aboriginal people
impacted by the residential school system “may have a heightened sensitivity to prac-
tices that are a routine part of hospital life.”175 For example, the institutional environ-
ment typical of hospitals can trigger traumatic childhood memories. Indeed, just the
fact of having to leave home communities to obtain services reproduces harmful pat-
terns associated with residential schools.
The Society of Obstetricians and Gynaecologists of Canada has a guide for health
professionals working with Aboriginal people that sets out basic expectations about
the knowledge that health professionals should have, including a basic understanding
of the appropriate names for various groups, current socio-demographics, traditional
geographic territories and language groups, and an understanding of the impact of
colonization on the health and well-being of Aboriginal people.176 Health profession-
als should recognize the need to provide health services for Aboriginal people as close
to home as possible, and the need to support Aboriginal individuals and communities
in the process of self-determination.177 These guidelines were based on input from a
number of Aboriginal contributors and supporting organizations, and they represent
a good model for other health professionals.
International historical and legal precedents

for Aboriginal health care rights
The United Nations Declaration on the Rights of Indigenous Peoples recognizes

that Indigenous peoples have the right to physical and mental integrity, as well as the
right to equal enjoyment of the highest attainable standard of physical and mental
health. In taking measures to achieve these goals, states are obligated to pay partic-
ular attention to the rights and special needs of Elders, women, youth, children, and
persons with disabilities.178 Indigenous peoples have the right to be actively involved
in developing, determining, and administering health programs that affect them.179
Indigenous peoples also have the right to their traditional medicines and to maintain
their traditional health practices.180
The UN Declaration is but one of several international human rights documents
that collectively establish a right to health, including a right to health care and a right
to a culturally appropriate health care system. There are no human rights without
health—and no health without human rights. In other words, the right to health in
international law is a holistic concept that incorporates much more than simple access
to health care. It is intimately tied to other key social, economic, and political rights:
the right to food, the right to adequate housing, the right to education, the right to work
and rights at work, the right to life, the right to information, the right to physical integ-
rity, the right to be free from discrimination, and the right to self-determination.181
Thus, the approach to health in international law is entirely consistent with
Aboriginal approaches to health.182 It is a positive right, which requires government to
take action to make the right meaningful.
The historic Treaties established additional international law obligations con-
cerning Aboriginal health and wellness.183 The right to medical care was enshrined
in Treaties 6, 7, 8, 10, and 11.184 Treaty 6 explicitly included provision of a “medicine
chest” and relief from “pestilence.”185 However, the right to health is not limited to
these Treaties. The Treaty negotiations included many references “to the protection
of, and non-interference with, traditional ways of life,” which encompasses Aboriginal
health.186 Health and wellness, including in some cases self-government provisions
for control over health care services, have also been a component of many of the con-
temporary Treaties and self-government agreements signed by Inuit, Métis, and First
Nation governments in many regions of the country.187
Finally, the honour of the Crown, with its fiduciary obligations to Inuit, Métis, and
First Nations peoples, requires that the Crown ensure Aboriginal peoples enjoy the
same standards of health and wellness as others.
Self-determination and health care
Self-determination is a foundational right, without which Aboriginal peoples’ rights

cannot be fully realized. There is a growing body of literature tying social and health
problems to a lack of “community control.” As such, community control and autonomy
are important protective factors in preventing ill health.188 The Commission believes
that community well-being and healing from the trauma of residential schools will
only be achieved through Aboriginal self-government and self-determination.
The Inuit Tapiriit Kanatami has argued,
Self-determination improves health outcomes since communities who control
their resources and services can initiate programs that match their needs, reduc-
ing delivery gaps and creating valuable support networks for vulnerable groups.
Control over fiscal resources enables communities to plan enduring, well-inte-
grated economic, social, and health programs that spawn lasting changes.
Furthermore, self-determination generates new employment opportunities
associated with running institutions and programs.189
Research also suggests that there is a need for healing centres in cities. One study
of Aboriginal women on Vancouver’s Downtown Eastside found that, despite the ser-
vices provided by the Vancouver Native Health Society and other organizations, many
Aboriginal women wanted more holistic options. One Aboriginal woman explained,
“I prefer to be around First Nations people because they’re the ones who understand
where we come from. When you go in there [the Clinic], a non-Native person will look
at you as a client. But a First Nation’s person will look at you like a friend, but will
maintain her professionalism.”190
A place for Aboriginal people and principles
The stories that Survivors have told the Commission have convinced us that tradi-
tional healing practices and involvement in Aboriginal culture and communities are
vital parts of healing the wounds that residential schools have inflicted on former stu-
dents and their families and students.
The Royal Commission on Aboriginal Peoples emphasized that simply increasing
resources within the current health care system would not be sufficient.191 A funda-
mental reorganization was recommended based on the following four principles:
(1) Equitable access to health services and equitable outcomes in health status
(2) Holistic approaches to treatment and preventive services
(3) Aboriginal control of services
(4) Diversity of approaches that respond to cultural priorities and community

needs.192
These remain relevant and achievable goals. Had these steps been taken at the
time of the rcap report in 1996, Aboriginal and non-Aboriginal communities would
be in a much better position to truly tackle the ongoing health legacy of the residential
schools. For example, rcap found that in 1993 that only about 0.1% of physicians in
Canada were Aboriginal. rcap found similar underrepresentation in other health and
social services professions such as nursing, dietetics, and dental therapy.193 Thus, the
need to develop Aboriginal health professionals is a pressing priority. This priority is,
of course, closely connected to the need to transform and invest in an educational
system that breaks with the residential school past. Consideration should be given to
schools that will train Aboriginal doctors and nurses and facilitate research and prac-
tice that combines Western and Aboriginal approaches to health care.
In its 1996 report, rcap challenged federal, provincial, and territorial governments
to train ten thousand Aboriginal professionals over a ten-year period in health and
social services, including medicine, nursing, mental health, psychology, social work,
dentistry, nutrition, addictions, gerontology, public health, community development,
planning, health administration, and other priority areas identified by Aboriginal
people.194
Research based on the censuses conducted in 1996, 2001, and 2006 found that
12,965 First Nations, Inuit, and Métis people entered health careers between 1996
and 2006. The study reported that the “10,000 target” set by the Royal Commission
can be interpreted as having been surpassed. However, despite these achievements,
equitable representation was still not achieved, with Aboriginal people making up
3.8% of Canada’s population according to the 2006 census and only representing 2.2%
(or 21,815 people) of Canadian workers in health occupations. The study observed
that Métis health professionals and paraprofessionals working in off-reserve areas
increased from 2,895 in 1996 to 10,425 in 2006, with two-thirds of the increase com-
ing in the 2001–06 period. First Nations representation increased from 3,745 to 7,530
between 1996 and 2006. For Inuit peoples, the increase was from approximately 325
to 430 over the same period, and for on-reserve populations, the numbers of First
Nations health care providers grew from 1,435 to 2,550 over the ten-year period from
1996 to 2006.195 Despite such progress, serious shortfalls remain.196
In September 2004, in part in response to several rcap recommendations, the
Government of Canada created a five-year program called the Aboriginal Health
Human Resources Initiative, which has three main goals: (1) to increase the number
of Aboriginal people working in health careers; (2) to adapt health care educational
curricula to support the development of cultural competencies; and (3) to improve
the retention of health care workers in Aboriginal communities. This program was not
extended at the conclusion of its five years of funding. Rather, the development of
health human resources for Aboriginal communities became part of a Pan-Canadian
Health Human Resources Strategy, which subsequently became the First Nations and
Inuit Health Human Resources program in 2011.197
A 2013 evaluation report (covering 2008–09 and 2012–13) found that there has
been “progress on increasing enrolments in and graduations from health programs”
through “access, bridging and support programs,” bursaries, and scholarships.
However, there is no “baseline information available pertaining to the number of First
Nations individuals originating from reserves or Inuit communities who are enrolling
in and/or graduating from post-secondary institutions from various health disciplines
or on the extent to which they return to their home communities after graduation,” so
it is not possible to know whether representation has improved.198
The anticipated success of such programs is expected to be limited in light of “many
barriers to enrolment in post-secondary education [that] do not fall under the pur-
view of Health Canada, specifically gaps in education at the primary and secondary
school level,” which again highlights the need for a holistic approach.199
Involvement of the churches
A small additional source of money and programs to promote healing has come
through the churches involved in running the residential schools. Those churches
involved in the Indian Residential School Settlement Agreement made commitments
to fund healing initiatives, although a number had already established reconciliation
and healing initiatives prior to the agreement. The Presbyterian Fund for Healing and
Reconciliation, the United Church of Canada Healing Fund, and the Anglican Healing
Fund were mandated under the Settlement Agreement to receive applications for
initiatives or programs designed to assist with healing and reconciliation for former
students and their families and communities, and to make grants or approve in-kind
services.200
The churches fund many small but important community projects. For example, in
the fall of 2013, the United Church’s Healing Fund decided to fund eleven proposals
at a total cost of $150,000. One project was to encourage Nuxalk language instruction;
another was to allow Elders to participate in the Ekiwaamijigaadeg Inwewin Language
Nest of the Chippewas of Nawash in Ontario. Another project involved anger manage-
ment, grief, and loss workshops.201
The church-funded programs are small and project-based. They are no substi-
tute for the Aboriginal Health Foundation. In addition, in the case of the Catholic
Church, funding of healing initiatives was tied directly to the Foundation. Pursuant
to the Settlement Agreement, the Catholic Church fund took applications and recom-
mended programs to the Aboriginal Healing Foundation. If the Aboriginal Healing
Foundation approved the application, the Committee would forward the funds to
support the program, which was then administered by the Foundation.202
The search for equal outcomes
The Canada Health Act requires all insured persons in Canada to have reasonable
access to health services.203 However, most Aboriginal health practices are not treated
as “insured services” (and therefore are not covered by provincial or federal health
programs).
Yukon is the only jurisdiction where health legislation recognizes the need to
respect traditional healing practices and the importance of establishing partnerships
with Aboriginal peoples. The Yukon Health Act provides that the minister of health
“shall promote mutual understanding, knowledge, and respect between the provid-
ers of health and social services offered in the health and social service system and
the providers of traditional aboriginal nutrition and healing.”204 The same section of
the Act also provides that its purpose “is to secure aboriginal control over traditional
aboriginal nutritional and healing practices and to protect these healing practices as a
viable alternative for seekers of health and healing services.”205
Ontario’s Aboriginal Healing and Wellness Strategy funds community wellness
workers, crisis intervention teams, health liaison, and health outreach as well as spe-
cialized projects such as healing lodges, treatment centres, and Aboriginal health
access centres that are intended to provide culturally sensitive service through joint
management with Aboriginal organizations. Traditional healing practices are encour-
aged.206 These and similar programs are, however, an exception and not the norm
across the country.
Integration of Indigenous knowledge and healing practices in Canada, in partner-
ship with Inuit, Métis, and First Nations communities, continues to be fragmented
and implemented on an ad hoc basis.207 A literature review conducted in 2008 con-
firmed the success of community-based addictions programs as an alternative to
treatment of individuals at distant residential addictions facilities. It warned that bet-
ter documentation of the results of such programs was required, but that they appear
to depend on long-term funding and infrastructure, and strong community leader-
ship and engagement.208
To underline the importance of traditional medicine, it is worth noting here a
groundbreaking ruling from an Ontario Court in November 2014 that determined
that a mother from the Six Nations of the Grand River Reserve had the right to with-
draw her eleven-year-old daughter from a course of chemotherapy in favour of tradi-
tional medicine. Justice Gethin Edward ruled that “the decision to pursue traditional
medicine for her daughter J. J. is her aboriginal right.” He went on in his judgment to
say, “the point is traditional medicine continues to be practiced on Six Nations as it
was prior to European contact and in this Court’s view there is no question it forms
an integral part of who the Six Nations are … a practice that has been rooted in their
culture from its beginnings.”209 In a later “clarification” of that ruling, Justice Edward
stated that “recognition and implementation of the right to use traditional medicines
must remain consistent with the principle that the best interests of the child remain
paramount.” He elaborated,
In law as well as in practice, then, the Haudenosaunee have both an aborigi-
nal right to use their own traditional medicines and health practices, and the
same right as other people in Ontario to use the medicines and health practices
available to those people. This provides Haudenosaunee culture and knowledge
with protection, but it also gives the people unique access to the best we have
to offer. Facing an unrelenting enemy, such as cancer, we all hope for and need
the very best, especially for our children. For the Haudenosaunee, the two sets of
rights mentioned above fulfill the aspirations of the United Nations Declaration
on the Rights of Indigenous Peoples, which states in article 24, that “Indigenous
peoples have the right to their traditional medicines and to maintain their health
practices … Indigenous individuals also have the right to access, without any
discrimination, to all social and health services.210
23) We call upon all levels of government to:

i. Increase the number of Aboriginal professionals working in the health-care
field.
ii. Ensure the retention of Aboriginal health-care providers in Aboriginal
communities.
iii. Provide cultural competency training for all health-care professionals.
24) We call upon medical and nursing schools in Canada to require all students to
take a course dealing with Aboriginal health issues, including the history and
legacy of residential schools, the United Nations Declaration on the Rights of
Indigenous Peoples, Treaties and Aboriginal rights, and Indigenous teachings and
practices. This will require skills-based training in intercultural competency, con-
flict resolution, human rights, and anti-racism.
Conclusion
Aboriginal people in Canada suffer levels of poor health that would simply not be
tolerated by other Canadians. Aboriginal people have higher mortality rates, higher
rates of disease, higher rates of accidental deaths and dramatically higher rates of sui-
cide. Many of these problems stem from the intergenerational legacy of residential
schools. The destructive beliefs and behaviours of many students have been passed
on to their children and grandchildren as physical and mental health issues.
Trudy King lives in Fort Resolution in the Northwest Territories. Both her father
and her ex-husband attended residential school. She reflected on the need for healing
in the community:
There was a residential school here in Fort Res, and there was never ever any
healing in this town. Everything is just a big hush-hush. I know there’s a lot of
abuse here. I learned all that when I left my ex, certain people disclosed to me.
And this town needs healing, the people need healing. People in this town don’t
know how to open up, because every, they kept everything so secret for so many
years, and it’s still like that, still like that in Fort Res. And there was a residen-
tial school here, but there’s no healing going on here, and it’s still affecting this
community. And there’s just, like, a big dark cloud over here, and it’s still like
that. I don’t know why I still live here. I used to say it’s because my mom’s here,
I can’t leave her. My mom’s been gone just about fifteen years now, and I’m still
here. It’s my community, and I, I don’t have to run away anywhere to … But I
really believe that this town needs healing, the people need healing, the leaders,
everybody. Until that happens, everything is gonna be secrets.211
There is a need to close the health gap that exists between Aboriginal and non-
Aboriginal Canadians. Unfortunately, matters are getting worse, not better, since the
residential schools settlement and the prime minister’s apology. The decision to allow
the Aboriginal Healing Foundation and other Aboriginal health organizations to wither
and die was an alarming step backwards given the costs of crisis health interventions
and the deeper causes of Aboriginal ill health, including the legacy of residential schools.
Other countries, especially Australia, offer models of reconciliatory policies that
Canada could follow. Australia set specific goals for closing various gaps—including
health-related gaps—between the Aboriginal and the non-Aboriginal population.
The Truth and Reconciliation Commission is concerned that Canadian govern-
ments have not made comparable, measureable commitments. Furthermore, there
is a continuing erosion of funds for the Aboriginal agencies that were making the
greatest progress in community-based healing efforts; and there is ongoing erosion of
agencies that can provide credible data about the gaps.
The Royal Commission on Aboriginal Peoples recognized that there is a growing
convergence between Western and Aboriginal understandings of health and well-
ness.212 This convergence has, if anything, increased in the almost twenty years since
rcap’s report was released. Today, the importance of prenatal care, early childhood
development, diet, and mental health are much better recognized in Western med-
icine. In addition, there is increasing recognition about how environmental degra-
dation, poor living conditions, poor education, and a lack of self-determination over
one’s life can manifest itself in ill health.
Although there is convergence that provides some grounds for reconciliation
between Aboriginal and non-Aboriginal perspectives on health, this convergence
should not be an excuse for continuing to deprive Aboriginal people of control over
their health care. To ensure that the residential school experience is not being repeated
in some other guise, the Government of Canada must continue to measure and com-
pare the health indicators of Aboriginal people and non-Aboriginal Canadians. The
need for equal outcomes is also supported by the fact that Aboriginal and Treaty rights
and the UN Declaration of the Rights of Indigenous Peoples guarantee a right to equi-
table Aboriginal health care.
Finally, the principle of self-determination runs throughout all of our Calls to
Action in this volume and is particularly important with respect to health. As rcap
noted so clearly in its report,
Whole health, in the full sense of the term, does not depend primarily on the
mode of operation of health and healing services—as important as they are.
Whole health depends as much or more on the design of the political and eco-
nomic systems that organize relations of power and productivity in Canadian
society. For Aboriginal people, those systems have been working badly. Before
whole health can be achieved, they must begin to work well.213
Residential schools inflicted grave harms on Aboriginal peoples. Self-determination
holds out the best hope for effective approaches that will begin to counter the harm-
ful legacy of the schools. Moreover, the very act of according Aboriginal peoples the
respect to conduct their own affairs will help renounce the colonial and racist views
about Aboriginal inferiority that informed the failed residential schools project.
Self-determination holds the key to better Aboriginal health by allowing commu-
nities to develop programs that are suited to their own needs, and to do so in a holistic
way, avoiding the jurisdictional disputes that have plagued progress in health and so
many other areas where the residential schools still cast a large shadow.
Chapter 5
A denial of justice
Introduction
Residential schools inflicted profound injustices on Aboriginal people. Children
were taken far from their communities to live in imposing and frightening custodial
institutions. Aboriginal parents were forced, often under threat of prosecution if they
resisted, to give up their children to these schools.
Residential schools resembled prisons. Aboriginal children were often treated as if
they were offenders who required rehabilitation, while the only thing they were guilty
of was being Aboriginal. The regimented life and religious indoctrination and curric-
ulum imposed on them was designed to ‘rehabilitate’ them by assimilating them into
mainstream Canadian society. Norman Courchene was one of many Survivors who
told the Commission that while he was at residential school, he “felt like an inmate.”1
If the children disobeyed the rules, spoke their own languages, or associated with
their own brothers and sisters, they were punished. If they ran away, they were tracked
down and forced to return to the schools where they would be again be punished for
trying to escape.
Children who attended the schools developed a variety of coping and resistance
mechanisms. Some of them stole food to supplement their inadequate diets. Others
adopted the bullying tactics of the school by abusing other students.
Mervin Mirasty told the Commission that both he and his brother were sexually
abused at Beauval residential school: “To this day, I’ve, I’ve always wanted to go back
and burn the place, and I never did.” He also recalled that, “I ran away from school. I’d
go out, I’d walk around town, and steal whatever I could steal … I started stealing cars,
I got caught, at 15 I ended up in jail. From, from that point of 15 years old ’til I was,
the year 2000, I got sentenced to 25 years all together … and I don’t know what I was
fighting, what I was trying to do.”2
The Canadian legal system also failed the children. When it eventually began to
respond to the claims of abuse in the late 1980s, it initially did so inadequately and in
a way that often re-victimized the Survivors. To Survivors, the criminal and civil justice
systems seemed to be tipped in favour of the school authorities and school administra-
tors. To Survivors, the justice system was a barrier to their efforts to bring out the truth
of their collective experience. The Indian Residential Schools Settlement Agreement
provided them access to compensation without the trial process, but their collective
need to engage in a process of public disclosure about what happened in the schools
would have been denied to them without the Truth and Reconciliation Commission.
The justice system denies Aboriginal people the safety and opportunities that most
Canadians take for granted. The failures of the justice system include the dispropor-
tionate imprisonment of Aboriginal people and the inadequate response to their
criminal victimization. The failures of the system are perhaps most marked in the high
number of Aboriginal women and girls who are missing or who have been murdered.
The first part of this chapter will review the failures of the criminal justice system in
protecting residential school students and punishing those who abused them physi-
cally, sexually, and emotionally. The second part of the chapter will examine the fail-
ures of the civil litigation process to provide justice to the Survivors of the residential
schools and their families. The third part of the chapter will detail the criminal legacies
of the schools, the myriad harms and intergenerational damage inflicted by the gov-
ernment policy of removing children from their homes and forcibly separating them
from their families and communities, language, and cultures, all of which have con-
tributed to the disturbingly high overrepresentation of Aboriginal people in prison.
The fourth part will look at the equally shameful overrepresentation of Aboriginal
people among victims of crime, particularly women. The fifth and final part of the
chapter is titled “The Way Forward,” and offers suggestions and insight derived from
the Commission’s hearings and research.
The Commission believes that significant reform of the Canadian justice system is
necessary to halt the legacy of residential schools. Resources will need to be shifted
from costly and often coercive crisis intervention towards crime prevention. Aboriginal
communities must also exercise their own inherent powers of self-determination, and
consider designing and administering their own justice systems. By using their own
traditions, Aboriginal people will be able to take a more holistic approach to offending
behaviour and recognize the need to address the underlying causes of the behaviour
as well.
The failures of the criminal justice system
Attendance at residential schools was often coerced. For many Aboriginal children,
their first encounter with the justice system came when an rcmp officer appeared in
their community to take them to residential school. The Mounted Police, who were
appointed residential school truant officers in 1927, were, along with local police,
A denial of justice • 187
used to force parents to send or return their children to school.3 For example, in 1914,
Indian agent W. J. Dilworth reported he had sent a parent from the Blood Reserve in
Alberta to jail for ten days for taking his son out of a residential school without permis-
sion.4 Robert Keesick recalled that in 1930 “the rcmp told my grandmother that she
had to take me to attend residential school at McIntosh. If she refused, she would be
put in jail.”5 The rcmp also had an active involvement with the schools by investigating
runaways.6
Harsh punishment excused
Students had few protections from the harsh discipline imposed in the schools. In
the spring of 1934, $53.44 was stolen from a locked drawer in a cabinet in the office
of the mother superior of the Shubenacadie, Nova Scotia, school. Several boys were
questioned: some admitted involvement in the theft; others denied it. Eight of them,
including some who denied involvement, were punished that day. They were thrashed
on their bare backs with a seven-thonged strap that was specially made by the school
carpenter.7 After a few more days of investigation, eleven more boys were thrashed
and had their hair clipped. Most were put on a bread-and-water diet for two days.8 A
local rcmp officer was present for the initial round of punishment, and said he did not
see any blood.9
The story was reported in the local papers. When alarmed parents showed up at
the school, Principal J. P. Mackey prevented them from seeing their children because
he “did not think it prudent they should see the children and talk the matter among
them.”10 Sufficient public attention was devoted to the matter that the federal govern-
ment appointed L. A. Audette, a retired judge of the Exchequer Court of Canada, to
conduct an inquiry into the event. He held two days of hearings in June 1934, two and
a half months after the boys were thrashed.
Audette defended the necessity of physical punishment and the strap not only on
the basis that it was used in Britain, but because “these Indians, in terms of civiliza-
tion, are children, having minds just emerging from barbarism.”11 The inquiry con-
cluded that “far from finding fault,” the principal of the school should be “commended
and congratulated” for his actions in maintaining discipline in the school.12
Rights denied
Just as the justice system did a poor job protecting the rights of students, it did little
to uphold those of their parents. Parents would sometimes voluntarily send their chil-
dren to a residential school. Sometimes in times of need, families could not provide
for their children. Sometimes when a mother died, the father could not care for the
children. Children sometimes wanted to go the schools to be with siblings or friends
rather than spend a lonely time in their community. Unlike children who were identi-
fied and ordered to be sent to the schools by government agents, these children were
not subject to a mandatory-stay determination. Legally, their voluntary enrolment
should have enabled them to leave when they wished, but government policy decreed
that once enrolled, all children in a school had to stay.
In some cases, Indian Affairs refused to discharge children who had been vol-
untarily enrolled until they turned eighteen. In 1903, when the government refused
to discharge two brothers who were over fifteen, the students ran away from the
Middlechurch school in Manitoba. They were apprehended and returned to the school
on the basis of a warrant issued under the 1894 regulations. Their father, William
Cameron, went to court and got a writ of habeas corpus. Normally, such a writ requires
that the person under arrest be brought before a court. According to Martin Benson,
Justice Richards of the Manitoba Court of Queen’s Bench found on the father’s behalf,
and wrote, “the regulations for the detention of children until they reached the age of
18 years do not apply to children who have been voluntarily placed in the school and
that as to such children the parents have a right to get them out of the school at any
time they wish to demand them.”13
In other words, the government’s discharge policy for students who had been vol-
untarily enrolled had no legal basis. But this court victory did not change the policy. In
1907, it was still government policy that children, whether voluntarily enrolled by their
parents or committed under the provisions of the Indian Act, could not be removed
without the minister’s permission.14 In his report for the year ending March 31, 1910,
Duncan Campbell Scott, then superintendent of Indian Education, wrote, “pupils of
residential schools are not usually allowed to leave the institutions until they reach the
age of 18.”15 Clearly, the government was willing to ignore court rulings.
One partial legal victory came in 1913 when a civil suit brought by a parent for the
treatment of his daughters at the Mohawk Institute was successful. The parent, with
the help of the Six Nations Council, sued the school and obtained $300 damages for
“a whipping on bare back with raw hide” received by his daughter and another $100
for a daughter being kept on a water diet for three days.16 In a pattern that would be
repeated in modern residential school litigation, however, other claims relating to the
cutting of the daughter’s hair, confinement, and bad food were rejected by the court.
The slow recognition of injustice in residential schools

The colonization and marginalization of Aboriginal peoples created a situation in
which children were vulnerable to abuse, and civil authorities were distant, hostile,
and skeptical of Aboriginal reports of abuse. As a result, there were very few prosecu-
tions for abuse while the schools were in operation.17 Poor pay, poor screening, lim-
ited supervision, the reassignment of perpetrators, and the normalization of abusive
behaviour all increased the vulnerability of students to adult and student predators.
It is also clear that abuse was often ‘hushed up’: people were dismissed rather than
prosecuted, parents were not informed, and children were not provided with supports
or counselling.18 The police investigations that took place in the 1990s were almost
invariably mounted in response to organized efforts on the part of the former students
themselves.19
The stories of these investigations are described in greater detail in the history vol-
umes of the Commission’s Final Report: Canada’s Residential Schools: The History,
Part 1, Origins to 1939; and Canada’s Residential Schools: The History, Part 2, 1939
to 2000. Those early convictions carry important legal weight. They demonstrate
that the abuses at the residential school were recognized as criminal offences at that
time, which casts doubt on officials’ later assertions that they were unaware that such
abuses were criminal in nature. Even if students were not the immediate victims of
abuse, they were victims of collateral violence, for they often witnessed or otherwise
became aware of the abuse. Memories of violence and abuse stayed with Survivors
decades after they left the schools.
Doris Young recalled a child being killed in the residential school in Elkhorn,
Manitoba:
I remember was, there was all these screams, and there was blood over the, the
walls. [Crying]… and we were told that if we, if we were, if we ever told, or tried
to run away, we would, the same thing would happen to us. [Crying] So, it was
a dangerous time for, for children, and for me at that, those days. [Crying] We
never really knew who would be next to be murdered because we witnessed one
already. [Crying]20
Young struggled with this memory and “had nightmares for years.” She eventually
reported the incident to the police as an adult:
The rcmp investigated, they said they couldn’t find anything. They came back
and told me that they found no evidence of what I was talking about, and but it
was not something that I would make up. The thing about all of this violence that
happened in those schools is that they had such free access to us, and there was
no one there to protect us. They, they had absolute authority over all the violence
they committed on, on me, and, and who, all the other children that were there
as well.21
The rcmp reports to having investigated fifteen deaths in the schools, but no
charges were laid as they concluded that all the deaths were accidental or due to
illness.22
The often-strained relations between Aboriginal people and the police in Canada is
directly connected to the history of their experience of policing at residential schools.
Not only did the police coercively enforce attendance at residential school, but they
also failed to protect the children from serious crimes while they were in the schools.
It has been important for the Commission to understand how the Canadian legal
system responded to residential schools in order to understand the full legacy of the
harms experienced by Survivors. In the next section, four separate police investiga-
tions will be highlighted: two in British Columbia, one in the Northwest Territories,
and one in Ontario. Each of the following investigations points to different failures of
the justice system, failures that have often led Aboriginal people to view the system
with a mixture of suspicion and fear.
The RCMP task force in British Columbia
The Nuu-chah-nulth Tribal Council (ntc), a body that coordinates political action
amongst the fourteen Nuu-chah-nulth First Nations on the west coast of Vancouver
Island, undertook a major study of the impact of residential schools on its members
in 1992. In 1996, the ntc published Indian Residential Schools: The Nuu-chah-nulth
Experience, a report that contains excerpts from interviews with former students, as
well as several former teachers. The report states that eighty-three of the ninety-six
Survivors who were interviewed reported being physically abused, and thirty reported
being sexually abused.23 The Tribal Council’s report did not place primary emphasis
on criminal investigations. It first called on the federal government to issue an apol-
ogy, and then stated that a public inquiry was necessary because the abuse it revealed
was only ‘the tip of the iceberg.’
In November 1994, tribal council representatives presented their findings to mem-
bers of the Port Alberni Royal Canadian Mounted Police detachment. In light of the
number of potential cases that the Nuu-Chah-Nulth inquiry might give rise to, it soon
became apparent to the rcmp that it needed to develop a coordinated response to the
issue; it established the Native Indian Residential School Task Force. The province-
wide task force was composed of officers from the central E Division Major Crime
Section, as well as investigators from eight local subdivisions. The task force com-
menced its work in 1995 and remained in operation for over eight years. It investigated
974 allegations of criminal misconduct in British Columbia schools.
Four hundred and fifty-three people said they had been criminally victimized.
Another 245 people were identified as possible victims, meaning that while there was
credible evidence to believe they had been victimized, they had not contacted the
police. That suggests there were nearly 700 potential victims. The task force identified
396 suspects. Complaints came from former students of 15 of the residential schools
in British Columbia. There were 515 alleged sexual assaults (involving 374 victims),
435 alleged physical assaults (involving 223 victims), and 23 other alleged offences
(involving 19 victims).
Yet, in its final report, the task force stated that despite “thousands of hours of inves-
tigative time and well over a million dollars in salaries and other expenses ... relatively
few criminal prosecutions resulted.”24
Its final report stated that, when the task force was formed in 1994, it
was immediately greeted with anxiety and mistrust from the very people it
sought to assist. The Aboriginal community expressed alarm at the potential
impact of the investigation on their people, citing the high suicide and substance
abuse rates that followed previous investigations. Their other concerns were
centred around their historic mistrust of both the rcmp and the Court system.
This situation was further aggravated by the rcmp’s earlier role as truant officers
supporting the very system that was now under criminal investigation.25
The Truth and Reconciliation Commission’s review concluded that the task force
led to the prosecution and conviction of only five men. Three of the five had already
been charged and convicted of abusing residential school students before the task
force was formed. The task force final report noted a further problem. It stated that
“a very common situation that kept occurring over and over again” was that provin-
cial Crown counsel refused to prosecute without corroboration in the form of physical
evidence.26 This approach was based on an unwillingness to take the complainant’s
own evidence as sufficient to justify a prosecution. It shows a reluctance to take the
evidence of Aboriginal people as worthy of belief.
Since 1982, the legal requirement for corroboration was specifically rescinded for
sexual offences and never was required for non-sexual offences.27 The rcmp’s own
report acknowledged that corroboration was no longer a legal requirement, but that it
was nevertheless seen as a practical prerequisite for the prosecution of these cases.28
There is also some evidence in the rcmp report that claims of physical assault were
viewed as less serious than claims of sexual abuse. The report suggests that com-
plaints of physical abuse “quite often … were the result of a culture clash between the
rigid ‘spare the rod, spoil the child’ Christian attitude, and the more permissive Native
tradition of child-rearing.”29
The rcmp’s report also notes that almost every complainant told the rcmp about
their loss of culture as well as the physical and sexual abuse that they suffered. This
reaffirms that loss of culture and language was extremely important to many former
students who looked to both the criminal and civil legal systems for justice.
Unfortunately, the Canadian legal system ignored the harms of loss of culture and
language. The rcmp’s E Division candidly explained, “enforced deprivation of Native
culture was official Canadian government policy sanctioned by the Indian Act. As
such, these complaints are beyond the scope of this investigation and will have to be
dealt with in another forum.”30
The rcmp, to its credit, responded to those concerns by negotiating a protocol in
which the force agreed not to forward a case for prosecution without the complain-
ant’s consent. However, the rcmp eventually betrayed the trust of the Survivors when
it shared files involving investigations into the Kuper Island residential school with
the federal Department of Justice, which was defending the government in civil
actions brought by former students. When the rcmp requested that the documents
be returned, Department of Justice lawyers refused. They insisted that the rcmp doc-
uments were also the property of the federal Crown.31 This argument ignored the con-
stitutional principle of police independence and suggested to Survivors that the rcmp
was not acting as an impartial law enforcer but as an agent of the federal government,
which was actively opposing the Survivors’ civil claims.
The Government of Canada stubbornly resisted rcmp demands for information.
This made it necessary for the rcmp to obtain and execute multiple search warrants
on the Department of Indian Affairs in Hull, Québec, in order to obtain information
relevant to the criminal investigation.32 The rcmp displayed praiseworthy indepen-
dence and determination in seeking the information. Nevertheless, it is shocking to
the Commission that the Department of Indian Affairs would resist cooperation with
an important criminal investigation in a manner that required the rcmp to obtain
search warrants to obtain material.
25) We call upon the federal government to establish a written policy which reaffirms
the independence of the Royal Canadian Mounted Police to investigate crimes
in which the government has its own interest as a potential or real party in civil
litigation.
Turquetil Hall, Chesterfield Inlet investigations
As was the case with the E Division Task Force, the investigation into sexual abuse
at Turquetil Hall only came after Aboriginal people took the initiative to examine and
reveal the abuses they suffered. In 1991, Marius Tungilik, a former student at Turquetil
Hall in Chesterfield Inlet in what is now Nunavut, told a hearing of the Royal Commission
on Aboriginal Peoples about being sexually abused at the school. Two years later, he and
others helped organize a reunion of students, at which about forty students revealed,
while participating in healing circles, that they had suffered sexual abuse.
The former students at the reunion did not stress criminal investigations as an
effective remedy. They asked for an acceptable apology, resources so that Survivors,
dependents, and abusers could receive therapy, and “a comprehensive independent
public inquiry” to investigate sexual, physical, and emotional abuse at Turquetil Hall/
Bernier School.33
Bishop Reynald Rouleau of the Hudson Bay Diocese attended the 1993 reunion.
He stated that he recognized “the courage of many students who accepted to reveal
publicly some aspects of their personal life and of their faith … I am very sorry for
those people toward whom abuses have been committed…. According to the limited
means I may have, I am willing to collaborate in the healing of those individuals who
are ready to get committed in their own healing.”34 Marius Tungilik noted that nothing
in the bishop’s statement admitted that sexual abuse had taken place.35
Two rcmp officers investigated 150 allegations of physical abuse and 86 allegations
of sexual abuse made by students at Joseph Bernier School in Chesterfield Inlet. The
rcmp interviewed 346 former students and almost all of the living staff all over Canada.
The rcmp compiled a list of 13 sexual abuse charges against 3 Roman Catholic clergy
and 41 charges against a lay staff member. The rcmp expressed confidence that they
could obtain convictions.36 Of the 23 staff identified as suspects, only 4 were deceased.
A report written for the government of the Northwest Territories concluded that “seri-
ous incidents of sexual assault did in fact occur at the Chesterfield Inlet school dur-
ing its years of operation.”37 The allegations “of abuse include fondling of the breast
areas of female students, the genital areas of female students, the genital areas of male
students and inappropriate sexual exhibition. An aura of fear, confusion and silence
appear to surround the students’ experiences at the time … While many students
indicated that they disliked the behaviour, felt it was wrong, and were afraid of it, it is
apparent that they felt on many occasions powerless to prevent repeat occurrences.”38
However, when the report was released in June 1995, it was also announced that even
the charges contemplated the previous year would not go forward.39
In 1996, Marius Tungilik, who had served in civil service positions in both the fed-
eral and the Northwest Territories governments, accepted an apology from Bishop
Rouleau. He observed at that time, “Today’s a historic day in Nunavut. Today, the
bishop acknowledged the pain we went through and that is very special to me.” At the
same time, he told the church congregation, “I felt betrayed very badly by the church
for so long … I felt betrayed, so badly, by my fellow Inuit, the church-goers who tried
so hard to make us feel bad for what we did.” Marius Tungilik died in 2012, at the age of
fifty-five.40 Both his wife and daughter shared with the Commission the many difficul-
ties that he struggled with throughout his life because of the abuse he suffered in resi-
dential school and the failure of the justice system to recognize the abuse he suffered.
St. Anne’s residential school
In 1992 former students of the Fort Albany school in Northern Ontario organized a
reunion that attracted about three hundred people.41 The reunion included a special
panel on physical and sexual abuse at the school. Thirty students addressed the panel.
The report of the panel stated that
Of the 19 men who gave testimony, 10 were sexually abused. Almost all of them
were physically abused in other ways; spiritually abused, humiliated, strapped,
hit with rulers, hair pulled and dragged by the hair, stabbed with a pencil, made
to eat their vomit, etc. etc.
Of the 11 women who gave testimony, 2 were sexually abused. Almost all of them
were physically abused in a variety of ways, including strapping, being made to
sit in the electric chair, being made to eat their vomit, being made to kneel on
concrete floors, locked away in dark basements, being wrongly punished for
things they did not do, etc. etc.42
The reunion report made further reference to the use of an electric chair at
the school:
Several people talked about the electric chair that was used in the girls [sic]
playroom. It seems odd how an electric chair can find its way into a Residential
School; however, it seems to have been brought to the school for fun. Neverthe-
less, all the people who remembered the electric chair do not remember it in
fun, but with pain and horror.43
Like other Survivor events at the time, the reunion report did not emphasize crim-
inal investigations and prosecutions as the appropriate remedial response. The report
called for an independent inquiry of Elders and former students to be appointed to
examine what happened. It also called for compensation and treatment for those who
had spoken at the reunion about being abused at the school. The report noted,
The individuals who gave testimony and disclosed physical, psychological, sex-
ual or spiritual abuse need immediate attention. It was a profound and painful
event for the victims to come forward and required much courage on their part.
They must not be let down now. They must receive ongoing counselling and
healing to be determined before they leave the community.44
The reunion included healing circles that lasted from five to eight hours to help the
former students deal with the aftermath of the abuse. No one was obliged to talk in
the healing circles, which were free “from destructive criticism” and provided a “safe
place for the disclosure of abuse and its aftermath.” In the course of the healing circle
process, many Survivors disclosed “a lack of self-esteem, alcoholism, domestic vio-
lence, marriage break down and a lack of parenting skills.”45
Following the reunion, Edmund Metatawabin, who was then the chief of the Fort
Albany First Nation, asked the Ontario Provincial Police to investigate complaints of
the treatment that students received at the school in the 1950s and 1960s. In 1997,
seven former staff members were charged with a variety of offences.46 None of the
documents made available to the Truth and Reconciliation Commission indicate that
charges were ever laid in relation to the use of the electric chair. Five former staff were
convicted of assault but the sentences were generally lenient.47 More importantly,
Survivors were subject to adversarial cross-examination that suggested that they were
lying simply to bolster their civil claims. The evidence available to the Commission
suggests that the prosecutions were poorly managed, not a good vehicle for the dis-
covery of the truth and re-victimized Survivors.
Bishop Hubert O’Connor
The story of the prolonged and ultimately failed prosecution of Hubert O’Connor
reveals much about the limits of the existing criminal justice system to respond to the
harms of residential schools. O’Connor was the principal of the St. Joseph’s residen-
tial school in Williams Lake, BC, from 1961 to 1967. He eventually became a bishop
but resigned that position in 1991 after being charged with two counts of raping two
Aboriginal employees and a former student of the school and having indecently
assaulted two students between 1964 and 1967. He was ordered to stand trial on those
charges. He was the highest-ranking Roman Catholic official charged in relation to
abuses at residential schools.
O’Connor did not deny having sexual relations with the complainants but argued
that they had consented, even though he was a person with authority over them. As
in other prosecutions, the process of an adversarial trial was particularly hard on the
complainants. It put them on trial and further victimized them.
In June 1992, Bishop O’Connor’s lawyer obtained the following sweeping pretrial
disclosure order:
this court orders that Crown Counsel produce names, addresses and tele-
phone numbers of therapists, counsellors, psychologists or psychiatrists who
have treated any of the complainants with respect to allegations of sexual assault
or sexual abuse.
this court further orders that the complainants authorize all therapists,
counsellors, psychologists and psychiatrists who have treated any of them with
respect to allegations of sexual assault or sexual abuse, to produce to the Crown
copies of their complete file contents and any other related material including
all documents, notes, records, reports, tape recordings and videotapes, and the
Crown to provide copies of all this material to counsel for the accused forthwith.
this court further orders that the complainants authorize the Crown to
obtain all school and employment records while they were in attendance at St.
Joseph’s Mission School and that the Crown provide those records to counsel for
the accused forthwith.
this court further orders that the complainants authorize the production
of all medical records from the period of time when they were resident at St.
Joseph’s Mission School as either students or employees.48
These orders were obtained without hearing from the complainants and with-
out apparent consideration of their privacy interests. It meant that, as a price of the
prosecution going forward, the complainants would have to give up their privacy
with respect to their medical, school, and employment records. The former students
understandably refused to grant consent to such a massive and open-ended invasion
of their privacy.
There was prolonged pretrial litigation with O’Connor bringing repeated motions
that proceedings be stayed because of non-disclosure. The Cariboo Tribal Council
wrote a letter to the trial judge to express its concerns about the possibility of the pros-
ecution being stayed and their concern about the victimization of the community. The
trial judge admonished the tribal council for inappropriately communicating with a
judge about a case out of court.49
The judge ordered that therapeutic files be disclosed, ruling that the accused’s
right to disclosure trumped the privacy rights of the complainants. Further disputes
arose from a failure of the Crown prosecutor to fully comply with the disclosure order.
The trial judge found that a Crown prosecutor had acted improperly and allowed her
personal opposition to the disclosure order to cloud her professional responsibility.
O’Connor then made a fifth motion for a stay of proceedings. This time he was suc-
cessful. The judge concluded,
To allow the case to proceed would tarnish the integrity of the court. The court
is left with no alternative but to order a stay of proceedings on all four counts.
In doing so I recognize that the decision will not be readily acceptable to all
segments of our society. It will certainly not be popular with many people. I can
only encourage such people or groups to carefully consider the reasons for the
decision … Those who will be angered or saddened by the outcome of this case
must strive to put themselves in the position of an accused person. They would
expect the Crown to fulfill its role to the standard required by law.50
David Neel, a member of the Kwakiutl Nation of Fort Rupert, BC, noted that the
decision revealed “two faces of justice.” He wrote, “Bishop O’Connor must face charges
and be found guilty or innocent in the eyes of his peers.” He added that he “personally
would like to have the opportunity to one day believe in the ‘justice system.’ For the
time being, where my people are concerned, it continues to be the injustice system.”
Neel also noted that, “it is not only the first nations that need to heal from this period
of institutionalized oppression, but our country as well. It continues to be our national
shame, as it will be until we come to grips with it.”51
The stay of proceedings was overturned by the British Columbia Court of Appeal,
which concluded that the trial judge had not found sufficient prejudice to the accused
or sufficient bad intent by the prosecution to justify the drastic remedy of permanently
stopping the prosecution.
The accused then appealed to the Supreme Court, which, in a six to three deci-
sion, held that the trial should proceed after all. Justice L’Heureux-Dubé stated for
the majority,
it is clear, at the end of the day, that the Crown was right in trying to protect the
interests of justice. The fact that it did so in such a clumsy way should not result
in a stay of proceedings, particularly so when no prejudice was demonstrated
to the fairness of the accused’s trial or to his ability to make full answer and
defence.52
The Supreme Court used the case to clarify the proper approach to the production
and disclosure of records in sexual assault cases. Once therapeutic records had fallen
into the hands of the Crown, then the Crown’s duty to disclose all relevant material
to the accused would apply. Neither the privacy interests of the complainants or any
privilege they might assert could be balanced against the accused’s rights.
This part of the Supreme Court’s decision was widely criticized. Parliament inter-
vened and enacted new legislation that instructed judges to balance the accused’s
right to make full answer and defence with the complainant’s right to privacy and
equality before deciding whether to order the production of the record to the judge or
its subsequent disclosure to the accused.53
As a result of the Supreme Court’s ruling, a new trial was ordered for Bishop
O’Connor. At the new trial, the nineteen-year-old complainant who had been
O’Connor’s secretary and also a member of the school’s travelling pipe band had tes-
tified that she had removed her clothes because she was afraid of losing her job and
her opportunity to travel with the band. In his own defence, O’Connor took the stand.
He defended the two rape charges by arguing that his former students had consented
to sexual intercourse. He denied the two other charges of indecent assaults.
O’Connor was convicted of one count of rape and one count of indecent assault and
acquitted on the two other counts. The trial judge stressed inconsistencies between
what the complainants told the police and their testimony, even though inconsisten-
cies were in part caused by the age of the case and the prolonged nature of the prelim-
inary battle over disclosure.
The trial judge sentenced O’Connor to two and half years imprisonment for the
rape and three months for the indecent assault to be served concurrently. The judge
also considered victim impact statements, including that of the victim in the rape con-
viction who stated that
The effects of this trauma have had a devastating impact on my emotional
well-being. As a young woman during my twenties and thirties, I had little es-
teem after this tragic event. I felt I could trust no one. I felt helpless and I could
not tell anyone what happened. I thought they would not believe me or that they
would not understand the shame I carried for years. Many times I felt vulnerable
and I was an object and not a person.54
The three-month sentence for the indecent assault conviction seems inordinately
light, given that it involved an abuse of power against a young girl who was a student
at the school. However, the story didn’t end there. O’Connor immediately appealed
the two convictions. He sought but was denied bail. 55 He renewed the request for bail
or supervised freedom in the community and was granted bail pending appeal after
serving six and a half months in prison.56
In the end, this was the only jail time he served. The British Columbia Court of
Appeal overturned both the rape and indecent assault convictions. It ordered that
O’Connor face a new trial on the rape charge. The Court of Appeal also entered an
acquittal on the indecent assault charge on the basis that the verdict was unreason-
able given inconsistencies in the evidence.57
The new trial of Bishop O’Connor on the one remaining rape charge was never held.
Instead, a long healing circle was held at Alkali Lake. It was attended by about sev-
enty members of the community, O’Connor and his lawyers, prosecutors and senior
justice officials, and one of the complainants. The complainant had already testified
three times at court. She said she was not sure if she “had the strength or the energy
to go through it all again.” The complainant was frustrated that the court system had
never let her express to O’Connor her feelings about the pain he had caused her. Her
sister-in-law said that a circle based on trust, respect, and honesty was “one of the
most painful and fearful processes O’Connor has ever had to go through,” probably
more so than another trial.58
In the healing circle, O’Connor did not admit to raping the complainant. He did,
however, acknowledge that it was wrong for him as her employer and former school
principal to have sex with the complainant when she was eighteen years of age. The
complainant told reporters that “it was nice to get out of the control of the court
system and out of the control of O’Connor himself. There was no way at Monday’s
Healing Circle that he got away with anything. I would say he felt some of the fear and
pain that natives have felt for all these years.” She recognized that O’Connor’s apology
was not an admission of criminal guilt, but the complainant said that “the apology to
me meant a lot because it came from him personally. The important thing for me and
my people is to move beyond the constant pain and to become stronger.”59
The denial of access to civil justice: Systemic issues

Civil law allows one person or party to take another to court, in search of financial
compensation (also called damages) for a wrong that is presumed to have taken place.
Having generally failed to find justice through police investigations and criminal pros-
ecutions, residential school Survivors increasingly turned to the civil justice system.
The residential schools civil litigation started in the 1990s represented the most exten-
sive engagement between Aboriginal people and the civil justice system. The history
of that development is worth considering.
Early after Confederation, the federal government had adopted, and publically
communicated, the questionable legal view that Aboriginal people who were subject
to the Indian Act were under a legal disability and were the ‘wards’ of the Crown. They
justified this on the basis that ruthless individuals could and would take advantage of
them, and therefore Aboriginal people needed to be ‘protected’ from such persons,
and from themselves. For example, through amendments to the Indian Act, limita-
tions were placed on the ability of First Nations people to market farm produce or dis-
pose of their own personal property.60 In her work, historian Sarah Carter points out
that many Aboriginal farmers were running successful agricultural operations before
and after Treaties were negotiated. Government interference with those operations
after the limitations were put into place rendered those farmers into peasant farmers,
able to make barely enough to feed themselves and their families.61
While on the face of it, the stated desire to protect Aboriginal people would be
commendable, it seems more likely, based on all of the available evidence from this
period, that the real purpose behind such amendments and public messaging was to
allow the government to exercise greater control over the lives of First Nations peoples
and their lands. The government certainly had no interest in ‘protecting’ Aboriginal
peoples who were not governed by the Indian Act or once they had surrendered their
status under it.
For many years, Aboriginal people were hindered in seeking legal redress in the
courts of Canada because of provisions in the Indian Act. Provisions enacted in 1927
forbade them or anyone on their behalf from raising money to begin court action,
or from beginning legal proceedings against the government, without the minister’s
permission.
Such limitations clearly had a chilling effect on the willingness of Aboriginal people
to turn to the civil system to address their disputes with government or to assert the
rights they felt they continued to have. In addition to the legislative hurdles such pro-
visions posed, First Nation people also saw the risks inherent in challenging decisions
and enactments of a government who controlled the laws, the legal administration,
and the appointment of judges to the courts they would have to use.
The Aboriginal experience with the civil courts generally reinforced that view. For
example, in the leading court decision from the nineteenth century of St. Catharine’s
Milling v. The Queen, the Judicial Committee of the Privy Council placed serious lim-
itations on the nature of Aboriginal title and entrenched into law the view that Crown
sovereignty held a superior and overriding position.62 This was a case about whether
the federal government had the right to issue lumber permits in surrendered ter-
ritory. The Province of Ontario argued that it controlled land surrendered to the
Crown by Indians through Treaty. The court held, in the absence of any Aboriginal
participation, that Aboriginal title to their lands was granted to the Indians by the
Royal Proclamation of 1763, and existed only at the will of the Crown. Aboriginal
title the courts held was merely a “personal and usufructuary right”—meaning that
it was only a right to use—and was not equivalent to legal title. Because the case was
primarily about timber permits, the only parties appearing in the case were those
for the federal and provincial governments and the milling company. Evidence from
Aboriginal people was not present. This very narrow legal view remained the law for
over eighty years.
The decision of the Supreme Court of Canada in Calder v. The Queen in 1973
changed everything.63 In that decision, the court recognized the legal validity of
Aboriginal title but was divided on the question of whether it still existed in British
Columbia. It was a landmark case in more ways than one. It represented not only a
shift in legal thinking; it also caused Aboriginal leaders and their advisers to think
about the possibility that perhaps the courts, under the leadership of the Supreme
Court, were prepared to rethink some of their earlier limiting legal precedents.
Subsequent decisions have affirmed that confidence, but there was little reason for
any confidence in the early years.
At one level, residential school litigation could be defined as a success story because
it produced the largest class action and settlement in Canadian history with over
$4 billion being paid out to residential school Survivors under the terms of a court-
approved settlement. Despite the magnitude of the settlement, the performance of
the legal system is less effective than it may seem. The residential school litigation was
extremely complex, expensive, and lengthy. Even in cases where defendants decided
to settle, Survivor’s faced challenges and possible re-victimization in order to assert
their claims. For example, Survivors sometimes had to endure insensitive questioning
or adversarial cross-examination in pretrial discoveries where judges are not present
to prevent the harassment of witnesses. As in the criminal justice system, the Survivors
often felt they were put on trial and re-victimized by residential school litigation.
Some of the failings of the civil justice system can be seen in the case of one con-
victed abuser. William Starr was the administrator of the Gordon’s residential school,
north of Regina. A number of criminal investigations involved allegations against
Starr between 1968 and his retirement in 1984. During that time, the school was
administered by the Government of Canada. In 1993, Starr was sentenced to four and
a half years for sexually assaulting ten boys at the school.64
Subsequently, hundreds of civil lawsuits were commenced by former students of
the Gordon’s school against Canada and against Starr. Given the criminal convictions,
it might be expected that these cases would be relatively simple to conclude. However,
these cases imposed further hardships on Survivors.
Higher standards of proof
Survivors in civil litigation should only have been required to prove that they were
sexually abused on a “balance of probabilities”—in other words, that it was more
likely than not that they had been sexually abused. This civil standard is much lower
than the “beyond a reasonable doubt” standard used in criminal trials. However, in
practice, civil courts often appear to apply higher standards of proof in cases where
sexual abuse is alleged.
Minor inconsistencies in Survivors’ accounts led to the dismissal of many claims.
A thirty-two-year-old member of the Key First Nation in Saskatchewan claimed he
was sexually assaulted by William Starr at the Gordon’s school in 1968.65 By the time
of this civil suit, Starr had already pleaded guilty to ten criminal charges. Yet, at the
civil trial, Starr denied some of the specifics of the allegations but also “acknowledged
that he cannot now remember all the children he had sexual contact with over the 16
years he was at Gordon’s. He says there could have been hundreds of victims.”66 The
plaintiff was subject to an adversarial pretrial discovery process in which civil litigants
(through their lawyers) are allowed to ask each other questions under oath without a
judge being present, but with their answers recorded for possible use in the civil trial.
The plaintiff was subjected to this difficult process first in 1997, then again in 1999, and
for a final time in 2000.
Because of inconsistencies in the details of his testimony at trial and in the previ-
ous discovery examinations, the trial judge found that the plaintiff was not credible.
The judge reached this conclusion on the basis that the head injury and addictions
suffered by the plaintiff likely contributed to the inconsistencies in his testimony. The
judge said, “I am unable to accept his evidence as proof of the events described.”67 He
added, “I do not find the plaintiff’s evidence to be assisted in any way by Starr’s failure
to recall, nor by his willingness to say anything is possible.”68 This case demonstrates
one of the principal difficulties that former students faced.
Vicarious liability
In some of the William Starr cases that went to trial, Starr was held liable for sex-
ual abuse and Canada was held “vicariously liable” for his actions. Vicarious liability
means that one defendant, such as the government, is legally responsible for the fault
of another defendant, such as Starr, on the basis that the second defendant acted under
the direction or control of the first. Vicarious liability was the most frequent basis on
which the federal government and the churches were held liable for sexual abuse in
the schools, as opposed to being held directly responsible for the harms that resulted
from the abuse. Residential school Survivors benefitted from judicial expansions of
the vicarious liability of organizations during the time period of the litigation.69
In the case of William Starr, Canada generally conceded that it was vicariously lia-
ble for the actions of its federally appointed school administrator. This approach was
efficient, but it avoided determining whether Canada or the churches were indepen-
dently at fault for the harms that Survivors suffered at residential school. It created the
impression that what happened to Aboriginal children at residential schools was the
result of the government and churches making mistakes by hiring pedophiles and by
giving them responsibility over the children.
The vicarious liability theory was consistent with the “bad apple” theory that
focused on the criminal behaviour of a few administrators within the schools as
opposed to the intrinsic harm caused by the residential schools themselves. It fed
into public perceptions that the problem of residential schools was that a few pedo-
philes were allowed to prey on children, as opposed to recognizing and acknowl-
edging that residential schools themselves were part of a larger genocidal attack on
Aboriginal culture.
Statutes of limitation
Limitation periods allow defendants to have cases dismissed if too much time has
elapsed. Although a statute of limitation can protect a defendant from a civil lawsuit,
it can also have the effect of denying a plaintiff an opportunity to have the truth of the
allegation determined on its merits or to receive compensation for a wrong.
The courts do not automatically apply a statute-of-limitation defence. It has to
be raised by the defendant. The Law Commission of Canada, in its 2000 report on
responding to child abuse in institutions, recommended that the federal government
should not rely on statute-of-limitations defences.70 This recognized that the federal
government is a unique litigant, unlike individual or even a corporate defendants,
because it can use public funds derived from taxes to pay damages. It also keeps
records longer than most defendants because of their historical significance and as
such is in a better position to defend itself in historical litigation after the time limit in
a statute of limitation has passed.
The federal government possessed many of the documents that would establish
whether allegations about long ago events were accurate. This is especially true in the
Aboriginal context where the Truth and Reconciliation Commission itself has discov-
ered that the federal government has a wealth of documents about residential schools
that were not always disclosed to this Commission as fully and promptly as they should
have been. Nevertheless, the Government of Canada, as well as the churches, has fre-
quently and successfully raised statute-of-limitations defences in residential school
litigation. Canadian courts applied statutes of limitations to bar many claims made by
residential school Survivors relating to loss of language, culture, and family relations.
Some courts even applied statutes of limitations to bar claims relating to sexual abuse.
For example, the Manitoba Court of Appeal concluded in a 2001 residential school
case that the Oblates had “a vested right to be immune from claims 30 years after the
respondents left the school.” It stressed that it would be unfair for the Oblates “to have
the sword of Damocles hanging over their head forever” and that it was up to the legis-
lature to intervene “if societal standards of the past are later regarded as unacceptable
or unjust in the eyes of a new generation.”71 The next year, the Manitoba legislature
amended the Limitation of Actions Act so that it would not apply to actions based on
assaults if they were of a sexual nature or other assaults if the plaintiff was dependent
on one of the persons alleged to have committed the abuse.72
Not all legislative reforms during this era were as enlightened. Alberta enacted a
ten-year ultimate limitation period that would apply regardless of when a cause of
action was reasonably discoverable.73 This forced many Survivors to rush to file res-
idential school claims.74 Some provinces, such as British Columbia, only provided
exemptions from statutes of limitations for childhood sexual abuse, and the BC Court
of Appeal refused to extend the exemption for childhood sexual abuse to other forms
of abuse of children.75
The early civil cases involving William Starr all focused on sexual abuse even though
Survivors were concerned about a much broader range of harms that they suffered at
residential school. Saskatchewan’s Limitations of Actions Act provided that no limita-
tion periods applied to claims relating to “misconduct of a sexual nature.”76 This meant
that it was easier and sometimes necessary for lawyers representing the plaintiffs to
focus on sexual misconduct rather than other matters.
26) We call upon federal, provincial, and territorial governments to review and amend
their respective statutes of limitations to ensure that they conform with the prin-
ciple that governments and other entities cannot rely on limitation defences to
defend legal actions of historical abuse brought by Aboriginal people.
Third-party claims against Aboriginal bands
Canada employed aggressive litigation tactics in some of the cases arising from
William Starr’s abuse of students. In two instances, the Attorney General of Canada
sought and was granted permission to make a third-party claim asserting that the
plaintiff’s own First Nation (the Gordon First Nation) was responsible for the abuse
by sending children to the residential school and having an advisory board for the
school.77 This defence strategy not only added additional expense and delay to the lit-
igation but sought to blame a First Nation that was itself victimized by the residential
school.
The “crumbling skull” argument
Even in cases where Canada accepted vicarious liability for sexual abuse, the
Survivors faced difficulties in establishing damages. The Attorney General of Canada
had considerable success with so-called “crumbling skull” arguments. These argu-
ments assert that while the Survivors experienced difficulties in their lives, these
difficulties were not sufficiently related to being sexually abused in the schools to be
compensable. The argument was that Survivors were already damaged before they
came to the schools. They had “crumbling skulls” and would have experienced diffi-
culties, such as unemployment, addictions, and imprisonment, even if they had not
been abused in the schools.78
In one William Starr case, the trial judge reduced a successful plaintiff’s damages
for loss of earnings by 50% on the basis that his troubled family life meant he would
have made less than an average worker even if Starr had not sexually abused him. The
judge stated,
The plaintiff was raised in poverty. He was the youngest of eight children born
to an alcoholic mother. He never knew his father (apparently all his siblings had
different fathers). His mother was unable to care for her children and, con-
sequently, the plaintiff was removed from her care and placed in the student
residence … He attended several different schools and was introduced to alcohol
and drugs at an early age by his peers. His siblings have all had problems with
drugs and/or alcohol and difficulty in holding employment. Many do not have a
high school education and none have post-secondary education.79
The court did not appear to consider the possibility that the life and home situation
upon which it relied to reduce the plaintiff’s damages may have themselves, been the
result of residential school experiences, or past government actions. This approach to
damages essentially blamed the victim and his family for many of the problems that
the victim experienced.
Re-victimization
Several of the Starr cases that were settled still resulted in adversarial litigation
about the terms of the settlement. In 1998, Canada successfully opposed paying for
treatments for a number of plaintiffs even though the treatment expenses had been
capped by the settlement at $15,000, and even though a therapist mutually approved
by Canada and the plaintiff had proposed the treatment. The rejected treatment plans
included those that would have provided money for post-secondary education, alco-
hol addiction treatment,80 and a fitness club membership.81 The rejection of these
proposed treatments as luxuries unrelated to the harms also fed into media and pub-
lic perceptions that the Survivors were abusing the system. The courts at times took
very narrow approaches to the harms caused by residential schools by, for example,
dismissing alcohol addiction treatment as not related to the admitted abuse that
occurred.
Even when the courts approved treatment plans, they demonstrated distrust that
the Survivors would abuse the funds that Canada had agreed to pay by specifying in
detail what sort of payments would be allowed to cover travel and accommodation
costs. In such cases, the Canadian legal system remained a colonial and an intrusive
presence in the lives of the Survivors that frustrated reasonable healing attempts.
Breach of fiduciary and statutory duty
Survivors brought a wide variety of different legal claims in their residential school
litigation. Breach of fiduciary duty was often alleged because of the long-standing trust
relationship between Aboriginal people and the Crown as well as the dependency of
the children in the schools. This cause of action also had the advantage of avoiding
prescription periods. The courts have recognized a distinct fiduciary duty designed to
protect the relationship between the Crown and Aboriginal peoples. Claims for breach
of fiduciary duty had the potential to highlight how the schools betrayed Aboriginal
children, highlighting the fact that those abused in the schools were children and they
were Aboriginal and that the government and the churches put their own interests in
assimilation, indoctrination, and saving money before the interests of the Aboriginal
children. However, the courts frequently refused to find breach of fiduciary duty.
Judges noted that litigants were unable to prove there was any intentional dishonesty
on the part of those who held the fiduciary duty.82
Another claim of liability that was frequently dismissed by the courts was that
of direct or statutory duty. Lawyers for the plaintiffs claimed that Canada had a
direct duty that it could not delegate or hand off to the churches with respect to the
treatment of the students. The statutory duty approach would emphasize that the
government was directly at fault for failing to protect the children in the schools
and not simply vicariously responsible for the wrongdoing of individual wrongdoers
employed in the schools. However, claims based on breach of fiduciary and statu-
tory duty frequently failed.83
Denying loss of family, language, and culture
The courts were reluctant to recognize claims that Survivors made seeking com-
pensation for loss of family, language, and culture. Often these claims were dismissed
on the basis that they had been brought too late and that statute of limitation defences
applied to these claims, in a way that they did not apply to claims of sexual and some-
times serious physical abuse.
The Alberta courts dismissed such claims and the Ontario Court of Appeal found
that children of Survivors of residential schools could not bring claims under the
Family Law Reform Act because it did not apply retroactively to the schools.84 The
eventual settlement of the litigation was limited to claims made by the living Survivors
of the schools. One British Columbia court specifically noted that it was “not here
assessing damages for the cultural destruction suffered by native peoples.”85
Considering that one element of the UN Convention on Genocide involves recog-
nizing that the forcible removal of children from one group to another group for the
purpose of wiping out the racial identity of the children is a crime, it is difficult to
understand why courts have not been more willing to recognize at least intentional
acts of cultural and racial destruction or deprivation as a compensable tort.
Denying loss of Aboriginal and Treaty rights
The creation and operation of residential schools also constituted a breach of Treaty
rights, which recognized that education was important for Aboriginal people but was
to be provided on reserves and on the terms that Aboriginal communities desired.
Treaty 1, for example, provides that, “Her Majesty agrees to maintain a school on each
reserve hereby made, whenever the Indians of the reserve should desire it.”86 Treaty
3, Treaty 5, and Treaty 6 all provide that “Her Majesty agrees to maintain schools for
instruction in such reserves hereby made as to her Government of her Dominion of
Canada may seem advisable, whenever the Indians of the reserve shall desire it.”87
Despite such clear language, claims relating to breach of Aboriginal and Treaty
rights did not have much success in the courts. In a number of cases, the courts ruled
that Aboriginal and Treaty rights could not be positively asserted by individuals.88
This approach had the effect of eroding the power of Aboriginal and Treaty rights as
constitutional rights. Other Canadians are able to assert constitutional rights in indi-
vidual proceedings for damages, but by classifying Aboriginal and Treaty rights as col-
lective rights, the courts were able to deny individual claims based on them.
Class actions
In a class-action lawsuit one party sues as a representative of a larger ‘class’ of peo-

ple. Such suits are seen to serve a public benefit because they reduce overall costs by
eliminating the need for repetitive hearings, allow for greater access to the courts, and
can modify the behaviour of actual and potential wrongdoers.89 Changes in Canadian
law in the 1990s created the opportunity for Survivors to make use of class-action law-
suits to pursue their claims for compensation. As late as 1991, such suits were per-
mitted only in Québec.90 Ontario adopted legislation allowing for class-action suits in
1992.91 British Columbia’s class-action legislation came into force in 1995.92 Alberta
adopted its legislation in 2003. In the following years, most other provinces adopted
similar legislation.93
In October 1998, a group of Survivors of the Mohawk Institute in Brantford, Ontario,
filed a statement of claim in the Ontario Superior Court on behalf of all students who
attended the school between the years 1922 to 1969, as well as their families.94 The
plaintiffs, who were led by Marlene Cloud, claimed $2.3 billion in damages from the
federal government, the General Synod of the Anglican Church, the New England
Company (the missionary society that operated the school), and the local Anglican
diocese, for the sustained, systematic program of physical, emotional, spiritual, and
cultural abuse they suffered.95 Cloud and the other Survivors claimed damages for a
breach of fiduciary duties, breaches of the Family Law Act, loss of culture and lan-
guage, and breach of Treaty and Aboriginal rights.96
In June 2000, Charles Baxter Sr., Elijah Baxter, and others filed a class-action law-
suit against the federal government in the Ontario Superior Court. The statement of
claim sought damages for negligence, breach of statutory duties under the Indian
Act, and breach of Treaty obligations.97 Since it included claims on behalf of students
who attended residential schools throughout Canada, it was often referred to as the
“national class action.”98 Over time, Survivor associations and litigants from around
the country joined the Baxter class-action suit.
In October 2001, Justice Roland J. Haines of the Ontario Superior Court declined to
certify the Cloud case, saying that that the experiences of the students were too diverse
to constitute a representative class, that many of the claims would be barred by stat-
ute of limitations provisions, and that the plaintiffs failed to establish that a class-
action suit was the preferable procedure for their claims.99 The decision was upheld
by the Ontario Divisional Court.100 In December 2004, however, the Ontario Court
of Appeal overturned the earlier rulings and certified the Cloud case.101 The Court of
Appeal stressed that that class actions were preferable to individual actions because
they would increase “access to justice.”102 This was a very important decision and the
Supreme Court’s refusal to hear an appeal of this decision played an important role
in encouraging the government and the churches to settle all of the claims through a
national class action settlement agreement.
Lawyer fees
Throughout the civil litigation period, many residential school Survivors were
unable to afford the legal fees required to file suit against the federal government. As
a result, individual Survivors were usually required to access legal services on a con-
tingency basis, which meant that they would not pay their lawyers unless they were
successful in obtaining compensation. In most residential school litigation, the con-
tingency fee arrangements provided that lawyers would receive at least 30% of any
compensation awarded to the Survivors. Contingency fees had traditionally been pro-
hibited in Canada because of a concern that lawyers might act unethically if they had
a financial stake in the litigation. These restrictions were eased in many jurisdictions
to increase access to justice. This change combined with the new availability of class
actions made residential school litigation economically feasible.
The Commission acknowledges that residential school litigation would likely not
have happened without the possibility of contingency fees that compensated lawyers
for investing in the cases of Survivors who were unable to pay legal fees. In most cases,
publicly funded legal aid or any other form of public funding for such litigation was
not available. However, the payment of legal fees became one of the most difficult
issues in reaching the settlement. The combination or rules governing contingency
fees and class actions had provided lawyers with an incentive both before and after
the settlement to represent as many Survivors as possible, thereby increasing their
legal fees. In some, but by no means all, cases this resulted in Survivors not being well
understood or served by their own lawyers.
There were numerous reports of aggressive, damaging, and sometimes unethical
and illegal tactics employed by some lawyers in recruiting residential school Survivors
as clients. Several lawyers were the subject of law society complaints and reprimands
about the way they recruited and represented residential school Survivors and col-
lected legal fees. In the end, the Indian Residential Schools Settlement Agreement
provided a process under which one firm, the Merchant Law Group, would receive
between $25 and $40 million in fees.103 The Law Society of Saskatchewan, in a decision
later upheld by the Court of Appeal, reprimanded Tony Merchant in connection with
a misleading solicitation letter that suggested that the Survivors “had nothing to lose.”
In late January 2015, the Government of Canada filed a suit against the Merchant Law
Group alleging that the group claimed millions of dollars in fees that were “intention-
ally inflated, duplicated or simply fabricated.” The suit also alleges that some individ-
ual lawyers billed for more than twenty-four hours of work in a single day.104
Response of the law societies
Although many lawyers worked hard for Survivors and tried to be sensitive, some
lawyers took advantage of their clients and this abuse simply added to the legacy of
residential schools. It also has influenced the attitudes of Aboriginal people towards
the Canadian legal system.
In August of 2000, the Canadian Bar Association recognized some of the difficul-
ties that aggressive and culturally insensitive solicitations created for Survivors and
enacted the following resolution:
whereas survivors of Aboriginal residential schools are often vulnerable and in
need of healing as well as legal assistance;
whereas the identity of persons who attended Aboriginal residential schools is

available without their consent;
whereas survivors of Aboriginal residential schools wanting to seek compen-

sation from the Government of Canada and the churches involved should have
legal assistance which takes into account the potential impact on their well-be-
ing when they begin to address their abuse;
be it resolved that:
1. The Canadian Bar Association urge each law society to adopt the following
guidelines for recommended conduct for lawyers acting or seeking to act for
survivors of Aboriginal residential schools, that recognizes their vulnerability
and need for healing:
(a) Lawyers should not initiate communications with individual survivors of Ab-
original residential schools to solicit them as clients or inquire as to whether
they were sexually assaulted;
(b) Lawyers should not accept retainers until they have met in person with the
client, whenever reasonably possible;
(c) Lawyers should recognize that survivors had control taken from their lives
when they were children and therefore, as clients, should be given as much
control as possible over the direction of their case;
(d) Lawyers should recognize that survivors may be seriously damaged from
their experience, which may be aggravated by having to relive their child-
hood abuse, and that healing may be a necessary component of any real set-
tlement for these survivors. Lawyers should therefore be aware of available
counselling resources for these clients to ensure that they have opportunities
for healing prior to testifying;
(e) Lawyers should recognize that damage to the survivors of Aboriginal resi-
dential schools may well include cultural damages from being cut off from
their own society, and should endeavour to understand their clients’ cultural
roots;
(f ) Lawyers should recognize that survivors are often at risk of suicide or vio-
lence towards others and should ensure appropriate instruction and training
for their own employees, including available referrals in time of crisis.105
27) We call upon the Federation of Law Societies of Canada to ensure that lawyers
receive appropriate cultural competency training, which includes the history and
legacy of residential schools, the United Nations Declaration on the Rights of
Indigenous Peoples, Treaties and Aboriginal rights, Indigenous law, and Aboriginal–
Crown relations. This will require skills-based training in intercultural competency,
conflict resolution, human rights, and anti-racism.
28) We call upon law schools in Canada to require all law students to take a course in
Aboriginal people and the law, which includes the history and legacy of residen-
tial schools, the United Nations Declaration on the Rights of Indigenous Peoples,
Treaties and Aboriginal rights, Indigenous law, and Aboriginal–Crown relations. This
will require skills-based training in intercultural competency, conflict resolution,
human rights, and anti-racism.
Slow progress towards compensation

Despite a variety of barriers posed by the legal system, slow progress was being
made to win justice for Survivors of residential schools. This progress resulted from a
combination of legal and political processes and culminated in the negotiation of the
Indian Residential School Settlement Agreement in 2006.
Alternative Dispute Resolution
In 1998 and 1999, there were discussions involving Survivors, Aboriginal organi-
zations, and representatives of the government and the churches that produced a
set of principles to guide twelve different pilot initiatives, called Alternative Dispute
Resolution Projects (adr). The principles for the pilot adr stressed the need for a sen-
sitive and safe approach that would promote “healing, closure and reconciliation.” It
could include monetary compensation, but also a broad range of remedies including
healing, memorialization, and prevention programs.106 Health supports would be pro-
vided in recognition that discussing what happened in residential schools was trau-
matic for many Survivors.
In 2001, the federal government created Indian Residential Schools Resolution
Canada as a federal department. It was designed to oversee the adr process. Under
the proposed program, the government required that those claiming injury lasting
more than six weeks submit many documents related to their income, treatment,
school, and correctional records. The program limited the relief available by not
providing compensation for loss of culture or language. It graded injury on a point
scale and provided caps on compensation of between $195,000 and $245,000 with
the cost of future care being capped at $25,000. Those who claimed injury lasting
less than six weeks would receive a maximum of $1,500, which could be raised by
additional amounts to a maximum of $3,500 if aggravating circumstances were
established.107
A report produced by the Assembly of First Nations (afn), released in 2004, was
highly critical of the proposed formula: “This cap … ignores the effects of the res-
idential schools on loss of language, culture, family life, parenting and secondary
harms to spouses and descendants. There is no provision to recognize or compen-
sate for emotional and spiritual abuse, neglect, forced labour or educational deficits,
or their consequences.”108 The report advocated a more flexible process that “would
be but a part of a holistic process with a truth-sharing component which would be
created in consultation with survivors, survivor’s families, secondary victims of resi-
dential school abuse, First Nation communities, religious entities, Canada and non-
Aboriginal Canadians.”109
The report expressed concerns that the caps on compensation were below some
awards provided to non-Aboriginal people. It proposed five principles for the equita-
ble settlement of claims:
1. Be inclusive, fair, accessible, and transparent.

2. Offer a holistic and comprehensive response recognizing and addressing
all the harms committed in and resulting from residential schools.
3. Respect human dignity and equality and racial and gender equality.
4. Contribute towards reconciliation and healing.
5. Do no harm to Survivors and their families.110
The report drew attention to an important gap in the government’s ADR pro-
gram—namely, the absence of an Aboriginal perspective. The report stated that true
reconciliation and healing would be possible if the afn’s recommended changes to

the ADR program were followed.111
The afn report recommended a “two-prong strategy.” One prong would focus on
compensation and the other on “truth-telling, healing and public education.” The
compensation part would include “a significant lump sum award” to every person
who attended residential school “to compensate for the loss of language and culture,”
combined with another sum tied to each year or part of the year spent in residential
school to “recognize emotional harms, including the loss of family life and parental
guidance, neglect, depersonalization, denial of a proper education, forced labour,
inferior nutrition and health care, and growing up in a climate of fear, apprehension,
and ascribed inferiority. As a rule, no adjudication should be necessary for these
awards to be made.”112
The second truth-telling and healing track would include “a voluntary truth-
sharing and reconciliation process designed to investigate the nature, causes, context
and consequences of all the harms resulting from the residential schools legacy. This
would include, but not be limited to, harms to individual Survivors, First Nations com-
munities, Survivors’ families, the future generations, culture, spirituality, language
and relationships between and among all parties involved.”113 This recommendation,
like those made by groups of Survivors in the early 1990s and subsequently by the
Royal Commission on Aboriginal Peoples in 1996 focused on the collective harms of
residential schools and collective responses to those harms—a significant contrast to
the relentlessly individualistic focus of the litigation that excluded compensation for
students who had died and for the children of Survivors.
The inadequacies of the ADR process were also revealed in hearings conducted in
February 2005 by the House of Common’s Standing Committee on Aboriginal Affairs
and Northern Development. They heard from Flora Merrick, an eighty-eight-year-old
Elder whose $1,500 ADR award was being appealed by the federal government. The
issue was whether she should be compensated for “being strapped so severely that
my arms were black and blue for several weeks” and for being “locked in a dark room
for about two weeks” after she ran away from Portage la Prairie residential school.
Merrick explained that she was willing
to accept the $1,500 award, not as a fair and just settlement, but only due to my
age, health, and financial situation. I wanted some closure to my residential
school experience, and I could use the money, even as small as it was. I am very
angry and upset that the government would be so mean-spirited as to deny me
even this small amount of compensation … I’m very upset and angry, not only
for myself, but also for all residential school survivors.114
The Committee recognized the urgency of the matter and noted that “on aver-
age some 30 to 50 former students die each week uncompensated and bearing the
grief of their experience to the grave.” The Committee condemned the ADR process
unanimously and in very strong terms, concluding that it “regrets the manner with
which the Government has administered the Indian Residential Schools Claims pro-
gram” and that the ADR process should be terminated. It recommended that “on an
urgent basis, with consideration for the frailty and short life expectancy of the former
students,” the federal government should move to court-supervised negotiations with
former students to secure a court-approved settlement.115
The Settlement and its aftermath
On May 30, 2005, the federal government appointed former Supreme Court Justice
Frank Iacobucci as its chief negotiator. He met with representatives from Aboriginal
communities, church groups, the federal government, and various law firms. Six
months later, on November 10, 2005, an agreement in principle between the par-
ties was reached.116 The details of the settlement were finalized and approved by the
federal cabinet on May 10, 2006.117 As a result, the thousands of legal claims made
against the federal government and the churches would be settled, although individ-
ual Survivors would be able to opt out of the settlement of their class-action claims.
The settlement followed the broad outline of what was recommended in 2004 in the
afn report. All Survivors would be eligible for a Common Experience Payment (cep)
based on verified attendance at one of the residential schools listed in the settlement.
Claimants would receive a base payment of $10,000 for attendance, plus $3,000 for
each additional year or part year of attendance.
In addition to the cep based on attendance at a residential school, there was an
Independent Assessment Process (iap) available for those who suffered neglect, or
serious sexual or physical assaults such as severe beating, whipping, and second-
degree burning at the schools. This process would include compensation for assaults
by other students if there was a lack of reasonable supervision. The settlement con-
tained a points system where points were assigned both on the type and frequency of
assaults. The categories used were “serious dysfunction,” “some dysfunction,” “con-
tinued detrimental impact,” “some detrimental impact,” and “modest detrimental
impact.” Additional points could be awarded for difficulties in obtaining and retaining
employment and an inability to undertake or complete education resulting in under-
employment or unemployment. Verbal abuse and racist acts, humiliation, and the
witnessing of violence to others were also recognized as aggravating factors deserving
of additional compensation points. The total number of points awarded to a claim-
ant determined the amount of the claimant’s award. The maximum iap payment was
$275,000, but up to an additional $250,000 could be awarded in more complex cases.
The settlement included an iap application form. iap adjudicators were instructed
in the settlement to take an inquisitorial, truth-seeking approach in which they (and
not the lawyers) questioned the witnesses. Similarly, the adjudicators (and not the
lawyers) would commission expert reports. The adjudicators would be chosen not
only for their legal expertise but knowledge about Aboriginal culture and history and
sexual and physical abuse issues. Support persons, counselling from Health Canada,
and cultural ceremonies would be provided at the hearings. It was anticipated that
decisions would be speedily issued. The process would be private rather than pub-
lic and it would make room for support persons and cultural ceremonies often not
allowed in courts.
The settlement also had collective dimensions. In addition to compensation for
individual Survivors in the form of the cep and iap processes, the settlement provided
a $125 million endowment to the Aboriginal Healing Foundation “to support the
objective of addressing the healing needs of Aboriginal People affected by the Legacy
of Indian Residential Schools, including the intergenerational impacts, by support-
ing holistic and community-based healing to address needs of individuals, families
and communities.”118 An additional $60 million of the settlement funds would also be
devoted to a Truth and Reconciliation Commission “to contribute to truth, healing
and reconciliation,” through hearings and reports as necessary, with an objective of
creating a permanent and public record of the “legacy of the residential schools.”119
The settlement would also involve the termination of a number of class-action pro-
ceedings that the courts had authorized. Consequently, it was necessary for courts in
most provinces and territories to consider whether the settlement was a fair resolu-
tion of the claims and in particular whether it adequately protected the interests of all
the class members. After some modifications, court approval was eventually given in
all nine jurisdictions.120
Survivors and other Aboriginal people were aware of some of the shortcomings
in the settlement. Phil Fontaine, in his affidavit filed in support of the settlement,
described how his mother, Agnes Mary Fontaine, was taken from her family when she
was seven years old and forced to attend Fort Alexander residential school from 1919
to 1928. He described how his mother “suffered by being removed from the care of her
parents, family, and community, and not being allowed to speak her native language,
or practice traditional spiritual ways. She also suffered sexual, physical and emotional
abuse, and was given inadequate food, health care and education.”121 Chief Fontaine,
who acted as the executor of his mother’s estate after she died in 1988, recognized
that “it is tragic that so many have died during this fight to have the wrongs that were
perpetuated on Aboriginal people through residential schools acknowledged.”122 He
recognized that his mother, along with other deceased former students, would receive
no monetary compensation in the settlement. Nevertheless, he stated that he believed
that the agreement “honors the memory of those who have already died through the
commemoration and truth and reconciliation initiatives” in the settlement. He con-
cluded, “I do not believe that we could have reached an agreement that would have
provided more for the deceased and that compromise was required in order to ensure
that we could achieve some level of compensation for the living.”123
Exclusions from the Settlement
The claims of many former residential school students were excluded from the set-
tlement agreement. Rosalie Webber told the Commission that “it was very frustrating”
that schools in Newfoundland and Labrador were excluded. She also commented that
even if she pursued litigation she was concerned that no money would go to her chil-
dren. She explained,
And I realized how my children have suffered because their mother was a
survivor of residential school. Through no fault of their own they suffered. And
their children will suffer, ’cause it will take at least generations before we come to
terms with the anger that we’ve passed on, the negativity that we’ve passed on.
Now that my health is failing, I want to make a documentary of this so that if my
children want to do research, or my grandchildren, or maybe seven generations
from now, that there might be somewhere a record of the fact that I stood up.…
Our children and our children’s children have to stand up and see that this not
happen again. And that starts with me.124
Jayko Allooloo told the trc Inuit Sub-Commission that, although he received some
Common Experience Payment, he had been unable to access the iap process with
respect to sexual abuse suffered while going to school in Ottawa.
They told me that wasn’t a residential school and they can’t help me … I wrote
down my story of what happened to me in Ottawa. I gave all my school records to
the lawyer and he told me “The place you stayed in Ottawa was not a residential
school so we can’t help you.”125
Litigation has been commenced on behalf of some students who were excluded
from the Settlement Agreement. It is expected that the federal government and the
churches will aggressively litigate the issues as they have in the past, even though
there has been a relatively clear statement of the legal liability questions raised in the
earlier class-action cases. To continue to put Survivors through an aggressive litiga-
tion process when so much has already been resolved in earlier cases seems both
unnecessary and punitive. The Commission recognizes that there may be valid liabil-
ity questions that need to be addressed, such as the liability related to placing children
in hostels or foster homes in order to be educated in urban or other public schools in
the South as opposed to residences attached to or affiliated with schools. There may
also be questions about the government’s liability concerning those children sent to a
particular residential school managed by others but not by the government. It is noted
by the Commission that, in addition to the 139 schools included in the settlement
agreement, individual Survivors have asked and been denied approval for compensa-
tion for having been sent to more than one thousand other schools.
For such a large number of Survivors to be excluded from the settlement and its
benefits is to make them feel excluded from the apology and from the process of rec-
onciliation. In the long term, it is in their, and in Canada’s, best interests to address this
issue as quickly and as harmlessly as possible.
29) We call upon the parties and in particular, the federal government, to work collab-
oratively with plaintiffs not included in the Indian Residential Schools Settlement
Agreement to have disputed legal issues determined expeditiously on an agreed
set of facts.
Survivor perspectives on the Settlement
It is important to appreciate Survivor perspectives on the settlement both to under-

stand the full legacy of residential schools and to understand if there are remaining
issues and grievances that may provide a barrier to reconciliation. Leona Bird attended
St. Albans school in Prince Albert, Saskatchewan. She explained to the Commission
how the settlement for being sexually abused in residential schools did little to alle-
viate the long-lasting effects on her and her family. She told the Commission that the
residential school
took away my happiness. It took everything, everything that I had known for the
first four years of my life at home, love, understanding, and being taken care of,
and never being hit, or anything. But ever since, ever since I learned how I was
treated in school that, that really build up that anger, and I can’t seem to get rid
of it ... To this very day, I haven’t changed. My sister prays for and I pray. That’s
all I can say. This is how the Indian residential school taught me how to live my
life in a cruel, wicked way. I can’t take back what I’ve done in my lifetime. I was
forever being charged with assault, sent to jail 18 months at a time.126
Myrtle Ward stressed that no amount of money can repair the harm she suffered
in residential school. She told the Commission, “They can give us all the money they
want, but it’s not gonna compensate for what happened to peoples’ lives.”127
Geraldine Bob attended residential school in Kamloops and later went on to
become a teacher. She told the Commission at Fort Simpson that the money
doesn’t recreate society, it doesn’t recreate extended family and everything it
stood for. You can’t recreate intergenerational knowledge that was taken from
our people. You know I’ll never get those stories now; yeah from my grand-
parents and my parents. They’re lost, they’re gone. You can’t recreate a loving
way; all of that was lost. And that pain and suffering will continue well into the
future.128
Survivor perspectives on the Independent Assessment Process
A number of Survivors have expressed concerns to the Commission that their iap
and other damage awards were considerably reduced by lawyers’ fees. Joseph Martin
Larocque attended the Beauval residential school. He told the Commission,
I was mad at the government for what they do to us, so … I went through the
court process. I went through the Department of Justice through the courts,
and you know they, they gave me a little bit of money. They gave me a total of
$33,000. What I didn’t know was that the lawyer, the lawyer just to take my case
got $15,000, and then he took another 11 from me, so he got about 27 and I got
about 21, so, but, like, that’s how it goes, yeah.129
Mabel Brown told the Commission her iap payments amounted to about $25,000—
an amount she observed was not enough for a house or even a vehicle and that the
legal fees in the case amounted to $10,500. She recognized that the litigation process
meant that Survivors had “a hard time, each one of them who went and had to make it
public. That was so awful for them, I thought.”130
Marie Brown attended Sturgeon Landing Indian residential school. She told the
Commission about the inadequacy of attempts made in the iap system to classify the
degree of harm suffered by Survivors. She explained,
There’s no difference if you’re psychologically abused it’s the worst, worst thing
ever a person can ever go through. Because my feelings, you know, about abuse,
abuses, we were verbally abused … I was psychologically abused. I mean psy-
chologically messed up in my mind…. I felt like a reject, too, from everybody,
even my family ... And they, they can’t tell me that sexually and physically abuse
are more important than, than emotion. I, I don’t believe that one bit, ’cause I
went through is the same kind of a hurt that as they went through. There’s no
difference to me.131
Chief Theresa Hall, who attended residential school at Fort Albany, also expressed
considerable anger at the categorization of sexual abuse used in her case and other
cases of sexual abuse. She remarked,
Sexual abuse to a degree, “two.” That’s bullshit. Sexual abuse is sexual abuse,
you know. Touching when, when you’re not wanted to be touched is an abuse
of the child … If I were to find out that someone was, you know, doing that to
my child, my grandchild, I’d go ballistic, you know. There’s no way you could
stop me, and that’s the anger that, that I still have. They would have to put me
in jail, you know, and that’d make headlines, a former justice of the peace goes
in jail, [laughs] you know.132
The overriding concern that Survivors expressed was to question whether the sys-
tem actually gave them the justice they were looking for. Amelia Thomas attended
Sechelt residential school. She said,
You can’t get justice. How are you gonna get justice when the people that did this
to us are gone? ... Like, they have us all apply for these statements and then our
abuse … Like, I’ve been waiting 5 years now for my appeal, and it hasn’t hap-
pened yet. And it’s almost time for them to stop giving the money out to us. And
they opened up all our wounds for what? To turn us all down? And some people
are dying…. So, so, why did they do this to us, again? They hurt us again. They
shouldn’t go back on their word to us. They already hurt us. Stop hurting us.133
Some Survivors had their iap claims disallowed outright. Darlene Thomas told us
that after a “two-part” iap hearing, “one before Christmas and finished it in January,”
she was denied. Thomas explained,
They said it, it could not be true … I haven’t even got a written document. The
only thing that I got was I got an email from my lawyer saying they denied me,
that they didn’t believe me … I went home and I gathered up all of my residential
school documents and I went up to the mountain and I burned it. I said this is
my story, this is what happened to me. And I don’t give a shit who believes me or
who doesn’t.134
The overrepresentation of Aboriginal people in prison

Aboriginal people in this country are imprisoned at a rate far greater than non-
Aboriginal Canadians. The reasons are complex, and understanding those reasons—
and their relationship to the residential school experience—is essential to moving
towards reconciliation.
For example, in 2011, Aboriginal people made up 4% of the Canadian popula-
tion, yet they accounted for 28% of admissions to sentenced custody.135 As recently
as 2013, Aboriginal people constituted 23.2% of the federal inmate population. And
since 2005–06, there has been a 43.5% increase in the Aboriginal population in federal
prisons for those serving sentences of two years or more, as compared to a rise of 9.6%
for non-Aboriginal inmates. One report indicates that from 2010 to 2013 the Prairie
Region of the Correctional Service of Canada (primarily the provinces of Manitoba,
Saskatchewan, and Alberta) accounted for 39.1% of all new federal inmates, and that
Aboriginal offenders comprised 46.4% of the Prairie Region inmate population. This
included a majority of the prisoners at the Stony Mountain Institution in Manitoba
(65.3% of inmates) and the Saskatchewan Penitentiary and the Edmonton Institution
(63.9% of inmates).136
Of those admitted into provincial and territorial custody in 2011–12, Aboriginal
females accounted for 43%, compared to 27% for Aboriginal males.137 And in the same
year, 49% of girls below the age of eighteen admitted to custody were Aboriginal, com-
pared to 36% of males.138
When Aboriginal people are arrested and prosecuted, they are more likely to
be sentenced to prison than non-Aboriginal people. In 2011–12, only 21% of those
granted probation and conditional sentences were Aboriginal, yet Aboriginal people
comprised 28% of those sentenced to prison.139
The situation for Aboriginal youth is even worse. In 1998–99, Aboriginal youth
were 24% of sentenced admissions, but by 2011–12 they constituted 39% of sentenced
admissions.140
Prison today is for many Aboriginal people what residential schools used to be:
an isolating experience that removes Aboriginal people from their families and com-
munities. They are violent places and often result in greater criminal involvement as
some Aboriginal inmates, particularly younger ones, seek gang membership as a form
of protection. Today’s prisons may not institutionally disparage Aboriginal cultures
and languages as aggressively as residential schools did, but racism in prisons is a
significant issue. In addition, prisons can fail to provide cultural safety for Aboriginal
inmates through neglect or marginalization. Many damaged people emerged from
the residential schools; there is no reason to believe that the same is not true of today’s
prisons.
David Charleson, who attended the Christie school on Vancouver Island, explained
that he has
a record in jail so bad it’s unreal, but it’s all abuse charges, assault. I used to be
happier when I went to jail. Talking to the guards, and they’d say, “You’re back.”
And I’d say, “Yeah,” said, “I’m in a safe place.” I said, “It’s more safe than the
fuckin’ residential school,” pardon my language. “You know there’s a lot of bad
people here ... but you can’t hit me…. I feel good in here.” I said, “Yeah, I feel so
good the government is so stupid putting us in here. They’ll look after me more
than the residential [school] did.”141
Although jail may have been a safer place for David Charleson than residential
school, it held terrors for Daniel Andre, who also attended residential school. He
explained that after he left school
everywhere I went … everything I did, all the jobs I had, all the towns I lived in,
all the people I met, always brought me back to, to being in residential school,
and being humiliated, and beaten, and ridiculed, and told I was a piece of gar-
bage, I was not good enough, I was, like, a dog.... So one of the scariest things for
me being in jail is being humiliated in front of everybody, being made, laughed
at, and which they do often, ’cause they’re just, like, that’s just the way they are.
And a lot of them are, like, survival of the fittest. And, like, the, if they, if, if, if you
show weakness, they’ll, they’ll just pick on you even more, and whatever, and
then I’m gay, and, oh, fuck, it’s just too many things, like, and it’s almost like why
am I here? ... and I had to … I became a, a, a bad person, I became a asshole. But
I survived, and learnt all those things to survive.142
Raymond Blake-Nukon’s attended residential school, as did his parents. He
explained to the Commission at the Yukon Correctional Centre that,
this year I’ve been in jail for I think 21 years. This past Christmas was my 18th …
year in jail … Every time I come to jail, it’s for fighting … I just wouldn’t want any
of my kids to go, like, even just see any violence that, like half the violence that
I’ve been through, yeah. Yeah, I turned out to be a pretty violent guy. Up in the
penitentiary, you know, did a few stabbings in there, and on the street. I’m sur-
prised I never killed anybody yet. I don’t want to kill anybody. So want to, want
to get some help, and move on with my life.143
The reasons for overrepresentation
Although some Aboriginal people have been wrongfully convicted of crimes that
they did not commit, most are in jail for having committed some offence. The avail-
able evidence suggests that these offences are likely to be violent and are likely to
involve alcohol or other drugs. Over half of those who had been convicted had been
convicted of assault or sexual offences or driving offences, 24.2% had been convicted
of theft, 11.3% had been convicted of drug offences, 8.1% had been convicted of rob-
bery, and 4.8% had been convicted of murder.144 There are higher rates of crime on
reserve than off reserve.
The Commission cannot ignore these facts, as uncomfortable as they may be. We
also need to look beyond the statistics to hear from the Survivors about the reasons
why they committed offences. We must understand the reasons why those affected by
the intergenerational legacy of residential schools commit crimes if we are to reduce
offences among Aboriginal people and the growing crisis of Aboriginal overrepresen-
tation in prison.
Willy Carpenter was forced to attend the Roman Catholic school in Aklavik, nwt.
He recalled,
The RC Mission was the roughest place that I’d ever been in my life; the hostel,
you know, that school. We’d get picked on, get into a lot of fights; I was very
young but I learned how to fight. I had to protect myself. As I grew up, I kept that
up. I got married, and without realizing what I was doing, I’ve been teaching
my children what I know best; hardship, rough time … I started serving time at
a very young age; started going in jail. I was not even 17 years old when I went
to jail. Lots of us; I met a lot of my school mates in jail ... All my boys are in jail;
two of, two of my youngest ones, right now, are in jail; waiting for court. I blame
myself for that … The thing I do best, crime. I’m not proud of it. Now my boys
are in there. I’ve been teaching them without realizing that I was teaching them;
they learned it from me. It goes on and on; probably my kids will teach their kids
the same thing I taught them; I don’t know, who knows? Goes on and on and on;
life goes on.145
Ruth Chapman attended a residential school in Manitoba where she was subject to
physical abuse. She recalled that by fourteen years of age she had moved “to The Pas,
went on the streets. I was, I was nominated for a leader for a gang. Yeah, by that time
my heart was hard. This, this is when I got out of the residence.” She recalled how the
experience of violence made her violent:
I’ve learned through that rape, I have, I’ve, I’ve learned to have power over men.
Because when that guy, when that, when that situation occurred, he had a knife,
and, and but somehow I got my strength, and, and I, I, I kneed his back foot, and
he fell back, and I was gonna, then I somehow I managed to get that knife from
him, and, and then I almost jammed it into his throat, but I stopped, something
made me stop, and then he knocked the wind out of me…. I fought, and that’s,
that’s, that’s where I, I began to look at men as wimps, disrespected them. When
I get mad at a male, I would cut him up. ’Cause if you punch someone, it only
hurts, what, five minutes, but then you demean them with your words, ’cause
that’s what I learned, right, ’cause if you get someone mad in residence, man,
you were cut to pieces.… And so I learned that. Even my husband, you know, he
experienced some of the effects. I was charged a couple of years ago for beating
him up … I was always scared because of that anger. I knew I had the power with
that anger. So, basically that, I would fight on the streets, too, with men in, in The
Pas, I would, yeah.146
Many Canadians may fail to understand how the present crisis of Aboriginal over-
representation in prison is related to residential schools when many of the remaining
Survivors are over fifty years of age. The answer lies in the intergenerational effects
of the residential school experience that are passed on through families and often
through the child welfare systems. Diana Lariviere was hit with the strap in residential
school, and she saw her daughter using the same harsh techniques; “she’ll just say,
‘Mom, that’s how you taught us.’”147
While some social science research supports the connection between the residen-
tial schools and the commission of criminal offences, there is a need for more Canadian
data that examines this connection. In the absence of such data, the Commission has
examined examples of Aboriginal offenders. The picture that emerges through court
documents is one in which Aboriginal overrepresentation in prison can be directly
connected to problems experienced by Aboriginal people whose roots are deep in
the intergenerational legacy of residential schools. The list of such problems reads
like a social minefield. It includes, poverty, addiction, abuse, racism, family violence,
mental health, child welfare involvement, loss of culture, and an absence of parenting
skills. And one of the least well-understood but most insidious afflictions borne by the
inheritors of the residential school legacy is fetal alcohol spectrum disorder (fasd).
Fetal alcohol spectrum disorder
According to the 2002–03 First Nations Regional Longitudinal Health Survey con-
ducted by the First Nations Centre of the National Aboriginal Health Organization,
Aboriginal adults have a higher rate of abstinence from alcohol than the general
Canadian population. Rates of alcohol consumption also were lower. For example, in
2002–03 only 65.6% of First Nations people reported consuming alcohol, compared
with 79.3% of the general population. Also in that year, rates of alcohol consumption
were lower among First Nations females (61.7%) than among males (69.3%), and
increased with age.148 But for many Aboriginal people, alcohol consumption has dev-
astating consequences.
Fetal alcohol spectrum disorder is a permanent brain injury caused when a moth-
er’s consumption of alcohol affects the fetus.149 About 1% of Canadian children are
born with some form of disability related to maternal alcohol consumption, but esti-
mates suggest that 10% to 25% of Canadian prisoners have fasd. There is a growing
consensus that people with fasd more frequently come into conflict with the law. A
2004 study that involved a sample of 415 patients diagnosed with fasd found that 60%
of the adults sampled had come into contact with criminal justice systems as suspects
or as charged accused.150 A 2011 Canadian study found that offenders with fasd had
much higher rates of criminal involvement than those without, including more youth
and adult convictions.151
A study done for the Aboriginal Healing Foundation drew connections between
the intergenerational trauma of residential schools, alcohol addictions, and fasd and
concludes that the “residential school system contributed to the central risk factor
involved, substance abuse, but also to factors shown to be linked to alcohol abuse,
such as child and adult physical, emotional and sexual abuse, mental health problems
and family dysfunction. The impact of residential schools can also be linked to risk
factors for poor pregnancy outcomes among women who abuse alcohol, such as poor
overall health, low levels of education and chronic poverty.”152
The Aboriginal Corrections Unit of Corrections Canada has also sponsored research
on fasd. A 2010 workshop concluded that,
Although fasd has not been documented in the Aboriginal community to have
a greater incidence rate than that of other peoples, the fact remains that alcohol
abuse in Aboriginal communities is a serious issue. Furthermore, the children
and youth population of Aboriginal peoples is growing at a rate that exceeds
non-Aboriginal population of Canada. It is fair to make an assumption that
increasing numbers of young Aboriginal people are at greater risk of being born
with fasd. Without the necessary prevention and interventions, diagnosis and
treatment, it is also safe to assume that the secondary characteristics of fasd
will be pronounced, including involvement in the mainstream criminal justice
system.153
The workshop report went on to observe that “currently the justice system is set
up to fail fasd-affected individuals—poor memory functions results in missed court
appearances resulting in fail to appear charges.”154
One problem, especially with adult offenders, is the difficulty of obtaining an fasd
diagnosis. Obtaining such a diagnosis requires a long and costly process of multi-
disciplinary referrals. Even if trial judges have been educated about the symptoms
of fasd, they are generally unable to take notice of fasd without evidence of a diag-
nosis.155 An expert panel, using a jury-style format and chaired by retired Supreme
Court Justice Ian Binnie (known as the Binnie Jury) concluded in 2013 that “the indi-
vidual with fasd is in a bind. No resources. No diagnosis. No evidence. No judicial
notice. Therefore no fair and appropriate fasd–related accommodation is available
within the usual rigours of the legal system.”156 The Binnie Jury recommended that
exemptions be made available for offenders with fasd from mandatory sentences and
restrictions on conditional sentences, an important subject to which we will return.157
Only a small minority of the judgments of criminal courts in Canada make clear
connections between residential schools, fasd, and criminal offences. One partic-
ularly dramatic case involves C. L. K., a twelve-year-old Aboriginal girl in Manitoba
who pleaded guilty to committing manslaughter as part of an unprovoked and severe
fatal beating of a stranger who would not give cigarettes to her group. The judgment
referred to a pre-sentencing report that indicated that the girl was one of seven chil-
dren of parents who are “themselves victims, having suffered from their experience
in foster homes and residential schools.” The parents were described as incapable of
parenting and this was clearly the case. The entire family had been involved with Child
and Family Services since 1987 when the children were apprehended due to aban-
donment and parental alcohol abuse. The report described the family as in crisis:
Of C. L. K.’s six siblings, four are known to Correctional Services and two have
had gang involvement. C. L. K. herself has gang affiliations. As an example of
the total absence of parental guidance the report refers to C. L. K.’s story about
how she was first introduced to crack cocaine. She apparently bought the highly
addictive drug from a friend of her brother’s who came to the house selling it.
When she didn’t know how to use it her mother showed her how.158
C. L. K. was diagnosed with attention deficit hyperactive disorder (adhd). The
sentencing judge noted that “her exposure to drug and alcohol abuse, and her own
drug abuse while still relatively young (particularly her use of Percocet, Restoril, and
Valium), did little to help her when she was in school.” When the girl was previously
incarcerated at the Manitoba Youth Centre, “she was placed in the isolation cell 33
times and was involved in over 70 ‘incidents’ which warranted documentation.”159
In another case, R. v. Jessie George, an Aboriginal man received seven years for
manslaughter for brutally assaulting and killing his Aboriginal friend in a dispute over
a girl, after he had been drinking. Jessie George’s pre-sentencing report was summa-
rized thusly:
Mr. George’s mother was raised in residential school and foster homes and had a
very difficult time. She became addicted to alcohol at a young age. Her addiction
while pregnant with Mr. George affected his brain development. He has been
diagnosed with alcohol related neurodevelopmental disorder which is within
the class of fetal alcohol spectrum disorders. Mr. George’s father is deceased
… The offender’s mother and his step-father separated when Mr. George was 5
years old and he bounced between both homes, always subject to the neglect
and rejection born of alcoholism and drug dependency.160
George’s subsequent life was also chaotic. His “attempts to return to school were
defeated by his association with a gang that emphasized excessive drinking and drug
use. He fathered a child when he was in his teens…. At 18, the offender moved back
with his mother. He began selling and consuming street drugs as well as drinking heav-
ily to escape his sadness … Life revolved around ‘partying, getting drunk and going
to jail.’”161 The trial judge accepted that those with fasd “tend to be impulsive, unin-
hibited, and fearless. They often display poor judgment and are easily distracted….
FAS patients have difficulties linking events with their resulting consequences. These
consequences include both the physical e.g. getting burned by a hot stove, and the
punitive, e.g. being sent to jail for committing a crime. Because of this, it is difficult
for these individuals to learn from their mistakes.”162 In delivering his seven-year sen-
tence, the judge noted,
Mr. George did not ask for the hand he was dealt even before his birth. He did
not ask for a chaotic childhood. His mother did not ask for the hand she was
dealt in her childhood. Her inability to parent compounded the prenatal effects
of alcohol on Mr. George’s brain. These are handicaps he will have to deal with
for the rest of his life. I am sorry he has to deal with them. I hope he can over-
come them. Nevertheless, the court must be concerned with the risk this young
man presents to the public as a result of his impaired judgment and inability to
control his impulsive behaviour.163
In R. v. Charlie, the accused was sentenced to six months and three years probation
for armed robbery, failure to attend court, and breach of recognizance. In his reasons
for sentencing, Judge Heino Lilles made an explicit connection between the residen-
tial schools and fasd as follows:
Mr. Charlie is a status member of the Kaska Nation. He is from Ross River, Yu-
kon, a remote village with a summer population of 450, of which 90 percent are
of aboriginal descent. Mr. Charlie’s parents were six years old when they were
taken by the Indian Agents, along with other children in the community, to
residential school. The parents of these children had little choice in the matter,
as they were threatened with the loss of their rations if they did not cooperate.
At the same time, they were offered $6 for each child that was taken to the
residential school.164
Judge Lilles then observed,
This history of Franklin Charlie’s family is important because it identifies a
direct link between the colonization of the Yukon and the government’s residen-
tial school policies to the removal of children from their families into abusive
environments for extended periods of time, the absence of parenting skills as a
result of the residential school functioning as an inadequate parent, and their
subsequent reliance on alcohol when returned to the communities. Franklin
Charlie’s fasd is the direct result of these policies of the Federal Government,
as implemented by the local Federal Indian Agent. Ironically, it is the Federal
Government who, today, is prosecuting Mr. Franklin Charlie for the offences he
has committed as a victim of maternal alcohol consumption.165
These cases underline the link between residential schools, fasd, and offending
behaviour that leads to involvement with the criminal justice system. Given the higher
rate of Aboriginal involvement in the criminal justice system and the higher rates of
incarceration, there is a need to take urgent measures both to prevent and better man-
age the harmful consequences of fasd for Aboriginal offenders.
33) We call upon the federal, provincial, and territorial governments to recognize as
a high priority the need to address and prevent Fetal Alcohol Spectrum Disorder
(FASD), and to develop in collaboration with Aboriginal people FASD preventative
programs that can be delivered in a culturally appropriate manner.
34) We call upon the governments of Canada, the provinces, and territories to under-
take reforms to the criminal justice system to better address the needs of offend-
ers with Fetal Alcohol Spectrum Disorder (FASD), including:
i. Providing increased community resources and powers for courts to ensure

that FASD is properly diagnosed, and that appropriate community supports
are in place for those with FASD.
ii. Enacting statutory exemptions from mandatory minimum sentences of
imprisonment for offenders affected by FASD.
iii. Providing community, correctional and parole resources to maximize the
ability of people with FASD to live in the community.
iv. Adopting appropriate evaluation mechanisms to measure the effectiveness of
such programs and ensure community safety.]
Parental neglect
The connection between parenting skills and subsequent juvenile delinquency has
been noted by Canadian courts. In finding an Aboriginal accused to be a dangerous
offender, Justice J. E. Topolniski wrote, “For example, the negative attitudes displayed
by Mr. Ominayak should be seen in light of his background as an Aboriginal man
whose mother failed to learn parenting skills because her parents were products of
the residential school system.”166
In another case, an offender’s father testified at his son’s sentencing for sexual
assault. He apologized to his son because “as a result of his own residential school
experience, he did not know how to raise him properly.”167
In R. v. Jimmie, the accused, a residential school Survivor, received two years plus a
day for armed robbery. The Court of Appeal noted,
Ms. Jimmie is a member of the Kluskus community which is situated in a very
remote area of the Chilcotin. There are no counselling services on or near the
community. Her life was described as being “full of horrors.” She was raised in
poverty by an alcoholic mother who often left her and her siblings alone to fend
for themselves. Ms. Jimmie was sent to residential school where she was exposed
to an atmosphere of violence. She has a sixth grade education. In 1985, her sis-
ter’s body was found in a river; she had been badly beaten. That crime has never
been solved.
About eight years ago, Ms. Jimmie’s children were apprehended and placed in
foster care. At the time of her sentencing, her spouse was hospitalized because of
a mental breakdown.168
Family violence
Many studies have found that domestic violence and abuse are characteristics
of dysfunctional homes that are passed along through the generations. One study
based on 457 participants found that children who were exposed to domestic vio-
lence, or were themselves abused, or were exposed to both (47.5%) had higher
rates of committing felony assault in comparison to those who had no exposure.169
Research has shown that when male children witness the abuse of their mothers
in the home, it significantly increases their chances of becoming intimate abusers
later in life not only of their partners but also of their children. An American study,
whose sample of 1,000 persons included black, white, and Latino persons found
that mistreatment experienced during adolescence also increased the probability
of criminal behaviour. Percentages for late adolescent criminality were 58.7% for
general offending, 39% for violent offending, 30.4% for drug use, and 30% for arrest.
Although such studies are rare with respect to Aboriginal people in Canada, there is
support for the connections between residential school, family violence, and subse-
quent offending in published cases.
In R. v. Rossi, we see an example in which the accused was abused in residential
schools and then in turn abused his own family. The sentencing judge observed,
“Beverley’s life is an example of the cost of the impact of residential schools, reserva-
tion life, and racism. The abuse her father suffered at the residential school at Brandon,
Manitoba, resurfaced in his own relationships and he perpetuated a cycle of violence,
addiction and in turn produced a broken family.”170
In R. v. Snake, the judge noted that “classic background factors are present. The
accused as a youth suffered alcohol-related abuse by his step-father. The step-father
himself had a history with residential schools which might provide some explanation
for his abusive behaviour.”171
The Commission’s point is not to suggest that family violence and related problems
are valid excuses for serious offences. They do, however, help to explain them. The
intergenerational legacy of residential schools is an important background and con-
textual factor that helps explain Aboriginal overrepresentation in prison.
Racism
The residential school environment was deeply racist. It presumed the intellectual
inferiority of the children and it demeaned Aboriginal culture, language, and parent-
ing. The students were treated as if they were prisoners who required strict discipline
simply because they were Aboriginal.
One study compared African American men who experienced racial discrimination
(for example, racial slurs, racial profiling by police, having been physically attacked
because of race) to subjects who had not experienced racial discrimination. Those
who reported higher discrimination committed crimes of intimate-partner violence
more often (28%) in comparison to those who reported lower discrimination (16%).
Another study found that black youth who personally experience racial discrim-
ination had increased levels of general and violent delinquency.172 As far as the
Commission is aware, similar studies have not been conducted with reference to
Aboriginal populations in Canada. Nonetheless, there is persuasive anecdotal evi-
dence of Aboriginal persons experiencing racism both within and without residential
schools.
In R. v. D. M. G., the trial judge remarked on the troubled background of the accused
saying, “D. M. G. was born in 1965 to parents who had significant substance abuse
problems. Her mother was native and had attended the residential school … suffer-
ing the effects of dislocation, loss of identity and self esteem. Her father was French
Canadian and ostracized by his family because of his relationship with a native. D. M.
G. felt the sting of racial intolerance at an early age.”173
There are other cases where racial taunting and other forms of overt racial dis-
crimination have been recognized as contributing factors to a crime committed by an
Aboriginal person.174
Loss of culture
Residential schools played a significant role in the loss of traditional culture and
knowledge, including the loss of customary laws that could have acted as a positive
mechanism of social control and restraint against criminal behaviour. This has pro-
found consequences for contemporary Aboriginal communities. Carol La Prairie
worked as the executive director of the Native Council on Justice. She wrote about the
James Bay Cree:
Residential schools, the decline of traditional activities, the emergence of the
reserve system which binds people together in unnatural ways, and the creation
of band government which locates power and resources in the hands of a few
have dictated the form of reserve life across the country and have profoundly
affected institutions such as kinship networks, families, as well as the unspoken
rules of behaviour in traditional societies ... The lack of respect for others, and
the absence of shame about one’s bad behaviour and about harming another or
the community were, to many Cree for example, the most troubling aspects of
contemporary life.175
One 2010 Ontario study involving ninety-seven First Nations children and adoles-
cents living in foster care found that those with more opportunities to participate in
First Nations culture had significantly fewer behavioural difficulties.176
Many Survivors, including offenders, have told us that relearning and re-engage-
ment with Aboriginal cultures and languages was very important in supporting them
to make progress on healing so that they could live productive and law-abiding lives.
Although cultural programming is available in some prisons, there aren’t enough
resources devoted to such programs, and Aboriginal offenders can be denied access
to such programming on the basis of favoritism, punishment, or security classifica-
tions tied to an offender’s past criminal history.
Sexual abuse
The available social science evidence establishes a disturbingly strong connection

between being sexually abused as a child and the later sexually abusing of others. A
study of 471 participants found that a youth who was abused by a female was 3.89
times more likely to subsequently abuse a female than a youth who was not abused by
a female. A youth abused by a male was 6.05 times more likely to subsequently abuse a
male. A youth abused by both males and females was 1.88 times more likely to subse-
quently abuse both males and females.177 Another study involving 179 pre-adolescent
girls found that girls were 3.6 times more likely to experience sexual victimization if
the mother was herself sexually abused as a child.178
In R. v. J. O., the accused was sentenced to ten months jail time and eighteen
months probation for sexual assault. The judge stated,
As a child, the accused, like many other children of aboriginal communities,
had to go to residential school. From the time he entered residential school until
1969, the accused was sexually assaulted by two adults in authority. The assaults
included touching, masturbation, and kisses on the mouth. These events left a
deep-seated scar in the accused. Mr. J. O., until his last incarceration in the mid
1990s, had never revealed the assaults he suffered. The assaults left him in a state
of confusion where affection, love and sexuality are entangled. Due to these
traumatic events, the accused developed an alcohol-related problem. He admits
having started to drink by the end of his school years. Many of the sexual assaults
committed by Mr. J. O. took place while he was under the influence of alcohol. A
link must be made between the past events of the accused’s life and the assaults
he committed ... In the testimony given at the hearing on sentence, the accused
says: “I knew it was bad. I thought that it was normal but bad.”179
In R. v. W. R. G., the accused was convicted of sexually touching his daughter. In his
judgment, Justice C. Baird Ellan observed,
Mr. G was himself abused sexually in two separate incidents when he was very
young, perhaps five. He also witnessed abuse at the residential school, and on
the reserve before that. He once walked in on his uncle abusing one of his sisters,
but she did not complain about the incident. He believed that his mother was
also sexually abused, as were her sisters, but his mother herself never told any-
one.180
Considering the effect of Mr. G’s attitude to the offence, I consider that his back-
ground, in particular the sexual abuse he experienced, may have resulted in a
blurring of the boundaries that would otherwise naturally prevail in a parental
relationship.181
There is a need to help those who suffered sexual abuse to overcome that expe-
rience and not to abuse others. There is also a need for culturally appropriate forms
of treatment that recognize the widespread sexual abuse that occurred in residential
school and now unfortunately continues in Aboriginal families.
Substance abuse
Substance abuse is widely recognized as a cause of offending behaviour. An anal-

ysis of thirty different studies showed that drug users were three to four times more
likely to offend than non-drug users.182 Subsequent studies have continued to con-
firm that drug and/or alcohol abuse significantly raise the risks of recidivism for many
offences, including crimes committed while incarcerated, sexual offences, domestic
violence offences, and juvenile delinquency. 183 In nearly two-thirds of non-spousal
violent incidents, Aboriginal crime victims related the offence to the offender’s use
of alcohol or drugs. Close to 88% of Aboriginal males (and 94% of Aboriginal women)
accused of homicide had consumed alcohol or drugs at the time of violent incident,
compared to 64% of non-Aboriginal accused and 41% of non-Aboriginal women.184
Aboriginal people who reported using drugs were four times as likely to be victimized
by crime compared to Aboriginal people who do not use drugs.185
Many sentencing decisions have recognized that substance abuse was at once
both a reaction to having been victimized in residential schools, and a contributor to
subsequent criminal behaviour.186 In R. v. Craft, the accused received a nine-month
conditional sentence and three years probation for driving under the influence. Chief
Judge Ruddy of the Yukon Territorial Court made very explicit connections to residen-
tial school:
His time spent in the residential school system was an extremely difficult period
of time in which he, as is described in the report, suffered from extreme violence,
torture and sexual abuse within the residential school system. That, in turn, led
to him abusing alcohol, which in turn led to his extensive involvement with the
criminal justice system between 1961 and 1986.187
In R. v. M. L. W., in which the accused was given a two-year conditional sentence
for driving under the influence, Dr. Peter Saunders, as an expert witness, connected
the accused’s residential school experiences to post-traumatic stress disorder, alcohol
abuse, and subsequent criminal behaviour as follows:
[M. L. W.] has been a patient of mine since May of 2001. Over the last three years
I have seen him regularly on a professional basis and have come to have some
understanding of the long-term effect on his health that has resulted from the
abuse that he sustained while attending residential school as a child. As a result
of the post-traumatic stress disorder that [M. L. W.] suffered as a young man, he
experienced periods of drug and alcohol abuse.188
Many studies have confirmed that alcohol and drug abuse in the home environ-
ment significantly increase the chances of the cycle of substance passing on from gen-
eration to generation.189 Judges cannot help but notice that substance abuse spans
generations in Aboriginal communities.
There are cases where individuals have been both residential school Survivors and
had been exposed to substance abuse in the home as a child. In one case, a judge who
sentenced an Aboriginal person to four years for sexual assault noted,
I have heard that he is a residential school survivor and I have heard that he was
faced, while growing up, and surrounded by, a lot of dysfunction, and by many
people who abused alcohol. There is very little doubt in my mind that Mr. G. has
indeed faced systemic factors that have contributed to his difficulties with the
law that probably contributed to his own unhealthy relationship with alcohol,
which in turn has resulted in a fairly consistent pattern of breaking the law, going
back to even before he was an adult.190
Intoxication by drugs or alcohol can, even in the most serious cases such as murder,
be argued as a mitigating factor for criminal conduct. The courts, however, have taken
a strict approach to such arguments. Even when intoxication is a factor, the accused
will almost always be convicted of a less serious offence.
Mental health issues
It is widely accepted that the criminal justice system is not well-equipped to deal
with mental health problems. Although mental illness is frequently present, it does
not amount to a lawful defence to a charge unless it is of such intensity that it renders
an accused incapable of knowing that which actions were wrong. Nonetheless, it can
be and often is, a factor in offending behaviour. The role that residential schools have
played in an accused’s mental health is something that the courts have to take note of.
A study done by the Aboriginal Healing Foundation looked at 127 Aboriginal per-
sons in British Columbia who had litigated residential school claims. Ninety-three
of those case files had evidence of mental health problems. They included 21.1% for
major depression, 20% for other disorders related to depression, 26.3% for substance
abuse disorder, and 64.2% for post-traumatic stress disorder.191 Sixty-two of those
127 case files had criminal histories, most for sexual offences, assault, and driving
offences.192
One recent case indicated how a man accused of murder had been held in pretrial
custody for four-and-a-half years. During that time he had been unable to obtain
either mental health services or Aboriginal-specific programming. This man’s father
had attended residential school at Chesterfield Inlet. His mother had been taken
away from her parents (who had also attended residential school) and adopted into
a non-Aboriginal home. The offender had been diagnosed by a forensic psychia-
trist as likely to be suffering post-traumatic stress disorder, personality disorder, and
fasd. The judge observed that the offender “has been ‘on hold’ for the last four and
a half years in an environment that cannot have done much for his spiritual or psy-
chological health” and that when he was sent to an Ontario federal penitentiary he
would be “caught in a Kafkaesque situation” because of the unavailability of any
Aboriginal-specific program for his alcohol and violence problems.193 The judge
went on to say that the “unavailability of Aboriginal programming in federal insti-
tutions should not become simply the latest example of how Canadian society let
[him] fall through the cracks.”194
Poverty
Aboriginal people are more likely to live in poverty than non-Aboriginal Canadians,
and when they do, the depth of their poverty is likely to be greater than that of other
Canadians. They have an average income that is further below the poverty line on
average than that of non-Aboriginal adults.195 The impact of the 2008 recession was
greater and persisted longer for Aboriginal workers than for the non-Aboriginal pop-
ulation.196 Aboriginal people are more likely to experience unemployment and are
more likely to collect employment insurance and social assistance.197 When working,
Aboriginal people have earnings well below their non-Aboriginal counterparts. The
median income for Aboriginal peoples in 2010 was approximately 30% lower than the
median income for non-Aboriginal workers ($20,701 vs. $30,195).198 It is not surpris-
ing, then, that the child poverty rate for Aboriginal children is very high—40%—com-
pared to 17% for all children in Canada.199
Many studies have shown a direct link between community poverty and higher
crime rates.200 This is apparently true even for the most serious of offences, including
homicide.201 Poverty and the lack of employment opportunities have also been found
to be a pathway to gang membership.202 Poverty also contributes to domestic violence.
It leaves women living with violence with fewer resources to obtain independence
from abusive partners.203 A 2010 study found that residential school attendees were
more likely to live in low-income households and to have experienced income insecu-
rity. Aboriginal children who came from higher-income households were more likely
to be successful in school than Aboriginal children from low-income households that
were vulnerable to food insecurity.204
In R. v. C. G .O., poverty was recognized as a strong contributing factor behind the
accused being brought into court. The judge observed,
Ms. C. O. grew up on a reserve near Regina … Ms. C. O. has lived her life in
poverty, isolation and violence. For the last ten years, if not longer, she has been
disconnected from her family and traditions that are her sources of strength and
support. She continues to live in poverty and violence. She is socially isolated
with no one to call upon for help. Her home community still struggles with
poverty, violence and offers few resources. Based on the evidence on sentencing,
Ms. C. O. has had few realistic opportunities to change. In my view, the poverty,
isolation and violence are precisely what brought Ms. C. O. to court.205
C. O. received a two years less a day conditional sentence plus three years pro-
bation for failure to provide the necessities of life and assaulting her three-and-half-
year-old child.206
Child welfare involvement
A child’s involvement in the child welfare system has been found to increase juve-
nile delinquency for children, in particular male children. One study of children who
were maltreated in Chicago and its Cook County suburbs found that maltreated chil-
dren who were placed into care had a delinquency rate of 16%, compared to 7% for
children who were not placed into care.207 Another study of children in California’s
system found that children who were placed at least once in a group home were 2.5
times more likely to become delinquent in comparison to children who were placed
in a foster home.208
Frequent changes in placement (known as placement instability) has also been
found to be significantly predictive for adult criminality. A study based on 772 per-
sons with histories of abuse or neglect prior to age twelve found that the rates of adult
arrest correlated with the degree of placement instability. The rates were 35% for no
child welfare placements, 45.4% for one, 60% for two, and 76.3% for three or more.209
R. v. J. E. R. presents a vivid account of how placement in the system involving one
generation led to further harm for those in the next generation:
Mr. R. is the youngest of four children. He was born in Winnipeg. His parents
separated just prior to his birth. Mr. R. understands that both were part of the
residential school system. Mr. R. understands that his mother, V., was taken and
sold as an orphan into the United States … It is believed V. and her sister were
placed in adoption in the United States at V.’s age five. They were physically
abused in this adoptive home. The parents divorced, and V. and her sister were
again placed in foster care and at V.’s age 12, adopted a second time and over the
next one-and-a-half years were exposed to emotional and mental abuse. There-
after, V. and her sister were separated and V. lived in several group homes … in
one she was sexually molested.
V. returned to her biological mom at age 16 and gave birth to Mr. R.’s brother, J.,
at her age 17, and moved out at age 18. Mr. R. lived with his mother initially in
Winnipeg. His mother and family then moved to Calgary and then on to Van-
couver. The Calgary move was when he was an infant of seven months or so. The
Vancouver move in August 1994 was when Mr. R. was about age two. The father
prior to separation used drugs and alcohol and abused the mother V.210
The reasons for the overrepresentation of Aboriginal people in the correctional sys-
tem are complex and interrelated. What is clear is that governments must commit to
ending this imbalance. Better monitoring and evaluation of the situation is only the
first step.
30) We call upon federal, provincial, and territorial governments, to commit to

eliminating the overrepresentation of Aboriginal people in custody over the next
decade and to issue detailed annual reports that monitor and evaluate progress
in doing so.
Sentencing and sanctions
Over the past two decades significant advances have been made in the process
of sentencing of Aboriginal offenders. However, these advances are under challenge
from more recent amendments to the criminal law that expand the circumstances in
which courts must impose mandatory minimum sentences.
Section 718.2(e)
In 1996, in recognition of the fact that Canada was imprisoning more people than
many other democracies, Parliament overhauled the laws relating to sentences. One
key change was the introduction of “conditional sentences,” which allow offenders
who might otherwise be imprisoned to serve their sentences in the community. But
the centrepiece of sentencing reform was section 718.2(e) of the Criminal Code. It
instructs judges that “all available sanctions other than imprisonment that are rea-
sonable in the circumstances should be considered for all offenders, with particular
attention to the circumstances of aboriginal offenders.” Then Minister of Justice Allan
Rock explained that
the reason we referred specifically there to aboriginal persons is that they are
sadly overrepresented in the prison populations of Canada. I think it was the
Manitoba justice inquiry that found that although aboriginal persons make up
only 12% of the population of Manitoba, they comprise over 50% of the prison
inmates. Nationally aboriginal persons represent about 2% of Canada’s popula-
tion, but they represent 10.6% of persons in prison. Obviously there’s a problem
here. What we’re trying to do, particularly having regard to the initiatives in the
aboriginal communities to achieve community justice, is to encourage courts to
look at alternatives where it’s consistent with the protection of the public, alter-
natives to jail, and not simply resort to that easy answer in every case.211
The 1996 reforms represented a genuine and comprehensive attempt to recognize
the need for restraint in the use of imprisonment and to provide trial judges with tools
to provide realistic alternatives to imprisonment.
R. v. Gladue
R. v. Gladue (Gladue) was a landmark decision by the Supreme Court of Canada

involving section 718.2(e) of the Criminal Code, in the case of an Aboriginal woman
from British Columbia. On September 16, 1995, Jamie Tanis Gladue was celebrating
her nineteenth birthday when she got into a violent disagreement with her boyfriend
and stabbed him. She was eventually convicted of manslaughter. At her sentenc-
ing hearing, the judge took into account her youth, her status as a mother, and the
absence of any serious criminal history. She was sentenced to three years imprison-
ment. When the Supreme Court dismissed her appeal of the sentence in 1999, the
Court approvingly quoted a study to the effect that “the prison has become for many
young native people the contemporary equivalent of what the Indian residential
school represented for their parents.”212
The Court noted that Aboriginal people constituted 12% of federal prisoners, and
included the following statement in its ruling:
The figures are stark and reflect what may fairly be termed a crisis in the Ca-
nadian criminal justice system. The drastic overrepresentation of aboriginal
peoples within both the Canadian prison population and the criminal justice
system reveals a sad and pressing social problem. It is reasonable to assume that
Parliament, in singling out aboriginal offenders for distinct sentencing treatment

in s. 718.2(e), intended to attempt to redress this social problem to some degree.
The provision may properly be seen as Parliament’s direction to members of the
judiciary to inquire into the causes of the problem and to endeavour to remedy
it, to the extent that a remedy is possible through the sentencing process.213
The judgment continues: “The fact that the reference to aboriginal offenders is con-
tained in section 718.2(e), in particular, dealing with restraint in the use of impris-
onment, suggests that there is something different about aboriginal offenders which
may specifically make imprisonment a less appropriate or less useful sanction.”214 R.
v. Gladue is a much cited judgment and it has in some jurisdictions resulted in the
introduction of more extensive pre-sentence or Gladue reports that provide the sen-
tencing judge with contextual information on the background of Aboriginal offenders.
Producing these reports has not been without difficulty and controversy. In 2012, the
Globe and Mail reported,
Saskatchewan, Alberta and Manitoba have barely begun to produce [Gladue]
reports. While the number in Alberta has shot up from 14 in 2011 to 100 that are
now in production, most of them are being prepared by probation officers—who
are trained to assess risk factors but have no particular understanding of aborigi-
nal culture and history. In Quebec, Gladue reports are almost unheard of.215
Many jurisdictions work with Aboriginal community groups to prepare Gladue
reports. This is a good practice because probation officers who prepare pre-sentence
reports generally do not have cultural training to work with Aboriginal offenders, fam-
ilies, and communities to prepare adequate Gladue reports prior to sentencing.
There are some concerns that defence lawyers may not always request a Gladue
report or use it to their clients’ advantage. One defence lawyer noted, “The lawyer
is not compensated for the report and yet we are expected to do multiple hours of
work that we are not paid for. Sometimes we are asked to review the report. That can
take 3 hours. More time is spent on the Gladue report than other psrs [Pre-Sentence
Reports] because of the structure of the program.”216
Gladue reports can often be difficult for offenders and their families. One Gladue
report writer stated, “The interviews are very hard. They are very emotional. Especially
if a person is in custody. I’ve had guys say, ‘I can’t talk about that because I can’t cry in
here.’ Sometimes I wonder if we are re-traumatizing them.”217
However, some judges see that they have a greater responsibility. In R. v. Jesse
Armitage, which was heard in the first official Canadian court established to adhere
to the principles expressed in R. v. Gladue and accordingly called a “Gladue court,”
Justice Nakatsuru wrote his entire judgment in unusually simple prose:
In the Gladue court at Old City Hall, accused persons who share a proud history
of the first people who lived in this nation, not only have a right to be heard, but
they also have a right to fully understand. Their voices are heard by the judges.
And they must also know that we have heard them ... I know that all accused,
whether they have any Aboriginal blood or not, should have this right. Judges
struggle to make sure they do. However, when judges write their decisions, they
are writing for different readers, different audiences. Judges write not only for
the parties before them. Judges write to other readers of the law. Lawyers. Other
judges. The community. In this case, I am writing for Jesse Armitage.218
In his ruling, Justice Nakatsuru noted that Jesse Armitage’s grandmother was a res-
idential school Survivor, and that her own children have struggled with alcoholism;
and that Armitage came from a broken home. The judge went on to say,
If I could describe Mr. Armitage as a tree, his roots remain hidden beneath the
ground. I can see what he is now. I can see the trunk. I can see the leaves. But
much of what he is and what has brought him before me, I cannot see. They are
still buried. But I am sure that some of those roots involve his Aboriginal heritage
and ancestry. They help define who he is. They have been a factor in his offend-
ing. They must be taken into account in his sentencing.219
R. v. Ipeelee
The case R. v. Ipeelee (Ipeelee) involved two men—one from Yukon, the other from
Nunavut, both with serious alcohol problems going back to their youth, both with long
criminal records, both from broken families, and both with links to residential schools.
The argument that reached the Supreme Court of Canada concerned the breach of
their long-term supervision order. In its 2012 ruling, the Court reduced the sentence
of one man and affirmed the other. What will be remembered from this ruling was the
Supreme Court’s decision to revisit and reaffirm Gladue. The justices noted that the
problem of Aboriginal overrepresentation had gotten worse in the thirteen years since
Gladue was decided. The Court pointed out that while Aboriginal people comprised
12% of federal inmates in 1999 when Gladue was decided, they constituted 17% of
federal admissions in 2005. The Court then noted that
courts must take judicial notice of such matters as the history of colonialism,
displacement, and residential schools and how that history continues to trans-
late into lower educational attainment, lower incomes, higher unemployment,
higher rates of substance abuse and suicide, and of course higher levels of incar-
ceration for Aboriginal peoples.220
The Supreme Court pointed out that some lower court judges had erred in their
application of Gladue by concluding that it did not apply to serious offences or that
it required an offender to demonstrate a causal connection between the commission
of the crime and the legacy of residential schools or other background or contextual
factors. Gladue mandates trial judges to consider all the background factors for
Aboriginal offenders. This was clear direction from the Supreme Court’s ruling that
offenders need not demonstrate a direct causal relationship between the legacy of
residential schools and the commission of offences.221
Section 718.1 of the Criminal Code codifies a long-standing principle of criminal
justice that “a sentence must be proportionate to the gravity of the offence and the
degree of responsibility of the offender.” The Court in Ipeelee indicated that the fun-
damental questions of proportionality must be addressed in a different light given
the reality of how Aboriginal people have been treated in Canada. The Court invited
judges to revise their understanding of traditional sentencing principles, includ-
ing deterrence and denunciation in light of evidence of their failure to achieve their
objectives and “to meet the needs of Aboriginal offenders and communities.”222
The Gladue factors require consideration of restorative principles of sentencing,
including acknowledgment of harm done to victims and communities and rehabilita-
tion of offenders in contrast to punitive principles of sentencing.
The Supreme Court’s landmark decisions in Gladue and Ipeelee remind trial judges
to take a different approach in applying the purposes and principles of sentencing to
Aboriginal offenders, including those related to deterrence, denunciation, and retri-
bution. These decisions recognize that the application of a uniform one-size-fits-all
approach to punishment will be discriminatory and ineffective given the treatment of
Aboriginal people in Canadian society, including the intergenerational legacy of resi-
dential schools. However, there is a pressing need for sufficient and stable funding to
implement and evaluate community sanctions that will provide realistic alternatives
to imprisonment for Aboriginal offenders and will respond to the underlying causes of
offending by them. Without adequate and stable funding of community sanctions and
evaluation of their success, it is likely that the overrepresentation of Aboriginal people
in prison and among crime victims will continue to grow.
Gladue, Ipeelee, and Aboriginal young offenders
Aboriginal youth experience the justice system in very different and more disrup-
tive ways than other youth. They are more likely to be detained in facilities that are far
from their homes, families, and communities. Having court processes hundreds of
kilometres away makes it more difficult for them to have someone in court to support
them or suggest alternatives to incarceration.
In an analysis of Ontario data from 2004–05 and 2005–06, Aboriginal youth were
underrepresented amongst those who received non-custodial sentences available
under the Youth Criminal Justice Act and overrepresented in more serious sen-
tences.223 The explanation does not lie in any differences in the types of crimes that
Aboriginal youth are charged with. In fact, Aboriginal youth receive custodial sen-
tences at a greater rate than non-Aboriginal youth for the same offences.224
Sentencing decisions are one of the most obvious points in the system for reform.
Courts often consider factors that may seem neutral on their face but are not. For
example, a person with a good job, a good education, and wealth is likely to receive a
sentence that is less disruptive to his or her lifestyle. On the other hand, as Professor
Tim Quigley has observed, “the unemployed, transients, the poorly educated are all
better candidates for imprisonment. When the social, political and economic aspects
of our society place Aboriginal people disproportionately within the ranks of the latter,
our society literally sentences more of them to jail. This is systemic discrimination.”225
Community sanctions
The Commission has heard testimony from Survivors about how community sanc-
tions can work to the benefit of both offenders and the community. Gerald McLeod
explained to the Commission how he developed an addiction to alcohol as a coping
mechanism after being sexual abused in two residential schools in Yukon. He recalled,
I was 16, I started getting impaireds. I ended up with 18 impaireds, ’cause of my
drinking and alcoholism, and I’m not proud of it. I’m, I’m happy that I didn’t kill
my, nobody, or I killed myself, or one of my family members. I was blessed that
way that I didn’t hurt no one.
McLeod faced a ten-year jail sentence when convicted for the eighteenth time, but
Justice Barry Stuart, a pioneer in community sanctions and circle sentencing, gave
him an opportunity to stay out of jail. McLeod recounted,
[I] got to treatment in Calgary, Stoney Medicine Lodge, and I sobered up for
two years, and I came home to the Yukon here. The judge put me through circle
court. I was the first one to go through circle court here in the community. I got
cleared of this charge for two years, and blood tests for two years. So, I did that
for two years, proved to them I can stay sober… and two of us did that, went to
treatment, Dennis Jackson and I, and we’ve been sober for 19 years now. And
you know when we came out of our sweat in Calgary, there was two eagles flying
around, and I told Dennis that that’s us up there, and then I said right on.226
The use of community sanctions to deal with deep traumas caused by residential
schools is not a panacea, and there may be failures on the road to recovery. Gerald
McLeod explained to us that despite his successful battle against alcoholism, he has
been convicted and imprisoned twice for sexual assaults. He explained, “I’m marked
by the government, to sign a paper saying, ‘I am a sexual assault offender for the rest
of my life.’ … And you know I’m marked for the rest of my life for something that I was
taught as a kid, or forced on as a kid, then I go do it, and I’m marked for life for doing
it.” McLeod admitted his offences and said, “I’m not trying to make excuses or any-
thing, but I, I can’t answer it yet. I can’t, you know, what was passed on to me, then am
I passing it on to others? Or, you know, the only way I can answer that is go through
treatment, and that’s what I’m seeking right now is treatment through my counsellors,
and I’m looking at residential treatment in the future.”
Such treatment can be more difficult for offenders like Gerald McLeod who have
served a lot of time in prison. He explained,
It’s a lot of work, and it’s, it’s not easy to keep opening up this can of beans to, or
can of worms to spread it out … It was all there from my childhood I was dig-
ging up, fighting all my life, and then now they want me to dig it all out again,
and then start over again with all this misery that I have to live with, that I’ve
lived with. But I know it’s the only answer for me is to get it out of me, and start
working on a new life … It’s a lot of stuff there that you have to work on the, your
spirituality, your language, your, everything that you lost, you know, you’re trying
to get it back so you can be in balance with yourself again a little bit. But you got
so many hurdles out to overcome from the residential [school] that you’re faced
every day in your community, everything that you live with in your community
that is, that is not right, ’cause it’s a stem off from residential that we do suffer in
our communities with today from our children, and from our grandchildren.227
All of that causes us to conclude that, for Aboriginal people, many, if not most,
offences committed by them result in sentences of incarceration that fail to address
the underlying causes of offending behaviour in a manner that supports their men-
tal, spiritual, and cultural needs or reduces crime. The promise of the Criminal Code
amendments of 1996 and the Supreme Court’s decisions in Gladue and Ipeelee have
not yet been met. More needs to be done.
31) We call upon the federal, provincial, and territorial governments to provide suf-
ficient and stable funding to implement and evaluate community sanctions that
will provide realistic alternatives to imprisonment for Aboriginal offenders and
respond to the underlying causes of offending.
Barriers to reducing Aboriginal overrepresentation in prison
Bill C-10 and mandatory minimum sentences
In 2012, Parliament enacted Bill C-10. This legislation includes more mandatory
minimum sentences and restrictions on conditional sentences. In announcing the
Royal Assent of the Bill, several federal parliamentarians declared, “Our Government
is committed to ensuring that criminals are held fully accountable for their actions
and that the safety and security of law-abiding Canadians comes first in Canada’s judi-
cial system. We will continue to fight crime and protect Canadians so our communi-
ties are safe places for people to live, raise their families and do business.”228
Mandatory minimum sentences are sentences that, if properly enacted, no judge
can reduce or modify. For example, Bill C-10 introduced longer mandatory minimum
sentences for several sexual offences against children, ranging from a ninety-day
minimum when the Crown prosecutor proceeds by summary conviction, and a one-
year minimum when the Crown prosecutor proceeds by indictment.229 Bill C-10 also
affected the mandatory minimum for various drug offences, like trafficking, export-
ing, and possession with intent to either traffic or export. The mandatory minimums
for these offences range from one to two years depending on the nature and amount
of the substance, and certain aggravating factors of which the court is obliged to con-
sider.230 Similarly, Bill C-10 introduced a mandatory minimum sentence of two years
for the production of certain substances, or a three-year mandatory minimum where
certain health and safety factors are proven.231
Since the enactment of Bill C-10, certain offences are also no longer eligible for
a conditional sentence—a term of imprisonment to be served in the community as
opposed to in a correctional facility. These include any offence that has a maximum
sentence of fourteen years or life (e.g., manslaughter, aggravated assault), as well as
certain offences punishable by ten years or more where the provincial Crown chooses
to proceed by indictment.232
The legislative emphasis on whether or not a charge proceeds by way of indictment
places particular importance on the role of provincial Crown prosecutors in pursuing
each charge. Prosecutorial discretion, being unreviewable by the courts, can have a
dramatic impact on the considerations available to the judiciary and possible oppor-
tunities for rehabilitation come sentencing. In addition, no conditional sentence is
available if there is any mandatory minimum term of imprisonment even for sen-
tences as short as thirty to ninety days.233 The restricted sentencing options challenge
courts to find appropriate sentencing, and impact the health and healing of Aboriginal
people, their communities, and their families.
Joann May Cunday explained to the Commission that she became addicted to alco-
hol and other drugs at an early age in part because of “learned behaviour” from her
mother who attended residential schools: “It’s only ’till last year that I quit drinking.
But the only reason I quit drinking is ’cause I was forced into it by the courts. But I
feel so much better that I did and I know my kids are, I know that they’re doing better
because I’m, I’m not drinking.”234 She explained that the judge was able to give her a
two-year “house arrest” sentence. The Crown prosecutor had initially asked that she
be incarcerated for seven years, but the conditional sentence allowed her to continue
her relationship with her children, attend Aboriginal ceremonies, and “to slow down”
and realize the intergenerational effects of residential school on her and her children.
The conditional sentence that she received would likely not be available under the
restrictions on such sentences in Bill C-10.
A number of judges have already pointed out how such restrictions are making it
even more difficult for them to provide appropriate sentences for Aboriginal offend-
ers. One judge observed,
Legislation designed to “get tough” on crime must not lose sight of the fact that
the very individuals that suffered harm, either directly or indirectly, perhaps as
children of students of residential schools, may be the same individuals who are
committing the crimes and who are, under such legislation, the individuals that
the justice system will “get tough” on.235
Bill C-10 and other similar Criminal Code amendments have undermined the 1996
reforms that required judges to consider all reasonable alternatives to imprisonment
with particular attention to the circumstances of Aboriginal offenders.
In 2015, the federal government passed a Canadian Victims Bill of Rights, which
emphasizes institutional imprisonment for the sake of community safety.236 The
premise of such approaches is that imprisonment keeps communities safe; however,
if that were true, Aboriginal communities should be among the safest of all Canadian
communities, given the high level of incarceration of Aboriginal adults and youth.
Although imprisonment prevents offenders from committing offences against the
community, while the person is imprisoned, offences including violence and drugs
take place in prisons just as other types of offences took place in residential schools.
All but a few offenders will be released, and the prison experience, just like the res-
idential school experience, often makes them more, rather than less, likely to reof-
fend. Prison also makes offenders less employable, less self-reliant, angrier, and often
more violent. Far from being kept safe by mandatory sentences of imprisonment and
restrictions on community sanctions, Aboriginal communities may be less safe due to
the bill’s movement away from alternatives to imprisonment.
The extended terms of Bill C-10’s mandatory sentences and restrictions on condi-
tional sentencing, as well as the enactment of the Canadian Victims Bill of Rights, will
likely have a disproportionate impact on Aboriginal offenders who are overrepresented
in the criminal justice system in part because of their poor socioeconomic circum-
stances and the effects of historical and systemic discrimination in Canadian society.
32) We call upon the federal government to amend the Criminal Code to allow trial
judges, upon giving reasons, to depart from mandatory minimum sentences and
restrictions on the use of conditional sentences.
Changing Canada’s correctional systems

Despite the disproportionate number of Aboriginal inmates, Canada’s correctional
systems fall short in their treatment of these prisoners.
Provincial corrections
Provinces and territories administer facilities for those imprisoned for less than
two years and awaiting trial, and they also supervise most community sanctions.
Most provinces and territories, however, appear not to have made Aboriginal-
focused corrections a priority. They generally underfund community sanctions
that can provide an alternative to imprisonment. For example, in 2011, community
supervision accounted for 37% of all admissions into provincial and territorial facil-
ities but only 16% of expenditures.237 Aboriginal people receive few services in pro-
vincial correctional facilities. The Manitoba Aboriginal Justice Inquiry, after visiting
various correctional institutions, concluded in 1991 that “Most of the jails we visited
reminded us of zoos where men and women were caged behind iron bars. For the
most part, there is nothing to do as the months and years drag by.”238
Only a few provinces, such as British Columbia, have Aboriginal justice strategies
that include cultural awareness training for officials, and contracting with Aboriginal
communities to provide spiritual leadership, counselling, and cultural program-
ming.239 Many provinces and territories have no such plans and do not provide public
data on the number of Aboriginal people imprisoned in their facilities.
Judges sometimes sentence Aboriginal offenders to “federal time” of two years plus
a day, or more, because the programming for Aboriginal offenders has generally been
better in federal penitentiaries than in provincial correctional facilities240 or through
community sanctions.241 This is particularly the case for the growing number of female
Aboriginal offenders.
The Commission finds little evidence that most provincial and territorial cor-
rectional services are making available culturally appropriate programming for
Aboriginal offenders, including those with violence and substance abuse problems
relating to the intergenerational legacy of residential schools.
Federal corrections
The 1992 Corrections and Conditional Release Act provides that the Correctional
Service of Canada (csc) “shall provide programs designed particularly to address the
needs of aboriginal offenders.”242 Section 81 allows offenders to be transferred to an
Aboriginal community to serve their sentence where the community consents.243 Section
83 guarantees that Aboriginal spirituality and Aboriginal spiritual leaders have the same
status as those of other religions. It also requires the Correctional Service of Canada to
take “all reasonable steps” to ensure that Aboriginal inmates have access to Aboriginal
Elders or spiritual leaders.244 Section 84 also provides for Aboriginal communities to be
involved in an Aboriginal offender’s release and integration into the community.245
The Correctional Service has committed itself to observing these principles.
Unfortunately, the implementation of this commitment lags and compliance looks
better on paper than in reality. The correctional investigator (a federal government
appointee who serves as an ombudsman for federally sentenced offenders) delivered
a report in 2012, that criticized the csc for failing to live up to its statutory and policy
commitments to Aboriginal inmates. This report recognized that
• Aboriginal offenders serve disproportionately more of their sentence behind

bars before first release.
• Aboriginal offenders are under-represented in community supervision popula-
tions and over-represented in maximum security institutions.
• Aboriginal offenders are more likely to return to prison on revocation of parole.
• Aboriginal offenders are disproportionately involved in institutional security
incidents, use of force interventions, segregation placements and self-injurious
behaviour.246
The investigator also reported that the promise of Aboriginal healing lodges is
largely illusory for most Aboriginal inmates because so few spaces are available.
In any event, a prisoner has to be classified as minimum security to qualify for an
Aboriginal healing lodge but 90% of Aboriginal inmates have medium or maximum
security classifications.247
The programming for Aboriginal offenders in federal penitentiaries is deteriorating
to such an extent that some judges are no longer sentencing Aboriginal offenders to
“federal time.” In one recent case, a judge noted that reports on federal corrections
“paint a grim picture for aboriginal offenders and their access to programming,” sug-
gesting that most Aboriginal inmates are placed on waiting lists and if admitted to
such programs often have their release date delayed as a result. The judge observed,
“the gap between aboriginal and non-aboriginal offenders continues to widen, the
situation for aboriginal people under federal sentence deteriorates, and the Service
revises and updates frameworks and strategies without apparent results.” The judge
also cited a Standing Parliamentary Committee on Public Safety report that found the
existing programs “for treating mental disorders and addiction issues constitute an
inadequate response to the cultural and spiritual needs of aboriginal offenders.”248
Security classifications
Another barrier to accessing needed programming is that Aboriginal offenders are

placed in stricter security classifications in disproportionate numbers in comparison
to non-Aboriginal offenders.
Initial determination of security classification upon arrival in a federal penitentiary
is mandated under to the Corrections and Conditional Release Act, and is made using
the Custody Ratings Scale.249 Under this scale, a score of 133.5 or higher on the security
risk component qualifies an inmate for maximum security.250 The factors to be consid-
ered in assigning a security classification are
a. the seriousness of the offence committed by the offender;

b. any outstanding charges against the offender;
c. the offender’s performance and behaviour while under sentence;
d. the offender’s social, criminal and, where available, young offender history;
e. any physical or mental illness or disorder suffered by the offender;
f. the offender’s potential for violent behaviour; and
g. the offender’s continued involvement in criminal activities.251
The offender’s prior criminal history is an important factor in the security assessment
that operates to the detriment of many Aboriginal inmates.252
In 1990, the Task Force of Federally Sentenced Women found that Aboriginal women
were much more likely to receive higher security classification than non-Aboriginal
women.253 The Native Women’s Association of Canada estimated that, as of 2003,
Aboriginal women comprised at least 50% of incarcerated federal women classified as
maximum security.254 A study done in 2000 found that Aboriginal inmates were clas-
sified as maximum security or medium security at rates of 27.7% and 34.7%, respec-
tively, in comparison to rates of 20.3% and 24.1% for non-Aboriginal offenders.255
The Canadian Human Rights Commission describes the effects of a maximum
security classification on female inmates as follows:
Maximum security inmates, unlike their minimum and medium security counter-
parts, are not eligible to participate in work-release programs, community release
programs or other supportive programming designed to enhance their chances of
reintegration. In fact, half of all maximum security women are now being released
directly from maximum security incarceration into the community after serving
two-thirds of their sentence, without the benefit of preparatory programming.256
This is clearly detrimental to the inmate’s prospects of reintegration in the commu-
nity. The inmates are released without having had adequate correctional program-
ming, as well as with a lack of resources and supports to facilitate rehabilitation.257
Studies have shown that Aboriginal inmates in the aggregate have criminal his-
tories that are considered by authorities as worse than those of non-Aboriginal
inmates.258 One study for example shows that in 2003 at least 80% of Aboriginal
federal inmates had previously served terms in provincial jails in comparison to
approximately 70% for non-Aboriginal inmates.259 Inuit and First Nations federal
inmates were more likely to have served a previous adult community supervision
sentence, at rates of 87% and 79%, respectively, in comparison to 72% for non-
Aboriginal inmates.260 Aboriginal inmates are more likely to have been convicted
of serious crimes than non-Aboriginal offenders. First Nations and Métis offenders
also have had greater involvement with the youth justice system.
The Correctional Service of Canada’s Commissioner’s Directive on Security
Classification makes little reference to the unique experiences and needs of Aboriginal
offenders, apart from a requirement to consider “Aboriginal social history.”261 It is a fair
question to ask whether this part of the directive results or will result in any tangible
benefits for Aboriginal inmates while static factors involving prior history remain a
substantial component of security classification determinations. Aboriginal offenders
continue to be placed more often in higher security classifications. Previous crimi-
nal history, youth history included, will represent enduring penalties for Aboriginal
offenders, even during reclassification determinations. Therefore, the security clas-
sification scheme as applied to Aboriginal inmates may represent a form of sys-
temic discrimination.
There are alternatives that may indeed be workable. The Security Reclassification
Scale for Women was developed as a gender-specific method of security classi-
fication for female offenders. The nine items that are considered in this scale are
as follows:
1. Correctional plan; program motivation.

2. Maintains regular positive family contact.
3. Number of convictions for serious disciplinary offences during the review
period.
4. Number of recorded incidents during the review period.
5. History of escape or unlawfully at large from work release, temporary ab-
sence or community supervision.
6. Pay level during the review period.
7. Number of times the offender was placed in involuntary segregation for
being a danger to others or the institution during the review period.
8. Total number of escorted temporary absences (etas) during the review
period.
9. Custody Rating Scale incident history.262
What is noteworthy is the de-emphasis on static factors involving the offence, or

previous criminal history, and a greater emphasis on progress and behaviour during
the review period. Early field tests involving 580 files have found that the scale is reli-
ably predictive of actual security risk.263 Given that there is evidence that Aboriginal
spiritual healing can improve offender behaviour, and improve prison conditions
generally, there is no reason other than bureaucratic inertia why the Canadian correc-
tional system could not develop an Aboriginal-specific classification scale.
Culturally relevant prison programming
Studies based on interviews with Aboriginal inmates have confirmed that partici-
pation in Aboriginal cultural programs in prison can contribute to the healing of the
inmates through increased self-esteem and positive changes in lifestyle that make
release and reintegration a real possibility.264
Joanne Nimik’s birth mother was a residential school Survivor. Nimik was adopted
into a white family. She recounted,
[I got] into the bad crowd and started partying and drinking and drugging and,
I ended up having three girls that were also apprehended through cfs [Child
and Family Services] … And it wasn’t until I was 28 years old that I was reunited
with my birth family. Apparently my mother Rowena had been looking for me
all those years that I was adopted out and we had the reunion and it was, it was
really nice ’cause, you know I always wondered who my family, like my real
family was, my birth family. And, there was that missing piece in my life that I’d
been searching for and didn’t know how to make up for it. So I was using drugs
and alcohol as a coping mechanism I guess. I’ve had a very hard life I guess;
involved with the justice system, cfs system, drugs and alcohol, the legal system.
And, because of my lack of knowledge of support systems or how to ask for help,
I stayed in that way of life for quite awhile. I didn’t identify myself as First Nation
or Aboriginal or didn’t have no clue about what it meant to be Anishina-abekwe
or anything.265
Joanne Nimik’s healing journey away from crime and drug abuse started at an
Aboriginal centre for addiction treatment as part of a sentence she was serving.
She recounted,
I went to treatment at Poundmakers in Alberta and that was actually the first
time I’ve been exposed to a sweat lodge. I signed up for it, but I was too scared
to go in. First time exposure to what an Elder was, to smudging, sharing circle,
sweetgrass. So it, it was a real eye opener, it scared me but I was still curious to
a degree … I had, been arrested and I guess in that being arrested that was the
turning point in my life where I was able to take advantage of a program to get
some help.266
Since she started her healing journey away from crime, Nimik has been able to help
others who like her were at risk of being victimized by crime and committing crimes.
Chris Gargan spoke to the Commission from The Yellowknife Correctional Centre
in the nwt. He was looking for Aboriginal guidance and not getting it:
Right now I’m doing a program. There’s a white, white woman that’s treating
that program, and they, and they put, they push it on us … like, I wish it was
somebody like Healing Drum Society program, or something like that…. They’re
teaching us about anger, anger. It would be nice if our own people would come
in here and teach us about life ... you know, how to live. This is not the way of life
for us. It’s not the way for us people.267
The regimented and often violent life of prison has striking resemblances to life in
residential schools. Judge Heino Lilles served on the Yukon Territorial Court.
Jail has shown not to be effective for First Nation people. Every family in Kwan-
lin Dun [Yukon] has members who have gone to jail. It carries no stigma and
therefore is not a deterrent. Nor is it a “safe place” which encourages disclosure,
openness, or healing. The power or authority structures within the jail operate
against “openness.” An elder noted: “jail doesn’t help anyone. A lot of our people
could have been healed a long time ago if it weren’t for jail. Jail hurts them more
and then they come out really bitter. In jail, all they learn is ‘hurt and bitter.’
(emphasis added)268
The Ma Mawi Wi Chi Itata program, based in the Stoney Mountain Institution in
Manitoba, is a program designed for Aboriginal inmates who have been convicted of
domestic violence offences. It approaches the problem through a combination of heal-
ing and spiritual ceremonies, and educational components that are designed to help
inmates understand and control their violence and develop healthier relationships
and parenting skills.269 During a review of the program after its first-year pilot, many of
the Aboriginal inmates who were interviewed by researchers indicated that the pro-
gram was a positive experience since it provided their first exposure to their tradi-
tional cultures and helped them understand and control their violence. Correctional
staff also noted positive changes, including reduced aggression in the inmates and
improved relationships between staff and inmates.270
A study has shown that the recidivism rate for Aboriginal offenders who partic-
ipated in cultural activities was 3.6% compared to 32.5% for those who did not.271
The recidivism rate was 14.4% for those who participated in spiritual activities (for
example, a sweat lodge ceremony) compared to 24.2% for those who did not.272 The
recidivism rate was 12.9% for those inmates who had contacts or meetings with an
Aboriginal Elder compared to 26.8% for those who did not.273 Authors of another
survey interviewed fifty-six male and twelve female Aboriginal ex-offenders who had
stayed out of trouble with the law for at least two years following their release. While
other factors such as family support and steady employment were important in keep-
ing them out of trouble, a large percentage of the respondents indicated that partici-
pation in spiritual ceremonies (71%) and cultural activities (68%) were also important
in helping them avoid conflict with the law.274
Unfortunately, such culturally appropriate programming is not always available
in Canada’s prisons. In 2008, Correctional Investigator of Canada Howard Sapers
indicated before the Senate Standing Committee on Legal and Constitutional Affairs
that the Correctional Service of Canada had an annual budget of $1.8 billion, and yet
allocated only $27 million of that for the delivery of core program services. He went
on to suggest that, given these figures, it was hardly surprising that many Aboriginal
inmates had no access to culturally specific programs that could help them progress
towards release.275
Culturally relevant programming has to accommodate the diverse spiritual needs
and practices of Aboriginal inmates. The Saskatchewan Commission on First Nations
and Métis Peoples and Justice Reform recommended that both provincial and federal
correctional authorities should ensure “that access to cultural and spiritual program-
ming, whether traditional or religious, be made more available” to Aboriginal offend-
ers.276 The wisdom of this recommendation is affirmed by what the Commission has
heard from Survivors about the value that traditional and other religious practices
have had in their healing.
36) We call upon the federal, provincial, and territorial governments to work with
Aboriginal communities to provide culturally relevant services to inmates on
issues such as substance abuse, family and domestic violence, and overcoming
the experience of having been sexually abused.
Aboriginal healing lodges
There are four Aboriginal healing lodges run by the Correctional Service of Canada
(csc) and four run by Aboriginal communities under section 81 of the Correctional
Services Act. According to the Correctional Service of Canada, its lodges “provide liv-
ing environments that use Aboriginal traditional healing approaches as a method of
intervention. Both are rooted in the spiritual and cultural activities led by Elders, and
supported by dynamic contact with the community through csc’s temporary absence
program and pro-social interactions with staff members and management, many of
whom are Aboriginal.”277
A 2011 report by csc documented positive findings about Aboriginal healing lodges,
including that healing lodge residents, staff members, and management interviewed
during the evaluation noted improvements in offenders’ attitudes and behaviours,
as well as their greater understanding of, and connection to, Aboriginal culture. For
example, offenders showed improvements in the areas of self-confidence, personal
responsibility, motivation, and self-discipline. They demonstrated deeper under-
standing of their lives and criminal behaviours, greater respect, and positive attitudes
towards others, and recognized the importance of seeking help and establishing sup-
port networks.278
Despite these positive findings, the most pressing concern about Aboriginal heal-
ing lodges is the lack of resources. At the basic level, section 81 lodges are in need of
physical improvements. Furthermore, the lack of funding has affected recruitment,
training, and retention of lodge staff. Recruitment is especially difficult as Aboriginal
people with the required skill sets are in high demand and the lodges cannot afford
to pay what the market dictates. In terms of training, most section 81 lodges do not
have the funds to adequately train their staff regarding csc procedures. Programming
is another area that has been affected by lack of funds. Smaller facilities do not offer
structured programs, as they do not have the resources to offer programs given the
small number of residents who need them.279
Given the positive role that healing lodges can have for those Aboriginal offend-
ers who must serve a period of incarceration, and the proven failure of existing cor-
rectional programs not specifically aimed at supporting Aboriginal inmates, it makes
considerable sense to provide more resources to healing lodges.
35) We call upon the federal government to eliminate barriers to the creation of addi-
tional Aboriginal healing lodges within the federal correctional system.
Reintegration of Aboriginal offenders
An important factor that is considered by the National Parole Board in whether to

grant or deny parole is an actuarial risk assessment of whether the offender is likely to
reoffend. According to one study, the percentages of inmates who were assessed as a
high-risk to reoffend were 85% for Inuit, 73% for First Nations, 67% for Métis, and 57%
for non-Aboriginal inmates.280 One problem here, as with initial security classification,
is a tendency to give great weight to the static factor of criminal history. This means
that Aboriginal offenders often come to the parole board with two strikes against them
and there is nothing they can do to overcome their prior convictions. Some research
has concluded that criminal history is a reliable risk predictor for both Aboriginal and
non-Aboriginal inmates.281 At the same time, however, prior convictions of Aboriginal
offenders are frequently a response to oppressive social conditions, including the

intergenerational legacy of residential school. Viewed in this light, reliance on crimi-
nal history in the parole context, as in the security context, may be a form of systemic
discrimination that disadvantages Aboriginal offenders. As in the security classifi-
cation context, there are strong arguments that more emphasis should be given to
dynamic factors such as substance abuse that the Aboriginal offender can, to some
extent, control. The John Howard Society says of dynamic factors,
Dynamic factors have been found to predict recidivism as well as, or better than,
static factors, and are also measured by several actuarial risk assessment tools.
It is knowledge of dynamic factors that is necessary in order to assess changes in
an offender’s risk level. Through participation in rehabilitative programming, an
offender may become less likely to recidivate, but corrections and parole work-
ers would not be able to measure this change unless they assessed the offender’s
risk based on changeable factors.282
Actuarial risk assessment of Aboriginal offenders that de-emphasize static factors,
and instead focus on participation in appropriate programming, including cultural
and spiritual healing programming for Aboriginal inmates, along with attendant
offender progress in addressing dynamic risk factors, would be just as useful and fairer
to Aboriginal inmates. It would also encourage Aboriginal inmates to engage in such
programs, once they know that participation would have more significant weight.
Such programming and spiritual healing can affect Aboriginal inmates’ behaviours so
they can prepare themselves for parole and reintegration. Such an approach, however,
will only achieve greater fairness for Aboriginal offenders to the extent that Aboriginal
programming is made available to them.
When the National Parole Board grants parole, the delivery of correctional pro-
gramming continues. The early stages of parole are often spent in a residential cor-
rectional facility—a halfway house. A halfway house, while not a prison, requires the
offender to reside there and not be absent save under specific exceptions (e.g., super-
vised absences or employment). It is meant as a transitory phase in an offender’s
parole, neither full incarceration nor full freedom in the community, with the goal of
gradual reintegration into the community.
There are a number of halfway houses designed specifically to provide culturally
sensitive services for the reintegration of Aboriginal offenders. These include but
are not limited to the Stan Daniels Centre in Edmonton, Waseskun House outside of
Montréal,283 and the Kwìkwèxwelhp Healing Village run by the Chehalis First Nation
in British Columbia. The Beardy’s and Okemasis First Nation in Saskatchewan began
operation of a forty-bed minimum security institution called the Willow Cree Healing
Lodge in 2003. In addition to core programs that address educational and life skills,
the facility also provides healing circles and programs designed to raise cultural and
spiritual awareness.284
Unfortunately, there are too few halfway houses that provide programming specif-
ically for Aboriginal offenders. A study by Jason Brown found that Aboriginal parol-
ees often faced a lack of adequate housing, or racial discrimination from prospective
landlords. They were therefore vulnerable to residential instability, which increased
their risk of reoffending. The study stressed the needs for increased community sup-
ports so that Aboriginal parolees can find adequate housing.285 The Commission con-
cludes that more supports are needed to address such issues.
37) We call upon the federal government to provide more supports for Aboriginal
programming in halfway houses and parole services.
Overrepresentation of Aboriginal youth in prison

Young offenders are defined as those young people who are at least twelve years of
age but less than eighteen at the time of sentencing. Of the youth admitted to custody
in Canada in 2011–12, 49% of young women admitted were Aboriginal, as were 36% of
the young men admitted. As troubling as these statistics are, they probably understate
the case, because they exclude Nova Scotia, Québec, Saskatchewan, and Nunavut, for
which data was not available for the period covered.286 Aboriginal youth accounted for
only 7% of the young people aged twelve to seventeen.
Young people who commit crimes have historically been treated differently than
adults. The justice system recognizes that young persons have a heightened vulner-
ability, less maturity, and a reduced capacity for moral judgment, standing as they
do at the borderline between childhood and maturity. Canada’s youth justice system
has operated on the presumption that young people have a reduced degree of moral
blameworthiness such that the use of incarceration should be restricted.287
This recognition is not only a long-standing characteristic of Canada’s domestic
law, but is also required by Canada’s international legal commitments.288 The United
Nations Convention on the Rights of the Child states that children have the right to a
criminal justice system that “takes into account the child’s age and the desirability
of promoting the child’s reintegration and the child’s assuming a constructive role in
society.”289
Currently, the procedures for addressing young people accused of crimes are set
out in the Youth Criminal Justice Act (YCJA), which was introduced in 2002. One of the
key objectives of the YCJA is to reserve jail for the most violent or habitual offenders.
Even in such cases, one of the express goals of the youth criminal justice system is to
address the circumstances underlying a young person’s offending behaviour in order
to rehabilitate and reintegrate young people back into society.290 The YCJA recognizes
that most youth come into contact with the law as a result of fairly minor and isolated
incidents, or by impulsive behaviour that should not stigmatize them with a crimi-
nal record in the same way as with an adult offender. There are a number of tools to
resolve youth cases in informal ways, such as “extrajudicial measures” (e.g., warnings,
cautions, mediation, and family conferencing.) This emphasis on reintegration and
restorative justice has much in common with Aboriginal perspectives on justice, and
gives reason to hope that Aboriginal youth can expect more appropriate treatment
when they come into contact with the law.
In addition, the YCJA requires youth courts to consider all available sanctions other
than custody that are reasonable “with particular attention to the circumstances of
aboriginal young persons.”291 The YCJA also requires that any “measures taken against
young persons who commit offences should … respond to the needs of aboriginal
young persons.”292 There is nothing comparable to such a provision in the Criminal
Code of Canada applicable to adults. In theory, this should allow Aboriginal youth to
maintain access to their traditional practices and to be dealt with by the justice system
in accordance with Aboriginal values.293
By many objective measures, the Youth Criminal Justice Act has been a success.
Prior to the YCJA, Aboriginal youth had a better chance of going to jail than of grad-
uating from high school.294 But while there has been a steady decline in youth crime,
youth court caseloads, youth supervised on a community sentence and in custody in
Canada since the legislation came into effect, 295 the rate of Aboriginal youth incarcer-
ation remains high.296
Many of today’s Aboriginal children and youth are living with the legacy of residen-
tial schools, as they struggle to deal with high rates of addiction, fetal alcohol spec-
trum disorder, mental health issues, family violence, the incarceration of parents, and
the intrusion of child welfare authorities. All of these factors place them at greater
risk of involvement with crime. In addition, the overincarceration of Aboriginal adults
(also tied to the residential schools) has repercussions for their children. One study
in British Columbia found that 39% of youth in custody have a parent with a criminal
record and 47% have another family member with a criminal record.297
Aboriginal youth crime and the child welfare system
The young person standing before a judge represents the end point of a history of
colonization and marginalization that is breathtaking in its scope. The criminal justice
system accomplishes little more than increasing that marginalization.
The growing overrepresentation of Aboriginal youth in custody mirrors the even
more dramatic overrepresentation of Aboriginal children in child welfare care. The
child welfare system plays an important role in Aboriginal youth crime. Not only do
children and youth in care have poorer outcomes in education, health, and well-being
than the general population,298 some child welfare facilities are also prime recruiting
grounds for Aboriginal gangs, with a large proportion of gang members reporting that
they became involved with gangs after placement in either a child welfare or correc-
tional facility.299
Almost three-quarters of youth in custody in British Columbia have been in gov-
ernment care at some point in their lives. The fact that, in 2005, 55% of children in care
in British Columbia were Aboriginal, leads to the conclusion that overrepresentation
within the child welfare system may be one factor contributing to higher proportions
of Aboriginal youth in custody.300 Addressing this national crisis must be a priority if
we are to keep Aboriginal young people out of the criminal justice system.
Legal scholar Larry Chartrand observed that it is hard to characterize the rates
of Aboriginal youth involvement in the criminal justice system as anything other
than discriminatory:
When the impact of social factors results in greater involvement in the criminal
justice system than would otherwise be the case, and the circumstances that
gave rise to such social factors of poverty and social marginalization are attrib-
uted to the continuing effects of colonization, the result is systemic discrimina-
tion of Aboriginal youth in the criminal justice system.301
The Commission believes that there are ways to reduce the growing overrepresen-
tation of Aboriginal youth in custody, but that they will primarily be found outside the
justice system. A recent study examined crime rates throughout Canada and found
that Québec had the lowest rates of crime, including violent crime. The author of the
study examined a number of possible explanations. He dismissed socioeconomic dif-
ferences because Québec has lower average incomes than the Prairies, Ontario, or
British Columbia, all of which have higher crime rates.302 He related the findings to
Québec’s greater investment in social services, including economic supports for fam-
ilies, family housing, a considerable range of services against family violence, health
and social services for families and children, parental educations and skills programs,
child day care and parental leave systems, and related crime prevention programs.303
Other provinces would do well to follow Québec’s example.
Barriers to reducing the number of Aboriginal youth in custody
Bill C-10 (passed by Parliament in 2012) made changes to the Youth Criminal
Justice Act. These changes are likely to undermine attempts within the youth justice
system to accommodate Aboriginal justice practices and values. The bill changed
some of the most basic principles that guide the way that the justice system deals
with young people.
The YCJA begins with a section that outlines the basic goals and aspirations of
the youth criminal justice system, which include dealing with young people in a way
that promotes rehabilitation and reintegration. Prior to the enactment of Bill C-10,
this section used to say that the goal was to “promote the long-term protection of the
public”304 (emphasis added). It now says that the goal is to “protect the public.”305 This
change is significant. Canada has signalled that the long-term gains that come from
investing in the rehabilitation of youth are not the priority. Instead, public protec-
tion in the here and now is the focus. It may seem a subtle difference, but the conse-
quences may signal a shift of resources away from diversion and informal resolutions
and towards custodial sentences.
Under Bill C-10, the Youth Criminal Justice Act has been amended to increase
reliance on pretrial detention and custodial sentences, in part by broadening the
definition of “serious offences” to include any indictable offence for which the maxi-
mum punishment is imprisonment for five years or more. This definition of “serious
offences” now captures such crimes as theft over $5,000.306 The powers of the Crown
prosecutor to apply to have youth as young as fourteen sentenced as adults have been
extended.307 Sentencing judges are now required to impose sentences that express
“denunciation and deterrence” of youth crime.
Denunciation and deterrence have long been sentencing principles in the adult
system. A denunciatory sentence reflects general societal disapproval of a given crime.
Those convicted are meant to feel the sting of this disapproval with the severity of the
sentence. Deterrence in a sentence speaks not just to the convicted, but to observers,
again directing the judge to ‘send a message’ with a severe sentence.
The introduction of deterrence in youth sentences is based on the same question-
able premise that harsh sentences will be an example to offenders and other youth,
thus deterring them from committing crime. Denunciation and deterrence, however,
can have a more punitive effect that can conflict with the goal of rehabilitation. Even
in the adult context, there is little evidence that imposing harsh sentences has any
impact in deterring crime. In criticizing the inclusion of these principles in the youth
system, the Assembly of First Nations observed, “one can assume the denunciation
and deterrence would be even less effective for young persons.”308 What the change
does accomplish is to send a message to sentencing judges that they are expected
to impose longer youth sentences.309 There is a danger that these amendments will
steer judges towards more punitive considerations and away from contextual factors
such as residential schools, child welfare system, and the crisis of overrepresentation
of Aboriginal people in prisons.
The Youth Criminal Justice Act also protects the privacy of youth by banning the
publication of names and identifying information. This is an important feature of the
criminal justice system designed to ensure that youthful indiscretions do not perma-
nently mar the lives and reputations of young people, including their opportunities
for employment. The underlying purpose of the publication ban is to minimize stigma
and instead focus on rehabilitation of the young person.310 The recent amendments
now give youth court judges the discretion to lift publication bans whenever a youth is
given a sentence for a violent offence.311 Giving judges the discretion to lift publication
bans is not necessary for public safety.
Other changes to the law will make it more likely that Aboriginal youth will find
themselves in the formal court process, rather than being diverted into more infor-
mal and restorative resolutions. The Youth Criminal Justice Act allows police to give
cautions or warnings to youth (called “extrajudicial sanctions”) rather than a criminal
charge. The changes to the Act now allow judges to consider these types of informal
sanctions as a reason to sentence youth to a custody centre.312 As the Canadian Bar
Association has observed, these amendments undermine the purpose of extrajudicial
sanctions and send a mixed message to the police that they must keep track of situa-
tions where they are lenient with a young person because the court may wish to use
those statistics at a future date to impose a custodial sentence.
Overall, opportunities to find alternative and restorative means to address youth
misconduct have been drastically reduced with a shift towards increased incarcera-
tion. The overrepresentation of Aboriginal youth in custody will increase under this
new regime, as judges will have less discretion and less inclination to consider the
particular circumstances of the young person before them.
All of this speaks to the need to recognize that Aboriginal youth incarceration rates
are likely to continue to increase when the evidence shows the ongoing ineffective-
ness of incarceration as a means to address Aboriginal youth criminal involvement.
The emphasis in the view of the Commission should be to recognize the very clear
evidence that youth crime is connected to poverty, home dysfunction, lack of proper
parenting, nurturing, and parental love, inadequate child welfare involvement, com-
munity breakdown, a poor sense of personal identity and cultural connection, poor
school success, youth gang involvement, substance abuse, unemployment, and sys-
temic racism in many aspects of social involvement available to youth. In the view of
the Commission, the emphasis when it comes to Aboriginal youth needs to be on how
to bring about a decrease in the use of incarceration.
commit to eliminating the overrepresentation of Aboriginal youth in custody over
the next decade.
Overrepresentation of Aboriginal
people among victims of crime
The justice system has historically and consistently failed Aboriginal victims
of crime. Aboriginal children were victims of crime in residential schools. Close to
38,000 living Survivors have applied for compensation for sexual or serious physical
abuse. Over $2.8 billion has been paid in the approximately 32,000 cases resolved so
far.313 This is the single largest recognition of criminal victimization in Canadian his-
tory. Today, the justice system continues to fail Aboriginal people who are dispropor-
tionately the victims of crime.
Missing data
Accurate information about the rate of victimization in Aboriginal communities

can be hard to come by. Statistics Canada surveys likely underreport the extent of vic-
timization, because they are not designed to reach Aboriginal people specifically. The
studies do not include people without a phone or who do not speak English or French,
and do not provide the kinds of supports necessary to permit some Aboriginal victims
to comfortably disclose their experience to researchers.
The most recent study by Statistics Canada indicates that the homicide victimiza-
tion rate of Aboriginal people between 1997 and 2000 was seven times that of non-
Aboriginal Canadians. However, that data is no longer being gathered. Statistics
Canada’s most recent data on homicide and family violence fails to report how many
victims were Aboriginal, despite reporting many other characteristics of victims
including their ages, gender, and occupations, and whether the victims consumed
intoxicants.314 It is positive that Statistics Canada has indicated that revised data on the
Aboriginal identity of victims that were reported to Statistics Canada as a result of the
Royal Canadian Mounted Police report on Missing and Murdered Aboriginal Women
are planned for release with the 2014 Homicide Survey data.315 However, so far Statistics
Canada has not committed to collecting such information on an ongoing basis.
The Commission notes that other more recent material produced by Statistics
Canada on violence against women includes data on police reports as to whether
homicide victims were Aboriginal.316 As in other areas, the Commission is concerned
that our statistical knowledge about the conditions faced by Aboriginal people in
Canada is getting worse and this may make these issues less visible to Canadians.
39) We call upon the federal government to develop a national plan to collect and
publish data on the criminal victimization of Aboriginal people, including data
related to homicide and family violence victimization.
Women as victims of violence
I ask that everyone here remembers a few simple words—love,

kindness, respect and forgiveness … As a survivor, I respectfully
challenge you all to call for a national inquiry into missing and
murdered indigenous women.317
—Rinelle Harper, speaking to the Assembly of First Nations
December 9, 2014
For a brief few moments in the early winter of 2014, a shy sixteen-year-old
Aboriginal girl stood before the cameras at a meeting of the Assembly of First Nations
in Winnipeg. She held an eagle feather and, though she spoke quietly, millions heard
what she had to say. The story of the savage attack she had endured barely a month
earlier had caught the attention of the country—as did the fact that she chose to
make such a public appeal. Her name is Rinelle Harper. In early November, two men
assaulted her, beat her, and left her for dead on the banks of the Assiniboine River in
Winnipeg. That she survived the attack is a testament to her strength.
The story of Rinelle Harper is but one part of a sweeping history of Aboriginal
women and girls who are victims of crime. In the past decade, there has been growing
public awareness and concern about the large number of Aboriginal women and girls
who have been killed or have gone missing. The recent release of data has amplified
that concern and led to the widespread call for a public inquiry into the issue. It is a
call that the Commission supports.
Aboriginal women are more likely than other women to experience risk factors for
violence. They are disproportionately young, poor, unemployed, likely to have been
involved with the child welfare system and to live in a community marked by social
disorder.318
Statistics Canada’s 2009 General Social Survey (gss) found that 13% of Aboriginal
women reported that they had experienced violence within the past year, a rate 2.5
times higher than non-Aboriginal women.319 Most of these violent incidents were
never reported to police (over three-quarters of such incidents).320 It is likely that the
gss study itself underreports the extent of crime against Aboriginal people because
of the failure to make special outreach to Aboriginal people. This makes it findings of
disproportionate victimization of Aboriginal women all the more disturbing.
Extremely high rates of intimate-partner violence are one of the causes of the high
victimization rate. Of those Aboriginal women with a current or former spouse who
responded to the gss, 15% reported having been a victim of spousal violence in the
previous five years, as compared to 6% of non-Aboriginal women.321 The spousal vio-
lence reported by Aboriginal women was more severe, with 59% of Aboriginal female
spousal violence victims reporting injury as compared to 41% of non-Aboriginal
female victims.322 Aboriginal survivors of spousal violence were also more likely to
report having been victimized multiple times in the past five years, with 59% reporting
being victimized more than once as compared to 43% of non-Aboriginal victims.323
Tabitha Takawgak was married to a residential school Survivor. She recounted,
I was married to him for 35 years. I couldn’t take it anymore and I finally left him.
I loved him and I wanted him as my husband for my lifetime. It’s so hard to be
married to a man who has been abused in this way. As the woman who spoke
before me said, my dear children also suffered. I have many sons with my former
husband and one has been in and out of jail and we lost our oldest to suicide.
During those times that we were suffering I wanted to help my husband but I
didn’t know what to do. I loved my husband and yet he was my abuser … I don’t
want people to think badly of my husband. I still love him so much but I had to
make a choice to no longer be his wife today.324
Residential schools deprived children of access to cultural and spiritual teachings
and disrupted Aboriginal women’s traditional roles as “mothers, grandmothers, care-
givers, nurturers, teachers, and family decision-makers.”325 Discriminatory Indian Act
provisions that had the effect of denying Aboriginal identity to women who married
non-Aboriginal men, and their children, and this contributed to the separation of
Aboriginal women from their communities.
Among the many tragic cases of violence perpetrated against Aboriginal women
several have become particularly well known and serve as case studies.
Helen Betty Osborne
Early in the morning of November 13, 1971, Helen Betty Osborne, aged nineteen,
was approached in The Pas, Manitoba, by four white men who wanted to pick up an
Aboriginal woman for sex. She was abducted, sexually assaulted, and brutally mur-
dered—stabbed fifty times with a screwdriver. Her skull, cheekbones, and palate were
broken and her face was unrecognizable. She was left naked.
Betty Osborne attended Guy Hill residential school because there were no similar
educational opportunities provided by the federal government in her home commu-
nity of Norway House, a northern Cree community. In 1991 the Manitoba Aboriginal
Justice Inquiry found that Betty Osborne was in The Pas because of government policy
of “removing Aboriginal children from the influence of their parents and their cultures
and to educate them to the ‘white man’s ways’” and found that “the actions of the gov-
ernment in doing so were clearly racist and discriminatory.”326
It was not until sixteen years later that one of the murderers was convicted. The
other three men went free. This was the conclusion of the Manitoba Aboriginal
Justice Inquiry:
Helen Betty Osborne would not have been killed if she had not been Aboriginal.
The four men who took her to her death from the streets of The Pas that night
had gone looking for an Aboriginal girl with whom to “party.” They found Betty
Osborne. When she refused to party she was driven out of town and murdered.
Those who abducted her showed a total lack of regard for her person or her
rights as an individual. Those who stood by while the physical assault took place,
while sexual advances were made and while she was being beaten to death
showed their own racism, sexism and indifference. Those who knew the story
and remained silent must share their guilt.327
One of Helen Betty Osborne’s friends spoke with the Commission about life today
in Norway House:
I’m glad you guys came … There’s so much drugs going on here; a lot of drink-
ing; young kids. Not too long ago we had a murder too, a young girl got stabbed.
I guess some guys went to her house, their house and beat up the dad and she
jumped in to help her dad and she got stabbed and she got killed; about two
weeks ago. She was only about 20 years old. I couldn’t even bring myself to go to
the wake, to the funeral, I just. I couldn’t do it; I couldn’t bring myself to come
there. There’s so much of that going on; holy it’s bad. And I always think, “Yup,
that’s the schools, the residential schools” put a big hole in our lives.328
This statement reveals how the trauma of residential schools and disproportionate
victimization by crime continue in Aboriginal communities like Norway House to
this day.
Robert Pickton’s victims
Another infamous case of violence against women that is connected with the
legacy of residential schools is Robert Pickton’s multiple murders of women from
Vancouver’s Downtown Eastside. Many of Pickton’s victims were Aboriginal; some
were residential school Survivors. One of the first victims who went missing in 1983
was Rebecca Guno, a member of the Nisga’a Nation, who attended residential school
and had been working as a sex worker. A friend told the provincial Missing Women
Commission about her last meeting with Guno:
She introduced me to her son. During the course of our conversation she said
“I’m a prostitute, Millie; I can’t really explain why. But it’s a living, we do what we
have to do … Life’s not that bad. I have my baby and that’s all that matters to me.
His dad is really good to us, but I’m gonna keep doing what I do, his dad knows
that and we are happy to be parents to our baby … We’re happy and that’s what
matters. I’m not ashamed of myself.”329
Georgina Papin was from Hobbema, Alberta, and attended residential school. She
was placed in foster care before she ran away at the age of twelve and began sex work
in Las Vegas at the age of fourteen.330 The police failed to investigate properly when
Papin went missing. For example, they did not conduct interviews at native friendship
centres she was known to attend.331 Her remains were later found on the Pickton farm,
and Robert Pickton was convicted of second-degree murder in her death.332 Dawn
Crey, another victim, was an intergenerational Survivor and was also placed in non
-Aboriginal foster homes as a child.333 When Crey was reported missing, the police
apparently did nothing for six weeks and only interviewed one witness.334
Marlene Bird
On June 1, 2014, police in Prince Albert, Saskatchewan, found the body of Marlene
Bird. She’d been sexually assaulted, beaten with a nail-studded board, and then set on
fire. Although she survived, she would later lose both her legs, and surgeons would
have to reattach half her face. “What did I do so wrong to have this happen to me?”
Bird asked aptn News in Prince Albert. “I do try my best to be strong.”335
Marlene Bird comes from the small northern Saskatchewan community of
Molanosa. Talking of her childhood at home with alcoholic parents she said, “I
remember playing with dolls, and they’d be inside drinking. When they started get-
ting loud that’s when I knew, dad bought something again … so I started drinking that
wine, me and my little brother.”336
She was also in the residential school system. In a graphic novel of her story, she
says that she was sexually abused in the school and again later as a young adult. 337
Her daughter was also abused but refused to speak about it to the police. Bird says she
blamed herself and turned to alcohol, and that’s when her own children were taken
away.
Tina Fontaine
In early August 2014, fifteen-year-old Tina Fontaine, a girl from Sagkeeng First
Nation, was reported missing in Winnipeg. A week later, two Winnipeg police offi-
cers stopped a car with Tina Fontaine in it. Even though she was fifteen and intoxi-
cated, and was already listed as a missing person, they allowed the car to move on
with her in it. Nine days later, her body was found wrapped in a bag in the Red River.
Fontaine’s great-aunt was told by the chief investigator that the officers had run her
identity through the system and released her anyway. When it became known that
the two officers had contact with Tina Fontaine prior to her murder, they were put on
administrative leave. Several months later, the Winnipeg Police Service announced
that although the officers were to be disciplined, no charges would be made against
them for their conduct.338 It is cases like this one that lead Aboriginal groups to ques-
tion the willingness of the police to protect Aboriginal citizens. This lack of trust has
some of its origins in the police’s role in enforcing attendance at residential schools
and in the less than robust performance of the police and courts in responding to wide
spread violence against Aboriginal children in the residential schools.
Missing and murdered Aboriginal women and girls
Public awareness of the issue of violence against Aboriginal women has continued
to grow through the efforts of advocates and through the work of high-profile investi-
gations, inquiries, and reports.
Native Women’s Association investigation
The Native Women’s Association of Canada (nwac), through its Sisters in Spirit
project, has done groundbreaking work in discovering the truth about murdered and
missing Aboriginal women and girls. This was a multi-year research, education, and
policy initiative funded by Status of Women Canada, and was specifically designed
to uncover the root causes, circumstances, and trends in violence against Aboriginal
women in order to promote policy change to increase the personal safety and security
of Aboriginal women and girls.
The Sisters in Spirit project found that, in most of the cases they identified, parents
or grandparents of the missing or murdered women had attended residential school.
Many grew up in families experiencing serious dysfunction, were forced into the child
welfare system and adopted into non-Aboriginal families.339 Without access to qual-
ity education and fewer employment opportunities, a high proportion of Aboriginal
women and their children live in poverty and in situations of dangerous dependency
and unsafe housing.340 The devaluing of Aboriginal peoples symbolized by residential
schools also contributes to the vulnerability of Aboriginal women. They are targeted for
violence because they are Aboriginal, on the assumption that no one will miss them and
police will not take the case seriously. Too often, this assumption proves to be true.
Sisters in Spirit also identified particular areas (and cities) in which Aboriginal
women are at extremely high risk of violence, disappearance, and death. The cities
include Regina, Saskatoon, Edmonton, Winnipeg, Vancouver, and communities in
Northern British Columbia along Highway 16.341 The 724 kilometres of Highway 16
that run between Prince Rupert and Prince George has been named the “Highway of
Tears” because of the extraordinary number of young women who have gone missing
along this stretch of road. Because of a lack of public transportation, those living in
rural areas often have to resort to hitchhiking rides with strangers. Over a thirty-five-
year period, some estimate that as many as forty women have been murdered or gone
missing on that highway.342 The majority of those victims were Aboriginal.343
In 2006, a Highway of Tears Symposium was organized by a number of affected
First Nations and allied organizations. Among the recommendations that resulted
from that symposium was a plan to prevent hitchhiking along Highway 16 through the
establishment of a shuttle bus service. In 2012, that recommendation was adopted by
the British Columbia Missing Women’s Inquiry and by mayors in communities along
the highway.344 Yet, a month later, Greyhound Canada announced cuts on fifteen
routes, including a 40% reduction in service along Highway 16.345 Three years after the
recommendation was accepted, it has not been implemented.
When the Sisters in Spirit project was completed, the Native Women’s Association
had identified 582 missing or murdered Aboriginal women and girls for the period
between 1944 and 2010. Of those women, 67% were murder cases, 20% were missing
persons, 4% were suspicious deaths, and 9% were simply unknown (i.e., it is unclear
whether the victim was murdered, is missing, or died in suspicious circumstances).346
Most of the cases in the database were from the previous ten years, occurring at a
rate of about twenty cases per year, but the association believed that there were many
unidentified older cases that were simply unrecorded and unknown.
The Sisters in Spirit final report indicated that 88% of the missing women had chil-
dren or grandchildren, and it underlined the intergenerational effects of the loss of
parents and parenting skills due to the residential schools experience and the Sixties
Scoop (the wide-scale apprehension of Aboriginal children in the 1960s, 1970s, and
1980s). The report noted that only 13% of the women it had identified had been mur-
dered on a reserve and only 7% had gone missing from a reserve.347 Of the cases where
location was known, 70% of the women and girls disappeared from an urban area
and 60% were found murdered in an urban area. The study concluded that Aboriginal
women were almost three times more likely to be murdered by a stranger than non-
Aboriginal women.348
There were 149 cases identified where the activity of the missing women was
known. About half of those women were involved in the sex trade, but the majority
were not.349 The study also found that only 53% of the cases involving homicide had
resulted in a charge, a much lower rate than is typical in homicide cases.350
In 2010, the Government of Canada ceased funding the Sisters in Spirit project.
While the Native Women’s Association maintains the database as best it can, it does
not have the resources that it once did.351 The Government of Canada’s refusal to
continue to fund the project is part of a disturbing and recurring pattern of cuts to
Aboriginal organizations that have been collecting information and knowledge about
Aboriginal people. Other examples include the cuts to various Aboriginal health orga-
nizations, the long-form census, and other research conducted by Statistics Canada.
In March 2013, the Native Women’s Association revised its record of cases of miss-
ing or murdered Aboriginal women and girls to 668.352 That research was supple-
mented through the work of Maryanne Pearce, who completed a dissertation in 2013
at the University of Ottawa on missing and murdered women in Canada.353 Also rely-
ing on publicly available information, Pearce’s database includes 3,329 women (both
Aboriginal and non-Aboriginal) who went missing or were murdered between 1946
and 2013. Ethnicity was known for only 1,595 of the women listed. Of these, 824 were
identified as Aboriginal.354
House of Commons Standing Committee on the Status of Women
In 2010–11 the House of Commons Standing Committee on the Status of Women

heard from 150 witnesses across the country about violence against Aboriginal
women. The Committee also heard about a pattern of police failing to take reports
of missing and murdered Aboriginal women and of serious delays in investigations.
They were told that in domestic violence situations, police do not always respond in
a timely manner, and that the police sometimes dismiss claims of sexual assault by
Aboriginal women who they consider to be living a ‘high-risk’ lifestyle.
Aboriginal women are often treated as offenders, rather than Survivors or victims,
making women less likely to contact police for help. Witnesses attributed this negli-
gent approach to violence against Aboriginal women to racism and sexism by police
officers, but also to the underresourced nature of policing on reserves and in more
remote communities. As with many other areas of the lives of Aboriginal peoples,
their access to police services can be undermined by overlapping and unclear juris-
dictional lines. In some cases, it is unclear whether the rcmp, First Nations, municipal,
or provincial police forces are responsible for the investigation.355
Oppal Inquiry
The Honourable Wally T. Oppal, formerly a justice of the British Columbia Court of
Appeal, and later BC’s attorney general, served as commissioner of the Missing Women
Commission of Inquiry. In his report, released in 2012, Justice Oppal said he was
particularly troubled by the failure of the police to employ an Aboriginal-specific
investigation strategy given the disproportionate number of Aboriginal women
among the missing women from the DTES [Downtown Eastside]. The First Nations
Summit had brought their concerns about the large number of murdered Aborigi-
nal women to the attention of the vpd, rcmp and puhu [Vancouver Police De-
partment, Royal Canadian Mounted Police, and Provincial Unsolved Homicides
Unit] through its requests for action in February 1997. Independent Counsel for
Aboriginal Interests repeatedly asked police witnesses about their consideration of

tailored investigative strategies involving the Aboriginal community: the responses
were woefully deficient … The police completely overlooked the Aboriginal dimen-
sions of the missing women crisis throughout the investigations. This systemic
blindness to distinctiveness and specificity of the Aboriginal communities is stag-
gering in light of the number of Aboriginal victims.356
Justice Oppal also singled out the rcmp for criticism by noting,
it is particularly difficult to comprehend the rcmp’s failure to prioritize the
missing and murdered women investigations. The fact that it did not do so is a
blatant manifestation of systemic bias. Given its long history of involvement in
the colonization process, including the forced recruitment and confinement of
Aboriginal children in residential schools, the rcmp has a heightened duty to
protect Aboriginal people. There is no evidence that the rcmp took active steps
to meet this moral obligation.357
2014 RCMP Report
In May 2014, the rcmp released Missing and Murdered Aboriginal Women: A
National Operational Overview. The document identified 1,181 cases of Aboriginal
women and girls who were murdered or still considered missing. To be more specific,
that’s 1,017 Aboriginal women and girls who are known to have been killed since 1980,
and 164 who are missing, and suspected to have been the victims of foul play. When
these rcmp statistics are compared to those of non-Aboriginal women, it reveals that
Aboriginal women are four times more likely to be victims of homicide. The report
notes that “In 2011, there were 718,500 Aboriginal females in Canada, representing
4.3% of the overall female population that year.”358 The report goes on to point out,
Between 1980 and 2012, there were 20,313 homicides across Canada, which
averaged approximately 615 per year. Females represented 32% of homicide
victims (6,551 victims) across all police jurisdictions between 1980 and 2012.
Every province and territory was implicated. There were 1,017 Aboriginal female
victims of homicide during this period, which represents roughly 16% of all
female homicides—far greater than their representation in Canada’s female
population.359
In its review, the rcmp attempted to explain a history of confusion that had pre-
vented the force from identifying Aboriginal victims of crime:
The use of the term “Aboriginal” as a descriptor has different definitions in the
different data sources that make up this research project. For example, CPIC (Ca-
nadian Police Information Centre) captures Aboriginal as an “ethnicity” whereas
Statistics Canada’s official position is that “Aboriginal” is not an ethnicity but rather
an origin ... Differences in police practice between agencies make it hard to create a
data set that is comparable across jurisdictions. For example, in collecting data on
homicides, some agencies use official Aboriginal “status” as the means to deter-
mine identity, others use officer discretion (as discussed above), and others rely on
self-identification by individuals or their associations (family, friend etc.) … Histor-
ical police service (including the rcmp) adherence to jurisdictional and organiza-
tional policies has undermined the consistent collection and sharing of information
on Aboriginal identity. This has meant a high number of Homicide Survey reports
where the identity of the victim (and/or the accused) remained “unknown.”360
Because of the ambiguities in identification and data collection, many believe that
the number of murdered and missing women has been underestimated. Aboriginal
scholar and activist Pamela Palmater wrote, “It is logical to conclude that the rcmp
grossly under-counted the actual numbers of murdered and missing Aboriginal
women in Canada. This conclusion is confirmed by the rcmp’s own admission that
due to these methodological problems ‘a high number of Homicide survey reports
where the identity of the victim (and/or accused) remained unknown.’”361
The release of the rcmp report has intensified public calls for a public inquiry into
the issue. The federal government, however, has denied there is need for an inquiry
and has suggested that the causes of violence against Aboriginal women are already
known. Aboriginal Affairs Minister Bernard Valcourt has said that First Nation men
have a “lack of respect” for women and girls on reserve. In a March 2015 speech he
told Alberta chiefs that 70% of the cases of murdered and missing Aboriginal women
were the result of the actions of Aboriginal men.362 Information subsequently released
by the rcmp was interpreted as supporting the minister’s assertion.363
Many Canadians have rejected the contention that an inquiry is unnecessary because
all the contributing factors are already known and understood. Pamela Palmater writes,
This shell game of numbers and statistics is meant to blame the victim and
deflect attention away from Canada’s continued inaction to address this crisis
which the United Nations has called a “grave violation” of our basic human
rights. The crisis of murdered and missing Indigenous women and little girls
continues while Canada (through Valcourt) blames the victim and the rcmp fail
to live up to their duty to serve and protect everyone in Canada.364
International voices of concern
Although there are many voices calling for a national inquiry into the murdered and
missing Aboriginal women and girls, the federal government has refused to establish
one. That refusal has drawn international criticism. Respected international human
rights organizations that often focus on disappearances in brutal dictatorships now
conclude that it is necessary to examine Canada’s problem of missing and murdered
Aboriginal women.365
United Nations
United Nations human rights treaty monitoring bodies—including those commit-

tees addressing children’s rights violations, torture, discrimination against women,
and civil and political rights violations—have criticized Canada for the inadequate
government response to violence against Aboriginal women and girls.366 The UN
Committee for the Elimination of Discrimination Against Women expressed concern
that “hundreds of cases involving aboriginal women who have gone missing or been
murdered in the past two decades have neither been fully investigated nor attracted
priority attention, with the perpetrators remaining unpunished.”367 The committee
urged Canada to investigate the cases, to determine whether there is a racial pattern
to the disappearances, and to take the necessary steps to remedy the deficiencies in
the system.
The UN special rapporteur on the rights of Indigenous peoples remarked that a
national inquiry “could help ensure a coordinated response and the opportunity for
the loved ones of victims to be heard, and would demonstrate a responsiveness to the
concerns raised by the families and communities affected by this epidemic. These and
further steps are required to realize the promise of healing and a new relationship that
was made in the 2008 apology.”368
Amnesty International
Amnesty International points out that the scale of violence faced by Aboriginal
women in Canada is a human rights violation. The organization says comprehensive
national response is required that “addresses the social and economic factors that
place Indigenous women at heightened risk of violence; … the police response to vio-
lence against Indigenous women; the dramatic gap in standard of living and quality of
life; … continued disruption of Indigenous societies by the high proportion of children
put into state care; and the disproportionate imprisonment of Indigenous women.”369
Human Rights Watch
In response to the number of missing and murdered women along the Highway
of Tears in Northern British Columbia, Human Rights Watch worked with the com-
munity to investigate. The organization conducted interviews with fifty Aboriginal
women and girls, nineteen community service providers, and seven current and for-
mer rcmp officers.370 The investigators found that “for many Indigenous women and
girls interviewed for this report, abuses and other indignities visited on them by the
police have come to define their relationship with law enforcement.”371
Human Rights Watch was told stories of excessive use of force, racist and sexist
verbal abuse, cross-gender searches, and sexual and physical abuse by police officers.
When police protection was sought in response to domestic violence, community

service providers and Aboriginal women reported that police sometimes blamed the
women for the abuse and shamed them for alcohol or substance use. Not surpris-
ingly, Human Rights Watch found that “indigenous women and girls report having
little faith that police forces responsible for mistreatment and abuse can offer them
protection when they face violence in the wider community.”372
For all the reasons enumerated by these organizations and many others, the
Commission believes that a comprehensive inquiry must be undertaken.
41) We call upon the federal government, in consultation with Aboriginal organizations,
to appoint a public inquiry into the causes of, and remedies for, the disproportion-
ate victimization of Aboriginal women. The inquiry’s mandate would include:
i. Investigation into missing and murdered Aboriginal women and girls.
ii. Links to the intergenerational legacy of residential schools.
In making this call to action, the Commission offers the following considerations:
1. A public inquiry will need to have two different components. It will need to
be a fact-based inquiry as well as a policy inquiry, examining both individ-
ual cases as well as systemic issues.
2. In order for the inquiry to have sufficient credibility, a consultation advi-
sory committee should be struck to make recommendations concerning its
mandate. Such a committee should include professional advisors, Aborigi-
nal women, and representatives of victims’ families.
3. In examining individual cases, the inquiry must be cautious when dealing
with open cases in which there may be a person of interest and where addi-
tional evidence is needed to lay a charge.
4. The inquiry should be allowed to look into the role of governments, the
rcmp, and other police services, and the child welfare system.
5. An inquiry should consider using witness panels with multiple witnesses as
opposed to only single witnesses testifying, when considering systemic issues.
6. Commissions would not be able to name offenders, or identify criminal
wrongdoing that has not already been found through an appropriate crimi-
nal process.
7. Anyone potentially affected by an inquiry must be protected from character
and reputational harm, and has the right to attend and be heard.
8. An inquiry would provide an opportunity for personal, family, and
community healing. Health supports for persons involved will need to be

provided.
9. The need for families of victims to know more must be an important factor.
10. The inquiry should be mandated to study the role of police in the investiga-
tions of the cases.
11. The inquiry should gather and analyze data relating to
• where and when incidents occurred;
• the specific circumstances of incidents;
• consistencies, similarities, and differences between incidents;
• how many victims were engaged in a high-risk lifestyle; and
• whether there been a change in the number of incidents since 2010.
12. The inquiry should examine whether there is evidence of gang involvement
(e.g., street gangs, motorcycle gangs, traffickers in the sex trade with inter-
national ties).
13. Is there evidence of serial killings?
14. What did police or others know, and when did they know it?
15. What is the degree of interprovincial and national coordination in investi-
gations?
16. Is violence against Aboriginal women and girls in Canada comparable to
what is happening to Indigenous women in other countries (including the
United States, Australia, New Zealand, and Africa)?
17. Is there a Great Lakes sex trade with operatives at play?
18. Since the termination of federal funding to the Native Women’s Association
of Canada’s Sisters in Spirit project, how effective have federal initiatives to
address Aboriginal female victimization been?
19. Is there evidence to support the contention that the government’s tough on
crime initiative is helping to reduce victimization?
20. What analysis did the federal government conduct prior to its decision to shut
down further research by the Native Women’s Association of Canada in 2010?
21. Has the number of missing and murdered Aboriginal women reduced in fre-
quency since 2010?
22. Is it likely that the number of missing and murdered Aboriginal women will
increase?
Supporting Aboriginal victims of crime
Supports to victims of crime are offered by a variety of service providers. These

supports may be provided by police services, community-based agencies, or by the
courts. Some provide assistance in navigating the justice system; some provide resi-
dential shelter, and others focus on the victims of sexual assault, providing specialized
medical care and emotional support.373 Culturally appropriate services are needed for
all Aboriginal victims of crime but particularly for Aboriginal women. A 2012 survey
conducted by Statistics Canada found that only 3% of shelters exclusively serve an
on-reserve population (a total of eighteen shelters).374 At the same time, funding from
Aboriginal Affairs for emergency shelters is currently available only to Aboriginal peo-
ple on reserves, which excludes almost all communities in the Territories.375 The prob-
lem is particularly severe for Inuit women living in the North, where more than 70%
of the communities do not have a shelter for abused women and children. Nunavik
has only three shelters to serve fourteen northern villages.376 There is also a lack of
culturally appropriate services for Aboriginal women in urban areas and a lack of any
services at all in some rural and remote communities.377
In a Statistics Canada survey conducted in 2011 and 2012, 760 victim service pro-
viders were interviewed. Only 28% of them reported that they provide services to
Aboriginal people. Twelve per cent of providers reported they could provide services
in Cree, 3% in Ojibway, 1% in Inuktitut, and 11% in other Aboriginal languages. The
majority of victim services said they provide protection and support for criminal
justice matters: 64% offered medical related services; 59% offered shelter-related ser-
vices; 56% offered assistance with compensation; and 47% offering counselling. Only
9% report providing restorative justice proceedings but 27% will provide support for
crime victims in such informal processes.378
There is an urgent need for more study of the effectiveness of the services that are
provided to Aboriginal crime victims. Some victim services are offered by the police
but, given the historic strains in the relationship between Aboriginal people and the
police, the police may not be the best service provider for Aboriginal crime victims.
There is a danger that victim services will focus on supporting victims only in the for-
mal criminal justice system and not on providing other supports including supports
in out of court processes.
Declaration of Basic Principles of Justice for Victims of

Crime and Abuse of Power
The General Assembly of the United Nations proclaimed a Declaration of Basic

Principles of Justice for Victims of Crime and Abuse of Power in 1985, which was co-
sponsored by the Department of Justice and subsequently adopted by Canada’s
federal and provincial/territorial governments.379 This declaration defines victims

broadly to include both victims of crime and abuse of power by “public officials or
other agents in acting in an official or quasi-official official capacity.”
Article 5 of the 1985 UN Declaration contemplates that victims should receive
redress through formal or informal means. Article 6 recognizes that efforts should
be taken to protect the privacy of victims in the criminal process and protect them
against unnecessary delay, intimidation, and retaliation. Article 7 specifically states
that “Informal mechanisms for the resolution of disputes, including mediation,
arbitration and customary justice or indigenous practices, should be utilized where
appropriate to facilitate conciliation and redress for victims.” It goes on to provide that
“Indigenous individuals have the rights to life, physical and mental integrity, liberty
and security of person,” and article 7(2) specifically affirms that Indigenous people
have “the collective right to live in freedom, peace and security as distinct peoples and
shall not be subjected to any act of genocide or any other act of violence, including
forcibly removing children of the group to another group.”
Article 8 obliges states to both prevent and redress acts such as the operation of
residential school, acts that have “the aim or effect of depriving” Indigenous people
of their integrity as distinct peoples, or of their cultural values or ethnic identities. As
with the 1985 United Nations Declaration, states are obligated to prevent and redress
serious breaches of these rights.
Article 12 provides that “States should endeavour to provide financial compensa-
tion to:
(a) Victims who have sustained significant bodily injury or impairment of physi-
cal or mental health as a result of serious crimes;
(b) The family, in particular dependents of persons who have died or become
physically or mentally incapacitated as a result of such victimization.
Article 14 of the 1985 UN Declaration recognizes the importance of Indigenous

communities providing various forms of assistance for Indigenous victims of crime or
abuse of state power by providing that “Victims should receive the necessary material,
medical, psychological and social assistance through governmental, voluntary, com-
munity-based and indigenous means.”
Article 17 also recognizes that in “providing services and assistance to victims,
attention should be given to those who have special needs because of … race, colour,
sex, age, language, religion, nationality, political or other opinion, cultural beliefs or
practices, property, birth or family status, ethnic or social origin, and disability.” This
UN Declaration provides a sound basis for recognizing the distinct needs of Aboriginal
crime victims and ensuring that they receive a broad range of appropriate health and
economic support.
2007 UN Declaration on the Rights of Indigenous Peoples
In 2007, the UN proclaimed another declaration of particular importance for rights

that are relevant to Aboriginal victims of crime or state power: the UN Declaration
on the Rights of Indigenous Peoples. 380 The 2007 UN Declaration provides for a broad
range of educational, linguistic, cultural, land, and self-government rights, and the
rights not to be removed from their land and not to suffer discrimination. Although
not formally framed as such, these broad rights to development and self-determina-
tion can be seen as crime prevention actions that foster strong Indigenous families,
schools, communities, and health services that will allow people to live law abiding
lives and to demonstrate greater resilience if crime does occur.
Article 22 of the 2007 UN Declaration also provides a right of particular relevance
given the situation of missing and murdered Aboriginal women and girls in Canada by
providing that “States shall take measures, in conjunction with indigenous peoples, to
ensure that indigenous women and children enjoy the full protection and guarantees
against all forms of violence and discrimination.”
The international recognition of the need for services for the victims of crime—
particularly women—has outpaced the willingness of Canadian governments to ade-
quately respond.
40) We call on all levels of government, in collaboration with Aboriginal people, to

create adequately funded and accessible Aboriginal-specific victim programs and
services with appropriate evaluation mechanisms.
Blurred lines between victims and offenders
One of the failings of the Canadian justice system towards Aboriginal people is its
tendency to divide services between those for victims and those for offenders and
ignore the overlap between the two populations. For so many in Aboriginal com-
munities, there’s no distinction between those who are the offenders and those who
are the victims. The cycle of abuse that began with the residential schools has not
been broken.
Michael Sillett was sexually assaulted while he was a student in a hostel in North
West River, Newfoundland. He explained,
These incidents, these incidents have had a tremendous impact in my later
life outside the dorm … I found it very hard to trust people. I didn’t like to be
hugged or touched. I didn’t have much respect for authority figures; I had a bad
attitude that stunted my full potential all my life. I have broken the law. I have
done things that I am deeply ashamed of. My greatest regret is hurting my three
daughters; especially my eldest.381
Ron McHugh, an intergenerational Survivor told the Commission of the connec-
tion he saw between victimization and crime:
It all stems from that one thing, that one policy, that one act—residential school.
And so, today, I mean, you take a dysfunctional family of people. You know, a
history of molestation over generations and generations—that’s just one family.
Now, you take a whole culture of people, and that kind of behaviour also goes
from generation to generation.382
Many of the difficulties that both Aboriginal victims of crime and offenders suf-
fer, including substance abuse and poverty, stem from the common legacy of resi-
dential schools. A related failure is the system’s reluctance to appreciate that, in the
Aboriginal context especially, it is often necessary to heal individuals by healing fami-
lies and communities. Strategies must be directed towards community structures and
dynamics as well as families. They must also recognize the tremendous diversity of
cultures among Aboriginal peoples.
The way forward: Aboriginal justice systems

The Royal Commission on Aboriginal Peoples recommended that justice systems
should be central in self-government for Aboriginal communities and that such sys-
tems respond to the legacy of colonialism and forced assimilation that distinguished
the circumstances of Aboriginal people from other disadvantaged groups.383
Article 5 of the United Nations Declaration on the Rights of Indigenous Peoples rec-
ognizes the right to self-determining justice systems: “Indigenous peoples have the
right to maintain and strengthen their distinct political, legal, economic, social and
cultural institutions, while retaining their right to participate fully, if they so choose, in
the political, economic, social and cultural life of the State.”384
Manitoba’s Aboriginal Justice Inquiry concluded,
Wherever possible, Aboriginal justice systems look toward the development of
culturally appropriate rules and processes which have as their aim the establish-
ment of a less formalistic approach to courtroom procedures so that Aboriginal
litigants are able to gain a degree of comfort from the proceedings while not
compromising the rights of an accused charged with a criminal offence.385
The Manitoba Inquiry proposed that all people within the relevant territory be
subject to Aboriginal justice systems and that Aboriginal communities be entitled to
enact their own criminal, civil, and family laws and to have those laws enforced by
their own justice systems. If they wish, they should also have the right to adopt any
federal or provincial law and to apply or enforce that as well.
Aboriginal forms of justice will be as diverse as Canada’s Aboriginal peoples.
Typically, they would involve community-based justice processes, employing custom-
ary law, and focusing on restoring balance to communities. This vision of Aboriginal
justice would, in a manner similar to American tribal courts, allow Aboriginal courts,
in some cases, to have jurisdiction over criminal, family, and civil matters involving
Aboriginal people that may arise, as they frequently will, in the cities.
Cautions
The Commission fully supports this vision but recognizes that there may be some
risks in undertaking Aboriginal justice initiatives, especially in small communities
that have suffered much intergenerational trauma. Aboriginal and restorative justice
is slower than processing through the courts. Extra time and expense must be invested
if a vulnerable victim is also included in the community justice process. Care must be
taken to ensure proper supports and ceremony for both offenders and victims and
their supporters.
Concerns have been raised about approaches that rely on often underfinanced and
strained communities to correct offenders. If an Aboriginal offender lacks support in
the community, he or she may be vulnerable to the exploitation of a power differ-
ential enjoyed by community factions who are hostile to the offender. In consensual
decision-making processes such as sentencing circles, this can result in a chorus of
disapproval voiced against an offender who demands especially harsh sanctions.
Joyce Dalmyn observes that such realities have tainted some sentencing circles:
If the feather gets passed around and no-one makes any comment whatsoever, I
have heard a judge state, right on the record, “Well it’s clear that because nothing
has been said, obviously they’re not willing to say anything good about this
person therefore I can only draw the conclusion that there’s no sympathy for this
person and I have to use the harshest penalties available to me.”386
Ross Gordon Green is a provincial court judge in Yorkton, Saskatchewan, who has
written about Aboriginal justice. He cautions, “A concern with these community sen-
tencing and mediation approaches is that local involvement should not become a
forum for the application of political pressure to the advantage of local elite and to the
detriment of politically unpopular or marginalized offenders or victims.”387
Judge Claude Fafard presided over Saskatchewan’s first modern day sentencing cir-
cle. He expressed these reservations:
I guess the greater thing is that it affects so many different people in that one
community, that I’m almost afraid of some political influence. Because it
touches on so many people, and I just sort of felt that maybe I should be there to
ensure that politics doesn’t get involved, that you don’t have a powerful family
dictating to a weaker family, that kind of thing.388
Some Aboriginal scholars have expressed concerns that Elders may be idealized as
participants on whom communities will depend in pursuing their visions of justice.389
There have been times, however, when individual Elders have fallen short of conduct-
ing themselves in accordance with expectations, and with serious repercussions for
justice processes.
Bruce Miller relates that abuses of power plagued the South Island Justice
Education Project on Vancouver Island. Elders, often from powerful families, would
try to convince female victims to acquiesce to lighter sanctions for offenders under
the project rather than the usual justice system. Their tactics included the offering
of various persuasions in favour of dropping the allegations, the threat of witchcraft
to inflict harm, or threatening to send the abuser to use physical intimidation. Some
women felt that the problem was exacerbated by the fact that some of the Elders were
themselves convicted sex offenders, which left them wondering how seriously their
safety and concerns would be addressed. The project ended in 1993.390
David Milward is a law professor, specializing in Aboriginal justice issues, and a
member of the Beardy’s and Okemasis Nation in Saskatchewan. He suggests that the
Canadian Charter of Rights and Freedoms has a role in ensuring the fairness of con-
temporary adaptations of Aboriginal justice. One of his proposals is for Aboriginal
communities to administer their own community courts. These courts would have an
important role in ensuring that participants in the process behave fairly towards each
other, without intimidation or coercion. The customary law of Aboriginal communi-
ties would govern the disputes and the ‘sentence’ without reference to Canadian sen-
tencing law. The community court judges would intervene only when one party has
tried to exploit a power differential or coerce the other party. The community court
judge could, for example, suspend matters indefinitely if the process is marginalizing
an accused. If it is the victim who is being coerced or harassed, the community court
judge could then impose a resolution that prioritizes the victim’s safety, even over the
objections of the other party. A community court judge thus becomes more of an arbi-
trator and mediator with some judicial powers.391
A prerequisite for change
Canada’s legal system failed to prevent the abuses that took place in the residential
schools and when it did, Survivors were often re-victimized by the adversarial and
alienating nature of the justice system. Eventually, all the parties to the residential
school litigation agreed that the Canadian legal system was not well-equipped to deal
with the massive injustice of residential schools and designed an innovative settle-
ment that allowed claims to be settled in a less adversarial forum. The settlement also
recognized the need for collective reparations in the form of the Aboriginal Healing
Foundation and this Commission. Given the failure of the Canadian legal system to
stop or repair the genocidal injustice of residential schools, it is only reasonable to
suggest that Aboriginal people be allowed to develop their own justice systems.
42) We call upon the federal, provincial, and territorial governments to commit to the
recognition and implementation of Aboriginal justice systems in a manner consis-
tent with the Treaty and Aboriginal rights of Aboriginal peoples, the Constitution
Act, 1982, and the United Nations Declaration on the Rights of Indigenous Peoples,
endorsed by Canada in November 2012.
Conclusion
The justice system needs to be reformed if the crisis of Aboriginal overrepresenta-
tion is not to become worse. Aboriginal people should not continue to be imprisoned
and victimized because of the legacy of residential schools. That said, the Commission
is convinced that overrepresentation in the justice system will not be reduced by
justice system reform alone. It will be necessary to address all of the ongoing harms
of residential schools—the harms to Aboriginal family, education, language and cul-
ture, and health. A key element of that change must be a justice system, based on
Aboriginal law and healing practices and under Aboriginal control. Such a system will
be essential in the movement to banish the legacy of residential schools and build a
new future of Canadian reconciliation.
Calls to action
In order to redress the legacy of residential schools and advance the process of
Canadian reconciliation, the Truth and Reconciliation Commission makes the following
Calls to Action.
LEGACY
Child welfare
1) We call upon the federal, provincial, territorial, and Aboriginal governments to commit
to reducing the number of Aboriginal children in care by:
i. Monitoring and assessing neglect investigations.
ii. Providing adequate resources to enable Aboriginal communities and child welfare
organizations to keep Aboriginal families together where it is safe to do so, and
to keep children in culturally appropriate environments, regardless of where
they reside.
iii. Ensuring that social workers and others who conduct child welfare investigations
are properly educated and trained about the history and impacts of residen-
tial schools.
iv. Ensuring that social workers and others who conduct child welfare investigations
are properly educated and trained about the potential for Aboriginal communities
and families to provide more appropriate solutions to family healing.
v. Requiring that all child welfare decision makers consider the impact of the resi-
dential school experience on children and their caregivers.
2) We call upon the federal government, in collaboration with the provinces and territo-
ries, to prepare and publish annual reports on the number of Aboriginal children (First
Nations, Inuit, and Métis) who are in care, compared with non-Aboriginal children,
as well as the reasons for apprehension, the total spending on preventive and care
services by child welfare agencies, and the effectiveness of various interventions.
3) We call upon all levels of government to fully implement Jordan’s Principle.
4) We call upon the federal government to enact Aboriginal child welfare legislation that
establishes national standards for Aboriginal child apprehension and custody cases
and includes principles that:
i. Affirm the right of Aboriginal governments to establish and maintain their own
child welfare agencies.
ii. Require all child welfare agencies and courts to take the residential school legacy
into account in their decision making.
iii. Establish, as an important priority, a requirement that placements of Aboriginal
children into temporary and permanent care be culturally appropriate.
5) We call upon the federal, provincial, territorial, and Aboriginal governments to develop
culturally appropriate parenting programs for Aboriginal families.
Education
6) We call upon the Government of Canada to repeal section 43 of the Criminal Code
of Canada.
7) We call upon the federal government to develop with Aboriginal groups a joint strat-
egy to eliminate educational and employment gaps between Aboriginal and non-
Aboriginal Canadians.
8) We call upon the federal government to eliminate the discrepancy in federal education
funding for First Nations children being educated on reserves and those First Nations
children being educated off reserves.
9) We call upon the federal government to prepare and publish annual reports compar-
ing funding for the education of First Nations children on and off reserves, as well as
educational and income attainments of Aboriginal peoples in Canada compared with
non-Aboriginal people.
10) We call on the federal government to draft new Aboriginal education legislation with
the full participation and informed consent of Aboriginal peoples. The new legislation
would include a commitment to sufficient funding and would incorporate the follow-
ing principles:
i. Providing sufficient funding to close identified educational achievement gaps
within one generation.
Calls to action • 279
ii. Improving education attainment levels and success rates.

iii. Developing culturally appropriate curricula.
iv. Protecting the right to Aboriginal languages, including the teaching of Aboriginal
languages as credit courses.
v. Enabling parental and community responsibility, control, and accountability, simi-
lar to what parents enjoy in public school systems.
vi. Enabling parents to fully participate in the education of their children.
vii. Respecting and honouring Treaty relationships.
11) We call upon the federal government to provide adequate funding to end the backlog
of First Nations students seeking a post-secondary education.
12) We call upon the federal, provincial, territorial, and Aboriginal governments to develop
culturally appropriate early childhood education programs for Aboriginal families.
Language and culture
13) We call upon the federal government to acknowledge that Aboriginal rights include
Aboriginal language rights.
14) We call upon the federal government to enact an Aboriginal Languages Act that incor-
porates the following principles:
i. Aboriginal languages are a fundamental and valued element of Canadian culture
and society, and there is an urgency to preserve them.
ii. Aboriginal language rights are reinforced by the Treaties.
iii. The federal government has a responsibility to provide sufficient funds for
Aboriginal-language revitalization and preservation.
iv. The preservation, revitalization, and strengthening of Aboriginal languages and
cultures are best managed by Aboriginal people and communities.
v. Funding for Aboriginal language initiatives must reflect the diversity of
15) We call upon the federal government to appoint, in consultation with Aboriginal
groups, an Aboriginal Languages Commissioner. The commissioner should help
promote Aboriginal languages and report on the adequacy of federal funding of
Aboriginal-languages initiatives.
16) We call upon post-secondary institutions to create university and college degree and
diploma programs in Aboriginal languages.
17) We call upon all levels of government to enable residential school Survivors and their
families to reclaim names changed by the residential school system by waiving admin-
istrative costs for a period of five years for the name-change process and the revision
of official identity documents, such as birth certificates, passports, driver’s licenses,
health cards, status cards, and social insurance numbers.
Health
acknowledge that the current state of Aboriginal health in Canada is a direct result of
previous Canadian government policies, including residential schools, and to recognize
and implement the health-care rights of Aboriginal people as identified in international
law, constitutional law, and under the Treaties.
19) We call upon the federal government, in consultation with Aboriginal peoples, to
establish measurable goals to identify and close the gaps in health outcomes between
Aboriginal and non-Aboriginal communities, and to publish annual progress reports
and assess long-term trends. Such efforts would focus on indicators such as: 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.
20) In order to address the jurisdictional disputes concerning Aboriginal people who
do not reside on reserves, we call upon the federal government to recognize,
respect, and address the distinct health needs of the Métis, Inuit, and off-reserve
Aboriginal peoples.
21) We call upon the federal government to provide sustainable funding for existing and
new Aboriginal healing centres to address the physical, mental, emotional, and spir-
itual harms caused by residential schools, and to ensure that the funding of healing
centres in Nunavut and the Northwest Territories is a priority.
22) We call upon those who can effect change within the Canadian health-care system to
recognize the value of Aboriginal healing practices and use them in the treatment of
Aboriginal patients in collaboration with Aboriginal healers and Elders where requested
by Aboriginal patients.
23) We call upon all levels of government to:
i. Increase the number of Aboriginal professionals working in the health-care field.
ii. Ensure the retention of Aboriginal health-care providers in

Aboriginal communities.
iii. Provide cultural competency training for all health-care professionals.
24) We call upon medical and nursing schools in Canada to require all students to take a
course dealing with Aboriginal health issues, including the history and legacy of res-
idential schools, the United Nations Declaration on the Rights of Indigenous Peoples,
Treaties and Aboriginal rights, and Indigenous teachings and practices. This will require
skills-based training in intercultural competency, conflict resolution, human rights, and
anti-racism.
Justice
25) We call upon the federal government to establish a written policy that reaffirms the
independence of the Royal Canadian Mounted Police to investigate crimes in which
the government has its own interest as a potential or real party in civil litigation.
26) We call upon the federal, provincial, and territorial governments to review and amend
their respective statutes of limitations to ensure that they conform with the principle
that governments and other entities cannot rely on limitation defences to defend legal
actions of historical abuse brought by Aboriginal people.
27) We call upon the Federation of Law Societies of Canada to ensure that lawyers receive
appropriate cultural competency training, which includes the history and legacy of res-
idential schools, the United Nations Declaration on the Rights of Indigenous Peoples,
Treaties and Aboriginal rights, Indigenous law, and Aboriginal–Crown relations. This will
require skills-based training in intercultural competency, conflict resolution, human
rights, and anti-racism.
28) We call upon law schools in Canada to require all law students to take a course in
Aboriginal people and the law, which includes the history and legacy of residential
schools, the United Nations Declaration on the Rights of Indigenous Peoples, Treaties
and Aboriginal rights, Indigenous law, and Aboriginal–Crown relations. This will require
skills-based training in intercultural competency, conflict resolution, human rights, and
anti-racism.
29) We call upon the parties and, in particular, the federal government, to work collab-
oratively with plaintiffs not included in the Indian Residential Schools Settlement
Agreement to have disputed legal issues determined expeditiously on an agreed set
of facts.
30) We call upon federal, provincial, and territorial governments to commit to eliminating
the overrepresentation of Aboriginal people in custody over the next decade, and to
issue detailed annual reports that monitor and evaluate progress in doing so.
31) We call upon the federal, provincial, and territorial governments to provide sufficient
and stable funding to implement and evaluate community sanctions that will provide
realistic alternatives to imprisonment for Aboriginal offenders and respond to the
underlying causes of offending.
32) We call upon the federal government to amend the Criminal Code to allow trial judges,
upon giving reasons, to depart from mandatory minimum sentences and restrictions
on the use of conditional sentences.
33) We call upon the federal, provincial, and territorial governments to recognize as a high
priority the need to address and prevent Fetal Alcohol Spectrum Disorder (FASD), and
to develop, in collaboration with Aboriginal people, FASD preventive programs that can
be delivered in a culturally appropriate manner.
34) We call upon the governments of Canada, the provinces, and territories to undertake
reforms to the criminal justice system to better address the needs of offenders with
Fetal Alcohol Spectrum Disorder (FASD), including:
i. Providing increased community resources and powers for courts to ensure that
FASD is properly diagnosed, and that appropriate community supports are in
place for those with FASD.
ii. Enacting statutory exemptions from mandatory minimum sentences of imprison-
ment for offenders affected by FASD.
iii. Providing community, correctional, and parole resources to maximize the ability
of people with FASD to live in the community.
iv. Adopting appropriate evaluation mechanisms to measure the effectiveness of
such programs and ensure community safety.
35) We call upon the federal government to eliminate barriers to the creation of additional
Aboriginal healing lodges within the federal correctional system.
36) We call upon the federal, provincial, and territorial governments to work with
Aboriginal communities to provide culturally relevant services to inmates on issues
such as substance abuse, family and domestic violence, and overcoming the experi-
ence of having been sexually abused.
37) We call upon the federal government to provide more supports for Aboriginal program-
ming in halfway houses and parole services.
38) We call upon the federal, provincial, territorial, and Aboriginal governments to com-
mit to eliminating the overrepresentation of Aboriginal youth in custody over the
next decade.
39) We call upon the federal government to develop a national plan to collect and publish
data on the criminal victimization of Aboriginal people, including data related to homi-
cide and family violence victimization.
40) We call on all levels of government, in collaboration with Aboriginal people, to create
adequately funded and accessible Aboriginal-specific victim programs and services
with appropriate evaluation mechanisms.
41) We call upon the federal government, in consultation with Aboriginal organizations,
to appoint a public inquiry into the causes of, and remedies for, the disproportionate
victimization of Aboriginal women and girls. The inquiry’s mandate would include:
i. Investigation into missing and murdered Aboriginal women and girls.
ii. Links to the intergenerational legacy of residential schools.
42) We call upon the federal, provincial, and territorial governments to commit to the
recognition and implementation of Aboriginal justice systems in a manner consistent
with the Treaty and Aboriginal rights of Aboriginal peoples, the Constitution Act, 1982,
and the United Nations Declaration on the Rights of Indigenous Peoples, endorsed by
Canada in November 2012.
RECONCILIATION
Canadian Governments and the United Nations

Declaration on the Rights of Indigenous Peoples
43) We call upon federal, provincial, territorial, and municipal governments to fully adopt
and implement the United Nations Declaration on the Rights of Indigenous Peoples as
the framework for reconciliation.
44) We call upon the Government of Canada to develop a national action plan, strategies,
and other concrete measures to achieve the goals of the United Nations Declaration on
the Rights of Indigenous Peoples.
Royal Proclamation and Covenant of Reconciliation
45) We call upon the Government of Canada, on behalf of all Canadians, to jointly develop
with Aboriginal peoples a Royal Proclamation of Reconciliation to be issued by the
Crown. The proclamation would build on the Royal Proclamation of 1763 and the Treaty
of Niagara of 1764, and reaffirm the nation-to-nation relationship between Aboriginal
peoples and the Crown. The proclamation would include, but not be limited to, the
following commitments:
i. Repudiate concepts used to justify European sovereignty over Indigenous lands
and peoples such as the Doctrine of Discovery and terra nullius.
ii. Adopt and implement the United Nations Declaration on the Rights of Indigenous
Peoples as the framework for reconciliation.
iii. Renew or establish Treaty relationships based on principles of mutual recognition,
mutual respect, and shared responsibility for maintaining those relationships into
the future.
iv. Reconcile Aboriginal and Crown constitutional and legal orders to ensure that
Aboriginal peoples are full partners in Confederation, including the recogni-
tion and integration of Indigenous laws and legal traditions in negotiation and
implementation processes involving Treaties, land claims, and other construc-
tive agreements.
46) We call upon the parties to the Indian Residential Schools Settlement Agreement
to develop and sign a Covenant of Reconciliation that would identify principles for
working collaboratively to advance reconciliation in Canadian society, and that would
include, but not be limited to:
i. Reaffirmation of the parties’ commitment to reconciliation.
ii. Repudiation of concepts used to justify European sovereignty over Indigenous
lands and peoples, such as the Doctrine of Discovery and terra nullius, and the
reformation of laws, governance structures, and policies within their respective
institutions that continue to rely on such concepts.
iii. Full adoption and implementation of the United Nations Declaration on the Rights
of Indigenous Peoples as the framework for reconciliation.
iv. Support for the renewal or establishment of Treaty relationships based on princi-
ples of mutual recognition, mutual respect, and shared responsibility for main-
taining those relationships into the future.
v. Enabling those excluded from the Settlement Agreement to sign onto the
Covenant of Reconciliation.
vi. Enabling additional parties to sign onto the Covenant of Reconciliation.
47) We call upon federal, provincial, territorial, and municipal governments to repudiate
concepts used to justify European sovereignty over Indigenous peoples and lands,
such as the Doctrine of Discovery and terra nullius, and to reform those laws, govern-
ment policies, and litigation strategies that continue to rely on such concepts.
Settlement Agreement Parties and the United Nations

Declaration on the Rights of Indigenous Peoples
48) We call upon the church parties to the Settlement Agreement, and all other faith
groups and interfaith social justice groups in Canada who have not already done so,
to formally adopt and comply with the principles, norms, and standards of the United
Nations Declaration on the Rights of Indigenous Peoples as a framework for reconcilia-
tion. This would include, but not be limited to, the following commitments:
i. Ensuring that their institutions, policies, programs, and practices comply with the
United Nations Declaration on the Rights of Indigenous Peoples.
ii. Respecting Indigenous peoples’ right to self-determination in spiritual mat-
ters, including the right to practise, develop, and teach their own spiritual and
religious traditions, customs, and ceremonies, consistent with Article 12:1 of the
United Nations Declaration on the Rights of Indigenous Peoples.
iii. Engaging in ongoing public dialogue and actions to support the United Nations
Declaration on the Rights of Indigenous Peoples.
iv. Issuing a statement no later than March 31, 2016, from all religious denomi-
nations and faith groups, as to how they will implement the United Nations
Declaration on the Rights of Indigenous Peoples.
49) We call upon all religious denominations and faith groups who have not already done
so to repudiate concepts used to justify European sovereignty over Indigenous lands
and peoples, such as the Doctrine of Discovery and terra nullius.
Equity for Aboriginal People in the Legal System
50) In keeping with the United Nations Declaration on the Rights of Indigenous Peoples,
we call upon the federal government, in collaboration with Aboriginal organizations,
to fund the establishment of Indigenous law institutes for the development, use, and
understanding of Indigenous laws and access to justice in accordance with the unique
cultures of Aboriginal peoples in Canada.
51) We call upon the Government of Canada, as an obligation of its fiduciary responsibility,
to develop a policy of transparency by publishing legal opinions it develops and upon
which it acts or intends to act, in regard to the scope and extent of Aboriginal and
Treaty rights.
52) We call upon the Government of Canada, provincial and territorial governments, and
the courts to adopt the following legal principles:
i. Aboriginal title claims are accepted once the Aboriginal claimant has established
occupation over a particular territory at a particular point in time.
ii. Once Aboriginal title has been established, the burden of proving any limitation
on any rights arising from the existence of that title shifts to the party asserting
such a limitation.
National Council for Reconciliation
53) We call upon the Parliament of Canada, in consultation and collaboration with
Aboriginal peoples, to enact legislation to establish a National Council for
Reconciliation. The legislation would establish the council as an independent, national,
oversight body with membership jointly appointed by the Government of Canada and
national Aboriginal organizations, and consisting of Aboriginal and non-Aboriginal
members. Its mandate would include, but not be limited to, the following:
i. Monitor, evaluate, and report annually to Parliament and the people of Canada
on the Government of Canada’s post-apology progress on reconciliation to ensure
that government accountability for reconciling the relationship between Aboriginal
peoples and the Crown is maintained in the coming years.
ii. Monitor, evaluate, and report to Parliament and the people of Canada on recon-
ciliation progress across all levels and sectors of Canadian society, including the
implementation of the Truth and Reconciliation Commission of Canada’s Calls
to Action.
iii. Develop and implement a multi-year National Action Plan for Reconciliation,
which includes research and policy development, public education programs,
and resources.
iv. Promote public dialogue, public/private partnerships, and public initiatives
for reconciliation.
54) We call upon the Government of Canada to provide multi-year funding for the National
Council for Reconciliation to ensure that it has the financial, human, and technical
resources required to conduct its work, including the endowment of a National

Reconciliation Trust to advance the cause of reconciliation.
55) We call upon all levels of government to provide annual reports or any current data
requested by the National Council for Reconciliation so that it can report on the prog-
ress towards reconciliation. The reports or data would include, but not be limited to:
i. The number of Aboriginal children—including Métis and Inuit children—in care,
compared with non-Aboriginal children, the reasons for apprehension, and the
total spending on preventive and care services by child welfare agencies.
ii. Comparative funding for the education of First Nations children on and
off reserves.
iii. The educational and income attainments of Aboriginal peoples in Canada com-
pared with non-Aboriginal people.
iv. Progress on closing the gaps between Aboriginal and non-Aboriginal communi-
ties in a number of health indicators such as: 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.
v. Progress on eliminating the overrepresentation of Aboriginal children in youth
custody over the next decade.
vi. Progress on reducing the rate of criminal victimization of Aboriginal peo-
ple, including data related to homicide and family violence victimization and
other crimes.
vii. Progress on reducing the overrepresentation of Aboriginal people in the justice
and correctional systems.
56) We call upon the prime minister of Canada to formally respond to the report of
the National Council for Reconciliation by issuing an annual “State of Aboriginal
Peoples” report, which would outline the government’s plans for advancing the cause
of reconciliation.
Professional Development and Training for Public Servants
57) We call upon federal, provincial, territorial, and municipal governments to provide
education to public servants on the history of Aboriginal peoples, including the
history and legacy of residential schools, the United Nations Declaration on the
Rights of Indigenous Peoples, Treaties and Aboriginal rights, Indigenous law, and
Aboriginal–Crown relations. This will require skills-based training in intercultural com-

petency, conflict resolution, human rights, and anti-racism.
Church Apologies and Reconciliation
58) We call upon the Pope to issue an apology to Survivors, their families, and communi-
ties for the Roman Catholic Church’s role in the spiritual, cultural, emotional, physical,
and sexual abuse of First Nations, Inuit, and Métis children in Catholic-run residen-
tial schools. We call for that apology to be similar to the 2010 apology issued to Irish
victims of abuse and to occur within one year of the issuing of this Report and to be
delivered by the Pope in Canada.
59) We call upon church parties to the Settlement Agreement to develop ongoing educa-
tion strategies to ensure that their respective congregations learn about their church’s
role in colonization, the history and legacy of residential schools, and why apologies
to former residential school students, their families, and communities were necessary.
60) We call upon leaders of the church parties to the Settlement Agreement and all other
faiths, in collaboration with Indigenous spiritual leaders, Survivors, schools of theol-
ogy, seminaries, and other religious training centres, to develop and teach curriculum
for all student clergy, and all clergy and staff who work in Aboriginal communities, on
the need to respect Indigenous spirituality in its own right, the history and legacy of
residential schools and the roles of the church parties in that system, the history and
legacy of religious conflict in Aboriginal families and communities, and the responsibil-
ity that churches have to mitigate such conflicts and prevent spiritual violence.
61) We call upon church parties to the Settlement Agreement, in collaboration with
Survivors and representatives of Aboriginal organizations, to establish permanent
funding to Aboriginal people for:
i. Community-controlled healing and reconciliation projects.
ii. Community-controlled culture- and language-revitalization projects.
iii. Community-controlled education and relationship-building projects.
iv. Regional dialogues for Indigenous spiritual leaders and youth to discuss
Indigenous spirituality, self-determination, and reconciliation.
Education for reconciliation
62) We call upon the federal, provincial, and territorial governments, in consultation and
collaboration with Survivors, Aboriginal peoples, and educators, to:
i. Make age-appropriate curriculum on residential schools, Treaties, and Aboriginal
peoples’ historical and contemporary contributions to Canada a mandatory educa-
tion requirement for Kindergarten to Grade Twelve students.
ii. Provide the necessary funding to post-secondary institutions to educate
teachers on how to integrate Indigenous knowledge and teaching methods
into classrooms.
iii. Provide the necessary funding to Aboriginal schools to utilize Indigenous knowl-
edge and teaching methods in classrooms.
iv. Establish senior-level positions in government at the assistant deputy minister
level or higher dedicated to Aboriginal content in education.
63) We call upon the Council of Ministers of Education, Canada to maintain an annual
commitment to Aboriginal education issues, including:
i. Developing and implementing Kindergarten to Grade Twelve curriculum and
learning resources on Aboriginal peoples in Canadian history, and the history and
ii. Sharing information and best practices on teaching curriculum related to residen-
tial schools and Aboriginal history.
iii. Building student capacity for intercultural understanding, empathy, and
mutual respect.
iv. Identifying teacher-training needs relating to the above.
64) We call upon all levels of government that provide public funds to denominational
schools to require such schools to provide an education on comparative religious
studies, which must include a segment on Aboriginal spiritual beliefs and practices
developed in collaboration with Aboriginal Elders.
65) We call upon the federal government, through the Social Sciences and Humanities
Research Council, and in collaboration with Aboriginal peoples, post-secondary insti-
tutions and educators, and the National Centre for Truth and Reconciliation and its
partner institutions, to establish a national research program with multi-year funding
to advance understanding of reconciliation.
Youth Programs
66) We call upon the federal government to establish multi-year funding for communi-
ty-based youth organizations to deliver programs on reconciliation, and establish a
national network to share information and best practices.
Museums and Archives
67) We call upon the federal government to provide funding to the Canadian Museums
Association to undertake, in collaboration with Aboriginal peoples, a national
review of museum policies and best practices to determine the level of compliance
with the United Nations Declaration on the Rights of Indigenous Peoples and to
make recommendations.
68) We call upon the federal government, in collaboration with Aboriginal peoples, and
the Canadian Museums Association to mark the 150th anniversary of Canadian
Confederation in 2017 by establishing a dedicated national funding program for com-
memoration projects on the theme of reconciliation.
69) We call upon Library and Archives Canada to:
i. Fully adopt and implement the United Nations Declaration on the Rights of
Indigenous Peoples and the United Nations Joinet-Orentlicher Principles, as
related to Aboriginal peoples’ inalienable right to know the truth about what hap-
pened and why, with regard to human rights violations committed against them
in the residential schools.
ii. Ensure that its record holdings related to residential schools are accessible to
the public.
iii. Commit more resources to its public education materials and programming on
70) We call upon the federal government to provide funding to the Canadian Association
of Archivists to undertake, in collaboration with Aboriginal peoples, a national review
of archival policies and best practices to:
i. Determine the level of compliance with the United Nations Declaration on the
Rights of Indigenous Peoples and the United Nations Joinet-Orentlicher Principles,
as related to Aboriginal peoples’ inalienable right to know the truth about what
happened and why, with regard to human rights violations committed against
them in the residential schools.
ii. Produce a report with recommendations for full implementation of these interna-
tional mechanisms as a reconciliation framework for Canadian archives.
Missing Children and Burial Information
71) We call upon all chief coroners and provincial vital statistics agencies that have not
provided to the Truth and Reconciliation Commission of Canada their records on the
deaths of Aboriginal children in the care of residential school authorities to make
these documents available to the National Centre for Truth and Reconciliation.
72) We call upon the federal government to allocate sufficient resources to the National
Centre for Truth and Reconciliation to allow it to develop and maintain the National
Residential School Student Death Register established by the Truth and Reconciliation
Commission of Canada.
73) We call upon the federal government to work with churches, Aboriginal communities,
and former residential school students to establish and maintain an online registry
of residential school cemeteries, including, where possible, plot maps showing the
location of deceased residential school children.
74) We call upon the federal government to work with the churches and Aboriginal
community leaders to inform the families of children who died at residential schools
of the child’s burial location, and to respond to families’ wishes for appropri-
ate commemoration ceremonies and markers, and reburial in home communities
where requested.
75) We call upon the federal government to work with provincial, territorial, and municipal
governments, churches, Aboriginal communities, former residential school students,
and current landowners to develop and implement strategies and procedures for the
ongoing identification, documentation, maintenance, commemoration, and protection
of residential school cemeteries or other sites at which residential school children
were buried. This is to include the provision of appropriate memorial ceremonies and
commemorative markers to honour the deceased children.
76) We call upon the parties engaged in the work of documenting, maintaining, commem-
orating, and protecting residential school cemeteries to adopt strategies in accordance
with the following principles:
i. The Aboriginal community most affected shall lead the development of
such strategies.
ii. Information shall be sought from residential school Survivors and other
Knowledge Keepers in the development of such strategies.
iii. Aboriginal protocols shall be respected before any potentially invasive technical
inspection and investigation of a cemetery site.
National Centre for Truth and Reconciliation
77) We call upon provincial, territorial, municipal, and community archives to work
collaboratively with the National Centre for Truth and Reconciliation to identify and
collect copies of all records relevant to the history and legacy of the residential school
system, and to provide these to the National Centre for Truth and Reconciliation.
78) We call upon the Government of Canada to commit to making a funding contribution
of $10 million over seven years to the National Centre for Truth and Reconciliation,
plus an additional amount to assist communities to research and produce histories
of their own residential school experience and their involvement in truth, healing,
and reconciliation.
Commemoration
79) We call upon the federal government, in collaboration with Survivors, Aboriginal orga-
nizations, and the arts community, to develop a reconciliation framework for Canadian
heritage and commemoration. This would include, but not be limited to:
i. Amending the Historic Sites and Monuments Act to include First Nations, Inuit,
and Métis representation on the Historic Sites and Monuments Board of Canada
and its Secretariat.
ii. Revising the policies, criteria, and practices of the National Program of Historical
Commemoration to integrate Indigenous history, heritage values, and memory
practices into Canada’s national heritage and history.
iii. Developing and implementing a national heritage plan and strategy for commem-
orating residential school sites, the history and legacy of residential schools, and
the contributions of Aboriginal peoples to Canada’s history.
80) We call upon the federal government, in collaboration with Aboriginal peoples, to
establish, as a statutory holiday, a National Day for Truth and Reconciliation to honour
Survivors, their families, and communities, and ensure that public commemoration of
the history and legacy of residential schools remains a vital component of the recon-
ciliation process.
81) We call upon the federal government, in collaboration with Survivors and their orga-
nizations, and other parties to the Settlement Agreement, to commission and install
a publicly accessible, highly visible, Residential Schools National Monument in the

city of Ottawa to honour Survivors and all the children who were lost to their families
and communities.
82) We call upon provincial and territorial governments, in collaboration with Survivors
and their organizations, and other parties to the Settlement Agreement, to commission
and install a publicly accessible, highly visible, Residential Schools Monument in each
capital city to honour Survivors and all the children who were lost to their families
and communities.
83) We call upon the Canada Council for the Arts to establish, as a funding priority, a strat-
egy for Indigenous and non-Indigenous artists to undertake collaborative projects and
produce works that contribute to the reconciliation process.
Media and Reconciliation
84) We call upon the federal government to restore and increase funding to the CBC/
Radio-Canada, to enable Canada’s national public broadcaster to support reconcilia-
tion, and be properly reflective of the diverse cultures, languages, and perspectives of
Aboriginal peoples, including, but not limited to:
i. Increasing Aboriginal programming, including Aboriginal-language speakers.
ii. Increasing equitable access for Aboriginal peoples to jobs, leadership positions,
and professional development opportunities within the organization.
iii. Continuing to provide dedicated news coverage and online public information
resources on issues of concern to Aboriginal peoples and all Canadians, including
the history and legacy of residential schools and the reconciliation process.
85) We call upon the Aboriginal Peoples Television Network, as an independent non-profit
broadcaster with programming by, for, and about Aboriginal peoples, to support recon-
ciliation, including but not limited to:
i. Continuing to provide leadership in programming and organizational culture that
reflects the diverse cultures, languages, and perspectives of Aboriginal peoples.
ii. Continuing to develop media initiatives that inform and educate the Canadian
public, and connect Aboriginal and non-Aboriginal Canadians.
86) We call upon Canadian journalism programs and media schools to require education
for all students on the history of Aboriginal peoples, including the history and legacy
of residential schools, the United Nations Declaration on the Rights of Indigenous
Peoples, Treaties and Aboriginal rights, Indigenous law, and Aboriginal–Crown relations.
Sports and Reconciliation
87) We call upon all levels of government, in collaboration with Aboriginal peoples, sports
halls of fame, and other relevant organizations, to provide public education that tells
the national story of Aboriginal athletes in history.
88) We call upon all levels of government to take action to ensure long-term Aboriginal
athlete development and growth, and continued support for the North American
Indigenous Games, including funding to host the games and for provincial and territo-
rial team preparation and travel.
89) We call upon the federal government to amend the Physical Activity and Sport Act
to support reconciliation by ensuring that policies to promote physical activity as a
fundamental element of health and well-being, reduce barriers to sports participation,
increase the pursuit of excellence in sport, and build capacity in the Canadian sport
system, are inclusive of Aboriginal peoples.
90) We call upon the federal government to ensure that national sports policies, pro-
grams, and initiatives are inclusive of Aboriginal peoples, including, but not limited to,
establishing:
i. In collaboration with provincial and territorial governments, stable funding for,
and access to, community sports programs that reflect the diverse cultures and
traditional sporting activities of Aboriginal peoples.
ii. An elite athlete development program for Aboriginal athletes.
iii. Programs for coaches, trainers, and sports officials that are culturally relevant for
Aboriginal peoples.
iv. Anti-racism awareness and training programs.
91) We call upon the officials and host countries of international sporting events such as
the Olympics, Pan Am, and Commonwealth Games to ensure that Indigenous peoples’
territorial protocols are respected, and local Indigenous communities are engaged in
all aspects of planning and participating in such events.
Business and Reconciliation
92) We call upon the corporate sector in Canada to adopt the United Nations Declaration
on the Rights of Indigenous Peoples as a reconciliation framework and to apply its
principles, norms, and standards to corporate policy and core operational activities
involving Indigenous peoples and their lands and resources. This would include, but
not be limited to, the following:
i. Commit to meaningful consultation, building respectful relationships, and obtain-

ing the free, prior, and informed consent of Indigenous peoples before proceeding
with economic development projects.
ii. Ensure that Aboriginal peoples have equitable access to jobs, training, and edu-
cation opportunities in the corporate sector, and that Aboriginal communities gain
long-term sustainable benefits from economic development projects.
iii. Provide education for management and staff on the history of Aboriginal peoples,
including the history and legacy of residential schools, the United Nations
Declaration on the Rights of Indigenous Peoples, Treaties and Aboriginal rights,
Indigenous law, and Aboriginal–Crown relations. This will require skills-
based training in intercultural competency, conflict resolution, human rights, and
anti-racism.
Newcomers to Canada
93) We call upon the federal government, in collaboration with the national Aboriginal
organizations, to revise the information kit for newcomers to Canada and its citi-
zenship test to reflect a more inclusive history of the diverse Aboriginal peoples of
Canada, including information about the Treaties and the history of residential schools.
94) We call upon the Government of Canada to replace the Oath of Citizenship with
the following:
I swear (or affirm) that I will be faithful and bear true allegiance to Her Majesty Queen
Elizabeth II, Queen of Canada, Her Heirs and Successors, and that I will faithfully
observe the laws of Canada including Treaties with Indigenous Peoples, and fulfill my
duties as a Canadian citizen.
Notes
Introduction
1. Canadian Department of Citizenship and Immigration, Report of Indian Affairs Branch for the
Fiscal Year Ended March 31, 1954, 88–89.
2. TRC, NRA, INAC file 6-21-1, volume 2, H. M. Jones to Deputy Minister, 13 December 1956.
[NCA-001989-0001]
3. For a discussion that places both child welfare and residential schools in the context of the
ongoing colonization of Aboriginal people, see McKenzie and Hudson, “Native Children.”
4. Sinha and Kozlowski, “The Structure of Aboriginal Child Welfare in Canada,” l.
5. Canada, Annual Report of the Department of Indian Affairs, 1942, 154; Canada, Annual Report
of the Department of Indian Affairs, 1943, 168; Canada, Annual Report of the Department of In-
dian Affairs, 1944, 177; Canada, Annual Report of the Department of Indian Affairs, 1945, 190;
Canada, Annual Report of the Department of Indian Affairs, 1946, 231; Canada, Annual Report
of the Department of Indian Affairs, 1947, 236; Canada, Annual Report of the Department of In-
dian Affairs, 1948, 234; Canada, Annual Report of the Department of Indian Affairs, 1948, 234;
of the Department of Indian Affairs, 1950, 86–87; Canada, Annual Report of the Department
of Indian Affairs, 1951, 34–35; Canada, Annual Report of the Department of Indian Affairs,
1952, 74–75; Canada, Annual Report of the Department of Indian Affairs, 1953, 82–83; Canada,
Annual Report of the Department of Indian Affairs, 1954, 88–89; Canada, Annual Report of
the Department of Indian Affairs, 1955, 78–79; Canada, Annual Report of the Department
of Indian Affairs, 1956, 76–77; Canada, Annual Report of the Department of Indian Affairs,
1956–57, 88–89; Canada, Annual Report of the Department of Indian Affairs, 1958, 91; Canada,
Annual Report of the Department of Indian Affairs, 1959, 94; Canada, Annual Report of the
Department of Indian Affairs, 1960, 94; Canada, Annual Report of the Department of Indian
Affairs, 1961, 102; Canada, Annual Report of the Department of Indian Affairs, 1962, 73; Can-
ada, Annual Report of the Department of Indian Affairs, 1963, 62.
6. Canadian Human Rights Commission, Report on Equality Rights of Aboriginal People, 3, 12,
32.
7. Wilson and Macdonald, The Income Gap, 14.
8. Macdonald and Wilson, Poverty or Prosperity, 6.
9. Assembly of First Nations, Breaking the Silence, 25–26.
10. TRC, AVS, Conrad Burns, Statement to the Truth and Reconciliation Commission of Canada,
Regina, Saskatchewan, 17 January 2012, Statement Number: SP036.
11. According to UNCESO, 36% of Canada’s Aboriginal languages are critically endangered, 18%
are severely endangered, and 16% are definitely endangered. The remaining languages are all
vulnerable. Moseley and Nicolas, UNESCO Atlas of the World’s Languages in Danger, 117.
12. Canada, Statistics Canada, Aboriginal Peoples and Language.
13. Library and Archives Canada, RG10, volume 3957, file 140754-1, P. H. Bryce to F. Pedley, 5
November 1909.
14. For long-term differences in the Aboriginal and non-Aboriginal tuberculosis death rates in
Canada, see Wherrett, The Miracle of the Empty Beds, 251–253.
15. Taylor, “Grollier Meeting Emotional,” Northern News.
16. Kirmayer et al., Suicide among Aboriginal People, xv, 22.
17. Canada, Indian Residential Schools Adjudication Secretariat, “Adjudication Secretariat
Statistics from September 19, 2007 to January 31, 2015.” By the spring of 2015, over $2.8 billion
in compensation had been awarded for sexual and serious physical abuse. Canada, Indian
Residential Schools Adjudication Secretariat, “Adjudication Secretariat Statistics.”
18. Perreault, “Aboriginal Adults Are Overrepresented.”
20. Perreault, “Aboriginal Youth Are Over-Represented.”
21. Canada, Public Health Agency of Canada, “Fetal Alcohol Spectrum Disorder”; Ospina and
Dennett, Systematic Review, iii.
22. Canada, Public Safety Canada, Fetal Alcohol Spectrum Disorder, 5.
23. MacPherson, Chudley, and Grant, Fetal Alcohol Spectrum Disorder, iv.
24. A study done for the Aboriginal Healing Foundation drew links between the intergenerational
trauma of residential schools, alcohol addictions, and the prevalence of FASD in Aboriginal
communities. Tait, Fetal Alcohol Syndrome.
25. Perrerault, “Violent Victimization of Aboriginal People.”
26. Brennan, “Violent Victimization of Aboriginal Women.”
27. Canada, Royal Canadian Mounted Police, Missing and Murdered Aboriginal Women, 3.
Child welfare: A system in crisis

1. Canadian Department of Citizenship and Immigration, Report of Indian Affairs Branch for the
Fiscal Year Ended March 31, 1954, 88–89.
2. Hughes, The Legacy of Phoenix Sinclair, 2:448.
3. TRC, AVS, Kay Adams, Statement to the Truth and Reconciliation Commission of Canada,
Goose Bay, Newfoundland and Labrador, 20 September 2011, Statement Number: SP025.
4. TRC, AVS, Tim McNeil, Statement to the Truth and Reconciliation Commission of Canada,
Goose Bay, Newfoundland and Labrador, 20 September 2011, Statement Number: SP025.
5. The complaint of inequitable funding was brought by the Assembly of First Nations and
the First Nations Child & Family Caring Society of Canada. For various documents on the
prolonged litigation, see the “I Am a Witness: Canadian Human Rights Tribunal Hearing”
timeline and documents at http://www.fncaringsociety.ca/i-am-witness-timeline-and-
documents.
Notes • 299
6. TRC, AVS, Daniel Big George, Statement to the Truth and Reconciliation Commission of Can-
ada, Winnipeg, Manitoba, 17 June 2010, Statement Number: 02-MB-17JU10-059.
7. TRC, AVS, Norma Kassi, Statement to the Truth and Reconciliation Commission of Canada,
Inuvik, Northwest Territories, 29 June 2011, Statement Number: NNE203.
8. Davin, Report on Industrial Schools for Indians and Half-Breeds, 12.
9. Canada, Annual Report of the Department of Indian Affairs for the Year ended 31st December
1883, 104.
10. TRC, NRA, Library and Archives Canada, RG10, volume 1347, reel C-13916, W. Lemmens to
W. R. Robertson, 10 February 1915. [KUP-004240]
11. For example, in 1935, a Department of Indian Affairs official told a principal of a residential
school that “Indians who come from a distance might be permitted to remain over night but
not for a longer period. The Indian parents from the nearby reserves should not be given
meals and not be allowed to remain on the premises over night.” TRC, NRA, Library and
Archives Canada, RG10, volume 6251, file 575-1, part 3, A. F. MacKenzie to E. H. Lockhart, 1
April 1935. [AEMR-010737]
12. Oreopoulos, Canadian Compulsory School Laws, 8.
13. TRC, NRA, Library and Archives Canada, RG10, volume 6032, file 150-40A, pt. 1, “Regulations
Relating to the Education of Indian Children,” Ottawa: Government Printing Bureau, 1894.
[AGA-001516-0000]
14. Canada, Annual Report of the Department of Indian Affairs for the Year Ended June 30, 1884,
xiii.
15. TRC, NRA, Library and Archives Canada, RG10, volume 6032, file 150-40A, pt. 1, “Regulations
Relating to the Education of Indian Children,” Ottawa: Government Printing Bureau, 1894.
[AGA-001516-0000]
16. Library and Archives Canada, no. 151-711-10, Minister of Justice, “Letter and copy of warrant
in reply to a request by Duncan Campbell Scott, Acting Superintendent General of Indian
Affairs,” 1895, 4.
17. TRC, NRA, Library and Archives Canada, RG10, volume 10410, Shannon box 36, 1918–1920,
Untitled Circular, Duncan Campbell Scott, 9 November 1914. [AEMR-200902]
18. Parliament of Canada, Special Committee on Reconstruction and Re-establishment, Minutes
of Proceedings and Evidence, no. 9, 24 May 1944, 306.
19. Canada, Special Joint Committee of the Senate and House of Commons, Minutes of Proceed-
ings and Evidence, no. 1, 1947, 155, 161.
20. Sinha and Kozlowski, “The Structure of Aboriginal Child Welfare in Canada,” 3, 4.
21. Sinha and Kozlowski, “The Structure of Aboriginal Child Welfare in Canada,” 4.
22. Canada, Royal Commission on Aboriginal Peoples, Report, 3:24.
23. In 1983, Patrick Johnston used this term and wrote that “the wholesale apprehension of
Native children during the Sixties Scoop appears to have been a terrible mistake. While some
individual children may have benefitted, many did not. Nor did their families. And Native cul-
ture suffered one of many severe blows. Unfortunately, the damage is still being done. While
attitudes may have changed to some extent since the Sixties, Native children continue to be
represented in the child welfare system at a much greater rate than non-Native children.”
Johnston, Native Children, 23, 62.
24. Sinha and Kozlowski, “The Structure of Aboriginal Child Welfare in Canada,” l.
25. Sinclair, “Identity Lost and Found,” 65–82; Kimelman, No Quiet Place; Carrière, “Connected-
ness and Health.”
26. TRC, NRA, INAC – Resolution Sector – IRS Historical Files collection – Ottawa, file 773/2901,
volume 1, 12/63-10/71, DRSRO, J. R. Tully to Regional Supervisor, Alberta, 21 May 1965. [BPD-
000248-0001]
27. TRC, NRA, DIAND HQ file 40-2-185, volume 1, 05/1966-02/1969, “Relationships between
Church and State in Indian Education,” 15. [AEMR-013448A]
28. TRC, NRA, DIAND HQ file 40-2-185, volume 1, 05/1966-02/1969, “Relationships between
Church and State in Indian Education,” 15. [AEMR-013448A]
29. Caldwell, Indian Residential Schools, 148–149.
30. Caldwell, Indian Residential Schools, 149.
31. Johnston, Native Children, 59–60.
32. Kimelman, No Quiet Place, 328–329.
33. Kimelman, No Quiet Place, 274.
34. TRC, AVS, [Name redacted], Statement to the Truth and Reconciliation Commission of Can-
ada, Winnipeg, Manitoba; 26 May 2010, Statement Number: S-MB-101-007.
35. TRC, AVS, Tara Picard, Statement to the Truth and Reconciliation Commission of Canada,
Winnipeg, Manitoba, 16 June 2010, Statement Number: 02-MB-16JU10-039.
36. TRC, AVS, Marci Shapiro, Statement to the Truth and Reconciliation Commission of Canada,
Winnipeg, Manitoba, 20 November 2011, Statement Number: 2011-2501.
ada, St. Albert, Alberta, 12 July 2011, Statement Number: 2011-0013.
40. TRC, AVS, Joanne Nimik, Statement to the Truth and Reconciliation Commission of Canada,
Winnipeg, Manitoba, 4 January 2012, Statement Number: 2011-2662.
41. Brown v. Canada, 2013 ONSC 5637; Skogamhallait v. Canada (VLC-S-S-11366), Notice of Civil
Claim; Merchant Law Group, “Indian and Metis Scoop Class Action.”
42. Brown v. Attorney General of Canada, 2014 ONSC 6967 (CanLII) at para. 30.
43. Canada, Auditor General of Canada, “Chapter 4: First Nations and Family Services Program,”
11.
44. Rae, Inuit Child Welfare and Family Support, 30.
45. Aboriginal Justice Inquiry of Manitoba, Aboriginal Justice Implementation Commission,
Report, 1:520.
47. Saskatchewan Child Welfare Review Panel, For the Good of Our Children, 24.
48. Canada, Standing Committee on Aboriginal Affairs and Northern Development, 15 February
2011, Evidence of Carolyn Loeppky (Assistant Deputy Minister, Child and Family Services,
Government of Manitoba), 40th Parliament, 3rd Session, 1; Child and Family Services Author-
ities Act, CCSM c C90, s 4.
49. Kozlowski et al., “First Nations Child Welfare in Manitoba, 2011.”
50. Manitoba, Auditor General of Manitoba, Follow-up of Our December 2006 Report, 8–9.
53. Sinha and Kozlowski, “The Structure of Aboriginal Child Welfare in Canada,” 8–9.
54. Sinha et al., Kiskisik Awasisak, 13.
Notes • 301
58. First Nations Child & Family Caring Society of Canada, Wen: De: We Are Coming, 89–90.
59. First Nations Child & Family Caring Society of Canada, Wen: De: We Are Coming, 17, 26.
60. Sinha and Kozlowski, “The Structure of Aboriginal Child Welfare in Canada,” 12. As described
above, Ontario operates under the “1965 Canada-Ontario Welfare Agreement.” In addition,
Aboriginal Affairs also provides over $18 million annually to Ontario for enhanced prevention
services provided directly to First Nations and to child welfare agencies controlled by First
Nations, as well as First Nations agencies that are developing but not yet mandated. Canada,
Auditor General of Canada, “Chapter 4: First Nations and Family Services Program,” 20.
62. Canada, Indian and Northern Affairs Canada, Departmental Audit and Evaluation Branch,
Evaluation of the First Nations Child and Family Services Program, ii.
63. UN General Assembly, Convention on the Rights of the Child, articles 3, 5, 18, 25, and 27(3).
See also United Nations Committee on the Rights of the Child, Commentary 11, paras. 46–48.
64. Canada, Standing Committee on Public Accounts, 19 October 2011, Evidence of Michael
Wernick (Deputy Minister, DIAAD), 41st Parliament, 1st Session, no. 8, 12.
65. Government of Canada, Government of Canada Response to the Report of the Standing Com-
mittee on Public Accounts, on Chapter 4.
66. Canada, Auditor General of Canada, “Chapter 4: Programs for First Nations on Reserves,” 24.
68. Canada, Standing Committee on Aboriginal Affairs and Northern Development, 20 October
2009, Evidence of Mary Quinn (Director General, Social Policy and Programs Branch, De-
partment of Indian Affairs and Northern Development), 40th Parliament, 2nd Session, 10–11;
Canada, Standing Committee on Aboriginal Affairs and Northern Development, 15 February
2011, Evidence of Carolyn Loeppky (Assistant Deputy Minister, Child and Family Services,
Government of Manitoba), 40th Parliament, 3rd Session, 1.
69. Canada, Standing Committee on Public Accounts, Report of the Standing Committee on Pub-
lic Accounts. Chapter 4: First Nations Child and Family Services Program, 10.
72. Canada, Indian and Northern Affairs Canada, Implementation Evaluation of the Enhanced
Prevention Focused Approach in Alberta for the First Nations Child and Family Services Pro-
gram, 18–20.
73. Canada, Aboriginal Affairs and Northern Development Canada, Final Report: Implementation
Evaluation, 21, 51.
74. Canada, Aboriginal Affairs and Northern Development Canada, Final Report: Implementation
Evaluation, 20.
75. Canada, Auditor General of Canada, “Chapter 4: First Nations and Family Services Program,”
2; British Columbia, Auditor General of British Columbia, Management of Aboriginal Child
Protective Services, 2.
76. The First Nations Child & Family Caring Society of Canada is a non-profit organization that
provides research, networking, public education, and engagement services for First Nations
on children’s rights issues.
77. Human Rights Commission Complaint Form, filed against Indian and Northern Affairs Can-
ada by Regional Chief Lawrence Joseph and Cindy Blackstock.
78. Devlin, DeForrest, and Mason, “Jurisdictional Quagmire,” 14.
79. First Nations Child and Family Caring Society v. Canada, 2011 CHRT 4 at para. 12.
80. Canada (Human Rights Commission) v. Canada (Attorney General), 2012 FC 445 (CanLII).
81. Canada (Attorney General) v. Canadian Human Rights Commission, 2013 FCA 75.
82. Canada (Attorney General) v. Canadian Human Rights Commission, 2013 FCA 75 at para. 22.
83. Cradock, “Extraordinary Costs and Jurisdictional Disputes,” 179.
84. Canadian Paediatric Society, Are We Doing Enough?, 28.
85. Aboriginal Affairs and Northern Development Canada, “Jordan’s Principle.”
86. Pictou Landing Band Council v. Canada (Attorney General), 2013 FC 342 (CanLII) at para. 82.
87. Pictou Landing Band Council v. Canada (Attorney General), 2013 FC 342 (CanLII) at para. 82.
88. Canadian Paediatric Society, Are We Doing Enough?
89. Pictou Landing Band Council v. Canada (Attorney General), 2013 FC 342 (CanLII).
90. Pictou Landing Band Council v. Canada (Attorney General), 2013 FC 342 at para. 106.
91. Canada, “First Nation Child and Family Services” (presentation), 2.
92. National Collaborating Centre for Aboriginal Health, Child and Youth Health, 3.
93. National Indian Child Welfare Association, “Indian Child Welfare Act of 1978.”
94. BC Representative for Children and Youth, When Talk Trumped Service, 52.
95. First Nations Child & Family Caring Society of Canada, Wen: De: We Are Coming to the Light of
Day, 38.
96. Canada, Public Health Agency of Canada, Canadian Incidence Study of Reported Child Abuse
and Neglect, xiii, xxvii.
97. Canada, Public Health Agency of Canada, Canadian Incidence Study of Reported Child Abuse
and Neglect—2008: Major Findings, 22.
98. Sinha et al., Kiskisik Awasisak, ix.
99. Sinha et al., Kiskisik Awasisak, x.
101. Every region of the country was included amongst the sampled agencies, but the applicability
of the findings in respect of Aboriginal child welfare is limited to the geographic jurisdiction
of the sampled agencies. Sinha et al., Kiskisik Awasisak, xi, 29.
102. Sinha et al., Kiskisik Awasisak, xvi.
103. TRC, NRA, INAC File 6-21-1, volume 2, H. M. Jones to Deputy Minister, 13 December 1956.
[NCA-001989-0001]
104. Canada, Statistics Canada, Aboriginal Peoples in Canada, 19.
107. UN General Assembly, Convention on the Rights of the Child, articles 3, 5, 18; United Nations
Committee on the Rights of the Child, Commentary 11, para. 48.
108. UN General Assembly, Convention on the Rights of the Child, article 8.
109. UN General Assembly, Convention on the Rights of the Child, articles 3, 5, 18, 25, and 27(3).
See also United Nations Committee on the Rights of the Child, Commentary 11, paras. 46–48.
Notes • 303
110. UN General Assembly, United Nations Declaration on the Rights of Indigenous Peoples, article
7(2).
111. UN General Assembly, United Nations Declaration on the Rights of Indigenous Peoples, arti-
cles 11, 13, 14, 15, 16.
112. UN, Committee on Economic, Social and Cultural Rights, “Consideration of Reports,” para. 24.
113. UN, Committee on Economic, Social and Cultural Rights, “Consideration of Reports,” para.
56.
114. UN Committee on the Rights of the Child, “Concluding Observations,” para. 55.
115. UN Committee on the Rights of the Child, “Concluding Observations,”, paras. 32–33.
116. UN Committee on the Rights of the Child, “Concluding Observations,” para 55.
117. UN Committee on the Rights of the Child, “Concluding Observations,” para. 33.d.
118. Saskatchewan Child Welfare Review, For the Good of Our Children, 18.
120. First Nations Centre, First Nations Regional Longitudinal Health Survey (RHS) 2002/03, 135.
122. From the Indian Residential Schools Adjudication Secretariat website (http://www.iap-pei.
ca/us-nous/us-nous-eng.php):
The Independent Assessment Process (IAP) is part of the Indian Residential Schools
Settlement Agreement—the largest class action settlement in Canadian history. The
agreement aims to bring a fair and lasting resolution to the harm caused by residential
schools. It involved representatives of Aboriginal groups, churches, the government of
Canada, and the legal profession. It was approved by the courts. The IAP is for former
students who have a claim of sexual or serious physical abuse. It provides them with
a way to settle their claim more quickly, out of court. The process is designed to be
claimant-centred, but fair and neutral. It is an adjudication process. The Adjudicator
resolves claims and awards compensation.
The deadline to submit an application under the Independent Assessment Process was
September 19, 2012. Consult the Indian Residential Schools Adjudication Secretariat website,
“Who We Are and What We Do” pages for more information.
123. Indian Residential Schools Adjudication Secretariat, “Observations on Residential School
Experience,” 7.
Experience,”7.
Experience,” 8.
Experience,” 9.
128. TRC, AVS, Alma Scott, Statement to the Truth and Reconciliation of Canada, Winnipeg, Mani-
toba, 17 June 2010, Statement Number: 02-MB-16JU10-016.
129. Sinha et al., Kiskisik Awasisak, xi. The authors concluded that there was not enough data on
Metis and Inuit children and excluded them from the study. Sinha et al., Kiskisik Awasisak, ix.
130. Sinha et al., Kiskisik Awasisak, 83–87.
131. Sinha et al., Kiskisik Awasisak, xviii. The study elaborates,
The disparity in First Nations and non-Aboriginal substantiated investigation rates was
smaller in the other maltreatment categories. In the population served by sampled
agencies, the rate of substantiated emotional maltreatment investigations was 5.4 times
greater for the First Nations population, the rate of substantiated exposure to intimate
partner violence investigations involving First Nations children was 4.7 times greater
than the rate for non-Aboriginal children, the rate of substantiated physical abuse
investigations was 2.1 times greater for the First Nations population, and the rate of
substantiated sexual abuse investigations was 2.7 times greater for the First Nations
population served by sampled agencies than for the non-Aboriginal population. (Sinha
et al., Kiskisik Awasisak, 85)
132. Sinha, Ellenbogen, and Trocmé, “Substantiating Neglect,” 2083, 2088.
133. Sinha, Ellenbogen, and Trocmé, “Substantiating Neglect,” 2089.
134. The authors concluded,
We found that neglect was significantly more likely to be substantiated for First
Nations children than for non-Aboriginal children, and that a statistically significant
difference in the odds of substantiation persisted even after controlling for investi-
gation, child, caregiver and household characteristics. Examination of interaction
effects showed that that this disproportionality in neglect substantiation of neglect
is also linked to differences in the weight that workers assign to mitigating factors.
Worker confirmation of caregiver substance abuse was associated with a much greater
increase in the odds of neglect substantiation for First Nations than for non-Aboriginal
children. The presence of a lone caregiver increased the odds of neglect substantiation
for First Nations, but not non-Aboriginal children. Finally, worker identification of
housing problems significantly increased the odds of neglect substantiation for non-
Aboriginal children; they did not do so for First Nations children. (Sinha, Ellenbogen,
and Trocmé, “Substantiating Neglect,” 2088)
135. Ruiz-Casares, Trocmé, and Fallon, “Supervisory Neglect,” 472.
136. Ruiz-Casares, Trocmé, and Fallon, “Supervisory Neglect,” 476–477.
139. Sinha et al., Kiskisik Awasisak, xii.
140. Sinha et al., Kiskisik Awasisak, xiv.
141. Sinha et al., Kiskisik Awasisak, xiv.
142. Canada, Indian and Northern Affairs, First Nation and Inuit Community Well-Being, 22.
143. Child, Youth and Family Enhancement Act, RSA 2000, c C-12, ss 34, 58.1; Adoption Act, RSBC
1996, c 5, ss 3, 17(1), 37; Adoption Act, CCSM c A2, ss 3, 19; Family Services Act, SNB 1980, c
F-2.2, ss 1, 8, 71(1), 78(1); Adoption Act, SNL 1999, c A-2.1, ss 3, 13; Children and Youth Care
and Protection Act, SNL 2010, c C-12.2, ss 9, 20–21; Child and Family Services Act, SNWT (Nu)
1997, c 13, ss 3, 27–28, 31, 38; Children and Family Services Act, SNS 1990, c 5, ss 2, 22, 30, 47,
78; Consolidation of Child and Family Services Act, SNWT (Nu) 1997, c 13, ss 3, 7, 27, 29.1, 38;
Child and Family Services Act, RSO 1990, c C.11, ss 1(1), 49; Child Protection Act, RSPEI 1988,
c C-5.1, ss 2, 9, 23, 38; Youth Protection Act, CQLR c P-34.1, ss 3, 91, 46–48.1, 62-64, 71–72.4;
Child and Family Services Act, SS 1989–90, c C-7.2, ss 4, 11, 16-18, 37; Child and Family Ser-
vices Act, SY 2008, c.1, ss 2, 38, 107(1).
144. Information about ethnicity was available for 94 of the 145 children who have died in foster
care since 1999. Of that number, 74 were Aboriginal. Henton, “Deaths of Aboriginal Children,”
Edmonton Journal.
145. Henton, “Deaths of Aboriginal Children,” Edmonton Journal.
Notes • 305
146. Henton, “Deaths of Aboriginal Children,” Edmonton Journal.

147. Alberta Centre for Child, Family and Community Research, A Preliminary Analysis of Mortal-
ities, 25.
148. BC Ministry of Health, Office of the Provincial Health Officer, and Child and Youth Officer for
British Columbia, Health and Well-Being of Children in Care, 54, 58.
149. Ontario, Office of the Chief Coroner of Ontario, Paediatric Death Review Committee, 34.
153. Hughes, The Legacy of Phoenix Sinclair, 1:19–20, 1:53.
154. Hughes, The Legacy of Phoenix Sinclair, 1:19–35.
157. Hughes, The Legacy of Phoenix Sinclair, 1:28; 2:148.
159. Schibler and Newton, Honouring Their Spirits, 6, 23.
160. Schibler and Newton, Honouring Their Spirits, 30, 32.
161. Schibler and Newton, Honouring Their Spirits, 47–49.
162. Schibler and Newton, Honouring Their Spirits, 57–58.
163. Schibler and Newton, Honouring Their Spirits, 76.
164. Canada, Statistics Canada, Aboriginal Peoples in Canada, 5. Issues related to Inuit history,
culture, and child and family welfare discussed in this chapter focus on the Canadian con-
text, but it is important to acknowledge that approximately 150,000 Inuit people live in the
circumpolar region encompassing Canada, Alaska, Russia, and Greenland. Inuit peoples of
the circumpolar region are interconnected with shared physical traits, kinships, languages,
rules, concepts, myths, legends, and cultural routines. With technological and institutional
progress, Inuit peoples have strengthened their connections and speak with one voice across
countries on many issues of common concern, including challenges of cultural erosion and
assimilation efforts directed towards them.
165. Canada, Statistics Canada, Aboriginal Peoples in Canada, 5, 14–17.
166. Tagalik, “Inuit Qaujimajatuqangit,” 1, 4.
167. Inuit Qaujimajatuqanginnut (IQ) Task Force, First Annual Report; Bonesteel, “Use of Tradi-
tional Inuit Culture.”
168. Rae, Inuit Child Welfare and Family Support, 10, 13–15.
169. Pauktuutit Inuit Women of Canada, The Inuit Way, 16.
170. Pauktuutit Inuit Women of Canada, The Inuit Way, 16.
171. Graburn, “Severe Child Abuse,” 211–225; Pauktuutit Inuit Women of Canada, The Inuit Way, 2.
172. Ochalski, “Addressing Inuit Child Welfare in Canada,” notes from 2012 focus group, in Black-
stock et al., “Is It Over Yet?” 33.
173. Tagalik, “Inunnguiniq: Caring for Children the Inuit Way”; Roberts, Eskimo Identification.
174. Legacy of Hope Foundation, Inuit and the Residential School System, 3.
175. Bonesteel, Canada’s Relationship with Inuit, 10, 11.
176. Reference whether “Indians” includes “Eskimo” Inhabitants of the Province of Quebec, [1939]
SCR 104; SC 1951, c 29,4 (1), P317.
177. King, Brief Report of the Federal Government, 12.
178. King, Brief Report of the Federal Government, 7.
179. King, Brief Report of the Federal Government, 11, 15, 17.
180. Graburn, “Severe Child Abuse,” 212.
181. Inuit Tuttarvingat, Inuit Men Talking about Health.
182. Inuit Tapiriit Kanatami, Social Determinants of Inuit Health in Canada, 38.
183. Blackstock et al., “Is It Over Yet?,” 38.
184. Gough, “Northwest Territories’ Child Welfare System,” 1.
185. Debbie DeLancey (Deputy Minister, Department of Health and Social Services, Government
of the NWT) email to Commissioner Wilson, 14 July 2015.
187. Gough “Northwest Territories’ Child Welfare System,” 3.
189. Trocmé et al., Canadian Incidence Study of Reported Child Abuse and Neglect, 2.
191. Gough, “Nunavut’s Child Welfare System,” 2–3.
192. Gough, “Nunavut’s Child Welfare System,” 3–4.
193. Gough, “Nunavut’s Child Welfare System,” 2.
194. Phaneuf, Dudding, and Arreak, Nunavut Social Service Review, 19.
195. Blumenthal and Sinha, “Newfoundland and Labrador’s Child Welfare System.”
196. Gough, “Newfoundland and Labrador’s Child Welfare System,” 4.
197. Québec, Commission des droits de la personne et des droits de la jeunesse, Investigation, 11.
201. Québec, Commission des droits de la personne et des droits de la jeunesse, Investigation, 58,
59.
204. Québec, Commission des droits de la personne et des droits de la jeunesse, Nunavik: Follow-
up Report.
206. Canada, Auditor General of Canada, Report of the Auditor General, 2.
207. Arnold, Director of Child and Family Services Annual Report 2011–2012, 1–8.
208. Rideout, “Commission Considers Rules for Custom Adoptions,” Nunatsiaq News.
210. Métis National Council, “Who Are the Métis?”
211. Canada, Statistics Canada, Aboriginal Peoples in Canada, First Nations People, Métis and
Inuit; Canada, Statistics Canada, Aboriginal Peoples and Language.
212. Andersen, “From Nation to Population,” 352.
213. Métis National Council, “Who Are the Métis?”
215. Chartrand, “Métis Residential School Participation,” 23.
216. Logan, “Lost Generations,” 63.
217. Logan, “Lost Generations,” 73, emphasis in original.
218. Métis Nation of Alberta, Métis Memories of Residential Schools, in Blackstock et al., “Is It Over
Yet?,” 49, 50.
Notes • 307
219. Métis Nation of Alberta (2004), Métis Memories of Residential Schools, in Blackstock et al., “Is
it Over Yet?,” 50.
220. Elmer Ghostkeeper, conversation with Jeannine Carrière at Victoria, BC, 1 October 2012, in
Blackstock et al., “Is It Over Yet?,” 46.
221. Deborah Dyck, conversation with Sinéad Charbonneau at Victoria, BC, 20 December 2012, in
222. Tom McCallum, conversation with Cathy Richardson at Victoria, BC, 19 October 2012, in
223. Obomsawin, Richard Cardinal.
224. Obomsawin, Richard Cardinal.
225. Deborah Canada, “The Strength of the Sash,” 10.
226. TRC, AVS, Robert Doucette, Statement to the Truth and Reconciliation Commission of Can-
ada, Batoche, Saskatchewan; 20 July 2010, Statement Number: 01-SK-18-25JY10-001.
227. Carrière, “Connectedness and Health”; Richardson and Nelson, “A Change of Residence”;
Richardson and Seaborn, “Working with Métis Children”; Manitoba Metis Federation, They
Are Taking Our Children.
228. Sinha et al., Kiskisik Awasisak, ix.
229. British Columbia, Ministry of Children and Family Development, Aboriginal Children in Care,
2, 21
230. Manitoba, Auditor General of Manitoba, Follow-up of Our December 2006 Report, 9.
231. Gonzalez-Mena, “Cross-Cultural Infant Care,” 368.
232. Carrière and Richardson, “From Longing to Belonging.”
233. Canada (Indian Affairs) v. Daniels, 2014 FCA 101 (CanLII) at para. 159.
234. Daniels v. Canada, 2013 FC 6 (CanLII).
235. Harry Daniels, et al. v. Her Majesty the Queen as represented by The Minister of Indian Affairs
and Northern Development, et al., 2014 CanLII 68707 (SCC).
236. Manitoba Metis Federation, “Departments, Portfolios and Affiliates.”
237. Gough, “Alberta’s Child Welfare System,” 1.
238. Canada, “The Strength of the Sash,” 138, 146.
239. Métis Nation of Ontario, Recommendations Concerning Métis-Specific Child and Family
Services, 15.
240. Chartrand, Maskikiwenow: The Métis Right to Health.
241. Leanne Laberge, conversation with Jeannine Carrière and Sinead Charbonneau at Victoria,
BC, 18 October 2012, in Blackstock et al., “Is It Over Yet?,” 46.
242. Barkwell, Dorion, and Hourie, Métis Legacy, vol. 2: Michif Culture, 56.
243. Richardson, “Métis Experiences of Social Work Practices,” 120.
244. Richardson, “Métis Experiences of Social Work Practices,” 123.
245. TRC, AVS, Mary Anne Clarke, Statement to the Truth and Reconciliation Commission of Can-
ada, Winnipeg, Manitoba, 12 January 2011, Statement Number: 03-001-10-026.
246. TRC, AVS, Shirley Morris, Statement to the Truth and Reconciliation Commission of Canada,
Halifax, Nova Scotia, 29 October 2011, Statement Number: 2011-2918.
247. Fletcher, “The Origins of the Indian Child Welfare Act,” n.p. (1).
249. Graham, “Reparations, Self-Determination,” 56.
250. Graham, “Reparations, Self-Determination, 90.
252. Basic, “Termination of Parental Rights,” 348.

253. Basic, “Termination of Parental Rights,” 348.
256. Cross, “Indian Family Exception Doctrine,” 688–689.
257. Gajewski, “Class-Action Lawsuit,” The Humanist, 48.
258. Atwood, “Voice of the Indian Child,” 129–130.
259. Atwood, “Voice of the Indian Child,” 128.
260. Blackstock et al., Reconciliation in Child Welfare, 4.
261. Blackstock et al., Reconciliation in Child Welfare, 4, 9–11.
262. Quinn and Saini, Touchstones of Hope.
263. Mishibinijima, Aboriginal Child Protection.
264. Pintarics and Sveinunggaard, “Meenoostahtan Minisiwin,” 67, 74, 75.
265. Timleck quoted in Baskin, Strong Helpers’ Teachings, 197.
266. Timleck quoted in Baskin, Strong Helpers’ Teachings, 198–199.
267. Timleck quoted in Baskin, Strong Helpers’ Teachings, 198.
268. Signs of Safety, Signs of Safety.
The failure to educate

1. TRC, AVS, Howard Stacy Jones, Statement to the Truth and Reconciliation Commission
of Canada, Victoria, British Columbia, 4 December 2010, Statement Number: 01-BC-
03DE10-001.
2. Canada, Annual Report of the Department of Indian Affairs, 1883, 96.
3. TRC, NRA, Library and Archives Canada, RG10, volume 6323, file 658-6, part 1, Department
of Indian Affairs Inspector’s Report for the St. Barnabas, Indian Residential School, D. Hicks,
25 September 1928. [PAR-003233]
4. Library and Archives Canada, RG10, volume 6205, file 468-1, part 2, S. R. McVitty to Secretary,
Indian Affairs, 30 January 1928.
5. Sluman and Goodwill, John Tootoosis, 106.
6. Bougie and Senécal, “Registered Indian Children’s School Success,” 26–30; Canada, Statistics
Canada, Educational Portrait of Canada, Census Year 2006, 19; Richards, Hove, and Afolabi,
“Understanding the Aboriginal/Non-Aboriginal Gap,” 1.
7. UN General Assembly, United Nations Declaration on the Rights of Indigenous Peoples, article
14(1).
8. TRC, NRA, Library and Archives Canada, RG10, volume 6040, file 160-4, part 1, R. B. Heron to
Regina Presbytery, April 1923. [AEMR-016371]
of the Department of Indian Affairs, 1942, 154; Canada, Annual Report of the Department of
Indian Affairs, 1943, 168; Canada, Annual Report of the Department of Indian Affairs, 1944,
177; Canada, Annual Report of the Department of Indian Affairs, 1945, 190; Canada, Annual
Report of the Department of Indian Affairs, 1946, 231; Canada, Annual Report of the Depart-
ment of Indian Affairs, 1947, 236; Canada, Annual Report of the Department of Indian Affairs,
1948, 234; Canada, Annual Report of the Department of Indian Affairs, 1949, 215, 234; Canada,
Notes • 309
the Department of Indian Affairs, 1951, 34–35; Canada, Annual Report of the Department of
Indian Affairs, 1952, 74–75; Canada, Annual Report of the Department of Indian Affairs, 1953,
82–83; Canada, Annual Report of the Department of Indian Affairs, 1954, 88–89; Canada,
Indian Affairs, 1956–57, 88–89; Canada, Annual Report of the Department of Indian Affairs,
1958, 90–91; Canada, Annual Report of the Department of Indian Affairs, 1959, 94; Canada,
Annual Report of the Department of Indian Affairs, 1960, 94; Canada, Annual Report of the
Department of Indian Affairs, 1961, 103.
Indian Affairs, 1944, 177; Canada, Annual Report of the Department of Indian Affairs, 1945,
190; Canada, Annual Report of the Department of Indian Affairs, 1946, 231; Canada, Annual
Report of the Department of Indian Affairs, 1947, 236; Canada, Annual Report of the Depart-
ment of Indian Affairs, 1948, 234; Canada, Annual Report of the Department of Indian Affairs,
1949, 215; Canada, Annual Report of the Department of Indian Affairs, 1950, 86–87; Canada,
Indian Affairs, 1953, 82–83; Canada, Annual Report of the Department of Indian Affairs, 1954,
88–89; Canada, Annual Report of the Department of Indian Affairs, 1955, 78–79; Canada,
Annual Report of the Department of Indian Affairs, 1956, 76–77; Canada, Annual Report of the
Department of Indian Affairs, 1956–57, 88–89; Canada, Annual Report of the Department of
Indian Affairs, 1958, 91; Canada, Annual Report of the Department of Indian Affairs, 1959, 94;
Indian Affairs, 1962, 73; Canada, Annual Report of the Department of Indian Affairs, 1963, 62.
11. TRC, NRA, Library and Archives Canada, RG10, volume 6342, file 750-1, part 1, Microfilm reel
C-8699, J. D. McLean to Reverend E. Ruaux, 21 June 1915. [MRY-001517] For a similar report
from the Battleford, Saskatchewan, school, see Canada, Annual Report of the Department of
Indian Affairs, 1909, 349–350. For a Manitoba example, see TRC, NRA, Library and Archives
Canada, RG10, volume 6267, file 580-5, part 4, Joseph Hamilton Inspection Report, not dated.
[DRS-000570]
12. TRC, NRA, INAC – Resolution Sector – IRS Historical Files Collection – Ottawa, file 673/23-5-
038, volume 1, H. L. Winter to Indian Affairs, 9 September 1932. [MRS-000138-0001]
13. Canada, Annual Report of the Department of Indian Affairs, 1903, 342–343. For other exam-
ples of the emphasis on religious training in the schools, see Canada, Annual Report of the De-
partment of Indian Affairs, 1887, 27–28; Canada, Annual Report of the Department of Indian
Affairs, 1910, 433–434; Canada, Annual Report of the Department of Indian Affairs, 1890, 119;
Canada, Annual Report of the Department of Indian Affairs, 1900, 323.
14. TRC, NRA, The Presbyterian Church in Canada Archives, Toronto, Tyler Bjornson File, Pres-
byterian Research, “Presbyterian Indian Residential School Staff Handbook,” 1. [IRC-041206]
15. TRC, NRA, Library and Archives Canada, RG10, volume 6327, file 660-1, part 1, J. D. McLean
to Rev. J. Hugonard, 30 May 1911. [PLD-007442]
16. TRC, NRA, Library and Archives Canada, RG10, volume 6422, file 869-1, part 2, R. H. Cairns,
inspector to J. D. McLean, 5 January 1915. [COQ-000390]
17. TRC, NRA, Library and Archives Canada, RG10, volume 6431, file 877-1, part 2, “Extract from
Report of Mr. Inspector Cairns dated September 5th and 6th, 1928 on the Alberni Indian
Residential School.” [ABR-001591]
18. TRC, NRA, Library and Archives Canada, RG10, volume 6001, file 1-1-1, part 3, “Department
of Indian Affairs, Schools Branch,” 31 March 1935. [SRS-000279]
19. For a British Columbia example, see TRC, NRA, Library and Archives Canada, RG10, volume
6431, file 877-1, part 1, A. W. Neill to A. W. Vowell, 8 July 1909. [ABR-007011-0001] For a Man-
itoba example, see TRC, NRA, Library and Archives Canada, RG10, volume 6262, file 578-1,
part 4, W. M. Graham to Secretary, Indian Affairs, 4 February 1922. [ELK-000299]
20. For example, a 1936 United Church document on First Nations education policy stated that
the staff of all United Church schools should be composed of people who had a “Christian
motive, or, in other words, a missionary purpose coupled with skill in some particular field
to teach his specialty to the Indians.” Staff members were expected to be “closely related to
and actively interested in the work of the nearest United Church,” and be acquainted with,
and sympathetic to, “the religious education programme of the United Church.” Having laid
out these fairly specific requirements, the policy document added that “some minimum
educational qualifications for staff members should be outlined.” TRC, NRA, United Church
Archives, Acc. 83.050C, box 144-21, “Statement of Policy Re Indian Residential Schools,” June
1936. [UCC-050004]
21. For an example of the link between low pay and unqualified teachers, see TRC, NRA, Library
and Archives Canada, RG10, volume 6039, file 160-1, part 1, Martin Benson, Memorandum,
15 July 1897, 4, 25. [100.00108]
22. TRC, NRA, Library and Archives Canada, RG10, volume 4041, file 334503, F. H. Paget to Frank
Pedley, 25 November 1908, 55. [RCA-000298]
23. TRC, NRA, Library and Archives Canada, RG10, volume 6431, file 877-1, part 1, A. W. Vowell
to Secretary, Indian Affairs, 14 July 1909. [ABR-007011-0000]
25. TRC, NRA, DIAND, file 1/25-1, volume 22, R. F. Davey to Bergevin, 15 September 1959, 3.
[AEMR-019616]
27. TRC, NRA, Library and Archives Canada, RG10, volume 6014, file 1-1-6 MAN, part 1, Duncan
Campbell Scott to Mr. Meighen, 1 June 1920. [NCA-002403]
28. Canada, Special Joint Committee, Minutes of Evidence, D. F. Brown Presiding, 15 April 1947,
483–484.
29. Canada, Special Joint Committee, Minutes of Evidence, D. F. Brown Presiding, 17 April 1947,
505.
30. TRC, NRA, National Archives of Canada, RG10, volume 8760, file 901/25-1, part 2, R. F. Davey
to Director, 14 March 1956, 4. [AEMR-120651]
31. See, for example, TRC, NRA, DIAND, file 1/25-1 (E.10), “Report on Textbooks,” 6–9 [AEM-
R-019193A]; Québec, Rapport Parent, para. 210; TRC, NRA, DIAND, file 1/25-1 (E.10), “Report
on Textbooks,” 6–9 [AEMR-019193A]; Vanderburgh, The Canadian Indian.
32. TRC, NRA, DIAND, file 1/25-1 (E.10), “Report on Textbooks,” 1–6. [AEMR-019193A]
33. TRC, AVS, Myrna Kaminawaish, Statement to the Truth and Reconciliation Commission of
Canada, Thunder Bay, Ontario, 7 January 2011, Statement Number: 01-ON-06JA11-004.
34. TRC, AVS, Paul Kaludjau, Statement to the Truth and Reconciliation Commission of Canada,
Notes • 311
35. TRC, AVS, Walter Russell Jones, Statement to the Truth and Reconciliation Commission of
Canada, Victoria, British Columbia, 14 April 2012, Statement Number: 2011-4008.
37. Bougie, “Aboriginal Peoples Survey, 2006,” 21.
38. TRC, NRA, Library and Archives Canada, RG10, volume 3920, file 116818, D. L. Clink to In-
dian Commissioner June 4 1895. [EDM-003380]
39. For an example from Battleford, see Library and Archives Canada, RG 10, volume 3880, file
92,499, Memorandum, Hayter Reed, undated; T. Clarke, “Report of Discharged Pupils,” Ses-
sional Papers 1894, Paper 13, 103. For an example from Brantford, see TRC, NRA, Library and
Archives Canada, RG 10 (Red), volume 2771, file 154,845, part 1, J. G. Ramsden to J. D. Mc-
Lean, 23 December 1907 [TAY-003542]. For an example from Kenora, see TRC, NRA, Library
and Archives Canada, RG10, volume 6197, file 465-1, part 1, Minakijikok to D. C. Scott, 30
September 1924 [KNR-000804-0001]; TRC, NRA, Library and Archives Canada, RG10, volume
6197, file 465-1, part 1, Frank Edwards to Assistant Deputy and Secretary, Indian Affairs, 8
October 1924. [KNR-000803]
40. TRC, AVS, Patricia Brooks, Statement to the Truth and Reconciliation Commission of Canada,
Indian Brook, Nova Scotia, 12 October 2011, Statement Number: 2011-2710.
41. Bougie and Senécal, “Registered Indian Children’s School Success,” 21.
43. Indian Residential Schools Adjudication Secretariat, “Observations.”
44. Canada, Statistics Canada, The Educational Attainment of Aboriginal Peoples in Canada, 5.
45. Canada, Statistics Canada, The Educational Attainment of Aboriginal Peoples in Canada, 4, 5.
46. TRC, AVS, Violet Rupp, Statement to the Truth and Reconciliation Commission of Canada,
Bloodvein, Manitoba, 25 January 2012, Statement Number: 2011-2565.
47. TRC, AVS, Esther Lachinette-Diabo, Statement to the Truth and Reconciliation Commis-
sion of Canada, Thunder Bay, Ontario, 25 November 2010, Statement Number: 01-ON-
24NOV10-020.
48. TRC, AVS, Darryl Siah, Statement to the Truth and Reconciliation Commission of Canada,
Mission, British Columbia, 18 May 2011, Statement Number: 2011-3473.
49. Indian Residential Schools Adjudication Secretariat, “Observations,” 4.
50. Canada, Statistics Canada, Portrait of Canada’s Labour Force, 14.
54. Bougie and Senécal, “Registered Indian Children’s School Success,” 26–30.
55. Bougie and Senécal, “Registered Indian Children’s School Success,” 26–29.
56. Canada, Statistics Canada, “The Education and Employment Experiences of First Nations,” 1.
57. Mendelson, “Improving Education on Reserves,” 2.
58. Sharpe and Lapointe, The Labour Market and Economic Performance, 6.
59. Canada, Auditor General of Canada, “Chapter 4: Programs for First Nations on Reserves,” 13.
61. Clement, “University Attainment of the Registered Indian Population,” 101; Wilk, White, and
Guimond, “Métis Educational Attainment,” 54.
62. Richards, Hove, and Afolabi, “Understanding the Aboriginal/Non-Aboriginal Gap,” 1.
63. Clement, “University Attainment of the Registered Indian Population,” 101.
64. Canadian Human Rights Commission, Report on Equality Rights of Aboriginal People, 3, 12,
32.
65. Canada, Statistics Canada, “Study: Aboriginal People and the Labour Market.”
71. The poverty line is measured by the 2009 SLID Low-Income Measure (LIM), which is based
on 50% of the median adjusted household income. Canada, Statistics Canada, “Low Income
Lines, 2008–2009.”
72. Canadian Human Rights Commission, Report on Equality Rights of Aboriginal People, 17, 18.
73. Penney, “Formal Educational Attainment of Inuit,” 43.
74. Berger, Nunavut Land Claims Agreement, iii.
75. National Committee on Inuit Education, First Canadians, Canadians First, 7.
76. Canadian Human Rights Commission, Report on Equality Rights of Aboriginal People, 15.
77. Canadian Human Rights Commission, Report on Equality Rights of Aboriginal People, 18.
78. O’Donnell and Wallace, “First Nations, Métis and Inuit Women,” 30.
79. Carr-Stewart, “A Treaty Right to Education,” 138.
80. Kelly v. Canada (Attorney General), 2013 ONSC 1220 (striking out claims based on educa-
tion rights in Treaty 3 as non-justiciable); Beattie v. Canada (Minister of Indian Affairs and
Northern Development), 1997 CanLII 6343 (FC); Canada (Attorney General) v. Desjarlais,
2005 ABQB 416 (CanLII); Ochapowace Indian Band No. 71 v. Canada (Department of Indian
Affairs and Northern Development), 1998 CanLII 13768 (SK QB).
81. UN, Expert Mechanism on the Rights of Indigenous Peoples, “Advice No. 1,” para. 91.
82. United Nations Committee on the Rights of the Child, Commentary 11, para. 57.
84. TRC, AVS, Laverne Victor, Statement to the Truth and Reconciliation Commission of Canada,
Mission, British Columbia, 17 May 2011, Statement Number: 2011-3463.
85. Australia, Council of Australian Governments, National Indigenous Reform Agreement.
86. Australian Government, Closing the Gap, 10–19.
87. For a 1940 assessment of building conditions, see TRC, NRA, Library and Archives Canada,
RG10, volume 6012, file 1-1-5A, part 2, R. A. Hoey to Dr. McGill, 31 May 1940. [BIR-000248]
88. Canada, Special Joint Committee, 1946, 3, 15.
89. Canada, Annual Report of the Department of Indian Affairs, 1945, 168, 183; Canada, Annual
Report of the Department of Indian Affairs, 1955, 70, 76–78.
91. An Act Respecting Indians, Statutes of Canada 1951, chapter 29, section 113, reproduced in
Venne, Indian Acts, 350.
94. See, for example, TRC, NRA, No document location, no document file source, The Canadian
Catholic Conference, “A Brief to the Parliamentary Committee on Indian Affairs,” May 1960, 8.
[GMA-001642-0000]
95. Newman, Indians of the Saddle Lake Reserve, 81–87.
Notes • 313
96. TRC, AVS, Annie Wesley, Statement to the Truth and Reconciliation Commission of Canada,
Thunder Bay, Ontario, 25 November 2010, Statement Number: 01-ON-24NOV10-034.
97. TRC, AVS, Dorothy Ross, Statement to the Truth and Reconciliation Commission of Canada,
98. TRC, AVS, Shirley Leon, Statement to the Truth and Reconciliation Commission of Canada,
Deroche, British Columbia, 19 January 2010, Statement Number: 2011-5048.
99. FNEC, NAN, and FSIN, Report on Priority Actions, 51.
100. Haldane et al., Nurturing the Learning Spirit, 14.
103. Canada, Standing Senate Committee on Aboriginal Peoples, Reforming First Nations Educa-
tion, 1.
tion, 1.
tion, 9.
106. Ontario, Office of the Chief Coroner of Ontario, “Schedule of Inquests.”
107. Canada, “Statement of the Government of Canada on Indian Policy, 1969”; National Indian
Brotherhood, Indian Control of Indian Education; TRC, NRA, National Capital Regional
Service Centre – LAC – Ottawa, File 301/25-1, volume 9, Jean Chrétien to George Manuel, 2
February 1973. [NCA-017031-0002]
tion, 56.
109. Paquette and Fallon, First Nations Education Policy, 81.
110. Nicholas, “Canada’s Colonial Mission,” 16, 17.
111. McCue, “First Nations 2nd and 3rd Level Education Services,” 52.
112. Kirkness, “Aboriginal Education in Canada,” 17.
113. First Nations Education Council, “Funding Formula for First Nation Schools,” 19–22; Canada,
Standing Senate Committee on Aboriginal Peoples, Reforming First Nations Education, 63.
tion, 11.
115. Canada, Standing Senate Committee on Aboriginal Peoples Reforming First Nations Educa-
tion, 31, 32.
116. Canada, Aboriginal Affairs and Northern Development Canada, Summative Evaluation, 32.
117. Canada, Aboriginal Affairs and Northern Development Canada, Summative Evaluation,
32–33.
118. Canada (Attorney General) v. Mohawks of the Quinte First Nation, 2012 FC 105 (CanLII) at
para. 1.
121. Porter, “Walls Crumble,” CBC News.
122. Rajekar and Mathilakath, The Funding Requirement, 51.
123. McCue, “First Nations 2nd and 3rd Level Education Services,” 36.
124. FNEC, NAN, and FSIN, Report on Priority Actions, 60; Haldane et al., Nurturing the Learning
Spirit, 12.
125. Education Act for Cree, Inuit and Naskapi Native Persons, RSQ, c I-14 at Part X.
tion, 12.
127. Québec c. Commission Scolaire Crie, 2001 CanLII 20652 (QC CA) 112.
tion, 9.
129. McCue, “An Overview,” 5.
tion, 61.
tion, 61.
132. People for Education, First Nations, Metis and Inuit Education, 3, 4.
133. Little Bear, “Naturalizing Indigenous Knowledge,” 7.
134. Western Canadian Protocol for Collaboration in Basic Education, Common Curriculum
Framework.
135. See Canada, Standing Senate Committee on Aboriginal Peoples, Reforming First Nations
Education, 1–2; Canada, Task Force on Aboriginal Languages and Culture, Towards a New
Beginning, 89.
136. Canada, Task Force on Aboriginal Languages and Culture, Towards a New Beginning, 88.
137. People for Education, First Nations, Métis and Inuit Education, 2, 9.
138. Ontario, Ontario’s New Approach, 12, 13; Ontario, A Solid Foundation.
139. Ontario, Aboriginal Education Office and Ministry of Education, Ontario First Nation, Métis,
and Inuit Education Policy Framework, 27.
140. Ontario, A Solid Foundation, 16.
141. Ontario, A Solid Foundation, 28.
143. Canada, Royal Commission on Aboriginal Peoples, Report, 3:422–423.
144. Assembly of First Nations, “Early Childhood Education.”
149. Canada, Health Canada, “Aboriginal Head Start on Reserve.”
150. Canada, Public Health Agency of Canada, Evaluation of the Aboriginal Head Start.
151. Preston et al., “Aboriginal Early Childhood Education,” 12–13.
152. Canada, Aboriginal Affairs and Northern Development Canada, Summative Evaluation, 40.
153. Mississaugas of the New Credit First Nation, “Special Education Human Rights Case.”
154. An Act Concerning Indians, Statutes of Canada 1876, chapter 18, section 86.1, reproduced
in Venne, Indian Acts, 47; An Act Concerning Indians, Statutes of Canada 1927, chapter 98,
section 110, reproduced in Venne, Indian Acts, 285–287.
155. Canada, Statistics Canada, Table 2: “Proportion of First Nations People, Métis, and Inuit
Aged 25 to 64 by Selected Levels of Educational Attainment and Sex, Canada, 2011,” in The
Educational Attainment of Aboriginal People in Canada, https://www12.statcan.gc.ca/nhs-
enm/2011/as-sa/99-012-x/2011003/tbl/tbl2-eng.cfm.
156. TRC, AVS, Jennie Thomas, Statement to the Truth and Reconciliation Commission of Canada,
Victoria, British Columbia, 14 April 2012, Statement Number: 2011-3992.
Notes • 315
157. TRC, AVS, Velma Jackson, Statement to the Truth and Reconciliation Commission of Canada,
St. Paul, Alberta, 6 January 2011, Statement Number: 01-AB-06JA11-003.
158. First Nations Education Council, “Paper on First Nations Education Funding,” 35.
161. Canada, Standing Senate Committee on Social Affairs, Science and Technology, Opening the
Door, 47.
163. Ogwehoweh Skills and Trades Training Centre; Yellowquill College, “Programs.”
165. Canada, Standing Senate Committee on Social Affairs, Science and Technology, Opening the
Door, 48–49.
166. Hodgson-Smith, “The State of Métis Nation Learning,” 4.
167. Hodgson-Smith, “The State of Métis Nation Learning,” 17, 18.
168. Métis National Council, Toward a Canada–Métis Nation, 27, 28.
169. National Committee on Inuit Education, First Canadians, Canadians First, 7–8.
tion, 3.
tion, 56.
tion, 62.
tion, 64.
tion, 24.
180. Haldane et al., Nurturing the Learning Spirit, iv.
181. Haldane et al., Nurturing the Learning Spirit, vii, 40.
183. Haldane et al., Nurturing the Learning Spirit, 33–38.
185. FNEC, NAN, and FSIN, Report on Priority Actions, 85–86.
186. Canada, Aboriginal Affairs and Northern Development Canada, Developing a First Nation
Education Act: A Blueprint for Legislation. For information on the consultation process see
AANDC, “The Consultation Process” at https://www.aadnc-aandc.gc.ca/eng/1358799141185
/1358799192535.
187. Canada, Aboriginal Affairs and Northern Development Canada, Developing a First Nation
Education Act, 6.
188. Canada, Aboriginal Affairs and Northern Development Canada Developing a First Nation
Education Act, 5.
189. Canada, Aboriginal Affairs and Northern Development Canada, Working Together for First
Nation Students.
Nation Students, s. 23.
Nation Students, ss. 27–30.
194. Bernard Valcourt, Minister of Aboriginal Affairs and Northern Development, to Jean Crowder,
MP, 17 April 2014.
195. Anaya, “Statement upon Conclusion of the Visit to Canada, 15 October 2013.”
196. Canada, Aboriginal Affairs and Northern Development Canada, “First Nations Control of First
Nations Education Act.”
197. Atleo, “First Nations Control.”
198. Canada, Aboriginal Affairs and Northern Development Canada, “First Nations Control of First
Nations Education Act.”
199. Kativik School Board, “About Kativik School Board.”
200. Kativik School Board, “About Kativik School Board”; Vick-Westgate, Nunavik, 85.
201. Consolidation of Inuit Language Protection Act, SNu 2008, c 17.
202. Education Act, SNu 2008, c 15.
207. Marie Battiste quoted in Canada, Standing Senate Committee on Aboriginal Peoples, Reform-
ing First Nations Education, 40.
208. Battiste, Decolonizing Education, 121.
209. Little Bear, “Naturalizing Indigenous Knowledge,” 21.
211. Canada and Mi’kmaq Bands in Nova Scotia, An Agreement with respect to Mi’kmaq education
in Nova Scotia, 14 February 1997. The agreement has been formalized through the Mi’kmaq
Education Act, SC 1998, c 24.
212. Battiste, Decolonizing Education, 87–94.
213. Canada, British Columbia, and First Nations Education Steering Committee, Education Juris-
diction Framework Agreement, 5 July 2006.
214. First Nations Jurisdiction over Education in British Columbia Act, SC 2006, c 10.
215. First Nations Jurisdiction over Education in British Columbia Act, SC 2006, c 10, ss 18–20.
tion, 43.
217. Canada, Aboriginal Affairs and Northern Development Canada, Government of Canada Prog-
ress Report (2006–2012), 5.
tion, 43.
219. Haldane et al., Nurturing the Learning Spirit, 12, 13.
Notes • 317

tion, 44–46.
222. People for Education, First Nations, Métis and Inuit Education, 11.
“I Lost My Talk”: The erosion of language and culture

2. TRC, NRA, Library and Archives Canada, RG10, volume 7183, file 1/25-1-1-4, part 2, Panel on
Indian Research – Committee on Scientific Problems of Indian Affairs. 1952–1959, Microfilm
reel C-9695, FA 10-28, H. M. Jones to E. Bussiere, 13 September 1954. [AEMR-255680]
3. MacGregor, Chief, 23.
4. Willis, Geniesh, 45–46.
5. Knockwood, Out of the Depths, 28.
6. Canadien, From Lishamie, 56.
7. Dickson, Hey, Monias!, 84.
8. TRC, NRA, INAC – Resolution Sector – IRS Historical Files Collection – Ottawa, file E4974-2,
volume 2, “Prince Albert District Chiefs Meeting on the Prince Albert Student Residence, 16
April 1973,” 2. [PAR-123592-0000]
11. Joe, Song of Eskasoni, 32.
12. TRC, AVS, Nellie Trapper, Statement to the Truth and Reconciliation Commission of Canada,
13. TRC, AVS, Greg Rainville, Statement to the Truth and Reconciliation Commission of Canada,
Saskatoon, Saskatchewan, 22 June 2012, Statement Number: 2011-1752.
14. Sluman and Goodwill, John Tootoosis, 106.
15. Davis, The Wayfinders, 198.
17. TRC, AVS, Doris Young, Statement to the Truth and Reconciliation Commission of Canada,
18. TRC, AVS, Martin Nicholas, Statement to the Truth and Reconciliation Commission of Can-
ada, Grand Rapids, Manitoba, 24 February 2010, Statement Number: 07-MB-24FB10-001.
19. TRC, AVS, Sarah McLeod, Statement to the Truth and Reconciliation Commission of Canada,
Kamloops, British Columbia, 8 August 2008, Statement Number: 2011-5009.
20. TRC, AVS, Archie Hyacinthe, Statement to the Truth and Reconciliation Commission of Can-
ada, Kenora, Ontario, 15 March 2011, Statement Number: 2011-0279.
21. TRC, AVS, Mary Courchene, Statement to the Truth and Reconciliation Commission of Can-
ada, Pine Creek First Nation, Manitoba, 28 November, 2011, Statement Number: 2011-2515.
22. TRC, AVS, Hubert Nanacowop, Statement to the Truth and Reconciliation Commission of
Canada, Winnipeg, Manitoba, 16 June 2010, Statement Number: 02-MB-16JU10-013.
23. TRC, AVS, Richard Kaiyogana, Sr., Statement to the Truth and Reconciliation Commission of
Canada, Inuvik, Northwest Territories, 30 June 2011, Statement Number: SC091.
24. TRC, AVS, Agnes Mills, Statement to the Truth and Reconciliation Commission of Canada,
Inuvik, Northwest Territories, 29 June 2011, Statement Number: SC090.
25. TRC, AVS, Betsy Olson, Statement to the Truth and Reconciliation Commission of Canada,
26. TRC, AVS, Eva Lapage, Statement to the Truth and Reconciliation Commission of Canada,
27. TRC, AVS, Roy Thunder, Statement to the Truth and Reconciliation Commission of Canada,
Winnipeg, Manitoba, 16 June, 2010, Statement Number: 02 MB-16JU10-081.
28. TRC, AVS, Sabina Hunter, Statement to the Truth and Reconciliation Commission of Canada,
Goose Bay, Labrador, 20 September 2011, Statement Number: SP025.
29. TRC, AVS, Rosemary Paul, Statement to the Truth and Reconciliation Commission of Canada,
30. Fontaine “Re-conceptualizing and Re-imagining Canada,” 314.
31. TRC, AVS, Henry Ruck, Statement to the Truth and Reconciliation Commission of Canada,
Winnipeg, Manitoba, 11 February 2011, Statement Number: 03-001-10-069.
32. Kinnon, Improving Population Health, 10.
33. First Peoples’ Heritage, Language and Culture Council, Report on the Status of B.C. First Na-
tions Languages, 2010, 7.
35. Canada, Standing Committee on Aboriginal Affairs, “You Took My Talk,” 31.
36. Hallet, Chandler, and Lalonde, Aboriginal Language Knowledge, 398. See also McIvor, Napo-
leon, and Dickie, “Language and Culture as Protective Factors for At-Risk Communities.”
37. Bougie and Senécal, “Registered Indian Children’s School Success,”18.
39. Assembly of First Nations, Breaking the Silence, 25.
40. Assembly of First Nations, Breaking the Silence, 108.
44. Moseley and Nicolas, UNESCO Atlas, 114; Canada, Statistics Canada, Aboriginal Peoples in
Canada in 2006, 28.
45. Assembly of First Nations, “Language and Culture.”
48. Canada, Statistics Canada, Aboriginal Peoples in Canada in 2006, 37.
50. R. v. Van der Peet, [1996] 2 SCR 507.
51. Slattery, “Making Sense,” 215, 222.
52. Leitch, “Canada’s Native Languages,” 107, 111.
53. Mitchell v. M. N. R., 2001 SCC 33 at para. 10.
54. Mitchell v. M. N. R., 2001 SCC 33 at para. 10.
55. United States v. Winans, 198 U.S. 371, 25 S.Ct. 662 (1905) at 381, states: “In other words, the
treaty was not a grant of rights to the Indians, but a grant of rights from them a reservation of
those not granted.”
56. Ford v. Quebec (Attorney General), [1988] 2 SCR 712.
57. Canadian Charter of Rights and Freedoms, s 22, Part I of the Constitution Act, 1982, being
Schedule B to the Canada Act 1982 (UK), 1982, c 11, http://publications.gc.ca/collections/
Collection/CH37-4-3-2002E.pdf.
Notes • 319
58. R. v. Van der Peet [1996] 2 SCR 507.

60. TRC, NRA, INAC – Resolution Sector – IRS Historical Files Collection – Ottawa file 501/23-5-
076, volume 1 (Ctrl #65-5). Philip Phelan to O. Chagnon, 6 June 1938. [NCA-008168]
61. Jenness, America’s Eskimos, 14. Jenness expressed concerns that “it is only when the child
begins school that he enters an atmosphere of English, and then only in relation to his teacher
and the topics that are dealt with in the classroom. Moreover, as soon as school ends for the
day, the door that closes behind him shuts from his mind all the English words and phrases
he has been struggling to memorize; and they seldom re-enter his consciousness until the
schoolbell rings again the next morning. Under such conditions progress can hardly fail to be
extremely slow, and also very superficial.” Jenness, “Eskimo Administration,” 132–133. At the
same time, Jenness was, to his credit, not blind to some of the faults of the mission school.
He recalled that in 1916 he encountered a fifteen-year-old who had been “raised in a mission
boarding school” from “very early childhood.” He recounted that the teenager “had com-
pletely forgotten his mother tongue” but “could speak French fluently” when Jenness found
him living with his family “in a primitive fishing camp at Shingle Point in the Mackenzie delta
– a sad, lonely boy, unfamiliar with their way of life and unable even to converse with them
except by signs.” Jenness, “Eskimo Administration,” 126.
62. In 1966, a R. C. Gagne challenged Jenness’s stress on assimilation and argued that the lan-
guage was connected with the preservation of culture and personality and that Aboriginal
languages should be taught in the residential schools including by teachers in the community
who would not necessarily have formal qualifications. See TRC, NRA, Library and Archives
Canada – Ottawa RG85, Perm. volume 1916, file 108-4, part 8 – “Northern Conference, 1966
The Role of Eskimo culture/language/personality triplex in Northern Education,” 29 March
1966. [RCN-006953]
65. Canada, Indian Affairs and Northern Development, Gathering Strength, 7.
66. Canada, Canadian Heritage, Aboriginal Languages Initiative (ALI) Evaluation. 3.
67. Canada, Canadian Heritage, Aboriginal Languages Initiative (ALI) Evaluation Final Report, 3.
69. Assembly of First Nations, Royal Commission on Aboriginal Peoples at 10 Years, 18.
70. Canada. House of Commons Debates, 39th Parliament, 1st session (3 November, 2006) at 1155
(Bev Oda, Minister of Canadian Heritage and Status of Women).
71. Canada, Canadian Heritage, Aboriginal Languages Initiative (ALI) Evaluation, 5, 6.
72. The Bank of Canada’s inflation calculator suggests that an increase of almost $4 million would
be necessary to keep up with inflation. Bank of Canada, Inflation Calculator.
73. Canada, Canadian Heritage, Aboriginal Languages Initiative (ALI) Evaluation, 13.
74. Email from Glenn Morrison (Policy Manager of the Aboriginal Affairs Directorate in the Citi-
zenship Participation Branch) to the Truth and Reconciliation Commission, 9 July 2012.
75. Glover, 2013–2014 Departmental Performance, 80.
76. See the program description in Canada, Canadian Heritage, Summative Evaluation of the
Aboriginal Peoples’ Program, 1.
77. For example, Aboriginal Friendship Centres, Cultural Connections for Aboriginal Youth, and
Young Canada Works for Aboriginal Urban Youth have all been transferred to the Department
of Aboriginal Affairs and Northern Development. Canada, Canadian Heritage, Quarterly

Financial Report.
78. Canada, Canadian Heritage, 2012–2013 Report on Plans, 21; Canada, Canadian Heritage,
Summative Evaluation, 79; Email from Glenn Morrison (Policy Manager of the Aboriginal
Affairs Directorate in the Citizenship Participation Branch) to the Truth and Reconciliation
Commission, 9 July 2012.
79. Public Law 101-477, Oct. 30, 1990, 104 STAT 1153-1156.
82. Mãori Language Act, 1987 no. 176.
83. Canada, Office of the Auditor General of Canada, 2011 June Status Report, Chapter 4, 2.
84. Canada, Office of the Auditor General of Canada, 2011 June Status Report, Chapter 4, 3.
85. Official Languages Act, RSNWT 1988, c O-1.
86. Official Languages Act, RSNWT (Nu) 1988, c O-1.
87. Official Languages Act, SNu 2008, c 10.
88. Languages Act, RSY 2002, c 133.
89. First Peoples’ Heritage, Language and Culture Act, RSBC 1996, c 147, s 6.
90. First Peoples’ Heritage, Language and Culture Regulation, BC Reg 65/2011, s 1.
91. Aboriginal Languages Recognition Act, CCSM c A1.5.
92. Regulation respecting the language of instruction of children residing on Indian reserves, RRQ,
c C-11, r 8.
93. Charter of the French Language, RSQ, c C-11.
94. Charter of the French Language, RSQ, c C-11, ss 88, 97.
95. United Church of Canada, “Apology to First Nations People.”
96. The Presbyterian Church, “The Confession of the Presbyterian Church.”
97. Canadian Conference of Catholic Bishops, “Pope Benedict XVI.”
98. Missionary Oblates of Mary Immaculate, “An Apology to the First Nations.”
99. CBC News, “‘I Am Sorry,’ NWT Bishop Says.”
100. R. J. G. v. Canada (Attorney General), 2004 SKCA 102 (CanLII).
101. Blackwater v. Plint, 2001 BCSC 997 at paras. 436–437 (Can LII).
102. C. J. Brenner stated, “There is simply no evidence of dishonesty or intentional disloyalty on the
part of Canada or the United Church towards the plaintiffs which would make it permissible
or desirable to engage the law relating to fiduciary obligations. I include in this conclusion the
more general complaints of the plaintiffs relating to linguistic and cultural deprivation. In my
view the plaintiffs have failed to demonstrate that either Canada or the Church were acting
dishonestly or were intentionally disloyal to the plaintiffs.” Blackwater v. Plint, 2001 BCSC 997
at para. 247. He also dismissed the language and culture claims on the basis that the claims
were made too late under statutes of limitations. Blackwater v. Plint, 2001 BCSC 997 at paras.
260–281. On appeal, the British Columbia Court of Appeal 2003 BCCA 671 at paras. 79-82
held that the language and culture loss claims were barred by statutes of limitations. Black-
water v. Plint, 2003 BCCA 671. The Supreme Court held that statutes of limitations would be
subverted and the plaintiffs inappropriately compensated “for torts that have been alleged
but not proven” if language and cultural loss was included as part of damages awarded for
sexual assault that were not barred by statute of limitations. Blackwater v. Plint, [2005] 3 SCR
3 at para. 85.
Notes • 321
104. Brown v. Attorney General of Canada, 2014 ONSC 6967 at para. 30.
105. UN General Assembly, United Nations Declaration on the Rights of Indigenous Peoples, articles
8, 13, 14, 16, 19.
106. UN General Assembly, UN Convention on the Prevention and Punishment of the Crime of
Genocide.
107. Borrows, “Residential Schools,” 502n48.
108. Canada, “Statement of Apology.”
109. French, My Name Is Masak, 19.
110. Gresko, “Everyday Life at Qu’Appelle Industrial School,” 80.
112. TRC, AVS, Paul Stanley, Statement to the Truth and Reconciliation Commission of Canada,
113. TRC, AVS, Esther Lachinette-Diabo, Statement to the Truth and Reconciliation Commission of
Canada, Thunder Bay, Ontario, 10 November 2010, Statement Number: 01-ON-24NO10-020.
114. TRC, AVS, Matilda Lampe, Statement to the Truth and Reconciliation Commission of Canada,
Goose Bay, Newfoundland and Labrador, 20 September 2011, (Inuktitut words translated by
Wintranslation Services, Ottawa, 2015_0244-1-1), Statement Number: 2011-4249.
115. Moseley and Nicolas, UNESCO Atlas, 115.
116. Canada, Statistics Canada, Aboriginal Languages in Canada, 2–3.
119. First Peoples’ Heritage, Language and Cultures Council, Report on the Status of B.C. First Na-
tions Languages, 4, 11. The First Peoples’ Heritage, Language and Culture Council (First Peoples’
Council) is a provincial Crown corporation dedicated to First Nations languages, arts, and
culture. Since its formation in 1990, the First Peoples’ Council has distributed over $21.5 million
to communities to fund arts, language, and culture projects. The First Peoples’ Council monitors
the status of BC’s First Nations languages, cultures, and arts, and facilitates and develops strate-
gies that help First Nations communities recover and sustain their heritage.
120. First Peoples’ Heritage, Language and Cultures Council, Report on the Status of B.C. First
Nations Languages, 29–30.
121. For the expansion, see TRC, NRA, National Capital Regional Service Centre – Library and
Archives Canada – Ottawa, volume 2, file 600-1, Locator #062-94, Education of Eskimos
(1949–1957), Department of Northern Affairs and National Resources to Northern Adminis-
tration and Land branch, 8 April 1958. [NCA-016925]
122. Canada, Advisory Committee on Northern Development, Government Activities in the North
– 1958, 71.
123. For 1949 figures, see TRC, NRA, National Capital Regional Service Centre – Library and
Archives Canada – Ottawa, volume 2, file 600-1, Locator #062-94, Education of Eskimos
(1949–1957), Department of Northern Affairs and National Resources to Northern Adminis-
tration and Land branch, 8 April 1958 [NCA-016925]. For 1959 figure, see TRC, NRA, Library
and Archives Canada – Ottawa, RG85, permanent volume 1468, file 630/125-9, part 1, Govt.
Hostel [R. C.] Inuvik, N.W.T 1956 – December 1959, F.A. 85-4, 1959–1960 Program, Inuvik,
NWT, 10 August 1959. [RCN-008488]
124. Hobart, “Report on Canadian Arctic Eskimos,” 7.
125. TRC, AVS, Willy Carpenter, Statement to the Truth and Reconciliation Commission of Can-
ada, Tuktoyaktuk, Northwest Territories, 20 September 2011, Statement Number: 2011-0353.
126. Moseley and Nicolas, UNESCO Atlas, 114; Canada, Statistics Canada, Aboriginal Peoples in
Canada in 2006, 28.
128. Canada, Statistics Canada, Aboriginal Languages and Selected Vitality Indicators, 3, 5.
130. Canada, Statistics Canada, Aboriginal Languages and Selected Vitality Indicators, 9; Canada,
Statistics Canada, Aboriginal Peoples in Canada in 2006, 28.
131. Canada, Statistics Canada, Aboriginal Languages and Selected Vitality Indicators,. 9.
133. Canada, Canadian Heritage, Summative Evaluation, 28.
134. Canada, Canadian Heritage, Aboriginal Languages Initiative (ALI) Evaluation, 13.
135. Official Languages Act, RSNWT (Nu) 1988, c O-1.
136. Canada, Standing Senate Committee on Legal and Constitutional Affairs, Language Rights in
Canada’s North, 13.
137. Education Act, SNu 2008, c 15.
138. Crosscurrent Associates, Hay River, Languages of the Land, 26.
140. Crosscurrent Associates, Hay River, Languages of the Land, 26.
141. Crosscurrent Associates, Hay River, Languages of the Land, 26; Moseley and Nicolas, UNESCO
Atlas, 120; Tulloch, Preserving Inuit Dialects in Nunavut, 10.
142. Canada, Standing Senate Committee on Legal and Constitutional Affairs, Language Rights in
Canada’s North, 19–20.
143. McIvor, Language Nest Programs in BC, 4. The identity of the speaker was not provided in the
publication.
144. Hume, Rutman, and Hubberstey, Language Nest Evaluation.
145. McIvor, Language Nest Programs in BC, 17. The identity of the speaker was not provided in the
publication.
146. McIvor, Language Nest Programs in BC, 22.
147. McIvor, Language Nest Programs in BC, 22, 23.
148. Hume, Rutman, and Hubberstey, Language Nest Evaluation, iv–v.
149. Norris, “Aboriginal Languages in Canada,” 20.
151. Canada, Statistics Canada, Aboriginal Languages and Selected Vitality Indicators, 6.
152. Norris, “Aboriginal Languages in Canada,” 24.
154. TRC, AVS, Sabrina Williams, Statement to the Truth and Reconciliation Commission of Can-
ada, Victoria, British Columbia, 13 April 2012, Statement Number: 2011-3982.
An attack on Aboriginal health: The marks and the memories

1. TRC, AVS, Ruby Firth, Statement to the Truth and Reconciliation Commission of Canada,
Inuvik, Northwest Territories, 22 July 2011, Statement Number: 2011-0326.
2. Bryce, National Crime, 14.
3. Canada, Annual Report of the Department of Indian Affairs for the Year Ended June 30th,
1906, 274–275.
Notes • 323
4. Library and Archives Canada, RG10, volume 4037, file 317,021, Saturday Night, untitled edito-
rial, 23 November 1907; Montreal Star, “Death Rate Among Indians Abnormal,” 15 November
1907; Ottawa Citizen, “Schools and White Plague,” 16 November 1907.
5. Canada, Annual Report of the Department of Indian Affairs, 1906, 274–275.
6. Bryce, Report on the Indian Schools, 18.
9. Scott, “Indian Affairs 1867–1912,” 615.
10. Kelm, Colonizing Bodies, 61.
11. TRC, NRA, Library and Archives Canada, RG10, volume 6039, file 160-1, part 1, Martin Ben-
son, to J. D. McLean, 15 July 1897. [100.00109]
13. TRC, NRA, Library and Archives Canada, RG10, volume 6012, file 1-1-5A, part 2, R. A. Hoey to
Dr. McGill, 31 May 1940 [BIR-000248]. For date of Hoey’s appointment, see Manitoba Histori-
cal Society, “Memorable Manitobans: Robert Alexander Hoey (1883–1965).”
14. TRC, NRA, INAC – Resolution Sector – IRS Historical Files Collection – Ottawa, file 6-21-1,
volume 4, control 25-2, The National Association of Principals and Administrators of Indian
Residences Brief Presented to the Department of Indian Affairs and Northern Development
as requested by Mr. E. A. Cote, Deputy Minister, prepared in 1967, presented 15 January 1968.
[NCA-011495]
15. For Beauval fire, see TRC, NRA, Library and Archives Canada, RG10, volume 6300, file 650-1,
part 1, Louis Mederic Adam to Indian Affairs, 22 September 1927 [BVL-000879]. For Cross
Lake fire, see TRC, NRA, Library and Archives Canada, RG10, volume 6260, file 577-1, part
1, J. L. Fuller to A. MacNamara, 8 March 1930 [CLD-000933-0000]; TRC, NRA, Library and
Archives Canada, RG10, volume 6260, file 577-1, part 1, William Gordon to Assistant Deputy
and Secretary, Indian Affairs, 10 March 1930. [CLD-000934]
16. For deaths, see Stanley, “Alberta’s Half-Breed Reserve,” 96–98; Library and Archives Canada,
RG10, volume 6300, file 650-1, part 1, O. Charlebois to Duncan Scott, 21 September 1927
[BVL-000874]; Louis Mederic Adam to Indian Affairs, 22 September 1927 [BVL-000879];
TRC, NRA, Library and Archives Canada, RG10, volume 6260, file 577-1, part 1, J. L. Fuller to
A. McNamara, 8 March 1930 [CLD-000933-0000]; William Gordon to Assistant Deputy and
Secretary, Indian Affairs, 10 March 1930 [CLD-000934]; TRC, NRA, INAC – Resolution Sector
– IRS Historical Files Collection – Ottawa, file 675/6-2-018, volume 2, D. Greyeyes to Indian
Affairs, 22 June 1968. [GDC-005571]
18. Library and Archives Canada, RG10, volume 3674, file 11422-5, H. Reed to Deputy Superin-
tendent General of Indian Affairs, 13 May 1891.
19. TRC, AVS, Paul Stanley, Statement to the Truth and Reconciliation Commission of Canada,
20. Brass, I Walk in Two Worlds, 25.
21. Brass, I Walk in Two Worlds, 25–26.
22. Moran, Stoney Creek Woman, 53–54.
23. Canada, Health Canada, Canada’s Food Guides from 1942 to 1992.
24. TRC, NRA, Library and Archives Canada, RG10, volume 6306, file 652-5, part 6, L. B. Pett to P.
E. Moore, 8 December 1947. [SMD-001897-0000]
25. TRC, NRA, Library and Archives Canada, RG29, volume 973, file 388-6-1, part 2, Nutrition
Division, Department of National Health and Welfare “Illness Found in Indian Residential
Schools” undated. [AEMR-174244].
26. TRC, NRA, Library and Archives Canada, RG29, volume 973, file 388-6-1, part 1, L. B. Pett to P.
E. Moore, 8 December 1947. [PAR-000365-0000]
27. TRC, NRA, Library and Archives Canada, RG10, volume 8796, file 1/25-13, part 4, L. B. Pett to
H. M. Jones, 21 March 1958. [NPC-400776]
28. TRC, AVS, David Charleson, Statement to the Truth and Reconciliation Commission of Can-
ada, Deroche, British Columbia, 20 January 2010, Statement Number: 2011-5043.
Statistics.”
31. TRC, AVS, Jean Pierre Bellemare, Statement to the Truth and Reconciliation Commission of
Canada, La Tuque, Québec, 5 March 2013, Statement Number: SP104.
32. TRC, AVS, Andrew Yellowback, Statement to the Truth and Reconciliation Commission of
Canada, Kamloops, British Columbia, 9 August 2009, Statement Number: 2011-5015.
33. See, for example, TRC, AVS, [Name redacted], Statement to the Truth and Reconciliation
Commission of Canada, Winnipeg, Manitoba, 18 June 2010, Statement Number: 02-MB-
18JU10-055; TRC, AVS, Myrna Kaminawaish, Statement to the Truth and Reconciliation
Commission of Canada, Thunder Bay, Ontario, 7 January 2011, Statement Number: 01-ON-
06JA11-004; TRC, AVS, Percy Tuesday, Statement to the Truth and Reconciliation Commis-
sion of Canada, Winnipeg, Manitoba, 18 June 2010, Statement Number: 02-MB-18JU10-083;
TRC, AVS, Isaac Daniels, Statement to the Truth and Reconciliation Commission of Canada,
34. TRC, AVS, Marlene Kayseas, Statement to the Truth and Reconciliation Commission of Can-
ada, Regina, Saskatchewan, 16 January 2012, Statement Number: SP035. For gifts of candy,
see TRC, AVS, Elaine Durocher, Statement to the Truth and Reconciliation Commission of
Canada, Winnipeg, Manitoba, 16 June 2010, Statement Number: 02-MB-16JU10-059; TRC,
AVS, John B. Custer, Statement to the Truth and Reconciliation Commission of Canada,
Winnipeg, Manitoba, 19 June 2010, Statement Number: 02-MB-19JU10-057; TRC, AVS, Louise
Large, Statement to the Truth and Reconciliation Commission of Canada, St. Paul, Alberta, 7
January 2011, Statement Number: 01-AB-06JA11-012. For field trips, see TRC, AVS, Ben Pratt,
Statement to the Truth and Reconciliation Commission of Canada, Regina, Saskatchewan, 18
January 2012, Statement Number: 2011-3318.
35. See, for example, TRC, AVS, [Name redacted], Statement to the Truth and Reconciliation
Commission of Canada, Winnipeg, Manitoba, 18 June 2010, Statement Number: 02-MB-
18JU10-055; TRC, AVS, Leona Bird, Statement to the Truth and Reconciliation Commission
of Canada, Saskatoon, Saskatchewan, 21 June 2012, Statement Number: 2011-4415; TRC,
AVS, Barbara Ann Pahpasay Skead, Statement to the Truth and Reconciliation Commission of
36. TRC, AVS, Josephine Sutherland, Statement to the Truth and Reconciliation Commission of
Canada, Timmins, Ontario, 8 November 2010, Statement Number: 01-ON4-6NOV10-013.
ada, Val d’Or, Québec, 6 February 2012, Statement Number: SP101.
38. Corrado and Cohen, Mental Health Profiles, 19.
Notes • 325
39. TRC, AVS, Anita Lenoir, Statement to the Truth and Reconciliation Commission of Canada,
Yellowknife, Northwest Territories, 14 April 2011.Statement Number: 2011-0239.
40. TRC, AVS, Paul Kaludjau, Statement to the Truth and Reconciliation Commission of Canada,
16 June 2010, Winnipeg, Manitoba, Statement Number: SC093.
41. TRC, AVS, Doris Young, Statement to the Truth and Reconciliation Commission of Canada,
42. TRC, AVS, Shirley Waskewitch, Statement to the Truth and Reconciliation Commission of
Canada, Saskatoon, Saskatchewan, 24 June 2012, Statement Number: 2011-3521.
43. TRC, NRA, Library and Archives Canada, RG29, volume 2764, file 822-1-A779, part 1, F. R.
Decosse to W. L. Falconer, 17 April 1958. [NPC-601091a]
44. TRC, AVS, Rose Marie Prosper, Statement to the Truth and Reconciliation Commission of
Canada, Halifax, Nova Scotia, 28 October 2011, Statement Number: 2011-2868.
45. TRC, NRA, Library and Archives Canada, RG29, volume 3404, file 823-1-A974, Victor Rassier
to Department of Indian Affairs Medical Branch, 5 June 1934. [NPC-603124]
46. Archibald, Final Report of the Aboriginal Healing Foundation, 3:97.
47. TRC, AVS, Charles Cardinal, Statement to the Truth and Reconciliation Commission of Can-
ada, St. Paul, Alberta, 7 January 2011, Statement Number: 01-AB-06JA11-005.
48. Meyercook and Labelle, “Namaji: Two-Spirit Organizing,” 30.
49. TRC, AVS, Laurie McDonald, Statement to the Truth and Reconciliation Commission of Can-
ada, Beausejour, Manitoba, 4 September 2010, Statement Number: 01-MB-3-6SE10-005.
50. Allan and Smylie, First Peoples, Second Class Treatment, 43.
51. TRC, AVS, Ken Ward, Statement to the Truth and Reconciliation Commission of Canada,
Gambier Island, British Columbia, 29 July 2011, Statement Number: 2011-3279.
52. TRC, AVS, Ken Ward, Statement to the Truth and Reconciliation Commission of Canada,
Gambier Island, British Columbia, 29 July 2011, Statement Number: 2011-3279.
53. Smylie, Fell, and Ohlsson, “A Review of Aboriginal Infant Mortality Rates,” 143.
56. Oliver, Peters, and Kohen, “Mortality Rates among Children and Teenagers,” 2.
57. Canada, Statistics Canada, “Life Expectancy.”
58. Tjepkema and Wilkins, “Remaining Life Expectancy.”
60. First Nations Centre, First Nations Regional Longitudinal Health Survey (RHS) 2002/03,
274–275.
62. Karmali et al., “Epidemiology of Severe Trauma,” 1007.
63. TRC, AVS, Ida Ralph, Statement to the Truth and Reconciliation Commission of Canada,
65. Kirmayer et al., Suicide among Aboriginal People in Canada, xv, 14–15, 21–22.
66. TRC, AVS, Katherine Copenace, Statement to the Truth and Reconciliation Commission of
67. TRC, AVS, Maurice Marceau, Statement to the Truth and Reconciliation Commission of Can-
68. TRC, AVS, Tanya Tungilik, Statement to the Truth and Reconciliation Commission of Canada,
Rankin Inlet, Northwest Territories, 21 March 2011, Statement Number: 2011-0159.
69. Laliberté and Tousignant, “Alcohol and Other Contextual,” 215–221.

70. Kirmayer et al., Suicide among Aboriginal People in Canada, 26.
72. TRC, AVS, Florence Horassi, Statement to the Truth and Reconciliation Commission of Can-
ada, Tulita, Northwest Territories, 10 May 2011, Statement Number: 2011-0394.
73. First Nations Centre, First Nations Regional Longitudinal Health Survey RHS) 2002/03, 115.
74. Pearce, “The Cedar Project,” 322.
75. Tait, Fetal Alcohol Syndrome, xv.
76. Tait, Fetal Alcohol Syndrome, 251.
77. TRC, AVS, [Name redacted] Statement to the Truth and Reconciliation Commission of Can-
78. Tait, Fetal Alcohol Syndrome, xv.
79. Edward John as quoted in Milloy, A National Crime, 295.
80. Barlow, Residential Schools, Prisons and HIV/AIDS, 15–16.
81. Canada, Public Health Agency of Canada, “Chapter 8: HIV/AIDS among Aboriginal People.”
82. Jackson and Reimer, Canadian Aboriginal People Living with HIV/AIDS, 53.
83. Ship and Norton, “HIV/AIDS and Aboriginal Women,” 25–31.
84. Craib et al., “Risk Factors for Elevated HIV Incidence,” 168.
85. TRC, AVS, Leona Bird, Statement to the Truth and Reconciliation Commission of Canada,
86. Canada, Indian and Northern Affairs Canada, Evaluation of Community-Based Healing
Initiatives, 5.
88. TRC, AVS, Anne Thomas, Statement to the Truth and Reconciliation Commission of Canada,
89. TRC, AVS, Angus Havioyak, Statement to the Truth and Reconciliation Commission of Can-
ada, Kugluktuk, Nunavut, 13 April 2011, Statement Number: 2011-0518.
90. TRC, AVS, Mabel Brown, Statement to the Truth and Reconciliation Commission of Canada,
Inuvik, Northwest Territories, 28 September 2011, Statement Number: 2011-0325.
91. Inuit Tapiriit Kanatami, “Social Determinants of Inuit Health in Canada,” 17.
92. First Nations Information Governance Centre, Regional Health Survey (RHS) Phase 2, 19.
93. Kirmayer et al., Suicide among Aboriginal People in Canada, 102; Kinnon, Improving Popula-
tion Health, 17.
94. Environics Institute, Urban Aboriginal Peoples Study, 116.
95. Garner et al., “The Health of First Nations,” 4–5.
97. Canada, Statistics Canada, “Study: Select Health Indicators.”
98. Council of Canadian Academics, Aboriginal Food Security, xiv.
99. Willows et al., “Associations between Household Food.”
101. First Nations and Inuit Regional Health Survey National Steering Committee, Regional Health
Survey, 49.
102. Allan and Smylie, First Peoples, Second Class Treatment, 44.
103. Beeby, “Aboriginal Affairs Spending,” CBC News; Staniforth, “Where Did Aboriginal Affairs?,”
The Nation.
104. Aboriginal Healing Foundation, 2009 Annual Report, 19.
Notes • 327
105. Canada, Indian and Northern Affairs Canada, Evaluation of Community-Based Healing Initia-
tives, 4.
106. Canada, Indian and Northern Affairs Canada, Evaluation of Community-Based Healing Initia-
tives, 4, 5.
108. Canada, Standing Senate Committee on Aboriginal Affairs and Northern Development, Study
and Recommendations, 10.
109. TRC, Interim Report, 10.
and Recommendations, 4, 5, 16.
112. Canada, Health Canada, “First Nations, Inuit and Aboriginal Health: Indian Residential
Schools Resolution Health Support Program.”
113. TRC, AVS, [Name redacted] Statement to the Truth and Reconciliation Commission of Can-
ada, Sault Ste. Marie, Ontario, 1 July 2011, Statement Number: 2011-0306.
and Recommendations, 5–7.
and Recommendations, 9–10.
117. TRC, AVS, Jackie Fletcher, Statement to the Truth and Reconciliation Commission of Canada,
Spanish, Ontario, 12 September 2009, Statement Number: 2011-5025.
118. TRC, Interim Report, “Recommendation 10,” 28.
119. TRC, AVS, Helen Doyle, Statement to the Truth and Reconciliation Commission of Canada,
120. Picard, “Harper’s Disregard for Aboriginal Health,” Globe and Mail; National Aboriginal
Health Organization, “Announcement.”
121. Young, “Review of Research on Aboriginal Populations,” 327.
122. Murphy, “Pauktuutit Wants Action,” Nunatsiaq Online.
123. Quoted in Stout and Peters, kiskinohamâtôtâpânâsk, 70.
124. Reimer et al., The Indian Residential Schools Settlement Agreement’s Common Experience
Payment and Healing, xiii–xv, 37.
125. Canada, Aboriginal Affairs and Northern Development Canada, “Water”; Canada, Aboriginal
Affairs and Northern Development Canada, “Backgrounder.”
126. Canada, Aboriginal Affairs and Northern Development Canada, Progress Report 2006–2012,
12.
127. Neegan Burnside Ltd., National Assessment of First Nations Water and Wastewater Systems, i–iii.
128. Canada, Aboriginal Affairs and Northern Development Canada, Final Report: Evaluation of
First Nations Water and Wastewater Action Plan, 18.
129. Safe Drinking Water for First Nations Act, SC 2013, c 21.
130. See Safe Drinking Water for First Nations Act, SC 2013, c 21, s. 3; Canada, Standing Senate
Committee on Aboriginal Peoples, Sixth Report: Bill S-8.
131. Canada, Standing Senate Committee on Aboriginal Peoples, Sixth Report: Bill S-8.
132. Canada, Aboriginal Affairs and Northern Development Canada, Final Report: Evaluation of
First Nations Water and Wastewater Action Plan, iii.
133. Canada, Standing Committee on Aboriginal Affairs and Northern Development, Seventh
Report.
134. Canada, Aboriginal Affairs and Northern Development Canada, Progress Report 2006–2012,
12.
135. Canada, Minister of Indian and Northern Affairs, Government Response to the Seventh Report.
136. United Nations General Assembly, Report of the Special Rapporteur on the Rights of Indige-
nous Peoples, para. 24.
138. “The active TB reported incidence rate for First Nations living on-reserve in the seven regions
of Health Canada’s First Nations and Inuit Health Branch was 26.6 per 100,000 in 2008, which
was 29.6 times higher than the Canadian-born non-Aboriginal population.” Canada, Health
Canada, “Summary of Epidemiology of Tuberculosis.
139. Curry, “Aboriginals in Canada,” Globe and Mail.
140. Canada, Statistics Canada, “Study: Life Expectancy.”
141. Council of Australian Governments, National Indigenous Reform Agreement.
142. Australian Government, Closing the Gap, 6–18.
143. Canadian Medical Association, “Aboriginal Health Programming,” E739.
145. Canadian Medical Association, “Aboriginal Health Programming,” E739
147. National Collaborating Centre for Aboriginal Health, Looking for Aboriginal Health, 24.
149. National Collaborating Centre for Aboriginal Health, Looking for Aboriginal Health, 6, 24–25.
153. British Columbia and First Nations Health Society, British Columbia Tripartite Framework
Agreement on First Nation Health Governance, s 6.3 and Schedule 3 s 1, 19, 49.
Agreement on First Nation Health Governance, Schedule 5, s 2; British Columbia, Tripartite
Governance Committee, “Implementing the Vision,” 10.
Agreement on First Nation Health Governance, s I.
156. Kinnon, Improving Population Health, 17–18.
158. Canada (Indian Affairs) v. Daniels, 2014 FCA 101 (CanLII) at para. 159.
159. Daniels v. Canada, 2013 FC 6 (CanLII); Canada (Indian Affairs) v. Daniels, 2014 FCA 101
(CanLII).
160. Chansonneuve, Addictive Behaviours, 37.
162. Aboriginal Healing Foundation, List of Contacts.
163. Ontario, Ministry of Community and Social Services, “Aboriginal Health and Wellness Strategy.”
164. National Aboriginal Health Organization, An Overview of Traditional Knowledge, 8.
Notes • 329

169. Chandler and Lalonde, “Cultural Continuity,” 12.
170. Hallett, Chandler, and Lalonde, “Aboriginal Language Knowledge,” 398
171. Hallett, Chandler, and Lalonde, “Aboriginal Language Knowledge,” 398.
172. Madeleine Keteskwew Dion Stout quoted in Allan and Smylie, First Peoples, Second Class
Treatment, 28.
173. Manitoba, Provincial Court of Manitoba, Report under the Fatality Inquiries Act into the Death
of Brian Lloyd Sinclair, 66–71, 181.
174. Manitoba, Provincial Court of Manitoba, Report under the Fatality Inquiries Act into the Death
of Brian Lloyd Sinclair, 186–187.
175. Health Council of Canada, Empathy, Dignity and Respect, 10.
176. Smylie, “A Guide for Health Professionals Working with Aboriginal Peoples,” 1.
177. Smylie, “A Guide for Health Professionals Working with Aboriginal Peoples,” 5.
7, 21, 22, 24.
179. UN General Assembly, United Nations Declaration on the Rights of Indigenous Peoples, article 23.
24, 31.
181. Boyer, “The International Right to Health for Indigenous Peoples,” 5, 10, 11.
182. See, for example, Chartrand “Maskikiwenow: The Métis Right to Health,” 27.
183. National Collaborating Centre for Aboriginal Health, Looking for Aboriginal Health, 43–50.
184. Boyer, “Aboriginal Health: A Constitutional Rights Analysis,” 5, 20–21.
185. Boyer, “Aboriginal Health: A Constitutional Rights Analysis,” 20–21, 23.
186. Boyer, “Aboriginal Health: A Constitutional Rights Analysis,” 18, 19.
187. National Collaborating Centre for Aboriginal Health, Looking for Aboriginal Health, 43–50. See,
for example, James Bay and Northern Quebec Agreement, Northeastern Quebec Agreement, In-
uvialuit Final Agreement, Sechelt Indian Band Self-Government Act, Metis Settlements Accord,
Gwich’in Comprehensive Land Claims Agreement, Carcross/Tagish First Nations Agreement,
Nunavut Land Claim Agreement, Nisga’a Final Agreement, Tlicho Agreement.
188. Tait, Fetal Alcohol Syndrome, xix. See also Chandler and Lalonde, “Cultural Continuity”; and
Kirmayer, Suicide among Aboriginal People.
189. Inuit Tapiriit Kanatami, “Social Determinants of Inuit Health in Canada,” 21.
190. Benoit, Carroll, and Chaudhry, “In Search of a Healing Place,” 821, 826.
195. Lecompte, “Aboriginal Health Human Resources,” 17, 21.
196. Canada, Evaluation Directorate of Health Canada and Public Health Agency Canada, Evalua-
tion of the First Nations and Inuit Health, 11.
197. Canada, Health Canada, “Aboriginal Health Human Resources Initiative”; Canada, Health
Canada, Pan-Canadian Health; Canada, Health Canada, “First Nations and Inuit Health”;
Canada, Evaluation Directorate of Health Canada and Public Health Agency Canada, Evalua-
tion of the First Nations and Inuit Health.
tion of the First Nations and Inuit Health, iii, iv.
tion of the First Nations and Inuit Health, ii.
200. Indian Residential Schools Settlement Agreement, Official Court Notice, Schedules O-1,
O-2, O-4; Presbyterian Church in Canada Archives, “Brief Administrative History”; Anglican
Church of Canada, “Anglican Healing Fund”; United Church of Canada, “The Healing Fund.”
201. United Church of Canada, “Fall 2013 Healing Fund Grants.”
202. Indian Residential Schools Settlement Agreement, Schedule O-3, “Catholic Entities Church
Agreement,” 47.
203. Canada Health Act, RSC 1985, c C-6, s 3.
204. Yukon Health Act, SY 2002, c 106 s 5.
205. Yukon Health Act, SY 2002, c 106 s 5.
206. Ontario, Ministry of Community and Social Services, “Aboriginal Healing and Wellness
Strategy.”
207. National Aboriginal Health Organization, An Overview of Traditional Knowledge, 8.
208. Jiwa, Kelly, and St. Pierre-Hansen, “Healing the Community.”
209. Hamilton Health Sciences Corp. v. D. H., 2014 ONCJ 603 (CanLII) at paras. 79–81.
210. Hamilton Health Sciences Corp. v. D. H., 2015 ONCJ 229 at paras. 83(a)–83(b).
211. TRC, AVS, Trudy King, Statement to the Truth and Reconciliation Commission of Canada,
Fort Resolution, NWT, 28 April 2011, Statement Number: 2011-0381.
A denial of justice
1. TRC, AVS, Norman Courchene, Statement to the Truth and Reconciliation Commission of
Canada, 16 June 2010, Statement Number: 02-MB-16JU10-065.
2. TRC, AVS, Norman Mirasty, Statement to the Truth and Reconciliation Commission of Can-
ada, Saskatoon, Saskatchewan, 21 June 2012, Statement Number: 2011-4391.
3. TRC, NRA, Library and Archives Canada, RG10, volume 6032, file 150-40A, part 1, Appoint-
ment of Truant Officers, D. C. Scott, 7 February 1927. [MRS-000045]
4. TRC, NRA, Library and Archives Canada, RG10, volume 6371, file 764-1, part 1, W. J. Dilworth
to Assistant Deputy and Secretary, Indian Affairs, 8 August 1914 [PUL-000900]. For other
examples of the police being used to force parents to send their children to school, see TRC,
NRA, Library and Archives Canada, RG10, volume 6445, file 881-10, part 5, Agent’s Report on
Stuart Lake Agency for September, Robert Howe, 2 October 1940 [LEJ-002079]; TRC, NRA,
Library and Archives Canada, RG10, volume 6445, file 881-10, part 6, Report of Corporal L. F.
Fielder, 14 October 1943 [LEJ-001389]; TRC, NRA, Library and Archives Canada, RG10, vol-
ume 6445, file 881-10, part 7, R. Howe to Indian Affairs, 7 October 1946. [LEJ-001830]
5. TRC, AVS, Robert Keesick, Statement to the Truth and Reconciliation Commission of Canada,
6. LeBeuf, The Role of the Canadian Mounted Police, 75–77.
7. TRC, NRA, Report on Allegations of Flogging at Shubenacadie Indian Residential School,
L. A. Audette to T. G. Murray, Superintendent General, DIAND, Ottawa, from Deschatelets
Archives, Oblates of Mary Immaculate, Ottawa HR 6811.C73 R, Doc #1, Sent from J. R. Miller
to I. Knockwood on Sept. 17, 1934, 4–5. [SRS-000187]
Notes • 331

to I. Knockwood on Sept. 17, 1934, 6–7. [SRS-000187]
to I. Knockwood on Sept. 17, 1934, 8. [SRS-000187]
13. Canada, Department of Indian Affairs Canada, Memorandum from William Cameron to the
Deputy Superintendent of Indian Affairs, Library and Archives Canada, RG10, volume 2552,
file 112-220-1, Martin Benson to Deputy Superintendent General of Indian Affairs, Ottawa, 25
September 1903.
14. TRC, NRA, Library and Archives Canada, RG10, volume 6320, file 658-1, part 1, Microfilm
reel C-9802, M. Benson to Deputy Superintendent General, Indian Affairs, 21 February 1907.
[120.00284]
15. Canada, Department of Indian Affairs, Annual Report of the Department of Indian Affairs,
1910, 273.
16. Miller, Shingwauk’s Vision, 357. For account of trial, see Public Archives Canada, “Damages
for Plaintiff in Miller v. Ashton Case: Girls Too Severely Punished,” in Brantford Expositor, 1
April 1914, RG10, volume 2771, file 154, 845, part 1.
17. The first successful prosecution of a staff member for the sexual abuse of a student that the
Truth and Reconciliation Commission has identified took place in 1945. See TRC, NRA,
Library and Archives Canada, RG10, volume 6309, file 654-1, part 3, Royal Canadian Mounted
Police, Constable A. Zimmerman, 28 July 1945. [GDC-010369-0001]
18. For examples of dismissal, rather than prosecution and a failure to contact parents, see F. S.
M. v. Clarke, 1999 CanLII 9405 (BC SC) and R. v. Frappier [1990] YJ No 163 (Territorial Court).
19. The inquiries described later in this chapter in British Columbia; Chesterfield Inlet; and Fort
Albany, Ontario were all established in response to Aboriginal pressure.
20. TRC, AVS, Doris Young, Statement to the Truth and Reconciliation of Canada, Saskatoon,
Saskatchewan, 22 June 2012, Statement Number: 2011-3517.
21. TRC, AVS, Doris Young, Statement to the Truth and Reconciliation of Canada, Saskatoon,
Saskatchewan, 22 June 2012, Statement Number: 2011-3517.
22. LeBeuf, The Role of the Canadian Mounted Police, 91.
23. Nuu-chah-nulth Tribal Council, Indian Residential Schools, 201.
24. TRC, ASAGR, Royal Canadian Mounted Police, M. W. Pacholuk, Final Report of the Native
Indian Residential School Task Force, Project E-NIRS, Royal Canadian Mounted Police, no
date, 1. [RCMP-564517]
date, 17. [RCMP-564517]
date, 40. [RCMP-564517]
27. Section 139 of the Criminal Code of Canada, previously “Special Provisions” (including “Cor-
roboration,” “Marriage a defence,” “Burden of Proof,” and “Previous sexual intercourse with
accused”), was repealed by An Act to amend the Criminal Code in relation to sexual offences
and other offences against the person and to amend certain other Acts in relation thereto or in
consequence thereof, SC 1980-81-82-83, c 125, s 5, and in 1985, the An Act to amend the Crimi-
nal Code and the Canada Evidence Act, RSC 1985 (3d Supp.), c 19, s 11, was introduced, which
created the existing Criminal Code of Canada, RSC, 1985, c C-46, s 274.
date, 109. [RCMP-564517]
date, 45. [RCMP-564517]
date, 43. [RCMP-564517]
31. Skelton and Kines, “School Abuse Queries,” Vancouver Sun; TRC, ASAGR, Royal Canadian
Mounted Police, Affidavit of Stephen Thatcher- Investigator, no style of cause, no court file
number, no date, paras. 23–25. [RCMP-564327]
date, 19, 28. [RCMP-564517]
33. TRC, ASAGR, Marius Tungilik, “A Report on the Turquetil Hall Reunion, In the Spirit of Heal-
ing: A Special Reunion, Chesterfield Inlet, NWT,” 19–23 July 1993, 14. [AGCA-563571]
34. Gyorgy, “Bishop’s Apology Falls Flat,” Gazette (Montréal).
35. Gyorgy, “Bishop’s Apology Falls Flat,” Gazette (Montréal).
36. Howard, “Probes Document Abuse at NWT Church Schools,” Globe and Mail.
37. Peterson, Sir Joseph Bernier Federal Day School, 7.
38. Peterson, Sir Joseph Bernier Federal Day School, 6–7.
39. Howard, “Probes Document Abuse at NWT Church Schools,” Globe and Mail.
40. Gregoire, “Marius Tungilik,” Nunatsiaq Online.
41. Moon, “Hundreds of Cree and Ojibwa Children Violated,” Globe and Mail.
42. Canada, Aboriginal Affairs and Northern Development, Report of the Testimonial/Panel
Component, 3.
43. TRC, ASAGR, Aboriginal Affairs and Northern Development, St. Anne’s Residential School
Reunion and Conference, Report of the Testimonial/Panel Component, Fort Albany First
Nation, 20 August 1992, 3.
Notes • 333
44. TRC, ASAGR, Aboriginal Affairs and Northern Development, St. Anne’s Residential School
Reunion and Conference, Report of the Testimonial/Panel Component, Fort Albany First
Nation, 20 August 1992, 5.
45. Mary Anne Nakogee-Davis, “Summary Report–St. Anne’s Residential School 1992 Reunion
and Keykaywin Conference,” 21 April 1994, 9. [AANDC-906125]
46. O’Grady, “School’s Former Staff Face Assault Charges,” Toronto Star.
47. Shea, Institutional Child Abuse, 10–15.
48. As quoted in R. v. O’Connor [1995] 4 SCR 411 at para. 39.
49. R. v. O’Connor [1992] BCJ No 2569 at paras. 19–20.
50. R. v. O’Connor [1992] BCJ No 2569 at paras. 66–68.
51. Neel, “Two Faces of Justice,” The Province (Vancouver).
52. R. v. O’Connor, [1995] 4 SCR 411 at para. 91.
53. Criminal Code of Canada, s 278.3(4) as amended by SC 1997 c 30, s 1.
54. R. v. O’Connor, 1996 CanLII 8458 (BCSC).
55. R. v. O’Connor, 1996 CanLII 8393 (BCCA).
58. McLintock, “He Finally Confesses,” The Province (Vancouver).
59. Vancouver Sun, “Bishop O’Connor Diverted.”
60. Carter, Lost Harvests.
61. Carter, Lost Harvests.
62. St. Catharine’s Milling and Lumber Company v. The Queen, [1888] UKPC 70, [1888] 14 AC 46
(12 December 1888).
63. Calder v. Attorney General (B.C.), [1973] SCJ No 56 (SCC).
64. TRC, NRA, Trevor Sutter, “Starr Admits to Sexual Assaults,” The Leader-Post (Regina), Library
and Archives Canada Reel NJ FM 752, 3 February 1993, A3 [GDC-026641]; Treble and O’Hara,
“Residential Church School Scandal.”
65. B. (D.) v. Canada (Attorney General), 2000 SKQB 574(CanLII). For another case dismissing
a claim brought against Starr see C.M. v. Canada (A.G.), 2004 SKQB 175(CanLII) at paras.
13–15, 32.
66. B. (D.) v. Canada (Attorney General), 2000 SKQB 574(CanLII) at para. 49.
67. B. (D.) v. Canada (Attorney General), 2000 SKQB 574 (CanLII) at para. 63.
68. B. (D.) v. Canada (Attorney General), 2000 SKQB 574 (CanLII) at paras. 63–64.
69. Moran, “The Role of Reparative Justice,” 534.
70. Law Commission of Canada, Restoring Dignity, 409.
71. M.M. v. Roman Catholic Church of Canada et al., 2001 MBCA 148 (CanLII) at paras. 41–42, 64.
72. Limitation of Actions Amendment Act, SM 2002 c 5, s 2.1(2).
73. Limitations Act, RSA 2000 c L-2, s 3.
74. Limitations Act, RSA 2000 c L-2, s 13.
75. Arishenkoff v. British Columbia, 2004 BCCA 299 (CanLII).
76. Limitations of Actions Act, RSS 1978 c L-15, s 3.1 (statute repealed).
77. P.(W.) v. Canada (Attorney General), 1999 SKQB 17 ; M.A. v. Canada (Attorney General),
[1999] SJ No 538 (SKQB).
78. Roach, “Blaming the Victim.”
79. W. (D.) v. Canada (Attorney General), 1999 SKQB 187 (CanLII) at para. 38.
80. Q. (A.) v. Canada (Attorney General), 1998 CanLII 13810 (SKQB) at paras. 62, 76. Justice
Matheson concluded that “there is nothing in the treatment plan which identifies the alcohol
problem as being attributable, in any manner, to the sexual assaults on Mr. [C. C.]. Thus, the
claim for the cost of alcohol treatment cannot be viewed as justified.”
81. In Q.(A.) v. Canada (Attorney General), 1998 CanLII 13810 (SKQB) at paras. 54, 57, Justice
Matheson rejected the fitness club proposal stating, “No doubt many unfit individuals would
feel better if they engaged in a consistent fitness program. But in what manner has it been re-
vealed that Mr. [J. M.]’s unfitness was in any way related to the injury—sexual assault—caused
to him by one of the defendants? … The recommended expenditure for a family membership
for two years at the Lawson Aquatic Centre appears to be not only a luxury but addressing a
matter wholly unrelated to the injuries suffered by Mr. [J. M.]. In any event, the recommenda-
tion does not fall within the concept of ‘treatment and counselling’ and cannot therefore be
justified.”
82. F. S. M. v. Clarke, 1999 CanLII 9405 (BCSC) at paras. 191, 196.
83. “Fresh as Amended Statement of Claim,” in court file 00-CV-192059 CP, (Baxter v. Canada
[Attorney General]) at paras. 68, 71, 72.
84. Re Residential Schools, [2000] AJ No 47 (ABQB); Bonaparte v. Canada (Attorney General),
[2003] OJ No 1046.
85. T. W. N. A. v. Clarke, 2001 BCSC 1177 (CanLII) at para. 305.
86. Canada, Treaties No. 1 and No. 2.
87. Canada, Treaties No. 3, No. 5, No. 6.
88. M. C. C. v. Canada, [2001] OJ No 4163 at para. 45, affirmed by [2003] OJ No 2698.
89. Eizenga et al., Class Actions Law and Practice.
90. Jones, Theory of Class Actions, 110.
91. Class Proceedings Act, 1992, SO 1992, c 6.
92. Class Proceedings Act, RSBC 1996, c 50.
93. Saskatchewan: The Class Actions Act, SS 2001, c C-12.01; Newfoundland and Labrador: Class
Actions Act, SNL 2001, c C-18.1; Manitoba: Class Proceedings Act, CCSM c C130; Alberta: Class
Proceedings Act, SA 2003, c C-16.5; New Brunswick: Class Proceedings Act, RSNB 2011, c 125;
Nova Scotia: Class Proceedings Act, SNS 2007, c 28. (All statutes cited are the provincial class
proceedings act in their contemporary form.)
94. “Statement of Claim” in Court File No. 29762 (Cloud v. Canada (Attorney General).
95. Cloud v. Canada (Attorney General), [2001] OJ No 4163 at para. 7.
96. “Statement of Claim” in Court File No. 29762 (Cloud v. Canada (Attorney General).
97. “Statement of Claim issued 13 June 2000,” in Court File No. 00-CV-192059CP (Baxter v. Can-
ada [Attorney General]).
98. “Joint Factum of the Plaintiffs, Motion for Settlement Approval – Returnable August 29-31
2006,” in Court File No. 00-CV-192059CP (Baxter v. Canada [Attorney General]) at para. 256.
99. Cloud v. Canada (Attorney General), [2001] OJ No 4163 at paras. 63, 74, 80.
100. Cloud v. Canada (Attorney General), [2003] OJ No 2698 at paras. 18–36.
101. Cloud v. Canada (Attorney General), [2004] OJ No 4924.
102. Cloud v. Canada (Attorney General), 2004 CanLII 45444 (ONCA) at para. 88.
103. Gatehouse, “The Residential Schools Settlement Biggest Winner”; Government of Canada and
Merchant Law Group, “Indian Residential Schools Settlement Agreement, Schedule V.” See
also Fontaine v. Canada (Attorney General), 2013 SKCA 22, outlining ongoing legal disputes
over fees.
Notes • 335
104. Kraus, “Merchant Law Group in Legal Battle of Its Own,” Global News.
105. Canadian Bar Association, Resolution 00-04-A.
106. Regan, Unsettling the Settler Within, 121.
107. Assembly of First Nations, Report on Canada’s Dispute Resolution Plan, 15.
110. Assembly of First Nations, Report on Canada’s Dispute Resolution Plan, 2, 24.
111. Assembly of First Nations, Report on Canada’s Dispute Resolution Plan, 107–116.
114. Quoted in Regan, Unsettling the Settler Within, 128.
115. Canada, House of Commons Standing Committee on Aboriginal Affairs and Northern Devel-
opment, Study on the Effectiveness of the Government Alternative Dispute Resolution Process.
116. “Agreement in Principle,” 1.
117. Indian Residential Schools Settlement Agreement.
118. Indian Residential Schools Settlement Agreement, Schedule M, Funding Agreement, s 3.03, 5.
119. Indian Residential Schools Settlement Agreement.
120. For example, Baxter v. Canada (Attorney General), 2006 CanLII 41673 (ONSC).
121. “Affidavit of Phillip Fontaine,” in court file 05-CV-294716CP, Fontaine v. Canada, 2006 at para.
17.
18.
18.
124. TRC, AVS, Rosalie Webber, Statement to the Truth and Reconciliation Commission of Canada,
Halifax, Nova Scotia, 26 November 2011, Statement Number: 2011-2891.
125. Canada, Truth and Reconciliation Commission, Internal Report of the Inuit Sub-Commission,
11.
126. TRC, AVS, Leona Bird, Statement to the Truth and Reconciliation Commission of Canada,
127. TRC, AVS, Myrtle Ward, Statement to the Truth and Reconciliation Commission of Canada,
128. TRC, AVS, Geraldine Bob, Statement to the Truth and Reconciliation Commission of Canada,
Fort Simpson, Northwest Territories, 23 November 2011, Statement Number: 2011-2685.
129. TRC, AVS, Joseph Martin Larocque, Statement to the Truth and Reconciliation Commission of
Canada, Saskatoon, Saskatchewan, 21 June 2012, Statement Number: 2011-4386.
130. TRC, AVS, Mabel Brown, Statement to the Truth and Reconciliation Commission of Canada,
Inuvik, Northwest Territories, 28 September 2011, Statement Number: 2011-0325.
131. TRC, AVS, Marie Brown, Statement to the Truth and Reconciliation Commission of Canada,
132. TRC, AVS, Theresa Hall, Statement to the Truth and Reconciliation Commission of Canada,
Timmins, Ontario, 10 November 2010, Statement Number: 01-ON-8-10Nov10-007.
133. TRC, AVS, Amelia Thomas, Statement to the Truth and Reconciliation Commission of Can-
ada, Victoria, British Columbia, 13 April, 2012, Statement Number: 2011-3975.
134. TRC, AVS, Darlene Thomas, Statement to the Truth and Reconciliation Commission of Can-
ada, Vancouver, British Columbia, 19 September 2013, Statement Number: 2011-3200.
135. Perreault, “Admissions to Adult Correctional Services.”

136. Canada, Office of the Correctional Investigator, “Backgrounder: Aboriginal Offenders.”
138. Perreault, “Aboriginal Youth Are Over-Represented.”
140. Canada, Statistics Canada, “Youth Custody and Community Services in Canada, 1998–99”;
Perreault, “Aboriginal Youth Are Over-Represented.”
141. TRC, AVS, David Charleson, Statement to the Truth and Reconciliation Commission of Can-
142. TRC, AVS, Daniel Andre, Statement to the Truth and Reconciliation Commission of Canada,
Whitehorse, Yukon, 23 May 2011, Statement Number: 2011-0202.
143. TRC, AVS, Raymond Blake-Nukon, Statement to the Truth and Reconciliation Commission of
Canada, 23 May 2011, Statement Number: 2011-0201.
144. Aboriginal Healing Foundation, Mental Health Profiles, 47.
145. TRC, AVS, Willy Carpenter, Statement to the Truth and Reconciliation Commission of Can-
ada, Tuktoyaktuk, Northwest Territories, 20 September 2011, Statement Number: 2011-0353.
146. TRC, AVS, Ruth Chapman, Statement to the Truth and Reconciliation Commission of Canada,
147. TRC, AVS, Diana Lariviere, Statement to the Truth and Reconciliation Commission of Can-
ada, Little Current, Ontario, 13 May 2011, Statement Number: 2011-2011.
149. Canada, Public Health Agency of Canada, “Fetal Alcohol Spectrum Disorder (FASD)”; Ospina
and Dennett, Systematic Review, iii.
150. Streissguth et al., “Risk Factors for Adverse Life Outcomes,” 233.
151. MacPherson, Chudley, and Grant, Fetal Alcohol Spectrum Disorder (FASD) in a Correctional
Population.
152. Tait, Fetal Alcohol Syndrome, 75.
153. Canada, Public Safety Canada, Fetal Alcohol Spectrum Disorder and the Criminal Justice
System, 2.
154. Canada, Public Safety Canada, Fetal Alcohol Spectrum Disorder and the Criminal Justice
System, 21.
155. R. v. Harris, 2002 BCCA 152 at para. 26.
156. Institute of Health and Economics, Consensus Statement on Legal Issues, 10.
157. Institute of Health and Economics, Consensus Statement on Legal Issues, 22–23.
158. R. v. C. L. K., 2009 MBQB 227 (CanLII) at paras. 9–11.
159. R. v. C. L. K., 2009 MBQB 227 (CanLII) at para. 13.
160. R. v. George, 2010 ONSC 6017 at para. 7.
161. R. v. George, 2010 ONSC 6017 at paras. 8–9.
162. R. v. George, 2010 ONSC 6017 at para. 11.
163. R. .v. George, 2010 ONSC 6017 at paras. 52–53.
164. R. v. Charlie, 2012 YKTC 5 at para. 6.
165. R. v. Charlie, 2012 YKTC 5 at para. 9.
166. R. v. Ominayak, 2007 ABQB 442 at para. 150.
167. R. v. Paulette, 2010 NWTSC 31 (CanLII) at para. 6.
168. R. v. Jimmie, 2009 BCCA 215 at para. 9.
169. Sousa et al., “Longitudinal Study on the Effects of Child Abuse,” 118.
Notes • 337
170. R. v. Rossi, [2011] OJ No 4736 at para. 27.

171. R. v. Snake, [2010] OJ No 5445 at para. 17.
172. Martin et al., “The Enduring Significance of Racism,” 662.
173. R. v. G. (D. M.), 2006 NSPC 58 (CanLII) at para. 14.
174. R. v. Paulin, 2011 ONSC 5027; R. v. Cappo, 2005 SKCA 134; R. v. Tymiak, 2012 BCCA 40; R. v.
Pauchay, 2009 SKPC 35; R. v. Leaney, 2002 BCCA 67; R. v. W. R. B., 2010 MBQB 102; R. v. Shawn
Curtis Keepness, 2011 SKQB 293; R v. Renschler, 2005 MBPC 53233; R. v. Klymok, 2002 ABPC 95;
R. v. R.L., 2012 MBPC 22; R. v. Boisseneau, 2006 ONSC 562; R. v. Corbiere, 2012 ONSC 2405; R. v.
Sharkey, 2011 BCSC 1541; R. v. Makela, 2006 BCPC 320; R. v. Loring, 2009 BCCA 166.
175. LaPrairie, “Aboriginal Crime and Justice,” 287.
176. Filbert and Flynn, “Developmental and Cultural Assets,” 563.
177. Burton, “Male Adolescents.”
178. McCloskey and Bailey, “The Intergenerational Transmission of Risk,” 1032.
179. R. v. J. O., 2007 QCCQ 716 at paras. 28–30.
180. R. v. W. R. G., 2011 BCPC 330 at para. 25.
181. R. v. W. R. G., 2011 BCPC 330 at para. 34.
182. Bennett, Holloway, and Farrington, “The Statistical Association between Drug Misuse and
Crime,” 117.
183. Phillips, “Substance Abuse and Prison Recidivism”; Looman and Abracen, “Substance Abuse
among High-Risk Sexual Offenders”; Hirschel, Hutchinson, and Shaw, “The Interrelationship
between Substance Abuse”; Tripodi and Bender, “Substance Abuse Treatment.”
184. Canada, Statistics Canada, “Victimization and Offending among the Aboriginal population in
Canada,” 9.
185. Perreault, “Violent Victimization of Aboriginal People,” 9.
186. R. v. Battaja, 2010 YKTC 145; R. v. E.K., 2012 BCPC 132; R. v. O. S., 2005 BCPC 727; R. v. Simon,
2006 ABPC 21; R. v. McLeod, 2006 YKTC 118; R. v. Joe, 2005 YKTC 21.
187. R. v. Craft, 2010 YKTC 127 at para. 12.
188. R. v. M. L. W., 2004 SKPC 90 at para. 8.
189. Kerr et al., “Intergenerational Influences on Early Alcohol Use,” 889–901; Handley and
Chassin, “Intergenerational Transmission of Alcohol Expectancies”; Campbell and Oei, “A
Cognitive Model for the Intergenerational Transference of Alcohol Use Behavior”: Belles et
al., “Parental Problem Drinking”; Thornberry, Krohn, and Freeman-Gallant, “Intergenera-
tional Roots,” 1; Dunlap et al., “Mothers and Daughters,” 21.
190. R. v. C. G., 2011 NWTSC 47 at para. 20.
191. Aboriginal Healing Foundation, Mental Health Profiles, 50, 51.
192. Aboriginal Healing Foundation, Mental Health Profiles, 46, 47.
193. R. v. Land, 2013 ONSC 6526 at paras. 65 and 69.
194. R. v. Land, 2013 ONSC 6526 at para. 76.
195. Canada, Canadian Human Rights Commission, Report on Equality Rights of Aboriginal Peo-
ple, 18–19.
196. Bougie, Kelly-Scott, and Arriagana, “The Education and Employment Experiences of First
Nations,” 24.
197. Canada, Canadian Human Rights Commission, Report on Equality Rights of Aboriginal Peo-
ple, 3, 12, 32; Anderson and Hohban, “Labour Force Characteristics of the Métis,” 12.
198. Canada, Statistics Canada, Table 99-014-039, 2011 National Household Survey: Data Tables.
200. Some recent studies include Hooghe et al., “Unemployment, Inequality, Poverty and Crime”:
Gustafson, “The Criminalization of Poverty”; Sabates, “Educational Attainment and Juvenile
Crime”; Atkins, “Racial Segregation, Concentrated Disadvantage, and Violent Crime”; Case,
“The Relationship of Race and Criminal Behavior.”
201. Some recent studies include Eitle, D’Alessio, and Stolzenberg, “Economic Segregation, Race,
and Homicide”; Pizarro and McGloin, “Explaining Gang Homicides in Newark, New Jersey”;
Pridemore, “A Methodological Addition to the Cross-National Empirical Literature on Social
Structure and Homicide.”
202. Spano, Frielich, and Bolland, “Gang Membership, Gun Carrying, and Employment.”
203. Moore “Understanding the Connection Between Domestic Violence, Crime, and Poverty,”
455; Purvin, Diane, “Weaving a Tangled Safety Net.”
205. R. v. C. G. O., 2011 BCPC 145 at paras. 4, 61.
206. R. v. C. G. O., 2011 BCPC 145 at paras. 62–63.
207. Ryan and Testa, “Child Maltreatment and Juvenile Delinquency.”
208. Ryan et al., “Juvenile Delinquency in Child Welfare.”
209. DeGue and Widom, “Does Out-Of-Home Placement,” 350.
210. R. v. J. E. R., 2012 BCPC 103 at paras. 30–34.
211. Allan Rock quoted in R. v. Gladue, [1999] 1 SCR 688; Canada, House of Commons Standing
Committee on Justice and Legal Affairs, Minutes of Proceedings and Evidence, No. 62, 17
November 1994, 62:15.
212. R. v. Gladue, [1999] 1 SCR 688 at para. 60, quoting Michael Jackson “Locking Up Natives in
Canada,” UBC Law Review 23 (1988–89): 215–216.
213. R. v. Gladue, [1999] 1 SCR 688 at para. 64.
214. R. v. Gladue, [1999] 1 SCR 688 at para. 37.
215. Makin, “Aboriginal Sentencing Rules Ignored,” Globe and Mail.
216. Legal Services Society of British Columbia, Gladue Report Disbursement, 61.
217. Legal Services Society of British Columbia, Gladue Report Disbursement, 62.
218. R. v. Armitage, 2015 ONCJ 64 (CanLII) at paras. 3–5.
219. R. v. Armitage, 2015 ONCJ 64 (CanLII) at para. 55.
220. R. v. Ipeelee, 2012 SCC 13 at para. 60.
221. Some legal commentators have suggested that even after Ipeelee some judges are insisting
on a causal connection between the commission of a crime and background factors and are
underestimating the intergenerational impact of residential schools. See Roach, “Blaming the
Victim.”
222. R. v. Ipeelee, 2012 SCC 13 at para. 66.
223. Rudin, “Incarceration of Aboriginal Youth in Ontario,” 265.
224. Rudin, “Incarceration of Aboriginal Youth in Ontario,” 268–269.
225. Tim Quigley quoted in R. v. Ipeelee, 2012 SCC 13 at para. 67.
226. TRC, AVS, Gerald McLeod, Statement to the Truth and Reconciliation Commission of Can-
ada, Whitehorse, Yukon, 27 May 2011, Statement Number: 2011-1130.
227. TRC, AVS, Gerald McLeod, Statement to the Truth and Reconciliation Commission of Can-
ada, Whitehorse, Yukon, 27 May 2011, Statement Number: 2011-1130.
228. Canada, Nicholson, Toews, Kenney, and Boisvenu, “Statement of the Government of Canada
on the Royal Assent of Bill C-10,” Reuters.com.
229. Criminal Code of Canada, RCS 1985 c C-46, ss 151–153.
Notes • 339
230. Bill C-10 amended the Controlled Drugs and Substances Act to impose a minimum pun-
ishment of imprisonment for a term of two years if certain other aggravating factors apply,
including that the offence was committed in or near a school, on or near school grounds, or
in or near any other public place usually frequented by persons under the age of eighteen. As
enacted: Controlled Drugs and Substances Act, SC 1996, c 19, s 5(3)(a).
231. Controlled Drugs and Substances Act, SC 1996, c 19, s 7(3)(a); Library of Parliament, Legal and
Legislative Affairs Division, Bill C-10: An Act to enact the Justice for Victims of Terrorism Act
and to amend the State Immunity Act, the Criminal Code, the Controlled Drugs and Substances
Act, the Corrections and Conditional Release Act, the Youth Criminal Justice Act, the Immigra-
tion and Refugee Protection Act and Other Acts, Publication no. 41-1 C10-E, 5 October 2011,
revised 17 February 2012.
232. Criminal Code of Canada, RCS 1985 c C-46, s 742.1(e) removes judicial discretion to grant
a conditional sentence where the offence has a ten-year maximum sentence, is prosecuted
by way of indictment, and either has resulted in bodily harm, involved drug import, export,
trafficking, or production, or involved a weapon.
233. Criminal Code of Canada, RCS 1985 c C-46, s 742.1(b).
234. TRC, AVS, Joann May Cunday, Statement to the Truth and Reconciliation Commission of
Canada, Winnipeg, Manitoba, 21 September 2011, Statement Number: 2011-0133.
235. R. v. Elias, 2009 YKTC 59 at para. 25 (quoting R. v. Quash, 2009 YKTC 54 at para. 56). There
have been some recent cases in which courts have made decisions counter to the mandatory
minimum provisions. See, for example, R. v. Smickle, 2012 ONSC 602.
236. Canada, House of Commons, Bill C-32.
237. Perreault, “Admissions to Adult Correctional Services.”
238. Manitoba, Aboriginal Justice Implementation Commission, Report of the Aboriginal Justice
Inquiry of Manitoba, 1: ch 11.
239. British Columbia, Ministry of Justice, Corrections Branch, Strategic Plan 2012–2016.
240. See, for example: R. v. NB, 2012 SKPC 99 (CanLII) at para. 24; R. v. Alkenbrack, 2011 BCPC 424
at para. 67.
241. See for example: R. v. Badger, 2013 SKQB 347.
242. Corrections and Conditional Release Act, SC 1992 c 20, s 80.
243. Corrections and Conditional Release Act, SC 1992, c 20, s 81.
246. Canada, Office of the Correctional Investigator, Spirit Matters.
247. Canada, Office of the Correctional Investigator, Spirit Matters.
248. R. v. J. T., 2011 ONSC 7275 (CanLII) at para. 58.
249. Corrections and Conditional Release Act, SC1992, c 20, s 30.
250. Blanchette, Verbrugge, and Wichmann, The Custody Rating Scale, 35.
251. Corrections and Conditional Release Act, SOR/92-620, s 17.
252. Blanchette, Verbrugge, and Wichmann, The Custody Rating Scale, 11. Other differentiating
factors between Aboriginal and non-Aboriginal women in this case included severity of cur-
rent offence and “street (in)stability.”
253. Canada, Task Force of Federally Sentenced Women, Creating Choices.
254. Elizabeth Fry Society, “Discrimination against Aboriginal Women Rampant.”
255. Welsh and Ogloff, “Full Parole and the Aboriginal Experience,” 469, 479.
256. Canada, Canadian Human Rights Commission, Protecting Their Rights, 28.
257. Walsh, “Is Corrections Correcting?,” 109.

258. Holsinger, and Lowenkamp, and Lotessa, “Ethnicity, Gender, and the Level of Service,” 314;
Welsh and Ogloff, “Full Parole and the Aboriginal Experience,” 469; Hann and Harman, Pre-
dicting Release Risk, 50.
259. Moore, First Nations, Métis, Inuit and Non-Aboriginal Offenders, 44.
261. Canada, Correctional Service Canada, Commissioner’s Directive: Security Classification and
Penitentiary Placement.
262. Blanchette and Taylor, “Development and Validation of a Security Reclassification Scale for
Women,” 29.
263. Blanchette and Taylor, “Development and Validation of a Security Reclassification Scale for
Women,” 29.
264. For a study that involved interviews with inmates in a minimum security institution designed
specifically for Aboriginal inmates, see Waldram, The Way of the Pipe, 129–150; Heckbert and
Turkington, “Turning Points”; Crutcher and Trevethan, “An Examination of Healing Lodges
for Aboriginal Offenders in Canada,” 52.
267. TRC, AVS, Chris Gargan, Statement to the Truth and Reconciliation Commission of Canada,
Yellowknife, Northwest Territories, 30 October 2012, Statement Number: 2011-0430.
268. R. v. Gingell, [1996] YJ No 52 at para. 63.
269. Zellerer, “Culturally Competent Programs.”
270. Zellerer, “Culturally Competent Programs,” 183.
271. Sioui and Thibault, The Relevance of a Cultural Adaptation, 43.
274. Heckbert and Turkington, “Turning Points,” 56.
275. Sapers, “Speaking Notes for Mr. Howard Sapers.”
276. Saskatchewan, Commission on First Nations and Métis Peoples and Justice Reform, Legacy of
Hope, Recommendation 6.23, 6.34.
277. Canada, Correctional Service of Canada, Evaluation Report.
278. Canada, Correctional Service of Canada, Evaluation Report.
279. Crutcher and Trevethan, “An Examination of Healing Lodges for Aboriginal Offenders in
Canada,” 54.
281. Bonta, “Native Inmates”; Bonta, LaPrairie, and Wallace-Capretta, “Risk Prediction and
Re-offending”; Bonta, Lipinski, and Martin, “The Characteristics of Aboriginal Recidivists.”
282. John Howard Society of Alberta, Offender Risk Assessment, 3. The studies being referred to are
Gendreau, Little, and Goggin, A Meta-Analysis of the Predictors of Adult Offender Recidivism;
Hanson and Bussière, Predictors of Sexual Offender Recidivism.
283. LaPrairie, Examining Aboriginal Corrections in Canada, 80–83.
284. Petten, “New Healing Lodge Opens for Offenders,” 1.
285. Brown et al., “Housing for Aboriginal Ex-Offenders.”
286. Perreault, “Admissions to Youth Correctional Services in Canada, 2011/12.”
Notes • 341
287. R. v. D. B., [2008] 2 SCR 3 at paras. 1, 41, 47–59.

288. Youth Criminal Justice Act, SC 2002, c 1, s 3(1)(b).
289. UN General Assembly, Convention on the Rights of the Child, article 40.
290. Youth Criminal Justice Act, SC 2002, c 1, s 38(1).
291. Youth Criminal Justice Act, SC 2002, c 1, s 38(2)(d).
292. Youth Criminal Justice Act, SC 2002, c 1, s 3(1)(c)(iv).
293. Chartrand, “Aboriginal Youth and the Criminal Justice System,” 326.
295. Canada, Statistics Canada, “Youth Court Statistics 2011/2012”; Munch, “Youth Correctional
Statistics in Canada, 2010/2011,” 5; Canadian Bar Association, Submission on Bill C-10, 8. Not
all provinces/territories have seen a decrease in youth in correctional services; in fact, Munch
reported that, since 2004/05, rates have increased in Manitoba, Yukon, and Alberta.
296. Perreault, “Admissions to Youth Correctional Services in Canada, 2011/12.” The study ex-
cluded data from Nova Scotia, Québec, Saskatchewan, and Nunavut. Overrepresentation of
Aboriginal youth is evident in all provinces and territories surveyed, with the exception of
Newfoundland and Labrador.
297. British Columbia, Office of the Provincial Health Officer, Health, Crime and Doing Time, 32.
298. BC Representative for Children and Youth, When Talk Trumped Service, 21.
299. Totten, “Aboriginal Youth and Violent Gang Involvement in Canada,” 141.
302. Howe, “Children’s Rights as Crime Prevention,” 467.
303. Howe, “Children’s Rights as Crime Prevention,” 468–469.
304. Historical version of the YCJA is available on the CanLII website at http://www.canlii.org/en/
ca/laws/stat/sc-2002-c-1/32863/sc-2002-c-1.html#history.
305. Youth Criminal Justice Act, SC 2002, c 1, s 3(1)(a).
306. Assembly of First Nations, Submission: Bill C-10 Safe Streets and Communities Act, 20.
307. Canada, House of Commons, Bill C-10, clauses 176–184.
310. Canadian Bar Association, Submission on Bill C-10, 80.
311. Canada, House of Commons, Bill C-10, clause 189.
Statistics.”
314. Canada, Canadian Centre for Justice Statistics, “Family Violence in Canada”; Canada, Statis-
tics Canada, “Homicide in Canada, 2013.”
315. Canada, Statistics Canada, “Homicide in Canada, 2013.”
316. Sinha, “Measuring Violence Against Women,” 9, 19.
317. Kennedy, “Rinelle Harper Calls for Missing Women Inquiry,” Ottawa Citizen.
318. Sinha, “Measuring Violence Against Women: Statistical Trends,” 9, 19; Native Women’s Asso-
ciation of Canada, Voices of Our Sisters in Spirit, 94–95.
319. Brennan, “Violent Victimization of Aboriginal Women in the Canadian Provinces, 2009,” 7, 8.
In the GSS, “Aboriginal women” refers to those persons who self-reported their sex as female
and who self-identified as belonging to at least one Aboriginal group—that is, North Ameri-
can Indian, Métis, or Inuit.
320. Brennan, “Violent Victimization of Aboriginal Women in the Canadian Provinces, 2009,” 9.
321. Brennan, “Violent Victimization of Aboriginal Women in the Canadian Provinces, 2009,” 10.
322. Sinha, “Measuring Violence Against Women,” 19.
323. Perreault, “Violent Victimization of Aboriginal People in the Canadian Provinces, 2009,” 10.
324. Canada, Truth and Reconciliation Commission, Internal Report of the Inuit Sub-Commission, 9.
325. Jacobs and Williams, “Legacy of Residential Schools: Missing and Murdered Women,” 127.
Inquiry of Manitoba, 2: 92.
Inquiry of Manitoba, 2: Chp. 10.
328. TRC, AVS, Eva Simpson, Statement to the Truth and Reconciliation Commission of Canada,
Norway House First Nation, Manitoba, 10 May 2011, Statement Number: 2011-0290.
329. Opal, Forsaken, 1:52.
330. Oppal, Forsaken, 1:63.
331. Oppal, Forsaken, 2A:124.
332. Oppal, Forsaken, 2A:63, 124.
333. Oppal, Forsaken, 1:42.
334. Oppal, Forsaken, 2A:121.
335. Burnouf, “Marlene Bird,” APTN.
336. CBC News, “Illustrations Tell Story of Marlene Bird.”
337. CBC News, “Illustrations Tell Story of Marlene Bird.”
338. Canadian Press, “Winnipeg Police Officer Suspended,” The Star (Toronto).
339. Jacobs and Williams, “Legacy of Residential Schools: Missing and Murdered Women,” 127,
132–133.
340. Jacobs and Williams, “Legacy of Residential Schools: Missing and Murdered Women,” 128,
132–133.
341. Jacobs and Williams, “Legacy of Residential Schools: Missing and Murdered Women,” 134.
342. Human Rights Watch, Those Who Take Us Away, 35.
343. Highway of Tears Symposium, Highway of Tears Symposium Recommendations Report, 9, 18.
344. Oppal, Forsaken, Recommendation 6.1; Pearce, “An Awkward Silence,” 644.
345. Pearce, “An Awkward Silence,” 644.
346. Native Women’s Association of Canada, “Fact Sheet: Missing and Murdered Aboriginal
Women and Girls,” 3.
347. Native Women’s Association of Canada, What Their Stories Tell Us, 24–27.
348. Native Women’s Association of Canada, “Fact Sheet: Missing and Murdered Aboriginal
Women and Girls,” 3.
349. Native Women’s Association of Canada, What Their Stories Tell Us, 31.
350. Native Women’s Association of Canada, What Their Stories Tell Us, 27
351. Canada, House of Commons Standing Committee on the Status of Women, Ending Violence
against Aboriginal Women and Girls, 11–12.
352. Canada, House of Commons Standing Committee on Violence Against Indigenous Women,
Invisible Women, 13.
353. See Pearce, “An Awkward Silence.”
354. Pearce, “An Awkward Silence,” 18–23.
355. Canada, House of Commons Standing Committee on the Status of Women, Interim Report –
Night, 15–18.
Notes • 343
356. Oppal, Forsaken, 2B:107–108.

357. Oppal, Forsaken, 2B:236.
358. Royal Canadian Mounted Police, Missing and Murdered Aboriginal Women, 7.
361. Palmater, “RCMP Report on Murdered and Missing Aboriginal Women,” Rabble.ca.
362. Barrera, “Valcourt Used Unreleased RCMP Data,” APTN.
363. Galloway, “70 Per Cent of Murdered Aboriginal Women,” Globe and Mail.
364. Palmater, “RCMP Report on Murdered and Missing Aboriginal Women,” Rabble.ca.
365. Amnesty International, No More Stolen Sisters, 4; Human Rights Watch, Those Who Take Us
Away, 37.
366. United Nations, High Commissioner for Human Rights, Discrimination against Women, para.
32; United Nations, Human Rights Committee, Concluding Observations of the Human Rights
Committee: Canada, para. 23.
367. Committee on the Elimination of Discrimination Against Women quoted in Canadian Femi-
nist Alliance for International Action, No Action: No Progress, 17.
368. Anaya, “Statement upon Conclusion of the Visit to Canada by the United Nations Special
Rapporteur.”
369. Amnesty International, No More Stolen Sisters, 4.
373. Munch, “Victim Services in Canada, 2009/2010.”
374. Mazowita and Burczycka, “Shelters for Abused Women in Canada, 2012.”
375. Canada, House of Commons Standing Committee on the Status of Women, Ending Violence
against Aboriginal Women and Girls, 31.
Invisible Women, 29–30.
Invisible Women, 20.
378. Mulligan, “Victim Services in Canada.”
379. UN General Assembly, Declaration of Basic Principles of Justice for Victims of Crime and Abuse
of Power; Canada, Department of Justice, Multi-Site Survey of Victims of Crime, 15.
380. UN General Assembly, United Nations Declaration on the Rights of Indigenous Peoples.
381. TRC, AVS, Michael Sillett, Statement to the Truth and Reconciliation Commission of Canada,
382. TRC, AVS, Ron McHugh, Statement to the Truth and Reconciliation Commission of Canada,
Batoche, Saskatchewan, 21 July 2010, Statement Number: 01-SK-18-25JY10-011.
383. Canada, Royal Commission on Aboriginal Peoples, Bridging the Cultural Divide.
384. UN General Assembly, United Nations Declaration on the Rights of Indigenous Peoples.
Inquiry of Manitoba, 1: Appendix 1.
386. Dalmyn quoted in Green, “Aboriginal Community Sentencing and Mediation,” 113.
387. Green, “Aboriginal Community Sentencing and Mediation,” 114.
388. Judge Claude Fafard interview with Ross Gordon Green (telephone), 16 December 1994, cited
in Green, “Aboriginal Community Sentencing and Mediation,” 111–112.
389. Turpel-Lafond and Monture-Angus, “Aboriginal Peoples and Canadian Criminal Law,” 246.
390. Miller, The Problem of Justice, 198–199.
391. Milward, Aboriginal Justice and the Charter.
Bibliography
Primary Sources
1. Truth and Reconciliation Commission Databases

The endnotes of this report often commence with the abbreviation TRC, followed by one of the
following abbreviations: ASAGR, AVS, CAR, IRSSA, NRA, RBS, and LAC. The documents so cited
are located in the Truth and Reconciliation Commission of Canada’s database, housed at the
National Centre for Truth and Reconciliation. At the end of each of these endnotes, in square
brackets, is the document identification number for each of these documents. The following is a
brief description of each database.
Active and Semi-Active Government Records (ASAGR ) Database: The Active and Semi-Active
Government Records database contains active and semi-active records collected from federal
governmental departments that potentially intersected with the administration and manage-
ment of the residential school system. Documents that were relevant to the history and/or legacy
of the system were disclosed to the Truth and Reconciliation Commission of Canada (TRC) in
keeping with the federal government’s obligations in relation to the Indian Residential Schools
Settlement Agreement (IRSSA). Some of the other federal government departments included,
but were not limited to, the Department of Justice, Health Canada, the Royal Canadian Mounted
Police, and National Defence. Aboriginal Affairs and Northern Development Canada undertook
the responsibility of centrally collecting and producing the records from these other federal
departments to the TRC.
Audio/Video Statement (AVS) Database: The Audio/Video Statement database contains video
and audio statements provided to the TRC at community hearings and regional and national
events held by the TRC, as well as at other special events attended by the TRC.
National Research and Analysis (NRA) Database: The National Research and Analysis data-
base contains records collected by the National Research and Analysis Directorate, Aboriginal
Affairs and Northern Development Canada, formerly Indian Residential Schools Resolution
Canada (IRSRC). The records in the database were originally collected for the purpose of re-
search into a variety of allegations, such as abuse in residential schools, and primarily resulted
from court processes such as civil and criminal litigation, and later the Indian Residential
Schools Settlement Agreement (IRSSA), as well as from out-of-court processes such as Alter-
native Dispute Resolution. A majority of the records were collected from Aboriginal Affairs and
Northern Development Canada. The collection also contains records from other federal depart-
ments and religious entities. In the case of some records in the database that were provided by
outside entities, the information in the database is incomplete. In those instances, the endnotes
in the report reads, “No document location, no document file source.”
2. Indian Affairs Annual Reports, 1864–1997

Within this report, Annual Report of the Department of Indian Affairs denotes the published
annual reports created by the Government of Canada, and relating to Indian Affairs over the
period from 1864 to 1997.
The Department of Indian Affairs and Northern Development was created in 1966. In 2011, it
was renamed Aboriginal Affairs and Northern Development. Before 1966, different departments
were responsible for the portfolios of Indian Affairs and Northern Affairs. The departments
responsible for Indian Affairs were (in chronological order):
• The Department of the Secretary of State of Canada (to 1869)

• The Department of the Secretary of State for the Provinces (1869–1873)
• The Department of the Interior (1873–1880)
• The Department of Indian Affairs (1880–1936)
• The Department of Mines and Resources (1936–1950)
• The Department of Citizenship and Immigration (1950–1965)
• The Department of Northern Affairs and National Resources (1966)
• The Department of Indian Affairs and Northern Development (1966–1997)
The exact titles of Indian Affairs annual reports changed over time, and were named for the
department.
3. Library and Archives Canada

RG10 (Indian Affairs Records Group) The records of RG10 at Library and Archives Canada are
currently part of the R216, Department of Indian Affairs and Northern Development fonds. For
clarity and brevity, in endnotes throughout this report, records belonging to the RG10 record
group have been identified simply with their RG10 information.
Where a copy of an RG10 document held in a TRC database was used, the TRC database holding
that copy is clearly identified, along with the RG10 information connected with the original
document.
Bibliography • 347
4. Government Publications
Aboriginal Justice Inquiry of Manitoba. Aboriginal Justice Implementation Committee. Report
of the Aboriginal Justice Inquiry of Manitoba. Vol. 1, The Justice System and Aboriginal Peo-
ple. Winnipeg: Province of Manitoba, 1999.
Anderson, Thomas, and Lori Hohban. “Labour Force Characteristics of the Métis: Find-
ings from the 2012 Aboriginal Peoples Survey.” Statistics Canada, catalogue no. 89-653-
X2014004, December 2014. http://www.statcan.gc.ca/pub/89-653-x/89-653-x2014004-eng.
pdf.
Arnold, Mark. Director of Child and Family Services Annual Report, 2011–2012. Nunavut Child
and Family Services, 2013. http://cwrp.ca/sites/default/files/publications/en/NU_DCFS_
Report_2011.pdf.
BC Ministry of Health. Office of the Provincial Health Officer, and Child and Youth Officer for
British Columbia. Health and Well-Being of Children in Care in British Columbia: Report 1
on Health Services Utilization and Mortality. Joint Special Report. Vancouver: Office of the
Provincial Health Officer, 2006. http://www.health.gov.bc.ca/pho/pdf/cyo/complete_joint_
report.pdf.
BC Representative for Children and Youth. When Talk Trumped Service: A Decade of Lost Op-
portunity for Aboriginal Children and Youth in B.C: Special Report. Vancouver: BC Repre-
sentative for Children and Youth, 2013. http://cwrp.ca/sites/default/files/publications/en/
BC_RCY_AboriginalServices2013.pdf.
Berger, Thomas R. Nunavut Land Claims Agreement Implementation Contract Negotiations for
the Second Planning Period 2003–2013: Conciliator’s Final Report on “The Nunavut Project.”
Ottawa: Aboriginal Affairs and Northern Development, 2006. http://epub.sub.uni-hamburg.
de/epub/volltexte/2010/5076/pdf/2006_03_01_Thomas_Berger_Final_Report_ENG.pdf.
Blanchette, Kelley, Paul Verbrugge, and Cherami Wichmann. The Custody Rating Scale, Initial
Security Level Placement, and Women Offenders. Correctional Service of Canada, Research
Branch, 2002. http://www.csc-scc.gc.ca/research/092/r127_e.pdf.
Bonesteel, Sarah. Canada’s Relationship with Inuit: A History of Policy and Program Develop-
ment. Ottawa: Department of Indian and Northern Affairs, 2006. http://www.aadnc-aandc.
gc.ca/eng/1100100016900/1100100016908.
Bougie, Evelyne. “Aboriginal Peoples Survey, 2006: School Experiences of Off-Reserve First
Nations Children Aged 6 to 14.” Fact Sheet 2006, no. 3. Statistics Canada, Ottawa, 2009.
Bougie, Evelyne, Karen Kelly-Scott, and Paula Arriagana. “The Education and Employment
Experiences of First Nations People Living Off Reserve, Inuit, and Metis: Selected Findings
from the 2012 Aboriginal Peoples Survey.” Statistics Canada Analytical Paper, catalogue
no. 89-653-X–No. 001, November 2013. http://www.statcan.gc.ca/pub/89-653-x/89-653-x-
2013001-eng.pdf.
Brennan, Shannon. “Violent Victimization of Aboriginal Women in the Canadian Provinces,
2009,” Juristat, catalogue no. 85-002-X, Statistics Canada, 2011. http://www.statcan.gc.ca/
pub/85-002-x/2011001/article/11439-eng.htm.
British Columbia. Auditor General of British Columbia. Management of Aboriginal Child
Protective Services. Victoria: Office of the Auditor General of British Columbia, 2008.
British Columbia. Ministry of Children and Family Development. Aboriginal Children in Care,
October 2009 Report. Ministry of Children and Family Development, Research, Analysis
and Evaluation Branch, 2009. http://www.fndirectorsforum.ca/downloads/aboriginal-chil-
dren-in-care-10-09.pdf.
British Columbia. Ministry of Justice, Corrections Branch. Strategic Plan 2012–2016: Aborig-
inal Programs and Relationships. N.d. Accessed 18 July 2015. http://www.pssg.gov.bc.ca/
corrections/docs/AboriginalStratPlan.pdf.
British Columbia. Office of the Provincial Health Officer. Health, Crime and Doing Time: Po-
tential Impacts of the Safe Streets and Communities Act (Former Bill C-10) on the Health and
Well-Being of Aboriginal People in B.C. Vancouver: Office of the Provincial Health Officer,
2013. http://www.health.gov.bc.ca/pho/pdf/health-crime-2013.pdf.
British Columbia. Tripartite Governance Committee. “Implementing the Vision: Governance
of First Nations Health Services in British Columbia.” Working paper of the Tripartite Gov-
ernance Committee. Tripartite First Nations Health Plan, Vancouver. Accessed 27 May 2012.
http://www.hc-sc.gc.ca/fniah-spnia/pubs/services/tripartite/vision-eng.php.
Bryce, P. H. Report on the Indian Schools of Manitoba and the North-West Territories. Ottawa:
Government Printing Bureau, 1907.
Canada. House of Commons Debates, 46 Victoria (9 May 1883) 14: 1107–1108.
Canada. House of Commons Debates, 39th Parliament, 1st session (3 November, 2006) at 1155.
(Bev Oda, Minister of Canadian Heritage and Status of Women).
Canada. Statement of Apology to Former Students of Residential Schools. 11 June 2008. http://
www.aadnc-aandc.gc.ca/eng/1100100015644/1100100015649.
Canada. “Statement of the Government of Canada on Indian Policy, 1969.” Aboriginal Affairs
and Northern Development Canada, 1969. https://www.aadnc-aandc.gc.ca/DAM/DAM-
INTER-HQ/STAGING/texte-text/cp1969_1100100010190_eng.pdf.
Canada. Treaties 1 and 2 between Her Majesty the Queen and the Chippewa and Cree Indians
of Manitoba and Country Adjacent with Adhesions. Ottawa: Edmond Cloutier, Queen’s
Printer and Controller Of Stationery Ottawa, 1957. Rpt. Aboriginal Affairs and Northern De-
velopment Canada, Treaty Texts – Treaty No. 1 and No. 2. https://www.aadnc-aandc.gc.ca/
eng/1100100028664/1100100028665.
Canada. Treaty 3 between Her Majesty the Queen and the Saulteaux Tribe of the Ojibbeway
Indians at the Northwest Angle on the Lake of the Woods with Adhesions. Ottawa: Roger
Duhamel, Queen’s Printer and Controller of Stationery, 1966. Rpt. Aboriginal Affairs and
Northern Development Canada, Treaty Texts – Treaty No. 3. https://www.aadnc-aandc.
gc.ca/eng/1100100028675/1100100028679.
Canada. Treaty 5 between Her Majesty the Queen and the Saulteaux and Swampy Cree Tribes
of Indians at Beren’s River and Norway House with Adhesions. Ottawa: The Queen’s Printer,
1969. Rpt. Aboriginal Affairs and Northern Development Canada, Treaty Texts – Treaty No. 5.
https://www.aadnc-aandc.gc.ca/eng/1100100028699/1100100028700.
Canada. Treaty No. 6 between Her Majesty the Queen and the Plain and Wood Cree Indi-
ans and other Tribes of Indians at Fort Carlton, Fort Pitt and Battle River with Adhesions.
Ottawa: Roger Duhamel, Queen’s Printer and Controller of Stationery, 1964. Rpt. Aborig-
inal Affairs and Northern Development Canada, Treaty Texts – Treaty No. 6. https://www.
aadnc-aandc.gc.ca/eng/1100100028710/1100100028783.
Canada. Aboriginal Affairs and Northern Development Canada. “Backgrounder – Canada’s
Economic Action Plan 2012: Investing in First Nations On-Reserve Water and Wastewater.”
Last modified 13 January 2013. http://www.aadnc-aandc.gc.ca/eng/1358080225341/13580
80569113.
Canada. Aboriginal Affairs and Northern Development Canada. Developing a First Nation
Education Act: A Blueprint for Legislation, July 2013. Ottawa: AANDC, 2013. https://www.
aadnc-aandc.gc.ca/DAM/DAM-INTER-HQ-EDU/STAGING/texte-text/fN-Education_blue-
print-ebauche_1373053903701_eng.pdf.
Canada. Aboriginal Affairs and Northern Development Canada. “Federal Funding Levels for
First Nations K-12 Education.” Last modified 22 May 2015. https://www.aadnc-aandc.gc.ca/
eng/1349140116208/1349140158945.
Canada. Aboriginal Affairs and Northern Development Canada. Final Report: Evalua-
tion of First Nations Water and Wastewater Action Plan. Ottawa: Evaluation, Perfor-
mance Measurement, and Review Branch, Audit and Evaluation Sector, AANDC, 2013.
http://www.aadnc-aandc.gc.ca/DAM/DAM-INTER-HQ-AEV/STAGING/texte-text/
ev_wwap_1400003583366_eng.pdf.
Canada. Aboriginal Affairs and Northern Development Canada. Final Report: Implemen-
tation Evaluation of the Enhanced Prevention Focused Approach in Saskatchewan and
Nova Scotia for the First Nations Child and Family Services Program. Ottawa: AANDC,
2013. http://www.aadnc-aandc.gc.ca/DAM/DAM-INTER-HQ-AEV/STAGING/texte-text/
ev_sns_1382040083423_eng.pdf.
Canada. Aboriginal Affairs and Northern Development Canada. “First Nations Control of First
Nations Education Act: The Case for Legislative Reform.” 7 February 2014. https://www.
aadnc-aandc.gc.ca/eng/1391788733526/1391788786996.
Canada. Aboriginal Affairs and Northern Development Canada. Government of Canada
Progress Report (2006–2012): With Strong Resolve: Advancing our Relationship with First
Nations Peoples and Communities. Ottawa: Minister of Aboriginal Affairs and Northern
Development, 2012.
Canada. Aboriginal Affairs and Northern Development Canada. “Jordan’s Principle.” Ac-
cessed 3 January 2014. http://www.aadnc-aandc.gc.ca/eng/1334329827982/1334329861
879.
Canada. Aboriginal Affairs and Northern Development Canada. Progress Report 2006–2012:
with Strong Resolve: Advancing our Relationship with First Nations Peoples and Communi-
ties. Ottawa: AANDC, 2012.
Canada. Aboriginal Affairs and Northern Development Canada. Report of the Testimonial/
Panel Component. St. Anne’s Residential School Reunion and Conference, Fort Albany First
Nation, 20 August 1992.
Canada. Aboriginal Affairs and Northern Development Canada. Summative Evaluation of the
Elementary/Secondary Education Program on Reserve. Ottawa: Evaluation, Performance
Measurement, and Review Branch Audit and Evaluation Sector, AANDC, 2012.
Canada. Aboriginal Affairs and Northern Development Canada. “Water.” Last modified 3
November 2014. https://www.aadnc-aandc.gc.ca/eng/1100100034879/1100100034883.
Canada. Aboriginal Affairs and Northern Development Canada. Working Together for First
Nations Students: A Proposal for a Bill on First Nations Education, October 2013. Gatineau,
QC: Educational Branch, AANDC. http://www.aadnc-aandc.gc.ca/DAM/DAM-INTER-HQ-
EDU/STAGING/texte-text/proposal_1382467600170_eng.pdf.
Canada. Advisory Committee on Northern Development. Government Activities in the North –
1958. Ottawa: ACND, 1959.
Canada. Auditor General of Canada. “Chapter 4: First Nations and Family Services Program:
Indian and Northern Affairs Canada.” In 2008 May Report of the Auditor General of Canada
to the House of Commons. Ottawa: Office of the Auditor General of Canada, 2008. http://
www.oag-bvg.gc.ca/internet/docs/aud_ch_oag_200805_04_e.pdf.
Canada. Auditor General of Canada. “Chapter 4: Programs for First Nations on Reserves.”
In 2011 Status Report of the Auditor General of Canada to the House of Commons. Ottawa:
Office of the Auditor General of Canada, 2011. http://www.oag-bvg.gc.ca/internet/docs/
parl_oag_201106_04_e.pdf.
Canada. Auditor General of Canada. Report of the Auditor General of Canada to the Legisla-
tive Assembly of Nunavut: Children, Youth and Family Programs and Services in Nunavut.
Ottawa: Office of the Auditor General of Canada, 2011.
Canada, British Columbia, and First Nations Education Steering Committee. Education Juris-
diction Framework Agreement, 5 July 2006.
Canada. Canadian Centre for Justice Statistics. “Family Violence in Canada: A Statistical
Profile, 2013” Juristat, catalogue no. 85-002-X, Statistics Canada, 2015. http://www.statcan.
gc.ca/pub/85-002-x/2014001/article/14114-eng.pdf.
Canada. Canadian Heritage. 2012–2013 Report on Plans and Priorities: Supplementary Tables.
Ottawa: Canadian Heritage, 2012.
Canada. Canadian Heritage. Aboriginal Languages Initiative (ALI) Evaluation: Final Report.
26 February 2003. http://publications.gc.ca/collections/Collection/CH34-12-2003E.pdf.
Canada. Canadian Heritage. Quarterly Financial Report for the Quarter Ending June 30, 2012
Ottawa: Canadian Heritage, 2012. http://www.pch.gc.ca/eng/1345648335518.
Canada. Canadian Heritage. Summative Evaluation of the Aboriginal Peoples’ Program.
Ottawa: Office of the Chief Audit and Evaluation Executive; Evaluation Services Directorate,
February 2011.
Canada. Canadian Human Rights Commission. Protecting Their Rights: A Systemic Review of
Human Rights in Correctional Services for Federally Sentenced Women. 2003. http://www.
chrc-ccdp.ca/sites/default/files/fswen.pdf.
Canada. Canadian Human Rights Commission. Report on Equality Rights of Aboriginal Peo-
ple. Ottawa: Government of Canada, 2013. http://www.chrc-ccdp.gc.ca/sites/default/files/
equality_aboriginal_report.pdf.
Canada. Correctional Service Canada. Commissioner’s Directive: Security Classification and
Penitentiary Placement. Last modified 24 November 2014. http://www.csc-scc.gc.ca/poli-
tiques-et-lois/705-7-cd-eng.shtml.
Canada. Correctional Service of Canada. Evaluation Report: Strategic Plan for Aboriginal
Corrections. Correctional Service of Canada, Evaluation Branch, Policy Sector, 2011. http://
www.csc-scc.gc.ca/text/pa/ev-ahl-394-2-49/healing-lodges-eng.shtml.
Canada. Department of Justice. Multi-Site Survey of Victims of Crime and Criminal Justice
Professionals across Canada. Ottawa: Department of Justice, 2004. http://www.justice.gc.ca/
eng/rp-pr/cj-jp/victim/rr05_vic1/rr05_vic1.pdf.
Canada. Evaluation Directorate of Health Canada and Public Health Agency Canada. Evalu-
ation of the First Nations and Inuit Health Human Resources Program 2008-09 to 2012–13.
Ottawa: Health Canada and Public Health Agency Canada, September 2013. http://www.
hc-sc.gc.ca/ahc-asc/alt_formats/pdf/performance/eval/2013-fni-hr-rh-pni-eng.pdf.
Canada. Health Canada. “Aboriginal Head Start on Reserve.” Last modified 15 June 2011.
http://www.hc-sc.gc.ca/fniah-spnia/famil/develop/ahsor-papa_intro-eng.php.
Canada. Health Canada. “Aboriginal Health Human Resources Initiative.” Last modified 19
March 2013. http://www.hc-sc.gc.ca/ahc-asc/activit/strateg/fnih-spni-eng.php.
Canada. Health Canada. Canada’s Food Guides from 1942 to 1992. Last modified 5 February
2007. http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/context/fg_history-histoire_ga-
eng.php.
Canada. Health Canada. “First Nations and Inuit Health.” Last modified 19 March 2012.
http://www.hc-sc.gc.ca/ahc-asc/activit/strateg/fnih-spni-eng.php#ahhri-irrhs.
Canada. Health Canada. “First Nations, Inuit and Aboriginal Health: Indian Residential
Schools Resolution Health Support Program.” First Nations and Inuit Health. Last modified
27 May 2015. http://www.hc-sc.gc.ca/fniah-spnia/services/indiresident/irs-pi-eng.php.
Canada. Health Canada. Pan-Canadian Health Human Resource Strategy, 2007/08 Report.
Ottawa: Health Canada, 2008. http://www.hc-sc.gc.ca/hcs-sss/alt_formats/pdf/pubs/
hhrhs/2008-ar-ra-eng.pdf.
Canada. Health Canada. “Summary of Epidemiology of Tuberculosis in First Nations Living
On Reserve 2000–2008.” First Nations and Inuit Health. Last modified 15 May 2012. http://
www.hc-sc.gc.ca/fniah-spnia/pubs/diseases-maladies/_tuberculos/tuberculos-epidemio/
index-eng.php.
Canada. House of Commons Standing Committee on Aboriginal Affairs and Northern Devel-
opment. Study on the Effectiveness of the Government Alternative Dispute Resolution Process
for the Resolution of Indian Residential School Claims. 38th Parliament, 1st session, Fourth
Report, 12 April 2005.
Canada. House of Commons Standing Committee on Justice and Legal Affairs. Minutes of
Proceedings and Evidence, No. 62, 17 November 1994.
Canada. House of Commons Standing Committee on the Status of Women. Ending Violence
Against Aboriginal Women and Girls: Empowerment – A New Beginning. December 2011,
41st Parliament, 1st Session.
Canada. House of Commons Standing Committee on the Status of Women. Interim Report –
Call into the Night: An Overview of Violence against Aboriginal Women. March 2011, 40th
Parliament, 3rd Session.
Canada. House of Commons Standing Committee on Violence Against Indigenous Women.
Invisible Women: A Call to Action. A Report on Missing and Murdered Women in Canada.
Ottawa: Queen’s Printer, 2014.
Canada. Indian Affairs and Northern Development. Gathering Strength: Canada’s Aboriginal
Action Plan. Ottawa: Minister of Public Works and Government Services, 1997.
Canada. Indian and Northern Affairs Canada. Evaluation of Community-Based Healing Initia-
tives Supported through the Aboriginal Healing Foundation. Ottawa: Indian and Northern
Affairs Canada, 2009.
Canada. Indian and Northern Affairs Canada. First Nation and Inuit Community Well-Being:
Describing Historical Trends (1981–2006). PowerPoint Presentation. Ottawa: Aboriginal
Affairs and Northern Development Canada, 2010. http://www.aadnc-aandc.gc.ca/eng/1100
100016600/1100100016641.
Canada. Indian and Northern Affairs Canada. Implementation Evaluation of the Enhanced
Prevention Focused Approach in Alberta for the First Nations Child and Family Services
Program. Ottawa: Evaluation, Performance Measurement, and Review Branch Audit and
Evaluation Sector, 2010.
Canada. Indian and Northern Affairs Canada, Departmental Audit and Evaluation Branch.
Evaluation of the First Nations Child and Family Services Program. Ottawa: Her Majesty the
Queen in Right of Canada, 2007.
Canada. Indian Residential Schools Adjudication Secretariat. “Adjudication Secretariat

Statistics, From September 19, 2007 to June 30, 2015.” http://www.iap-pei.ca/information/
stats-eng.php?act=.
Canada. Minister of Indian and Northern Affairs. Government Response to the Seventh Report
of the Standing Committee on Aboriginal Affairs and Northern Development; Aboriginal
Housing. Parliament of Canada, 17 October, 2007. http://www.parl.gc.ca/HousePublica-
tions/Publication.aspx?DocId=3077327&Language=E&Mode=1&Parl=39&Ses=1.
Canada. Minister of Justice. “Letter and copy of warrant in reply to a request by Duncan
Campbell Scott, Acting Superintendent General of Indian Affairs,” 1895. Library and Ar-
chives Canada, no. 151-711-10.
Canada. Office of the Auditor General of Canada. 2011 June Status Report of the Auditor Gen-
eral of Canada. Ottawa: Office of the Auditor General, 2011.
Canada. Office of the Correctional Investigator. Spirit Matters: Aboriginal People and the Cor-
rections and Conditional Release Act, Final Report. 22 October 2012. http://www.oci-bec.
gc.ca/cnt/rpt/oth-aut/oth-aut20121022-eng.aspx.
Canada. Parliament of Canada. Special Committee on Reconstruction and Re-establishment.
Minutes of Proceedings and Evidence, No. 9, 24 May 1944.
Canada. Parliament Special Joint Committee of the Senate and House of Commons. Minutes
of Proceedings and Evidence. Ottawa: King’s Printer, 1946.
Canada. Parliament Special Joint Committee of the Senate and House of Commons. Minutes
of Proceedings and Evidence. Ottawa: King’s Printer, 1947.
Canada. Public Health Agency of Canada. Canadian Incidence Study of Reported Child Abuse
and Neglect: Final Report. Ottawa: Her Majesty the Queen in Right of Canada, 2001.
Canada. Public Health Agency of Canada. Canadian Incidence Study of Reported Child Abuse
and Neglect—2008: Major Findings. Ottawa: Her Majesty the Queen in Right of Canada,
2010. http://cwrp.ca/sites/default/files/publications/en/CIS-2008-rprt-eng.pdf.
Canada. Public Health Agency of Canada. “Chapter 8: HIV/AIDS among Aboriginal People in
Canada.” HIV/AIDS Epi Updates. Last modified 15 May 2015. http://www.phac-aspc.gc.ca/
aids-sida/publication/epi/2010/8-eng.php#a20.
Canada. Public Health Agency of Canada. Evaluation of the Aboriginal Head Start in Urban
and Northern Communities Program at the Public Health Agency of Canada. 20 March 2012.
http://www.phac-aspc.gc.ca/about_apropos/evaluation/reports-rapports/2011-2012/ah-
sunc-papacun/index-eng.php#toc.
Canada. Public Health Agency of Canada. “Fetal Alcohol Spectrum Disorder (FASD).” Last
modified 29 April 2014. http://www.phac-aspc.gc.ca/hp-ps/dca-dea/prog-ini/fasd-etcaf/
index-eng.php.
Canada. Public Safety Canada. Fetal Alcohol Spectrum Disorder and the Criminal Justice Sys-
tem. Ottawa: Aboriginal Corrections Policy Unit, 2010. http://www.publicsafety.gc.ca/cnt/
rsrcs/pblctns/ftl-lchl-spctrm/ftl-lchl-spctrm-eng.pdf.
Canada. Royal Commission on Aboriginal Peoples. Bridging the Cultural Divide: Report on
Aboriginal People and Criminal Justice in Canada. Ottawa: Supply and Services, 1996.
Canada. Royal Commission on Aboriginal Peoples. Report of the Royal Commission on Ab-
original Peoples. 5 vols. Ottawa: Indian and Northern Affairs, 1996. https://qspace.library.
queensu.ca/handle/1974/6874.
Canada. Special Joint Committee of the Senate and House of Commons. Minutes of Proceed-
ings and Evidence, No. 1. Ottawa: Edmond Cloutier, 1947. Harriet Irving Archives, University
of New Brunswick.
Canada. Standing Committee on Aboriginal Affairs. “You Took My Talk”: Aboriginal Literacy
and Empowerment. Ottawa: Standing Committee on Aboriginal Affairs, 1990.
Canada. Standing Committee on Aboriginal Affairs and Northern Development. Seventh Re-
port of the Standing Committee on Aboriginal Affairs and Northern Development: Aboriginal
Housing. Parliament of Canada, 2007. http://www.parl.gc.ca/HousePublications/Publica-
tion.aspx?DocId=3077327&Language=E&Mode=1&Parl=39&Ses=1.
Canada. Standing Senate Committee on Aboriginal Affairs and Northern Development. Study
and Recommendations of the Standing Senate Committee on Aboriginal Affairs and North-
ern Development Concerning the Aboriginal Healing Foundation. Ottawa: Senate Commit-
tee Report, 2010.
Canada. Standing Senate Committee on Aboriginal Peoples. Reforming First Nations Educa-
tion: From Crisis to Hope. Ottawa: Senate Committees Directorate, 2011.
Canada. Standing Senate Committee on Aboriginal Peoples. Sixth Report: Bill S-8, An Act
respecting the safety of drinking water on First Nation lands, without amendment, but with
observations. Parliament of Canada, 7 June 2012. http://www.parl.gc.ca/Content/SEN/
Committee/411/appa/rep/rep06jun12-e.htm.
Canada. Standing Senate Committee on Legal and Constitutional Affairs. Language Rights
in Canada’s North: Nunavut’s New Official Languages Act: Final Report. Ottawa: Senate
Committees Directorate, 2009.
Canada. Standing Committee on Public Accounts. Report of the Standing Committee on
Public Accounts. Chapter 4: First Nations Child and Family Services Program—Indian and
Northern Affairs Canada of the May 2008 Report of the Auditor General. Parliament of
Canada, 2009. http://www.parl.gc.ca/HousePublications/Publication.aspx?Mode=1&Parl=-
40&Ses=2&DocId=3731041&File=18.
Canada. Standing Senate Committee on Social Affairs, Science and Technology. Opening the
Door: Reducing Barriers to Post-Secondary Education in Canada. Ottawa: Senate of Canada,
2011. http://www.parl.gc.ca/content/sen/committee/411/soci/rep/rep06dec11-e.pdf.
Canada. Statistics Canada. Aboriginal Languages and Selected Vitality Indicators in 2011.
Ottawa: Ministry of Industry, 2014.
Canada. Statistics Canada. Aboriginal Languages in Canada, Language, 2011 Census of Popu-
lation. Catalogue no. 98-314-X2011003, 2011. http://www12.statcan.gc.ca/census-recense-
ment/2011/as-sa/98-314-x/98-314-x2011003_3-eng.pdf.
Canada. Statistics Canada. Aboriginal Peoples in Canada, First Nations People, Métis and
Inuit. National Household Survey, 2011. Catalogue no. 99-011-X2011001. Ottawa: Minister
of Industry, 2013. http://www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-011-x/99-011-x-
2011001-eng.pdf.
Canada. Statistics Canada. Aboriginal Peoples in Canada in 2006: Inuit, Métis and First Na-
tions, 2006 Census. Ottawa: Minister of Industry, 2009.
Canada. Statistics Canada. Aboriginal Peoples and Language. National Household Survey
(NHS), 2011. Catalogue no. 99-011-X2011003. Ottawa: Minister of Industry, 2013. http://
www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-011-x/99-011-x2011003_1-eng.pdf.
Canada. Statistics Canada. “The Education and Employment Experiences of First Nations
People Living off Reserve, Inuit, and Métis: Selected Findings from the 2012 Aboriginal
Peoples Survey.” The Daily, 25 November 2013. http://www.statcan.gc.ca/daily-quoti-

dien/131125/dq131125b-eng.pdf.
Canada. Statistics Canada. The Educational Attainment of Aboriginal People in Canada,
National Household Survey, 2011. Catalogue no. 99-012-X2011003. Ottawa: Ministry of
Industry, 2013. https://www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-012-x/99-012-x-
2011003_3-eng.cfm.
Canada. Statistics Canada. Educational Portrait of Canada, Census Year 2006. Catalogue no.
97-560-XIE2006001. Ottawa: Ministry of Industry, 2008. http://www12.statcan.ca/cen-
sus-recensement/2006/as-sa/97-560/pdf/97-560-XIE2006001.pdf.
Canada. Statistics Canada. “Homicide in Canada, 2013.” The Daily, 1 December 2014. http://
www.statcan.gc.ca/daily-quotidien/141201/dq141201a-eng.pdf.
Canada. Statistics Canada. “Life Expectancy.” Last modified 21 June 2010. http://www.stat-
can.gc.ca/pub/89-645-x/2010001/life-expectancy-esperance-vie-eng.htm.
Canada. Statistics Canada. “Low Income Lines, 2008–2009.” Income Research Paper Series.
Catalogue no. 75F0002M—No. 005. 2010. Minister of Industry, 2010. http://www.statcan.
gc.ca/pub/75f0002m/75f0002m2010005-eng.pdf.
Canada. Statistics Canada. Portrait of Canada’s Labour Force: National Household Survey,
2011. Ottawa: Statistics Canada, 2013.
Canada. Statistics Canada. “Study: Aboriginal People and the Labour Market.” The Daily, 23
November 2011. http://www.statcan.gc.ca/daily-quotidien/111123/dq111123b-eng.htm.
Canada. Statistics Canada. “Study: Life Expectancy in the Inuit-Inhabited Areas of Canada.”
The Daily, 23 January 2008. http://www.statcan.gc.ca/daily-quotidien/080123/dq080123d-
eng.htm.
Canada. Statistics Canada. “Study: Select Health Indicators of First Nations People Living off
Reserve, Métis and Inuit, 2007 to 2010.” The Daily, 29 January 2013. http://www.statcan.
gc.ca/daily-quotidien/130129/dq130129b-eng.htm.
Canada. Statistics Canada. Table 99-014-039. 2011 National Household Survey: Data Tables.
Statistics Canada, 2011. http://www12.statcan.gc.ca/nhs-enm/2011/dp-pd/dt-td/Dir-eng.
cfm#topic-94.
Canada. Statistics Canada. “Victimization and Offending among the Aboriginal Population
in Canada.” Juristat 26, no. 3 (2006). http://www.statcan.gc.ca/pub/85-002-x/85-002-x-
2006003-eng.pdf.
Canada. Statistics Canada. “Youth Court Statistics 2011/2012.” The Daily, 13 June 2013. http://
www.statcan.gc.ca/daily-quotidien/130613/dq130613d-eng.pdf.
Canada. Statistics Canada. “Youth Custody and Community Services in Canada, 1998-99.”
Juristat 20, no. 8 (2000). http://www.statcan.gc.ca/pub/85-002-x/85-002-x2000008-eng.pdf.
Canada. Task Force of Federally Sentenced Women. Creating Choices: Report of the Task Force
of Federally Sentenced Women. Ottawa: Correctional Service of Canada, 1990. http://www.
csc-scc.gc.ca/women/toce-eng.shtml.
Canada. Task Force on Aboriginal Languages and Culture. Towards a New Beginning: A
Foundational Report for a Strategy to Revitalize First Nation, Inuit and Métis Languages and
Cultures. Ottawa: Department of Canadian Heritage, 2005.
Canada. Truth and Reconciliation Commission. Internal Report of the Inuit Sub Commission
of the Truth and Reconciliation Commission, Baffin Tour. N.d.
Canada. Truth and Reconciliation Commission of Canada. Truth and Reconciliation Com-
mission of Canada: Interim Report. Winnipeg: Truth and Reconciliation Commission of
Canada, 2012.
Canadian Human Rights Commission. Report on Equality Rights of Aboriginal People. Ottawa:
Government of Canada, 2013.
Davin, Nicholas Flood. Report on Industrial Schools for Indians and Half-Breeds. Ottawa: n.p.,
1879.
First Nations and Inuit Regional Health Survey National Steering Committee. First Nations
and Inuit Regional Health Survey. Ottawa: First Nations and Inuit Regional Health Survey,
1999.
Garner, Rochelle, Gisèle Carrière, Claudia Sanmartin, and the Longitudinal Health and
Administrative Data Research Team. The Health of First Nations Living Off-Reserve, Inuit,
and Métis Adults in Canada: The Impact of Socio-economic Status on Inequality in Health.
Ottawa: Statistics Canada, 2010. http://www.statcan.gc.ca/pub/82-622-x/82-622-x2010004-
eng.pdf.
Glover, Shelly. 2013–2014 Departmental Performance Report. Ottawa: Canadian Heritage,
2014. http://www.pch.gc.ca/DAMAssetPub/DAM-verEval-audEval/STAGING/texte-text/
dpr-rmr-2013-14_1415218344790_eng.pdf.
Government of Canada. Government of Canada Response to the Report of the Standing Com-
mittee on Public Accounts, on Chapter 4, First Nations Child And Family Services Program
– Indian And Northern Affairs Canada of the May 2008 Report of the Auditor General. Par-
liament of Canada, 19 August 2009. http://www.parl.gc.ca/HousePublications/Publication.
aspx?DocId=4017684&Language=E&Mode=1&Parl=40&Ses=2.
Hann, Robert, and William Harman. Predicting Release Risk for Aboriginal Penitentiary In-
mates. Ottawa: Secretariat of the Ministry of the Solicitor General of Canada, 1993.
Hanson, R. K., and M. T. Bussière. Predictors of Sexual Offender Recidivism: A Meta-Analysis.
Ottawa: Public Works and Government Services Canada, 1996.
Hume, Sharon, Deborah Rutman, and Carol Hubberstey. Language Nest Evaluation Report.
Yellowknife: Department of Education, Culture, and Education, May 2006.
King, David. A Brief Report of the Federal Government of Canada’s Residential School System
for Inuit. Ottawa: Aboriginal Healing Foundation, 2006. http://www.ahf.ca/downloads/
kingsummaryfweb.pdf.
Law Commission of Canada. Restoring Dignity: Responding to Child Abuse in Canadian Insti-
tutions. Ottawa: Supply and Services, 2000.
LeBeuf, Marcel-Eugene. The Role of the Canadian Mounted Police during the Indian Residen-
tial School System. Ottawa: RCMP, 2011.
MacPherson, Patricia, Albert Chudley, and Brian Grant. Fetal Alcohol Spectrum Disorder
(FASD) in a Correctional Population: Prevalence, Screening and Characteristics. Ottawa:
Correctional Service of Canada, 2011. http://www.publicsafety.gc.ca/lbrr/archives/
cn21451-eng.pdf.
Manitoba. Aboriginal Justice Implementation Commission. Report of the Aboriginal Justice
Inquiry of Manitoba. 3 vols. Winnipeg: Aboriginal Justice Implementation Commission,
1999. http://www.ajic.mb.ca/volume.html.
Manitoba. Auditor General of Manitoba. Follow-up of Our December 2006 Report: Audit of the
Child and Family Services Division Pre-Devolution Child in Care Processes and Practices.
Winnipeg: Office of the Auditor General of Manitoba, 2012.
Manitoba. Provincial Court of Manitoba. Report under the Fatality Inquiries Act into the Death
of Brian Lloyd Sinclair. Provincial Court of Manitoba, 12 December 2014. http://www.mani-
tobacourts.mb.ca/site/assets/files/1051/brian_sinclair_inquest_-_dec_14.pdf.
Mazowita, Benjamin, and Marta Burczycka. “Shelters for Abused Women in Canada, 2012.”
Juristat, catalogue no. 85-002-XWF, Statistics Canada, 2014. http://www.statcan.gc.ca/
pub/85-002-x/2014001/article/11906-eng.htm.
Moore, John-Patrick. First Nations, Métis, Inuit and Non-Aboriginal Offenders: A Comparative
Profile. Ottawa: Correctional Service of Canada, Research Branch. 2003.
Mulligan, Leah. “Victim Services in Canada: National, Provincial and Territorial Fact
Sheets, 2011/2012.” Statistics Canada. Last modified 24 March 2014. http://www.statcan.
gc.ca/pub/85-003-x/2014001/part-partie1-eng.htm.
Munch, Christopher. “Youth Correctional Statistics in Canada, 2010/2011.” Juristat, catalogue
no. 85-002-X, Canadian Centre for Justice Statistics, Statistics Canada, 2012. http://www.
statcan.gc.ca/pub/85-002-x/2012001/article/11716-eng.pdf.
Munch, Christopher. “Victim Services in Canada, 2009/2010.” Juristat, catalogue no. 85-
002-X, Statistics Canada, 2012. http://www.statcan.gc.ca/pub/85-002-x/2012001/arti-
cle/11626-eng.htm.
Neegan Burnside Ltd. National Assessment of First Nations Water and Wastewater Systems:
National Roll-Up Report (Final). Ottawa: Department of Indian Affairs and Northern Devel-
opment, April 2011.
Norris, Mary Jane. “Aboriginal Languages in Canada: Emerging Trends and Perspectives on
Second Language Acquisition.” Statistics Canada, catalogue no. 11-008. Canadian Social
Trends (May 2007): 19–27.
O’Donnell, Vivian, and Susan Wallace. “First Nations, Métis and Inuit Women.” In Women in
Canada: A Gender-Based Statistical Report. Ottawa: Statistics Canada, 2011.
Oliver, Lisa N., Paul A. Peters, and Dafna E. Kohen. “Mortality Rates among Children and
Teenagers Living in Inuit Nunangat, 1994 to 2008.” Statistics Canada, catalogue no. 82-003-
XPE. Health Reports 23, no. 3 (2012). http://www.statcan.gc.ca/pub/82-003-x/2012003/
article/11695-eng.pdf.
Ontario. Ontario’s New Approach to Aboriginal Affairs: Prosperous and Healthy Aboriginal
Communities Create a Better Future for Aboriginal Children and Youth. Toronto: Queen’s
Printer for Ontario, 2005. http://docs.files.ontario.ca/documents/222/6-maa-new-ap-
proach-to-aboriginal-affairs.pdf.
Ontario. A Solid Foundation: Second Progress Report on the Implementation of the Ontario
First Nation, Metis and Inuit Education Policy Framework. Toronto: Queen’s Printer for
Ontario, 2013. http://edu.gov.on.ca/eng/aboriginal/ASolidFoundation.pdf.
Ontario. Aboriginal Education Office and Ministry of Education. Ontario First Nation, Métis,
and Inuit Education Policy Framework. Toronto: Queen’s Printer for Ontario, 2007. https://
www.edu.gov.on.ca/eng/aboriginal/fnmiFramework.pdf.
Ontario. Office of the Chief Coroner of Ontario. Paediatric Death Review Committee and
Deaths Under Five Committee Annual Report 2013. Toronto: Office of the Chief Coroner of
Ontario, 2013. http://www.mcscs.jus.gov.on.ca/stellent/groups/public/@mcscs/@www/@
com/documents/webasset/ec163306.pdf.
Ontario. Office of the Chief Coroner of Ontario. “Schedule of Inquests: Jethro Anderson,
Reggie Bushie, Robyn Harper, Kyle Morrisseau, Paul Panacheese, Curran Strang, Jordan
Wabasse.” Ministry of Community Safety and Correctional Services, 9 August 2013. http://
www.mcscs.jus.gov.on.ca/english/DeathInvestigations/office_coroner/ScheduleofIn-
quests/OCC_schedule.htm.
Oppal, Wally T., Commissioner. Forsaken: The Report of the Missing Women Commission of
Inquiry. 4 vols. Victoria: British Columbia, Missing Women Commission of Inquiry, 2012.
http://www.missingwomeninquiry.ca/obtain-report/.
Oreopoulos, Philip. Canadian Compulsory School Laws and Their Impact on Educational At-
tainment and Future Earnings. Catalogue no. 11F0019, no. 251. Ottawa: Family and Labour
Studies Division, Statistics Canada, 2005. http://publications.gc.ca/Collection/Statcan/11F-
0019MIE/11F0019MIE2005251.pdf.
Perreault, Samuel. “Aboriginal Adults Are Overrepresented in Admissions to Correctional
Services.” Admissions to Adult Correctional Services in Canada 2011/2012. Statistics Canada.
Last modified 27 March 2014. http://www.statcan.gc.ca/pub/85-002-x/2014001/arti-
cle/11918-eng.htm#a5.
Perreault, Samuel. “Aboriginal Youth Are Over-Represented in the Correctional System.” Ad-
missions to Adult Correctional Services in Canada 2011/2012. Statistics Canada. Last mod-
ified 27 March 2014. http://www.statcan.gc.ca/pub/85-002-x/2014001/article/11917-eng.
htm#a5.
Perreault, Samuel. “Admissions to Adult Correctional Services in Canada 2011–2012” Juristat,
catalogue no. 85-002-x, Statistics Canada. Last modified 27 March 2014. http://www.statcan.
gc.ca/pub/85-002-x/2014001/article/11918-eng.htm#a5.
Perreault, Samuel. “Admissions to Youth Correctional Services in Canada, 2011/12.” Juristat,
catalogue no. 85-002-x, Statistics Canada. Last modified 27 March 2014. http://www.statcan.
gc.ca/pub/85-002-x/2014001/article/11917-eng.htm#a5.
Perreault, Samuel. “Violent Victimization of Aboriginal People in the Canadian Provinces,
2009.” Juristat, catalogue no. 85-002-x, Statistics Canada, 2011. http://www.statcan.gc.ca/
pub/85-002-x/2011001/article/11415-eng.pdf.
Peterson, Katherine. Sir Joseph Bernier Federal Day School, Turquetil Hall: Investigation Re-
port. Yellowknife: Government of the Northwest Territories. 1994.
Québec. Commission des droits de la personne et des droits de la jeunesse. Investigation
into Child and Youth Protection Services in Ungava Bay and Hudson Bay. Nunavik: Report,
Conclusions of the Investigation and Recommendations. Montréal: Commission des droits
de la personne et des droits de la jeunesse, 2007. http://www.cdpdj.qc.ca/Publications/rap-
port_Nunavik_anglais.pdf.
Québec. Commission des droits de la personne et des droits de la jeunesse Québec. Nuna-
vik: Follow-up Report on the Recommendations of the Investigation into Youth Protection
Services in Ungava Bay and Hudson Bay. Montréal: Commission des droits de la personne
et des droits de la jeunesse, June 2010.
Québec. Rapport Parent. Rapport de la Commission royale d’enquête sur l’enseignement dans
la province de Québec. Vol. 3, L’administration de l’enseignement, part A, Diversité religieuse,
culturelle, et unité de l’administration. Chicoutimi, QC: Publications Québec, 2004. http://
classiques.uqac.ca/contemporains/quebec_commission_parent/rapport_parent_4/rap-
port_parent_vol_4.pdf.
Rajekar, Ashutosh, and Ramnarayanan Mathilakath. The Funding Requirement for First Na-
tions Schools in Canada. Ottawa: Office of the Parliamentary Budget Officer, 2009.
Roberts, Barry A. Eskimo Identification and Disc Numbers: A Brief History. Ottawa: Social
Development Division, Department of Indian and Northern Affairs, 1975.
Royal Canadian Mounted Police. Missing and Murdered Aboriginal Women: A National
Operational Overview. Ottawa: RCMP, 2014. http://www.rcmp-grc.gc.ca/pubs/mmaw-faap-
d-eng.pdf.
Sapers, Howard. “Speaking Notes for Mr. Howard Sapers, Correctional Investigator of Canada:
Appearance before the Senate Standing Committee on Legal and Constitutional Affairs,”
14 February 2008. Office of the Correctional Investigator. http://www.oci-bec.gc.ca/cnt/
comm/sp-all/sp-all20080214-eng.aspx.
Saskatchewan Child Welfare Review Panel. For the Good of Our Children and Youth: A New
Vision, a New Direction. Regina: Saskatchewan Child Welfare Review Panel, 2010. http://
saskchildwelfarereview.ca/CWR-panel-report.pdf.
Saskatchewan. Commission on First Nations and Métis Peoples and Justice Reform. Legacy
of Hope: An Agenda for Change. Final Report from the Commission on First Nations and
Métis Peoples and Justice Reform. Vol. 1. 2008. http://www.justice.gov.sk.ca/justicereform/
volume1.shtml.
Shea, Goldie. Institutional Child Abuse in Canada: Criminal Cases. Ottawa: Law Commission
of Canada, 1999.
Sinha, Maire, ed. “Measuring Violence against Women: Statistical Trends.” Juristat, catalogue
no. 85-002-X, Statistics Canada, 2013. http://www.statcan.gc.ca/pub/85-002-x/2013001/
article/11766-eng.pdf.
Sioui, Raymond, and Jacques Thibault. The Relevance of a Cultural Adaptation of the Rein-
tegration Potential Reassessment Scale (RPRS). Ottawa: Correctional Service of Canada,
Research Branch, 2001.
Tjepkema, Michael, and Russell Wilkins. “Remaining Life Expectancy at Age 25 and Probabil-
ity of Survival to Age 75.” Statistics Canada, catalogue no. 82-003-XPE. Health Reports 22, no.
4 (2011).
Trocmé, Nico, Barbara Fallon, Bruce MacLaurin, Joanne Daciuk, Caroline Felstiner, Tara
Black, Lil Tonmyr, Cindy Blackstock, Ken Barter, Daniel Turcotte, and Richard Cloutier. Ca-
nadian Incidence Study of Reported Child Abuse and Neglect—2003: Major Findings. Ottawa:
Minister of Public Works and Government Services Canada, 2005.
Tulloch, Shelley. Preserving Inuit Dialects in Nunavut: Research Report. Iqaluit: Office of the
Languages Commissioner of Nunavut, 2005.
Western Canadian Protocol for Collaboration in Basic Education. Common Curriculum
Framework for Aboriginal Language and Culture Programs: Kindergarten to Grade 12.
Crown in Right of the Governments of Alberta, British Columbia, Manitoba, Yukon Ter-
ritory, Northwest Territories, and Saskatchewan, 2000. http://education.alberta.ca/me-
dia/929730/abor.pdf.
Willows, Noreen, Paul Veugelers, Kim Raine, and Stefan Kuhle. “Associations between
Household Food Insecurity and Health Outcomes in the Aboriginal Population (Excluding
Reserves).” Statistics Canada, catalogue no. 82-003-X. Health Reports 22, no. 2 (2011). http://
www.statcan.gc.ca/pub/82-003-x/2011002/article/11435-eng.htm.
5. Legal Sources
Case Law
Arishenkoff v. British Columbia, 2004 BCCA 299 (CanLII).
Baxter v. Canada (Attorney General), 2006 CanLII 41673 (ONSC).
B(D) v. Canada (Attorney General), 2000 SKQB 574(CanLII).
Beattie v. Canada (Minister of Indian Affairs and Northern Development), 1997 CanLII 6343
(FC).
Bird v. Canada (Attorney General), 1999 CanLII 12476 (SKQB).
Blackwater v. Plint, 2001 BCSC 997 (Can LII).
Brown v. Attorney General of Canada, 2014 ONSC 6967 (CanLII).
Brown v. Canada, 2013 ONSC 5637.
Calder v. Attorney General (BC), [1973] SCJ No 56 (SCC).
Canada (Attorney General) v. Canadian Human Rights Commission, 2013 FCA 75
Canada (Attorney General) v. Desjarlais, 2005 ABQB 416 (CanLII).
Canada (Attorney General) v. Maracle, 2012 FC 105 (CanLII).
Canada (Human Rights Commission) v. Canada (Attorney General), 2012 FC 445 (CanLII).
Canada (Indian Affairs) v. Daniels, 2014 FCA 101 (CanLII).
Cloud v. Canada (Attorney General), [2001] OJ No 4163.
Cloud v. Canada (Attorney General), 2004 CanLII 45444 (ONCA).
C. M. v. Canada (Attorney General), 2004 SKQB 175(CanLII).
Daniels v. Canada, 2013 FC 6 (CanLII).
F. H. v. McDougall, [2008] 3 SCR 41.
First Nations Child and Family Caring Society v. Canada, 2011 CHRT 4.
Fisher v. Canada (Attorney General), 1999 CanLII 12781 (SKQB).
Fontaine v. Canada (Attorney General), 2013 SKCA 22.
Ford v. Quebec (Attorney General) [1988] 2 SCR 712.
F. S. M. v. Clarke, 1999 CanLII 9405 (BCSC).
Harry Daniels, et al. v. Her Majesty the Queen as represented by The Minister of Indian Affairs
Kelly v. Canada (Attorney General), 2013 ONSC 1220.
M. A. v. Canada (Attorney General), [1999] SJ No 538 (SKQB).
M. C. C. v. Canada, [2001] OJ No 4163.
Mitchell v. M. N. R., 2001 SCC 33.
M. M. v. Roman Catholic Church of Canada et al., 2001 MBCA 148 (CanLII).
Ochapowace Indian Band No. 71 v. Canada (Department of Indian Affairs and Northern
Development), 1998 CanLII 13768 (SK QB).
Pictou Landing Band Council v. Canada (Attorney General), 2013 FC 342 (CanLII).
P.(W.) v. Canada (Attorney General), 1999 SKQB 17 (CanLII).
Q.(A.) v. Canada (Attorney General), 1998 CanLII 13810 (SKQB).
Quatell v. Attorney General of Canada, 2006 BCSC 1840.
Québec c. Commission Scolaire Crie, 2001 CanLII 20652 (QC CA).
R. v. Alkenbrack, 2011 BCPC 424.
R. v. Armitage, 2015 ONCJ 64 (CanLII).

R. v. Badger, 2013 SKQB 347.
R. v. Battaja, 2010 YKTC 145.
R. v. Boisseneau, 2006 ONSC 562.
R. v. Cappo, 2005 SKCA 134.
R. v. C. G., 2011 NWTSC 47.
R. v. C. G. O., 2011 BCPC 145.
R. v. Charlie, 2012 YKTC 5.
R. v. C. L. K., 2009 MBQB 227 (CanLII).
R. v. Corbiere, 2012 ONSC 2405.
R. v. Craft, 2010 YKTC 127.
R. v. E. K., 2012 BCPC 132.
R. v. Elias, 2009 YKTC 59.
R. v. Frappier [1990] YJ No 163
R. v. G(D. M.), 2006 NSPC 58 (CanLII).
R. v. George, 2010 ONSC 6017.
R. v. Gingell, [1996] YJ No 52.
R. v. Gladue, [1999] 1 SCR 688.
R. v. Harris, 2002 BCCA 152.
R. v. Ipeelee, 2012 SCC 13.
R. v. J.E.R., 2012 BCPC 103.
R. v. Jimmie, 2009 BCCA 215.
R. v. J. O., 2007 QCCQ 716.
R. v. Joe, 2005 YKTC 21.
R. v. J. T., 2011 ONSC 7275 (CanLII).
R. v. Keepness, 2011 SKQB 293.
R. v. Klymok, 2002 ABPC 95.
R. v. Knowlton, 2005 ABPC 29 (CanLII).
R. v. Land, 2013 ONSC 6526.
R. v. Leaney, 2002 BCCA 67.
R. v. Loring, 2009 BCCA 166.
R. v. Makela, 2006 BCPC 320.
R. v. McLeod, 2006 YKTC 118.
R. v. Mitchell, [2001] 1 SCR 911.
R. v. M. L. W., 2004 SKPC 90.
R. v. NB, 2012 SKPC 99 (CanLII).
R. v. O’Connor [1992] BCJ No 2569.
R. v. O’Connor [1995] 4 SCR 411.
R. v. O’Connor, 1996 CanLII 8458 (BCSC).
R. v. O’Connor, 1996 CanLII 8393 (BCCA).
R. v. Ominayak, 2007 ABQB 442.
R. v. O. S., 2005 BCPC 727.
R. v. Paulette, 2010 NWTSC 31 (CanLII).
R. v. Pauchay, 2009 SKPC 35.
R. v. Paulin, 2011 ONSC 5027.

R. v. Quash, 2009 YKTC 54.
R. v. Renschler, 2005 MBPC 53233.
R. v. R. L., 2012 MBPC 22.
R. v. Rossi, [2011] O.J. No. 4736.
R. v. Sharkey, 2011 BCSC 1541.
R. v. Simon, 2006 ABPC 21.
R. v. Smickle, 2012 ONSC 602.
R. v. Snake, [2010] OJ No 5445.
R. v. Sparrow, (1990) 1. SCR 1075.
R. v. Tymiak, 2012 BCCA 40.
R. v. Van der Peet, [1996] 2 SCR 507.
R. v. Whitehead, 2008 SKPC 90 (CanLII).
R. v. W.R.B., 2010 MBQB 102.
R. v. W.R.G., 2011 BCPC 330.
Reference whether “Indians” includes “Eskimo” Inhabitants of the Province of Quebec, [1939]
SCR 104.
Re Residential Schools, [2000] AJ No 47 (ABQB).
R. J. G. v. Canada (Attorney General), 2004 SKCA 102 (CanLII).
St. Catharine’s Milling and Lumber Co. v. R., 13 SCR 577, 1887 CanLII 3 (SCC).
T. W. N. A. v. Clarke, 2001 BCSC 1177 (CanLII).
United States v. Winans, 198 U.S. 371, 25 S.Ct. 662 (1905).
W.(D.) v. Canada (Attorney General), 1999 SKQB 187 (CanLII).
Statutes
Aboriginal Languages Recognition Act, CCSM c A1.5.
An Act Concerning Indians, Statutes of Canada 1876, chapter 18, section 86.1, reproduced in
An Act Concerning Indians, Statutes of Canada 1927, chapter 98, section 110, reproduced in
Venne, Indian Acts, 285–287.
An Act Respecting Indians, Statutes of Canada 1951, chapter 29, section 113, reproduced in
Adoption Act, CCSM c A2.
Adoption Act, RSBC 1996, c 5.
Adoption Act, SNL 1999, c A-2.1.
Canada Health Act, RSC 1985, c C-6, s 3.
Charter of the French Language, RSQ, c C-11, s 97.
Child and Family Services Act, RSO 1990, c C-11.
Child and Family Services Act, SNWT (Nu) 1997, c 13.
Child and Family Services Act, SS 1989-90, c C-7.2.
Child and Family Services Act, SY 2008.
Child and Family Services Authorities Act, CCSM c C90.
Child Protection Act, RSPEI 1988, c C-5.1.
Child, Youth and Family Enhancement Act, RSA 2000, c C-12.
Children and Family Services Act, SNS 1990, c 5.
Children and Youth Care and Protection Act, SNL 2010, c C-12.2.
Class Actions Act, SS 2001, c C-12.01.
Class Actions Act, SNL 2001, c C-18.1.
Class Proceedings Act, CCSM c C-130.
Class Proceedings Act, RSBC 1996, c 50.
Class Proceedings Act, RSNB 2011, c 125.
Class Proceedings Act, SA 2003, c C-16.5.
Class Proceedings Act, SNS 2007, c 28.
Class Proceedings Act, SO 1992, c 6.
Consolidation of Inuit Language Protection Act, SNu 2008, c 17.
Controlled Drugs and Substances Act, SC 1996, c 19.
Corrections and Conditional Release Act, SC 1992 c 20.
Corrections and Conditional Release Act, SOR/92-620.
Criminal Code of Canada, RCS 1985 c C-46.
Criminal Code of Canada, RCS 1985 c C-46 as amended by SC 1997 c 30.
Education Act, SNu 2008, c 15.
Education Act for Cree, Inuit and Naskapi Native Persons, RSQ, c I-14 at Part X.
Family Services Act, SNB 1980, c F-2.2.
First Nations Jurisdiction over Education in British Columbia Act, SC 2006, c 10.
First Peoples’ Heritage, Language and Culture Act, RSBC 1996, c 147, s 6.
First Peoples’ Heritage, Language and Culture Regulation, BC Reg 65/2011, s 1.
Hamilton Health Sciences Corp. v. D. H., 2014 ONCJ 603 (CanLII).
Hamilton Health Sciences Corp. v. D. H., 2015 ONCJ 229.
Harry Daniels, et al. v. Her Majesty the Queen as represented by the Minister of Indian Affairs
Indian Act, RSC, 1985, c 1–5.
Indian Act (Amendment to), RSC 1927 c 98.
Limitations Act, RSA 2000 c L-2.
Limitations of Actions Act, RSS 1978 c L-15.
Limitation of Actions Amendment Act, S.M. 2002 c 5.
Mi’kmaq Education Act, SC 1998, c 24.
Mãori Language Act, No. 176 of 1987.
Official Languages Act, RSNWT 1988, c O-1.
Official Languages Act, RSNWT (Nu) 1988, c O-1.
Official Languages Act, SNu 2008, c 10.
Public Law No. 101-477, October 30, 1990.
Regulation respecting the language of instruction of children residing on Indian reserves, RRQ,
c C-11, r 8.
Safe Drinking Water for First Nations Act, SC 2013, c 21.
Statutes of Canada (57-58 Vic, cap. 32, 1895), ss. 137–139 under the 11th clause, pages
232–233.
Statutes of Canada (58-59 Vic, 1895), Orders-in-council, Canada, pages liv–lviii: o/c of 10 Nov.
1894, vide Canada Gazette, vol. xxviii, page 832.
Youth Protection Act, CQLR c P-34.1.
Yukon Health Act, SY 2002, c 106, s 5.
Other
“Affidavit of Phillip Fontaine,” in Court File No. 05-CV-294716CP (Fontaine v. Canada), 2006.
“Affidavit of Darcy Merkur, sworn July 28,” in Court File No. 00-CV-192059CP (Baxter v. Can-
ada (Attorney General)), 2006.
“Agreement in Principle,” between Canada, the Plaintiffs, the Assembly of First Nations, and
the Anglican, Presbyterian, United and Roman Catholic Entities, 10 November 2005. http://
www.residentialschoolsettlement.ca/AIP.pdf.
Canada. House of Commons. Bill C-10: An Act to Enact the Justice for Victims of Terrorism
Act and to Amend the State Immunity Act, the Criminal Code, the Controlled Drugs and
Substances Act, the Corrections and Conditional Release Act, the Youth Criminal Justice Act,
the Immigration and Refugee Protection Act and other Acts. 41st Parliament, 1st Session, 13
March 2012.
Canada. House of Commons. Bill C-32: An Act to Enact the Canadian Victims Bill of Rights
and to Amend Certain Acts. 41st Parliament, 2nd Session, 23 April 2015.
British Columbia and First Nations Health Society. British Columbia Tripartite Framework
Agreement on First Nation Health Governance, 13 October 2011. http://www.pnwbha.org/
wp-content/uploads/2011/10/Tripartite-Agreement.pdf.
“Fresh as Amended Statement of Claim,” in Court File No. 00-CV-192059 CP (Baxter v. Can-
Government of Canada and Merchant Law Group. “Indian Residential Schools Settlement
Agreement, Schedule V, Agreement between the Government of Canada and the Merchant
Law Group Respecting the Verification of Legal Fees,” 20 November 2005. http://www.resi-
dentialschoolsettlement.ca/ScheduleV.pdf.
Indian Residential Schools Settlement Agreement, between Canada, the Plaintiffs, the Assem-
bly of First Nations, and the Anglican, Presbyterian, United and Roman Catholic Entities, 8
May 2006. http://www.residentialschoolsettlement.ca/settlement.html.
Indian Residential Schools Settlement Agreement. Official Court Notice, 8 May 2006. http://
www.residentialschoolsettlement.ca/settlement.html.
Indian Residential Schools Settlement Agreement. Schedule O-3: “Catholic Entities Church
Agreement,” 8 May 2006. http://www.residentialschoolsettlement.ca/Schedule_O-3.pdf.
“Joint Factum of the Plaintiffs, Motion for Settlement Approval – Returnable August 29-31
2006,” in Court File No. 00-CV-192059CP (Baxter v. Canada (Attorney General)), 2006.
Skogamhallait v. Canada (VLC-S-S-11366), Notice of Civil Claim. Accessed 7 Novem-
ber 2013. http://www.kleinlyons.com/class/aboriginal-sixties-scoop/Aborginal-Six-
ties-Scoop-Notice-Civil-Claim.pdf.
“Statement of Claim,” in Court File No. 29762 (Cloud v. Canada (Attorney General)), 1998.
“Statement of Claim issued 13 June 2000,” in Court File No. 00-CV-192059CP (Baxter v. Can-
6. Other Sources
Canada. “First Nation Child and Family Services: Opportunities for Collaboration and Part-
nership—Presentation to the Federal, Provincial and Territorial Directors of Child Welfare
Working Group.” 3 October 2012.
Morrison, Glenn (Policy Manager of the Aboriginal Affairs Directorate in the Citizenship Par-
ticipation Branch) email to the Truth and Reconciliation Commission. 9 July 2012.
Valcourt, Bernard (Minister of Aboriginal Affairs and Northern Development) to Jean Crow-
der, MP, 17 April 2014. https://www.documentcloud.org/documents/1150681-letter-to-mp-
jean-crowser.html.
Secondary Sources
1. Books
Barkwell, Lawrence J., Leah Dorion, and Audreen Hourie. Métis Legacy. Vol. 2, Michif Culture,
Heritage, and Folkways. Saskatoon: Gabriel Dumont Institute, 2006.
Baskin, Cyndy. Strong Helpers’ Teachings: The Value of Indigenous Knowledges in the Helping
Professions. Toronto: Canadian Scholars’ Press, 2011.
Battiste, Marie. Decolonizing Education: Nourishing the Learning Spirit. Saskatoon: Purich
Publishing, 2013.
Brass, Eleanor. I Walk in Two Worlds. Calgary: Glenbow Museum, 1987.
Bryce, P. H. The Story of a National Crime: An Appeal for Justice to the Indians of Canada.
Ottawa: James Hope and Sons, 1922.
Canadien, Albert. From Lishamie. Penticton, BC: Theytus Books, 2010.
Carter, Sarah. Lost Harvests: Prairie Indian Reserve Farmers and Government Policy. Montréal
and Kingston: McGill-Queen’s University Press, 1990.
Davis, Wade. The Wayfinders: Why Ancient Wisdom Matters in the Modern World. Toronto:
Anansi, 2009.
Dickson, Stewart. Hey, Monias!: The Story of Raphael Ironstand. Vancouver: Arsenal Pulp
Press, 1993.
Eizenga, Michael, et al. Class Actions Law and Practice. 2nd ed. Markham: Lexis Nexis, 2008.
French, Alice. My Name Is Masak. Winnipeg: Peguis Publishers, 1977.
Joe, Rita. Song of Eskasoni: More Poems of Rita Joe. Charlottetown: Ragweed Press, 1988.
Johnston, Patrick. Native Children and the Child Welfare System. Toronto: Lorimer, 1983.
Jones, Craig. Theory of Class Actions. Toronto: Irwin Law, 2003.
Kelm, Mary-Ellen. Colonizing Bodies: Aboriginal Health and Healing in British Columbia
1900–1950. Vancouver: University of British Columbia Press, 1998.
Knockwood, Isabelle. Out of the Depths. New Extended Edition. Lockport, NS: Roseway Pub-
lishing, 2001.
MacGregor, Roy. Chief: The Fearless Vision of Billy Diamond. Toronto: Viking, 1989.
Miller, Bruce. The Problem of Justice: Tradition and Law in the Coast Salish World. Lincoln:
University of Nebraska Press, 2001.
Miller, J. R. Shingwauk’s Vision: A History of Native Residential Schools. Toronto: University of
Toronto Press, 1996.
Milloy, John. A National Crime: The Canadian Government and the Residential School System,
1879 to 1986. Winnipeg: University of Manitoba Press, 1999.
Milward, David. Aboriginal Justice and the Charter: Realizing a Culturally Sensitive Interpreta-
tion of Legal Rights. Vancouver: University of British Columbia Press, 2012.
Moran, Bridget. Stoney Creek Woman: The Story of Mary John. Vancouver: Arsenal Pulp Press,
1997.
Moseley, Christopher, ed. and Alexandre Nicolas, cart. UNESCO Atlas of the World’s Lan-
guages in Danger. 3rd ed. Paris: UNESCO Publishing, 2010.
Newman, Morton. Indians of the Saddle Lake Reserve. Edmonton: Human Resources and
Development Council, 1967.
Paquette, Jerry, and Gérald Fallon. First Nations Education Policy in Canada: Progress or
Gridlock? Toronto: University of Toronto Press, 2010.
Sluman, Norma, and Jean Goodwill. John Tootoosis: Biography of a Cree Leader. Winnipeg:
Pemmican Publications, 1984.
Vanderburgh, Rosamond M. The Canadian Indian in Ontario’s Social Studies Textbooks,
Grades 1 Through 8: A Report Prepared for the University Women’s Club of Port Credit, On-
tario. Toronto: Indian-Eskimo Association of Canada. 1970.
Venne, Sharon H., ed. Indian Acts and Amendments 1868–1975, An Indexed Collection. Saska-
toon: University of Saskatchewan, Native Law Centre, 1981.
Vick-Westgate, Ann. Nunavik: Inuit-Controlled Education in Arctic Quebec. Calgary: Univer-
sity of Calgary Press, 2002.
Waldram, James. The Way of the Pipe: Aboriginal Spirituality and Symbolic Healing in Cana-
dian Prisons. Peterborough, ON: Broadview Press, 1997.
Wherrett, George Jasper. The Miracle of Empty Beds: A History of Tuberculosis in Canada.
Toronto: University of Toronto Press, 1977.
Willis, Jane. Geniesh: An Indian girlhood. Toronto: New Press, 1973.
2. Book Chapters and Journal Articles

Andersen, Chris. “From Nation to Population: The Racialisation of ‘Métis’ in the Cana-
dian Census.” Nations and Nationalism 14, no. 2 (2008): 347–368. doi:10.1111/j.1469-
8129.2008.00331.x.
Atkins, Scott. “Racial Segregation, Concentrated Disadvantage, and Violent Crime” Journal of
Ethnicity in Criminal Justice 7 (2009): 30–52.
Atwood, Barbara. “The Voice of the Indian Child: Strengthening the Indian Child Welfare Act
Through Children’s Participation.” Arizona Law Review 50, no. 1 (2008): 127–156.
Basic, Christine. “Termination of Parental Rights: An Overview of the Indian Child Welfare
Act of 1978.” Contemporary Legal Issues 16 (2007): 345–349.
Belles, Stefan, et al. “Parental Problem Drinking Predicts Implicit Alcohol Expectancy in Ado-
lescents and Young Adults.” Addictive Behaviors 36, no. 11 (2011): 1091–1094.
Bennett, Trevor, Katie Holloway, and David Farrington. “The Statistical Association be-
tween Drug Misuse and Crime: A Meta-Analysis.” Aggression & Violent Behavior 13 (2008):
107–118.
Benoit, Cecilia, Dena Carroll, and Munaza Chaudhry. “In Search of a Healing Place: Aborig-
inal Women in Vancouver’s Downtown Eastside.” Social Science and Medicine 56 (2003):
821–833.
Blackstock, Cindy. “First Nations Child and Family Services: Restoring Peace and Harmony in
First Nations Communities.” In Child Welfare: Connecting Research, Policy and Practice, ed-
ited by Kathleen Kufeldt and Brad McKenzie, 331–342. Waterloo, ON: Wilfrid Laurier Press.
Blanchette, Kelley, and Kelly Taylor. “Development and Validation of a Security Reclassifica-
tion Scale for Women.” Forum on Corrections Research 16, no. 1 (2004): 28–30.
Bonta, James. “Native Inmates: Institutional Response, Risk, and Needs.” Canadian Journal of
Criminology 31, no. 1 (1989): 49–62.
Bonta, James, Carol LaPrairie, and Suzanne Wallace-Capretta. “Risk Prediction and Re-
Offending: Aboriginal and Non-Aboriginal Offenders.” Canadian Journal of Criminology 39,
no. 2 (1997): 127–144.
Bonta, James, Stan Lipinski, and Michael Martin. “The Characteristics of Aboriginal Recidi-
vists.” Canadian Journal of Criminology 34, nos. 3 and 4 (1992): 517–522.
Bonesteel, Sarah. “Use of Traditional Inuit Culture in the Policies and Organization of the
Government of Nunavut.” Orality: Orality in the 21st Century: Inuit Discourse and Practices:
Proceedings of the 15th Inuit Studies Conference, edited by Béatrice Collignon, Michèle
Therrien, and Florence Duchemin-Pelletier. Paris: INALCO-CERLOM, 2009. http://inuito-
ralityconference.com/art/Bonesteel.pdf.
Borrows, John. “Residential Schools, Respect and Responsibilities for Past Harms.” University
of Toronto Law Journal 64, no. 4 (2014): 486–504.
Bougie, Evelyne, and Sacha Senécal. “Registered Indian Children’s School Success and Inter-
generational Effects of Residential Schooling in Canada.” International Indigenous Policy
Journal 1, no. 1 (2010): 1–41. http://ir.lib.uwo.ca/iipj/vol1/iss1/5.
Brown, Jason, et al. “Housing for Aboriginal Ex-Offenders in the Urban Core.” Qualitative
Social Work 7, no. 2 (2008): 238–253.
Burton, David. “Male Adolescents: Sexual Victimization and Subsequent Sexual Abuse.” Ado-
lescent Social Work Journal 20, no. 4 (2003): 277–296.
Campbell, Justine, and Tian Oei. “A Cognitive Model for the Intergenerational Transference of
Alcohol Use Behavior.” Addictions Behavior 35, no. 2 (2010): 73–83.
Canadian Medical Association. “Aboriginal Health Programming under Siege, Critics Charge.”
Canadian Medical Association Journal 184, no. 14 (2012): E739–E740.
Carrière, Jeannine, and Cathy Richardson. “From Longing to Belonging: Attachment Theory.
Connectedness, and Indigenous Children in Canada.” In Passion for Action in Child and
Family Services: Voices from the Prairies, edited by Sharon McKay, Don Fuchs, and Ivan
Brown, 49–68. Regina: Canadian Plains Research Centre, 2009.
Carr-Stewart, Sheila. “A Treaty Right to Education.” Canadian Journal of Education 26, no. 2
(2001): 125–143.
Case, Patricia. “The Relationship of Race and Criminal Behavior: Challenging Cultural Expla-
nations for a Structural Problem.” Critical Sociology 34, no. 2 (2008): 213–238.
Chandler, Michael J., and Christopher Lalonde. “Cultural Continuity as a Hedge against Sui-
cide in Canada’s First Nations.” Transcultural Psychiatry 35, no. 2 (1998): 191–219.
Chartrand, Larry. “Aboriginal Youth and the Criminal Justice System.” In Understanding
Youth Justice in Canada, edited by Kathryn Campbell, 313–335. Toronto: Pearson Education
Canada, 2004.
Chartrand, Larry N. “Métis Residential School Participation: A Literature Review.” In Métis
History and Experience and Residential Schools in Canada, edited by Larry N. Chartrand,
Tricia E. Logan, and Judy D. Daniels, 5–55. Ottawa: Aboriginal Healing Foundation, 2006.
Clement, John. “University Attainment of the Registered Indian Population, 1981–2006: A

Cohort Approach.” In Aboriginal Education: Current Crisis and Future Alternatives, edited
by Jerry P. White et al., 69–106. Toronto: Thompson Educational Publishing, 2009.
Cornell, Stephen, and Joseph Kalt. “Reloading the Dice: Improving the Chances for Economic
Development on American Indian Reservations.” In What Can Tribes Do? Strategies and
Institutions in American Indian Economic Development, edited by Stephen Cornell and
Joseph Kalt, 1–59. Los Angeles: American Indian Studies Center, 1992.
Cradock, Gerald. “Extraordinary Costs and Jurisdictional Disputes.” In Wen: De: We Are Com-
ing to the Light of Day, by First Nations Child & Family Caring Society of Canada, 178–207.
Ottawa: First Nations Child & Family Caring Society of Canada, 2005.
Craib, Kevin, et al. “Risk Factors for Elevated HIV Incidence among Aboriginal Injection Drug
Users in Vancouver.” Canadian Medical Association Journal 168, no. 1 (2003): 19–24.
Cross, Suzanne. “Indian Family Exception Doctrine: Still Losing Children Despite the Indian
Child Welfare Act.” Child Welfare 85, no. 4 (2006): 671–690.
Crutcher, Nicole, and Shelley Trevethan. “An Examination of Healing Lodges for Aboriginal
Offenders in Canada.” Forum on Corrections Research 14, no. 3 (2002): 52–54.
DeGue, Sarah, and Cathy Spatz Widom. “Does Out-Of-Home Placement Mediate the Rela-
tionship Between Child Maltreatment and Adult Criminality?” Child Maltreatment 14, no. 4
(2009): 344–355.
Dunlap, Eloise, et al. “Mothers and Daughters: The Intergenerational Reproduction of Vio-
lence and Drug Use in Home and Street Life.” Journal of Ethnicity in Substance Abuse 3, no.
2 (2004): 1–24.
Eitle, David, Stewart D’Alessio, and Lisa Stolzenberg. “Economic Segregation, Race, and Ho-
micide.” Social Science Quarterly 87, no. 3 (2006): 638–657.
Filbert, Katherine, and Robert Flynn. “Developmental and Cultural Assets and Resilient
Outcomes in First Nations Young People in Care: An Initial Test of an Explanatory Model.”
Children and Youth Services Review 32, no. 4 (2010): 560–564.
Fontaine, Lorena Sekwan. “Re-conceptualizing and Re-imagining Canada: Opening Doors for
Aboriginal Language Rights.” In Languages, Constitutionalism and Minorities: Proceedings
of a Conference Held at the University of Ottawa, Nov. 12–13, 2004, edited by André Braën,
Pierre Foucher, and Yves Le Bouthillier. Markham, ON: LexisNexis Canada Inc., 2006.
Gonzalez-Mena, Janet. “Cross-Cultural Infant Care and Issues of Equity and Social Justice.”
Contemporary Issues in Early Childhood 2, no. 3 (2001): 368–371.
Graburn, Nelson. “Severe Child Abuse among the Canadian Inuit.” In Child Survival: An-
thropological Perspectives on the Treatment and Maltreatment of Children, edited by Nancy
Scheper-Hughes, 211–225. Dordrecht, Holland: D. Reidel Publishing, 1987.
Graham, Lorie M. “Reparations, Self-Determination and the Seventh Generation.” In Facing
the Future: The Indian Child Welfare Act at 30, edited by Matthew Fletcher, Wenona Singel,
and Kathryn Fort, 110–126. East Lansing: Michigan State University, 2009.
Green, Ross Gordon. “Aboriginal Community Sentencing and Mediation: Within and Without
the Circle.” Manitoba Law Journal 25, no. 1 (1997–1998): 77–126.
Gresko [Kennedy], Jacqueline. “Everyday Life at Qu’Appelle Industrial School.” In Western
Oblate Studies 2/Études oblates de l’ouest 2: Proceedings of the Second Symposium on the
History of the Oblates in Western and Northern Canada, edited by Raymond Huel, 71–113.
Lewiston, NY: Edwin Mellen Press, 1992.
Gustafson, Kaaryn. “The Criminalization of Poverty.” Journal of Criminal Law & Criminology
99, no. 3 (2009): 643–716.
Hallett, Darcy, Michael J. Chandler, and Christopher E. Lalonde. “Aboriginal Language
Knowledge and Youth Suicide.” Cognitive Development 22, no. 3 (2007): 392–399.
Handley, Elizabeth, and Laurie Chassin. “Intergenerational Transmission of Alcohol Ex-
pectancies in a High-Risk Sample.” Journal of Studies on Alcohol & Drugs 70, no. 5 (2009):
675–682.
Heckbert, Doug, and Douglas Turkington. “Turning Points: Factors Related to the Successful
Reintegration of Aboriginal Offenders.” Forum on Correctional Research 14, no. 3 (2002):
55–57.
Hirschel, David, Ira Hutchinson, and Meaghan Shaw. “The Interrelationship between
Substance Abuse and the Likelihood of Arrest, Conviction, and Re-Offending in Cases of
Intimate Partner Violence.” Journal of Family Violence 25, no. 1 (2010): 81–90.
Hobart, Charles. “Report on Canadian Arctic Eskimos: Some Consequences of Residential
Schooling.” Journal of American Indian Education 7, no. 2 (1968): 7–17.
Holsinger, A. M., C. T. Lowenkamp, and E. J. Lotessa. “Ethnicity, Gender, and the Level of
Service Inventory – Revised.” Journal of Criminal Justice 31, no. 4 (2003): 309–320.
Hooghe, Marc, et al. “Unemployment, Inequality, Poverty and Crime: Spatial Distribution
Patterns of Criminal Acts in Belgium, 2001–06.” British Journal of Criminology 51, no. 1
(2011): 1–20.
Howe, Brian. “Children’s Rights as Crime Prevention.” International Journal of Children’s
Rights 16, no. 4 (2008): 457–474.
Jackson, Michael. “Locking up Natives in Canada.” UBC Law Review 23 (1988–89): 215–230.
Jiwa, Ashifa, Len Kelly, and Natalie St. Pierre-Hansen. “Healing the Community to Heal the
Individual: Literature Review of Aboriginal Community-Based Alcohol and Substance
Abuse Programs.” Canadian Family Physician 54, no. 7 (2008): 1000.e.1–1000.e7.
Karmali, Shahzeer, et al. “Epidemiology of Severe Trauma among Status Aboriginal Canadi-
ans: A Population-Based Study.” Canadian Medical Association Journal 172, no. 8 (2005):
1005–1011.
Kerr, David, et al. “Intergenerational Influences on Early Alcohol Use: Independence from the
Problem Behavior Pathway.” Development & Psychopathology 24, no. 3 (2012): 889–901.
Kirkness, Verna. “Aboriginal Education in Canada: A Retrospective and a Prospective.” Journal
of American Indian Education 39, no. 1 (1999): 14–30.
Laliberté, Arlene, and Michel Tousignant. “Alcohol and Other Contextual Factors of Suicide in
Four Aboriginal Communities of Quebec, Canada.” Crisis: The Journal of Crisis Intervention
and Suicide Prevention 30, no. 4 (2009): 215–221.
LaPrairie, Carol. “Aboriginal Crime and Justice: Explaining the Present, Exploring the Future.”
Canadian Journal of Criminology 34 (1992): 281–298.
Lecompte, Emily. “Aboriginal Health Human Resources: A Matter of Health.” Journal of Ab-
original Health 8, no. 2 (2012): 16–22.
Leitch, David. “Canada’s Native Languages: The Right of First Nations to Educate their Chil-
dren in their Own Languages.” Constitutional Forum 15, no. 1 (2006): 107–120.
Logan, Tricia E. “Lost Generations: The Silent Métis of the Residential School System Revised
Interim Report.” In Métis History and Experience and Residential Schools in Canada, edited
by Larry N. Chartrand, Tricia E. Logan, and Judy D. Daniels, 58–93. Ottawa: Aboriginal
Healing Foundation, 2006.
Looman, Jan, and Jeffrey Abracen. “Substance Abuse among High-Risk Sexual Offenders: Do
Measures of Lifetime History of Substance Abuse Add to the Prediction of Recidivism over
Actuarial Risk Assessment Instruments?” Journal of Interpersonal Violence 26, no. 4 (2011):
683–700.
Martin, Monica, et al. “The Enduring Significance of Racism: Discrimination and Delin-
quency Among Black American Youth.” Journal of Research on Adolescence 21, no. 3 (2010):
662–676.
McCloskey, Laura, and Jennifer Bailey. “The Intergenerational Transmission of Risk for Sexual
Abuse.” Journal of Interpersonal Violence 15, no. 10 (2000): 1019–1035.
McCue, Harvey, “An Overview of Federal and Provincial Policy Trends in First Nations Edu-
cation.” In The New Agenda: A Manifesto for First Nations Education in Ontario, edited by
Chiefs in Ontario. Ontario: Chiefs in Ontario, 2004. http://www.chiefs-of-ontario.org/sites/
default/files/files/An%20Overview%20of%20Federal%20and%20Provincial%20Policy%20
Trends%20in%20First%20Nations%20Education.pdf.
McIvor, Onowa, Art Napoleon, and Kerissa M. Dickie. “Language and Culture as Protective
Factors for At-Risk Communities.” Journal of Aboriginal Health (November 2009): 6–25.
Meyercook, Fiona, and Diane Labelle. “Namaji: Two-Spirit Organizing in Montreal, Can-
ada.” Journal of Gay and Lesbian Social Services 16, no. 1 (2003): 29–51. doi:10.1300/
J041v16n01_02.
Moore, Shelby. “Understanding the Connection Between Domestic Violence, Crime, and
Poverty: How Welfare Reform May Keep Battered Women from Leaving Abusive Relation-
ships.” Texas Journal of Women & Law 12 (2003): 451–484.
Moran, Mayo. “The Role of Reparative Justice in Responding to the Legacy of Indian Residen-
tial Schools.” University of Toronto Law Journal 64 (2014): 529–565.
Nicholas, Andrea Bear. “Canada’s Colonial Mission: The Great White Bird.” In Aboriginal
Education in Canada: A Study in Decolonization, edited by K. P. Binda and Sharilyn Calliou,
9–33. Mississauga, ON: Canadian Educators’ Press, 2001.
Pearce, Margo, et al. “The Cedar Project: Historical Trauma and Vulnerability to Sexual
Assault Among Young Aboriginal Women who use Illicit Drugs in Two Canadian Cities.”
Violence Against Women 21, no. 3 (2015): 313–329.
Penney, Chris. “Formal Educational Attainment of Inuit in Canada, 1981–2006.” In Aborigi-
nal Education: Current Crisis and Future Alternatives, edited by Jerry P. White et al., 33–47.
Toronto: Thompson Educational Publishing, 2009.
Petten, Cheryl. “New Healing Lodge Opens for Offenders.” Saskatchewan Sage 7, no. 11
(2003): 1.
Phillips, Lindsay. “Substance Abuse and Prison Recidivism: Themes from Qualitative Inter-
views.” Journal of Addictions & Offender Counseling 31, no. 1 (2010): 10–24.
Pintarics, Joe, and Karen Sveinunggaard. “Meenoostahtan Minisiwin: First Nations Family
Justice ‘Pathways to Peace.’” The First Peoples Child and Family Review 2, no. 1 (2005): 67–88.
Pizarro, Jesenia, and Jean Marie McGloin. “Explaining Gang Homicides in Newark, New
Jersey: Collective Behavior or Social Disorganization?” Journal of Criminal Justice 34, no.
(2006): 195–207.
Preston, Jane P., Michael Cottrell, Terrance R. Pelletier, and Joseph V. Pearce. “Aboriginal Early
Childhood Education in Canada: Issues of Context.” Journal of Early Childhood Research 10,
no. 1 (2012): 3–18.
Pridemore, William Alex. “A Methodological Addition to the Cross-National Empirical

Literature on Social Structure and Homicide: A First Test of the Poverty-Homicide Thesis.”
Criminology 46, no. 1 (2008): 133–154.
Purvin, Diane. “Weaving a Tangled Safety Net: The Intergenerational Legacy of Domestic
Violence and Poverty.” Violence Against Women 9, no. 10 (2003): 1263–1277.
Regan, Paulette. Unsettling the Settler Within: Indian Schools, Truth Telling and Reconciliation
in Canada. Vancouver: University of British Columbia Press, 2010.
Richardson, Cathy. “Métis Experiences of Social Work Practices.” In Walking This Path To-
gether: Anti Racist and Anti Oppressive Child Welfare Practice, edited by Jeannine Carrière
and Susan Strega. Winnipeg: Fernwood Publishing, 2009.
Richardson, Cathy, and Bill Nelson. “A Change of Residence: Government Schools and Foster
Homes as Sites of Forced Aboriginal Assimilation—A Paper Designed to Provoke Thought
and Systemic Change.” First Peoples Review 3, no. 2 (2007): 75–83.
Richardson, Cathy, and Dana Seaborn. “Working with Métis Children and Their Families.” The
BC Counsellor 24, no. 2 (2002): 47–51.
Roach, Kent. “Blaming the Victim: Canadian Law, Causation and Residential Schools.” Uni-
versity of Toronto Law Journal 64 (2014): 566–595.
Rudin, Johnathan. “Incarceration of Aboriginal Youth in Ontario 2004 to 2006: The Crisis
Continues.” Criminal Law Quarterly 53 (2007): 260–272.
Ruiz-Casares, Mónica, Nico Trocmé, and Barbara Fallon. “Supervisory Neglect and Risk of
Harm: Evidence from the Canadian Child Welfare System.” Child Abuse & Neglect 36, no. 6
(2012): 471–480.
Ryan, Joseph, and Mark Testa. “Child Maltreatment and Juvenile Delinquency: Investigating
the Role of Placement and Placement Instability.” Children & Youth Services Review 27
(2005): 227–249.
Ryan, Joseph, et al. “Juvenile Delinquency in Child Welfare: Investigating Group Home Ef-
fects” Children & Youth Services Review 30 (2008): 1088–1099.
Sabates, Ricardo. “Educational Attainment and Juvenile Crime: Area-Level Evidence Using
Three Cohorts of Young People.” British Journal of Criminology 48 (2008): 395–409.
Scott, Duncan Campbell. “Indian Affairs 1867–1912.” In Canada and Its Provinces: A History
of the Canadian People and Their Institutions, vol. 7, edited by A. Shortt and A. Doughty.
Glasgow: Brook and Company, 1914.
Ship, Susan Judith, and Laura Norton. “HIV/AIDS and Aboriginal Women in Canada: A Case
Study.” Canadian Woman Studies 21, no. 2 (2001): 25–31.
Sinha, Vandna, and Anna Kozlowski. “The Structure of Aboriginal Child Welfare in Canada.”
International Indigenous Policy Journal 4, no. 2 (2013): 1–21. http://ir.lib.uwo.ca/iipj/vol4/
iss2/2.
Sinha, Vandna, Stephen Ellenbogen, and Nico Trocmé. “Substantiating Neglect of First
Nations and Non-Aboriginal Children.” Child and Youth Services Review 35, no. 12 (2013):
2080–2090.
Slattery, Brian. “Making Sense of Aboriginal and Treaty Rights.” Canadian Bar Review 79
(2000): 196–224.
Smylie, Janet, Deshayne Fell, and Arne Ohlsson. “A Review of Aboriginal Infant Mortality
Rates in Canada: Striking and Persistent Aboriginal/Non-Aboriginal Inequities.” Canadian
Journal of Public Health 101, no. 2 (2010): 143–148.
Sousa, Cindy, et al. “Longitudinal Study on the Effects of Child Abuse and Children’s Expo-
sure to Domestic Violence, Parent-Child Attachments, and Antisocial Behavior in Adoles-
cence.” Journal of Interpersonal Violence 26, no. 1 (2011): 111–136.
Spano, Richard, Joshua D. Frielich, and John Bolland. “Gang Membership, Gun Carrying, and
Employment: Applying Routine Activities Theory to Explain Violent Victimization among
Inner City, Minority Youth Living in Extreme Poverty.” Justice Quarterly 25, no. 2 (2008):
381–410.
Stanley, George F. G. “Alberta’s Half-Breed Reserve Saint-Paul-des Métis 1896–1909.” In The
Other Natives: The Metis, vol. 2, edited by A. S. Lussier and D. B. Sealey, 75–107. Winnipeg:
Manitoba Metis Federation Press, 1978.
Streissguth, Ann, Fred Bookstein, Helen Barr, Kieran O’Malley, and Julia Kogan Young. “Risk
Factors for Adverse Life Outcomes in Fetal Alcohol Syndrome and Fetal Alcohol Effects.”
Developmental and Behavioral Pediatrics 25, no. 4 (2004): 228–238.
Thornberry, Terence, Marvin Krohn, and Adrienne Freeman-Gallant. “Intergenerational
Roots of Early Onset Substance Abuse.” Journal of Drug Issues 36, no. 1 (2006): 1–28.
Totten, Mark. “Aboriginal Youth and Violent Gang Involvement in Canada: Quality Prevention
Strategies.” IPC Review 3 (March 2009): 135–156. http://www.reginapolice.ca/gang/publica-
tions/IPC%20Review%203%20-%20Totten.pdf.
Tripodi, Stephen, and Kimberly Bender. “Substance Abuse Treatment for Juvenile Offenders:
A Review of Quasi-Experimental and Experimental Research.” Journal of Criminal Justice 39
(2011): 246–252.
Turpel-Lafond, Mary Ellen, and Patricia Monture-Angus. “Aboriginal Peoples and Canadian
Criminal Law: Rethinking Justice.” Special Edition on Aboriginal Justice. UBC Law Review
(1992): 239–279.
Walsh, Tamara. “Is Corrections Correcting?: An Examination of Prisoner Rehabilitation Policy
and Practice in Queensland.” Australian and New Zealand Journal of Criminology 39, no. 1
(2006): 109–133.
Welsh, Andrew, and James P. Ogloff. “Full Parole and the Aboriginal Experience: Accounting
for the Racial Discrepancies in the Release Rates.” Canadian Journal of Criminology 42, no.
4 (2000): 469–491.
Wilk, Piotr, Jerry P. White, and éric Guimond. “Métis Educational Attainment.” In Aboriginal
Education: Current Crisis and Future Alternatives, edited by Jerry P. White et al., 49–67.
Toronto: Thompson Educational Publishing, 2009.
Young, T. Kue. “Review of Research on Aboriginal Populations in Canada: Relevance to Their
Health Needs.” British Journal of Medicine 327, no. 7412 (2003): 419–422.
Zellerer, Evelyn. “Culturally Competent Programs: The First Family Violence Program for
Aboriginal Men in Prison.” The Prison Journal 83, no. 2 (2003): 171–190.
3. Published Papers and Reports

Aboriginal Healing Foundation. The 2009 Annual Report of the Aboriginal Healing Founda-
tion. Ottawa: AHF. Accessed 12 January 2012. http://www.ahf.ca/downloads/annual-re-
port-2010.pdf.
Aboriginal Healing Foundation. The 2014 Annual Report of the Aboriginal Healing Founda-
tion. Ottawa: AHF. Accessed 13 May 2015. http://www.ahf.ca/downloads/2014-annual-re-
port-english.pdf.
Aboriginal Healing Foundation. Mental Health Profiles for a Sample of British Columbia’s
Aboriginal Survivors of the Canadian Residential School System. Ottawa: AHF, 2003.
Alberta Centre for Child, Family and Community Research. A Preliminary Analysis of Mortal-
ities in the Child Intervention System in Alberta. Edmonton: Government of Alberta, 2014.
http://www.humanservices.alberta.ca/documents/accfcr-analysis-mortalities.pdf.
Allan, Billie, and Janet Smylie. “First Peoples, Second Class Treatment: The Role of Racism
in the Health and Well-Being of Indigenous peoples in Canada.” Discussion paper. The
Wellesley Institute, Toronto, 2015. http://www.wellesleyinstitute.com/wp-content/up-
loads/2015/02/Report-First-Peoples-Second-Class-Treatment-Feb-2015.pdf.
Amnesty International. No More Stolen Sisters: The Need for a Comprehensive Response to
Discrimination and Violence Against Indigenous Women in Canada. London: AMI Publica-
tions, 2006.
Anaya, James (Former United Nations Special Rapporteur on the Rights of Indigenous
People). “Statement upon Conclusion of the Visit to Canada, 15 October 2013.” http://unsr.
jamesanaya.org/statements/statement-upon-conclusion-of-the-visit-to-canada.
Archibald, Linda. Final Report of the Aboriginal Healing Foundation. Vol. 3, Promising Heal-
ing Practices in Aboriginal Communities. Ottawa: Aboriginal Healing Foundation, 2006.
Assembly of First Nations. Breaking the Silence: An Interpretive Study of Residential School Im-
pact and Healing as Illustrated by the Stories of First Nation Individuals. Ottawa: Assembly
of First Nations, 1994.
Assembly of First Nations. “Early Childhood Education in First Nations Communities.” AFN
Fact sheet. Chiefs Assembly on Education, Gatineau, QC, 1 – 3 October 2012. http://www.
afn.ca/uploads/files/events/fact_sheet-ccoe-5.pdf.
Assembly of First Nations. “Language and Culture.” AFN Fact sheet. Chiefs Assembly on
Education, Gatineau, QC, 1 – 3 October 2012. http://www.afn.ca/uploads/files/events/
fact_sheet-ccoe-10.pdf.
Assembly of First Nations. Report on Canada’s Dispute Resolution Plan to Compensate for
Abuses in Indian Residential Schools. Ottawa: Assembly of First Nations, 2004.
Assembly of First Nations. Royal Commission on Aboriginal Peoples at 10 Years: A Report
Card. Ottawa: Assembly of First Nations, 2006. http://www.turtleisland.org/resources/afnr-
cap2006.pdf.
Assembly of First Nations. Submission: Bill C-10 Safe Streets and Communities Act. 22 Novem-
ber 2011. http://www.afn.ca/uploads/files/parliamentary/billc-10.pdf.
Australia. Council of Australian Governments. National Indigenous Reform Agreement
(Closing the Gap). Council of Australian Governments, 2012. http://www.federalfinan-
cialrelations.gov.au/content/npa/health_indigenous/indigenous-reform/national-agree-
ment_sept_12.pdf.
Australian Government. Closing the Gap: Prime Minister’s Report, 2015. Commonwealth of
Australia, 2015. http://www.dpmc.gov.au/sites/default/files/publications/Closing_the_
Gap_2015_Report_0.pdf.
Barlow, J. Kevin. Residential Schools, Prisons and HIV/AIDS among Aboriginal Peoples in
Canada: Exploring the Connections. Ottawa: Aboriginal Healing Foundation, 2009.
Blackstock, Cindy, Terry Cross, John George, Ivan Brown, and Jocelyn Formsma. Reconcili-
ation in Child Welfare: Touchstones of Hope for Indigenous children, Youth, and Families.
Ottawa: First Nations Child & Family Caring Society of Canada; Portland, OR: National
Indian Child Welfare Association, 2006. http://cwrp.ca/sites/default/files/publications/en/
Touchstones_of_Hope.pdf.
Blumenthal, Anne, and Vandna Sinha. “Newfoundland and Labrador’s Child Welfare System.”
Information Sheet #130E. Canadian Child Welfare Research Portal, August 2014. http://
cwrp.ca/sites/default/files/publications/en/NL_final_infosheet_0.pdf.
Boyer, Yvonne. “Aboriginal Health: A Constitutional Rights Analysis.” NAHO Discussion Paper
Series, no. 1, June 2003. http://www.naho.ca/documents/naho/english/publications/
DP_rights.pdf.
Boyer, Yvonne. “The International Right to Health for Indigenous Peoples in Canada.” NAHO
Discussion Paper Series, no. 3, September 2004. http://www.naho.ca/documents/naho/
english/pdf/aboriginal_health_paper3.pdf.
Caldwell, George. Indian Residential Schools: A Research Study on the Child Care Programs of
Nine Residential Schools in Saskatchewan. Ottawa: The Canadian Welfare Council, 1967.
Canadian Bar Association. Resolution 00-04-A, carried as amended by the Council of the Ca-
nadian Bar Association, Annual Meeting, Halifax, NS, 19–20 August 2000. http://www.cba.
org/cba/sections_abor/main/00_04_a.aspx.
Canadian Bar Association. Submission on Bill C-10: Safe Streets and Communities Act. Ottawa:
Canadian Bar Association, 2011. http://www.cba.org/cba/submissions/PDF/11-45-eng.pdf.
Canadian Feminist Alliance for International Action. No Action: No Progress: Canadian Fem-
inist Alliance for International Action Report on Canada’s Progress in Implementing Priority
Recommendations made by the United Nations Committee on the Elimination of Discrimina-
tion against Women in 2008. Ottawa: CFAIA, 2010. http://www2.ohchr.org/english/bodies/
cedaw/docs/ngos/NoActionNoProgress_CanadaFU.pdf.
Canadian Paediatric Society. Are We Doing Enough? A Status Report on Canadian Public
Policy and Child and Youth Health. Ottawa: Canadian Paediatric Society, 2012. http://www.
cps.ca/advocacy/StatusReport2012.pdf.
Chansonneuve, Deborah. Addictive Behaviours among Aboriginal People in Canada. Ottawa:
Aboriginal Healing Foundation, 2007.
Chartrand, Larry N. Maskikiwenow: The Métis Right to Health under the Constitution of
Canada and under Selected International Human Rights Obligations. Ottawa: National
Aboriginal Health Organization, 2010. http://www.naho.ca/documents/metiscentre/en-
glish/2011_right_to_health.pdf.
Corrado, Raymond, and Irwin Cohen. Mental Health Profiles for a Sample of British Colum-
bia’s Aboriginal Survivors of the Canadian Residential School System. Ottawa: Aboriginal
Healing Foundation, 2003.
Council of Canadian Academics. Aboriginal Food Security in Northern Canada: An Assess-
ment of the State of Knowledge. Ottawa: Council of Canadian Academics, 2014. http://www.
scienceadvice.ca/uploads/eng/assessments%20and%20publications%20and%20news%20
releases/food%20security/foodsecurity_execsummen.pdf.
Crosscurrent Associates, Hay River. Languages of the Land: A Resource Manual for Aboriginal
Language Activists. Yellowknife: NWT Literacy Council, 1999.
Devlin, Christopher, Leah DeForrest, and Caitlin Mason. “Jurisdictional Quagmire: First Na-
tions Child Welfare as a Human Right.” Devlin Gailus, Victoria, 2012. http://www.dgwlaw.
ca/wp-content/uploads/2014/12/Child_Welfare_Human_Rights_Paper.pdf .
Environics Institute. Urban Aboriginal Peoples Study: Main Report. Toronto: Environics
Institute, 2010. http://www.northcentralsharedfacility.ca/docs/Urban%20Aboriginal%20
Peoples%20Study-Environics%202010.pdf.
First Nations Centre. First Nations Regional Longitudinal Health Survey (RHS) 2002/03. Ot-
tawa: First Nations Centre, 2005.
First Nations Child & Family Caring Society of Canada. Wen: De: We Are Coming to the Light of
Day. Ottawa: First Nations Child & Family Caring Society of Canada, 2005.
First Nations Education Council. “Funding Formula for First Nation Schools: The Instrument
of a Detrimental Policy.” FNEC, 2009. http://www.cepn-fnec.com/PDF/etudes_documents/
fiche_complete_eng.pdf.
First Nations Education Council. “Paper on First Nations Education Funding.” Wendake, QC:
FNEC, 2009.
First Nations Education Council, Nishnawbe Aski Nation, and Federation of Saskatchewan
Indian Nations. Report on Priority Actions in View of Improving First Nations Educa-
tion. FNEC, NAN, and FSIN, 2011. http://www.fsin.com/index.php/downloads-educa-
tion/708-report-on-priority-actions-in-view-of-improving-first-nations-education.
First Nations Information Governance Centre. Regional Health Survey (RHS) Phase 2
(2008/10) Preliminary Results: Adult, Youth. Child. Rev. ed. Ottawa: First Nations Informa-
tion Governance Centre, 2011.
First Peoples’ Heritage, Language and Cultures Council. Report on the Status of B.C. First Na-
tions Languages 2010. Brentwood Bay, BC: First Peoples’ Heritage, Language and Cultures
Council, 2010.
Fletcher, Matthew. “The Origins of the Indian Child Welfare Act: A Survey of the Legislative
History.” Indigenous Law & Policy Center Occasional Paper Series, Occasional Paper 2009-
04, 10 April 2009. https://www.law.msu.edu/indigenous/papers/2009-04.pdf.
Gendreau, P., T. Little, and C. Goggin. A Meta-Analysis of the Predictors of Adult Offender
Recidivism: What Works! Ottawa: Public Works and Government Services Canada, 1996.
Gough, Pamela. “Alberta’s Child Welfare System.” CECW Information Sheet #46D. Faculty of
Social Work, University of Toronto, Toronto, 2006. http://cwrp.ca/sites/default/files/publi-
cations/en/Altachildwelfaresystem46E.pdf.
Gough, Pamela. “Newfoundland and Labrador’s Child Welfare System.” CECW Information
Sheet #49E, Faculty of Social Work, University of Toronto, 2007.
Gough, Pamela. “Northwest Territories’ Child Welfare System.” CECW Information Sheet
#53E, Faculty of Social Work, University of Toronto, Toronto, 2007.
Gough, Pamela. “Nunavut’s Child Welfare System.” CECW Information Sheet #55E, Faculty of
Social Work, University of Toronto, Toronto, 2007.
Haldane, Scott, George Lafond, Caroline Krause, and National Panel on First Nation Elemen-
tary and Secondary Education for Students on Reserve. Nurturing the Learning Spirit of First
Nation Students: The Report of the National Panel on First Nation Elementary and Secondary
Education for Students on Reserve. Ottawa: National Panel on First Nation Elementary and
Secondary Education for Students on Reserve, 2012.
Health Council of Canada. Empathy, Dignity and Respect: Creating Cultural Safety for Aborigi-
nal People in Urban Health Care. Toronto: Health Council of Canada, 2012. http://www.
healthcouncilcanada.ca/tree/Aboriginal_Report_EN_web_final.pdf.
Highway of Tears Symposium. Highway of Tears Symposium Recommendations Report: A Col-
lective Voice For Victims Who Have Been Silenced. 16 June 2006. http://highwayoftears.org/
uploads/Highway%20of%20Tears%20Symposium%20Recommendations%20Report%20
-%20January%202013.pdf.
Hodgson-Smith, Kathy. “The State of Métis Nation Learning.” Canadian Council on Learning,
2005. http://www.ccl-cca.ca/pdfs/AbLKC/StateOfMetisNationLearning.pdf.
Hughes, Ted. The Legacy of Phoenix Sinclair: Achieving the Best for All Our Children. 2 vols.
Winnipeg: Commission of Inquiry into the Death of Phoenix Sinclair, 2014.
Human Rights Watch. Those Who Take Us Away: Abusive Policing and Failures in the Pro-
tection of Indigenous Women and Girls in Northern British Columbia, Canada. New York:
Human Rights Watch, 2013.
Inuit Qaujimajatuqanginnut (IQ) Task Force. The First Annual Report of the Inuit Qaujima-
jatuqanginnut (IQ) Task Force. August 2002. http://www.inukshukmanagement.ca/IQ%20
Task%20Force%20Report1.pdf.
Inuit Tapiriit Kanatami. “Social Determinants of Inuit Health in Canada: A Discussion Paper.”
Inuit Tapiriit Kanatami, Ottawa, 22 April 2007. http://ahrnets.ca/files/2011/02/ITK_Social_
Determinants_paper_2007.pdf.
Inuit Tapiriit Kanatami. Social Determinants of Inuit Health in Canada. Ottawa: Inuit Tapiriit
Kanatami, 2014. https://www.itk.ca/publication/comprehensive-report-social-determi-
nants-inuit-health-national-inuit-organization.
Inuit Tuttarvingat. Inuit Men Talking about Health. Ottawa: National Aboriginal Health Orga-
nization, 2008. http://www.naho.ca/documents/it/2008_Mens_Health.pdf.
Jackson, Randy, and Gwen Reimer. Canadian Aboriginal People Living with HIV/AIDS: Care,
Treatment and Support Issues. Ottawa: Canadian Aboriginal AIDS Network, 2005. http://
www.aboriginalaidsawareness.com/drafts2011/research-docs/Care%20Treatment%20
and%20Support%20Documentl.pdf.
Jacobs, Beverly, and Andrea J. Williams. “Legacy of Residential Schools: Missing and Mur-
dered Women.” In From Truth to Reconciliation: Transforming the Legacy of Residential
Schools, edited by Marlene Brant Castellano, Linda Archibald, and Mike DeGagné, 121–138.
Ottawa: Aboriginal Healing Foundation, 2008.
Jenness, Diamond. America’s Eskimos: Can They Survive? Waterloo, ON: Waterloo Lutheran
University, 1962.
Jenness, Diamond. “Eskimo Administration: II. Canada.” Arctic Institute of Canada Technical
Paper no. 14, May 1964.
John Howard Society of Alberta. Offender Risk Assessment. Edmonton: John Howard Society of
Alberta, 2000. http://www.johnhoward.ab.ca/pub/C21.htm.
Kimelman, Edwin. No Quiet Place: Final Report to the Honourable Muriel Smith, Minister of
Community Services / Review Committee on Indian and Métis Adoptions and Placements.
Winnipeg: Manitoba Department of Community Services, 1985.
Kinnon, Dianne. Improving Population Health, Health Promotion, Disease Prevention and
Health Protection Services and Programs for Aboriginal People: Recommendations for NAHO
Activities. Ottawa: National Aboriginal Health Organization, 2002. http://www.naho.ca/
documents/naho/english/pdf/research_pop_health.pdf.
Kirmayer, Laurence, Gregory Brass, Tara Holton, Ken Paul, Cori Simpson, and Caroline Tait.
Suicide among Aboriginal People in Canada. Ottawa: Aboriginal Healing Foundation, 2007.
Kozlowski, Anna, Vandna Sinha, Tara Petti, and Elsie Flette. “First Nations Child Welfare in
Manitoba, 2011.” CWRP Information Sheet #97E. McGill University, Centre for Research on
Children and Families, Montréal, 2012.
LaPrairie, Carole. Examining Aboriginal Corrections in Canada. Ottawa: Aboriginal Correc-
tions, Ministry of the Solicitor General, 1996.
Legacy of Hope Foundation. Inuit and the Residential School System. Ottawa: Legacy of Hope
Foundation, 2013. http://www.legacyofhope.ca/downloads/inuit-and-the-rss.pdf.
Legal Services Society of British Columbia. Gladue Report Disbursement: Evaluation. Vancou-
ver: Legal Services Society of British Columbia, 2013.
Little Bear, Leroy. “Naturalizing Indigenous Knowledge, Synthesis Paper.” Aboriginal Edu-
cation Research Centre, University of Saskatchewan, Saskatoon; First Nations and Adult
Higher Education Consortium, Calgary, 2009. http://www.ccl-cca.ca/pdfs/ablkc/naturali-
zeIndigenous_en.pdf.
Macdonald, David, and Daniel Wilson. Poverty or Prosperity: Indigenous Children in Canada.
Ottawa: Canadian Centre for Policy Alternatives, 2013.
Manitoba Metis Federation. They Are Taking our Children from Us: An Inside Look at How the
Manitoba Child and Family Service System Deals with Métis Children and Families; A Criti-
cal Review, Analysis and Recommendations. Winnipeg: The Federation, 1999.
McCue, Harvey. “First Nations 2nd & 3rd Level Education Services: A Discussion Paper for
the Joint Working Group INAC-AFN.” Harvey McCue Consulting, 2006. http://www.afn.ca/
uploads/files/education/9._2006_april_harvey_mccue_first_nations_2nd_&_3rd_level_ser-
vices_paper.pdf.
McIvor, Onowa. Language Nest Programs in BC: Early Childhood Immersion Programs in two
First Nation communities. Brentwood Bay, BC: First People’s Cultural Council, 2006. http://
www.fpcc.ca/files/PDF/language-nest-programs_in_BC.pdf.
Mendelson, Michael. “Improving Education on Reserves: A First Nations Education Authority
Act.” Caledon Institute of Public Policy, Ottawa, 2008. http://www.caledoninst.org/publica-
tions/pdf/684eng.pdf.
Métis National Council. Toward a Canada–Métis Nation Economic Development Framework.
February 2009. http://www.metisportals.ca/ecodev/wp-content/uploads/MNC_Econom-
icDevelopmentFramewok(2009).pdf.
Métis Nation of Alberta. Métis Memories of Residential Schools: A Testament to the Strength of
the Métis. Edmonton: Métis Nation of Alberta, 2004.
Métis Nation of Ontario. Recommendations Concerning Métis-Specific Child and Family Ser-
vices. Toronto: Métis Nation of Ontario, 2012. http://www.metisnation.org/media/239001/
mno_cfsrpt_2012-03-30_final.pdf.
Mishibinijima, Lori. Aboriginal Child Protection Alternative Dispute Resolution. Toronto:
Aboriginal Legal Services of Toronto, 2006.
National Aboriginal Health Organization. An Overview of Traditional Knowledge and
Medicine and Public Health in Canada. Ottawa: National Aboriginal Health Organization,
January 2008. http://www.naho.ca/documents/naho/publications/tkOverviewPublicHe-
alth.pdf.
National Collaborating Centre for Aboriginal Health. Looking for Aboriginal Health in Legis-
lation and Policies, 1970 to 2008: The Policy Synthesis Project. Prince George, BC: National
Collaborating Centre for Aboriginal Health, 2011.
National Collaborating Centre for Aboriginal Health. Child and Youth Health: Child Welfare
Services in Canada: Aboriginal and Mainstream. Prince George, BC: National Collaborating
Centre for Aboriginal Health, 2009–2010.
National Committee on Inuit Education. First Canadians, Canadians First: National Strategy
on Inuit Education. Ottawa: Inuit Tapiriit Kanatami, 2011. https://www.itk.ca/sites/default/
files/National-Strategy-on-Inuit-Education-2011_0.pdf.
National Indian Brotherhood. Indian Control of Indian Education: Policy Paper Presented
to the Minister of Indian Affairs and Northern Development. Ottawa: The National Indian
Brotherhood, 1972.
Native Women’s Association of Canada. “Fact Sheet: Missing and Murdered Aboriginal
Women and Girls.” Native Women’s Association of Canada, Akwesasne, ON, 2010. http://
www.nwac.ca/wp-content/uploads/2015/05/Fact_Sheet_Missing_and_Murdered_Aborigi-
nal_Women_and_Girls.pdf.
Native Women’s Association of Canada. Voices of Our Sisters in Spirit: A Report to Fam-
ilies and Communities. 2nd ed., March 2009. http://www.nwac.ca/wp-content/up-
loads/2015/05/2009_Voices_of_Our_SIS_A_Report_to_Families_and_Communities.pdf.
Native Women’s Association of Canada. What Their Stories Tell Us: Research for the Sisters
in Spirit Initiative. Ohsweken, ON: Native Women’s Association of Canada, 2010. http://
www.nwac.ca/wp-content/uploads/2015/07/2010-What-Their-Stories-Tell-Us-Research-
Findings-SIS-Initiative.pdf.
Nuu-chah-nulth Tribal Council. Indian Residential Schools: The Nuu-chah-nulth Experi-
ence. Port Alberni, BC: Nuu-chah-nulth Tribal Council, 1996.
Ospina, Maria, and Liz Dennett. Systematic Review on the Prevalence of Fetal Alcohol Spec-
trum Disorders. Edmonton: Institute of Health Economics, 2013.
Pauktuutit Inuit Women of Canada. The Inuit Way: A Guide to Inuit Culture. N.p.: Pauktuutit
Inuit Women of Canada, 2006. http://www.uqar.ca/files/boreas/inuitway_e.pdf.
People for Education. First Nations, Metis and Inuit Education: Overcoming Gaps in Pro-
vincially Funded Schools. Toronto: People for Education, 2013. http://www.peoplefored-
ucation.ca/wp-content/uploads/2013/10/First-Nations-M%C3%A9tis-and-Inuit-Educa-
tion-2013.pdf.
Phaneuf, G., P. Dudding, and J. Arreak. Nunavut Social Service Review: Final Report. Ottawa:
Child Welfare League of Canada, 2011.
Presbyterian Church in Canada Archives. “Brief Administrative History of the Residential
Schools and the Presbyterian Church in Canada’s Healing and Reconciliation Efforts.” Sep-
tember 2010. www.presbyterian.ca/?wpdmdl=94.
Quinn, Ashley, and Michael Saini. Touchstones of Hope: Participatory Action Research to
Explore Experiences of First Nation Communities in Northern British Columbia: Evaluation
Report. Toronto: Factor-Inwentash Faculty of Social Work, University of Toronto, 2012.
Rae, Lisa. Inuit Child Welfare and Family Support: Policies, Programs and Strategies. Ottawa:
National Aboriginal Health Organization, 2011. http://www.naho.ca/documents/it/2011_
Inuit_Child_Welfare_Family_Support.pdf.
Reimer, Gwen, Amy Bombay, Lena Ellsworth, Sara Fryer, and Tricia Logan. The Indian Resi-
dential Schools Settlement Agreement’s Common Experience Payment and Healing: A Qual-
itative Study Exploring Impacts on Recipients. Ottawa: Aboriginal Healing Foundation, 2010.
Richards, John, Jennifer Hove, and Kemi Afolabi. “Understanding the Aboriginal/Non-Ab-
original Gap in Student Performance: Lessons from British Columbia.” C.D. Howe Institute,
Toronto, 2008. https://www.cdhowe.org/sites/default/files/attachments/research_papers/
mixed/commentary_276.pdf.
Schibler, Billie, and James H. Newton. Honouring Their Spirits: The Child Death Review: A
Report to the Minister of Family Services and Housing. Winnipeg: Office of the Children’s
Advocate, 2006. http://www.childrensadvocate.mb.ca/wp-content/uploads/Child-Death-
Review-2006.pdf.
Sharpe, Andrew, and Simon Lapointe. The Labour Market and Economic Performance of
Canada’s First Nations Reserves: The Role of Educational Attainment and Remoteness CSLS
Research Report 2011-05. Ottawa: Centre for the Study of Living Standards, 2011. http://
www.csls.ca/reports/csls2011-05.pdf.
Sinha, Vandna, Nico Trocmé, Barbara Fallon, Bruce MacLaurin, Elizabeth Fast, Shelley
Thomas Prokop, et al. Kiskisik Awasisak: Remember the Children: Understanding the Over-
Representation of First Nations Children in the Child Welfare System. Ontario: Assembly of
First Nations, 2011.
Smylie, Janet. “A Guide for Health Professionals Working with Aboriginal Peoples: Cross
Cultural Understanding.” SOGC Policy Statement, no. 100, February 2001. http://sogc.org/
wp-content/uploads/2013/01/100E-PS4-February2001.pdf.
Stout, Roberta, and Sheryl Peters. kiskinohamâtôtâpânâsk: Inter-generational Effects on Pro-
fessional First Nations Women Whose Mothers Are Residential School Survivors. Winnipeg:
Prairie Women’s Health Centre of Excellence, August 2011.
Tagalik, Shirley. “Inuit Qaujimajatuqangit: The Role of Indigenous Knowledge in Supporting
Wellness in Inuit Communities in Nunavut.” National Collaborating Centre for Aborigi-
nal Health, Prince George, BC, 2010. http://www.nccah-ccnsa.ca/docs/fact%20sheets/
child%20and%20youth/Inuit%20IQ%20EN%20web.pdf.
Tagalik, Shirley. “Inunnguiniq: Caring for Children the Inuit Way.” National Collaborating
Centre for Aboriginal Health, Prince George, BC, 2010. http://www.nccah-ccnsa.ca/docs/
fact%20sheets/child%20and%20youth/Inuit%20caring%20EN%20web.pdf.
Tagalik, Shirley. “Inutsiaqpagutit—That Which Enables You to Have a Good Life: Supporting
Inuit Early Life Health.” National Collaborating Centre for Aboriginal Health, Prince George,
BC, 2010. http://www.nccah-ccnsa.ca/Publications/Lists/Publications/Attachments/5/
Have%20a%20Good%20Life%20-%20Supporting%20Inuit%20Early%20Life%20Health%20
(English%20-%20web).pdf.
Tait, Caroline L. Fetal Alcohol Syndrome among Aboriginal People in Canada: Review and
Analysis of the Intergenerational Links to Residential Schools. Ottawa: Aboriginal Healing
Foundation, 2003.
United Nations. Committee on Economic, Social and Cultural Rights. “Consideration of
Reports Submitted by States Parties under Articles 16 and 17 of the Covenant: Concluding
Observations of the Committee on Economic, Social and Cultural Rights.” E/C.12/CAN/
CO/5, May 2006.
United Nations. Committee on the Rights of the Child. Commentary 11: Indigenous Children
and Their Rights Under the Convention. Geneva: UN, 2009.
United Nations. Committee on the Rights of the Child. “Concluding Observations on the
Combined Third And Fourth Periodic Report of Canada, Adopted by the Committee at Its
Sixty-First Session (17 September – 5 October 2012).” CRC/C/CAN/CO/3-4, 2012.
United Nations. Expert Mechanism on the Rights of Indigenous Peoples. “Advice No. 1: On
the Right of Indigenous Peoples to Education.” Geneva: UN, 2009.
United Nations General Assembly. Convention on the Prevention and Punishment of the
Crime of Genocide. 9 December 1948. https://treaties.un.org/doc/Publication/UNTS/Vol-
ume%2078/volume-78-I-1021-English.pdf
United Nations General Assembly. Convention on the Rights of the Child. 20 November
1989. United Nations, Treaty Series, vol. 1577, p. 3, articles 3, 5, 18, 25 and 27 (3). United
Nations General Assembly. Declaration of Basic Principles of Justice for Victims of Crime
and Abuse of Power. 29 November 1985, A/RES/40/34. http://www.refworld.org/do-
cid/3b00f2275b.html.
United Nations General Assembly. Report of the Special Rapporteur on the Rights of Indig-
enous Peoples, James Anaya, on the Situation of Indigenous Peoples in Canada. United
Nations Human Rights Council, 27th Session, A/HRC/27/52/Add.2. 4 July 2014. http://unsr.
jamesanaya.org/docs/countries/2014-report-canada-a-hrc-27-52-add-2-en.pdf.
United Nations General Assembly. United Nations Declaration on the Rights of Indigenous
Peoples. A/RES/61/295, adopted by the General Assembly 2 October 2007. http://www.
un.org/esa/socdev/unpfii/documents/DRIPS_en.pdf.
United Nations. High Commissioner for Human Rights. Discrimination against Women,
Concluding Observations on Canada’s 7th review, November 2008, CEDAW/C/CAN/CO/7.
http://www2.ohchr.org/english/bodies/cedaw/cedaws42.htm.
United Nations. Human Rights Committee. Concluding Observations of the Human
Rights Committee: Canada, April 2006, CCPR/C/CAN/CO/5. http://www.refworld.org/
pdfid/453777a50.pdf.
Wilson, Daniel, and David Macdonald. The Income Gap between Aboriginal Peoples and the
Rest of Canada. Ottawa: Canadian Centre for Policy Alternatives, 2010.
4. Websites
Canadian Conference of Catholic Bishops. “Pope Benedict XVI Meets with Represen-
tatives of Former Indian Residential School Students and the Church in Canada.” Ca-
nadian Conference of Catholic Bishops. Accessed 11 August 2015. http://www.cccb.
ca/site/eng/church-in-canada-and-world/catholic-church-in-canada/indigenous-
peoples/3203-pope-benedict-xvi-meets-with-representatives-of-former-indian-residential-
school-students-and-the-church-in-canada.
First Nations Child & Family Caring Society of Canada. “I Am a Witness: Canadian Human
Rights Tribunal Hearing.” http://www.fncaringsociety.ca/i-am-witness-timeline-and-doc-
uments.
Indian Residential Schools Adjudication Secretariat. “Who We Are and What We Do.” Ac-
cessed 9 August 2015. http://www.iap-pei.ca/us-nous/us-nous-eng.php#sthash.vkjx05c0.
dpuf.
Kativik School Board. “About Kativik School Board.” Accessed 10 August 2015. http://www.
kativik.qc.ca/about-kativik-school-board.
Manitoba Historical Society. “Memorable Manitobans: Robert Alexander Hoey (1883–1965).”
Accessed 21 December 2013. http://www.mhs.mb.ca/docs/people/hoey_ra.shtml.
Manitoba Metis Federation. “Departments, Portfolios and Affiliates: Metis Child and Family
Services.” Accessed 9 August 2015. http://www.mmf.mb.ca/departments_portfolios_and_
affiliates_details.php?id=22.
Merchant Law Group. “Indian and Metis Scoop Class Action.” Accessed 7 November 2013.
https://www.merchantlaw.com/classactions/scoop.php.
Métis National Council. “Who Are the Métis: Citizenship.” Accessed 4 April 2013. http://www.
metisnation.ca/index.php/who-are-the-metis/citizenship.
Mississaugas of the New Credit First Nation. “Special Education Human Rights Case: About
the Case.” Accessed 26 October 2013. http://www.firstnationsspecialeducation.ca/about-
the-case/.
National Indian Child Welfare Association. “Indian Child Welfare Act of 1978.” NICWA. Ac-
cessed 8 August 2015. http://www.nicwa.org/Indian_Child_Welfare_Act/.
Ogwehoweh Skills and Trades Training Centre. OSTTC homepage. Accessed 10 August 2015.
http://www.osttc.com/.
Ontario. Ministry of Community and Social Services. “Aboriginal Health and Wellness Strat-
egy.” Accessed 18 March 2012. http://www.mcss.gov.on.ca/en/mcss/programs/commu-
nity/programsforaboriginalpeople.aspx/programs/hacc.html.
Signs of Safety. Signs of Safety: Simplifying Child Protection Complexity. Accessed 9 August
2015. http://www.signsofsafety.net/signs-of-safety/.
United Church of Canada. “The Healing Fund, Criteria for Healing Fund Projects.” Accessed
12 August 2015. http://www.united-church.ca/funding/healing/grantcriteria.
Yellowquill College. “Programs.” Accessed 10 August 2015. http://yellowquill.org/programs.
5. Newspapers and Broadcast Media

Barrera, Jorge. “Valcourt Used Unreleased RCMP Data to claim Aboriginal MEN Responsi-
ble for Majority of Murders of Aboriginal Women: Chiefs.” APTN, 25 March 2015. http://
aptn.ca/news/2015/03/25/chiefs-say-valcourt-used-unreleased-rcmp-data-claim-indige-
nous-men-responsible-majority-indigenous-women-murders/.
Beeby, Dean. “Aboriginal Affairs Spending Shortfall Amounts to $1B, Internal Document
Says.” CBC News, 5 June 2015. www.cbc.ca/news/politics/aboriginal-affairs-spending-
shortfall-amounts-to-1b-internal-document-says-1.3100937.
Burnouf, Larissa. “Marlene Bird Talks about Being Attacked and Her Struggle Since.” APTN,
10 October 2014. http://aptn.ca/news/2014/10/10/marlene-bird-talks-attacked-struggle-
since.
Canada, Rob Nicholson, Vic Toews, Jason Kenney, and Senator Pierre-Hugues Boisvenu.
“Statement of the Government of Canada on the Royal Assent of Bill C-10.” Reuters.com, 13
March 2012.
Canadian Press. “Winnipeg Police Officer Suspended without Pay in Tina Fontaine Case.” The
Star (Toronto), 24 March 2015. http://www.thestar.com/news/canada/2015/03/24/winni-
peg-police-officer-suspended-without-pay-in-tina-fontaine-case.html.
CBC News. “‘I Am Sorry,’ NWT Bishop Tells Dene Residential School Survivors.” 28 May 2009.
http://www.cbc.ca/news/canada/north/story/2009/05/28/catholic-dene-apology.html.
CBC News. “Illustrations Tell Story Of Marlene Bird, Homeless Woman Beaten and Set on
Fire.” 20 January 2015. http://www.cbc.ca/news/multimedia/illustrations-tell-story-of-mar-
lene-bird-homeless-woman-beaten-and-set-on-fire-1.2919832.
CBC News. “Pope Expresses ‘Sorrow’ for Abuse at Residential Schools.” 29 April 2009. http://
www.cbc.ca/news/world/story/2009/04/29/pope-first-nations042909.html.
Curry, Bill. “Aboriginals in Canada Face ‘Third World’ Level Risk of Tuberculosis.” Globe and
Mail, 10 March 2010. http://www.theglobeandmail.com/news/national/aboriginals-in-
canada-face-third-world-level-risk-of-tuberculosis/article4352641/.
Gajewski, Karen Ann. “A Class-Action Lawsuit Has Been Filed by South Dakota Parents and
Tribes over Unlawful Separation of Children from Their Families.” The Humanist, May–June
2013.
Galloway, Gloria. “70 Per Cent of Murdered Aboriginal Women Killed by Indigenous Men:
RCMP.” Globe and Mail, 9 April 2015. http://www.theglobeandmail.com/news/poli-
tics/70-per-cent-of-murdered-aboriginal-women-killed-by-indigenous-men-rcmp-con-
firms/article23868927/.
Gatehouse, Jonathan. “The Residential Schools Settlement Biggest Winner: A Profile of Tony
Merchant.” Maclean’s, 11 September 2006. Rpt. macleans.ca, 4 April 2013. http://www2.
macleans.ca/2013/04/04/white-mans-windfall-a-profile-of-tony-merchant/.
Gregoire, Lisa. “Marius Tungilik: Inuit Leader, Whistleblower and Public Servant, Dead at
55.” Nunatsiaq Online, 22 December 2012. http://www.nunatsiaqonline.ca/stories/arti-
cle/65674marius_tungilik_inuit_leader_whistleblower_and_public_servant_dead_at_.
Gyorgy, Jane. “Bishop’s Apology Falls Flat: Former Students Want Public Inquiry into Abuse at
Chesterfield Inlet School.” Gazette (Montréal), 25 July 1993. E8.
Henton, Darcy. “Deaths of Aboriginal Children in Care No ‘Fluke of Statistics.” Edmonton
Journal, 8 January 2014. http://www.edmontonjournal.com/life/Deaths+Alberta+aborigi-
nal+children+care+fluke+statistics/9212384/story.html.
Howard, Ross. “Probes Document Abuse at NWT Church Schools Inuit Students Were Power-
less to Stop Assaults 25 Years Ago by Clergy, Teachers.” Globe and Mail, 28 June 1995.
Kennedy, Mark. “Rinelle Harper Calls for Missing Women Inquiry, Urges Forgiveness.”
Ottawa Citizen, 9 December 2014. http://ottawacitizen.com/news/politics/rinelle-harper-
calls-for-missing-women-inquiry-urges-forgiveness.
Kraus, Sarah. “Merchant Law Group in Legal Battle of Its Own.” Global News, 30 January 2015.
http://globalnews.ca/news/1804029/merchant-law-group-in-legal-battle-of-its-own/.
Makin, Kirk. “Aboriginal Sentencing Rules Ignored Due to Lack of Funding, Interest.” Globe
and Mail, 19 November 2012. http://www.theglobeandmail.com/news/politics/aborigi-
nal-sentencing-rules-ignored-due-to-lack-of-funding-interest/article5459491/#.
McLintock, Barbara. “He Finally Confesses: Roman Catholic Bishop Apologizes for His Sins,
and a Proud Native Woman Can Start Putting The Past behind Her.” The Province (Vancou-
ver), 18 June 1998.
Moon, Peter. “Hundreds of Cree and Ojibwa Children Violated.” Globe and Mail, 19 October
1996.
Murphy, David. “Pauktuutit Wants Action on Violence against Inuit Women, but Ottawa
Denies Funding.” Nunatsiaq Online, 28 February 2014. http://www.nunatsiaqonline.ca/
stories/article/65674inuit_womens_organization_shut_out_of_funding_again/.
Neel, David. “Two Faces of Justice.” The Province (Vancouver), 17 December 1992.
Palmater, Pamela. “RCMP Report on Murdered and Missing Aboriginal Women is Statisti-
cally Skewed.” Rabble.ca, 13 April 2015. http://rabble.ca/blogs/bloggers/pamela-palma-
ter/2015/04/rcmp-report-on-murdered-and-missing-aboriginal-women-statisti.
Picard, Andre. “Harper’s Disregard for Aboriginal Health.” Globe and Mail, 10 September
2012.
Porter, Jody. “Walls Crumble, Mould Infects First Nation School.” CBC News, 19 April 2012.
http://www.cbc.ca/news/canada/thunder-bay/story/2012/04/19/tby-mouldy-school.html.
Rideout, Denise. “Commission Considers Rules for Custom Adoptions: Nunavummiut Seek
Balance Between Legal Regulations and Longstanding Tradition.” Nunatsiaq News, 8 De-
cember 2000. http://www.nunatsiaqonline.ca/archives/nunavut001231/nvt21208_11.html.
Skelton, Chad, and Linsay Kines. “School Abuse Queries Overwhelm RCMP: The Force’s Abil-
ity To Bring Suspects to Trial Is Being Impaired, a Senior Officer Argues.” Vancouver Sun, 11
February 2000. A5.
Staniforth, Jesse B. “Where Did Aboriginal Affairs Put That Missing $1 Billion?” The Na-
tion (Eeyou Istchee), 26 June 2015. www.nationnews.ca/where-did-aboriginal-af-
fairs-put-that-missing-1-billion/.
Taylor, Glenn. “Grollier Meeting Emotional.” Northern News Services Online, 23 January 1998.
http://www.nnsl.com/frames/newspapers/1998-01/jan23_98grol.html.
Treble, Patricia, and Jane O’Hara. “Residential Church School Scandal.” Maclean’s, 26 June
2000. Rpt. in The Canadian Encyclopedia, 17 March 2013. http://www.thecanadianencyclo-
pedia.ca/en/article/residential-church-school-scandal/.
Vancouver Sun. “Bishop O’Connor Diverted.” 18 June 1998. Reproduced at Vancouver Rape
Relief and Women’s Shelter, http://www.rapereliefshelter.bc.ca/learn/news/bishop-ocon-
nor-diverted.
6. Theses and Dissertations

Canada, Deborah. “The Strength of the Sash: The Métis People and the British Columbia
Child Welfare System.” PhD diss., University of British Columbia, Vancouver, 2012. https://
circle.ubc.ca/bitstream/handle/2429/42150/ubc_2012_spring_canada_deborah.pdf?se-
quence=1.
Carrière, Jeannine. “Connectedness and Health for First Nation Adoptees.” PhD diss., Univer-
sity of Alberta, Edmonton, 2005.
Pearce, Maryanne. “An Awkward Silence: Missing and Murdered Vulnerable Women and the
Canadian Justice System.” PhD diss., University of Ottawa, Faculty of Law, 2013.
7. Other
Aboriginal Healing Foundation. List of Contacts for Healing Centres. Accessed 23 March
2012. http://www.ahf.ca/downloads/updated-list-of-healing-centres.pdf.
Anglican Church of Canada. “Anglican Healing Fund, Granting Criteria.” Accessed 12 August
2015. http://www.anglican.ca/healingfund/criteria/.
Atleo, Shawn. “First Nations Control of First Nations Education Announcement and Federal
Budget 2014.” Assembly of First Nations, Communiqué from Grand Chief Shawn Atleo,
February 2014. http://www.afn.ca/uploads/files/14-02-14_nc_bulletin_fn_education_an-
nouncement_and_budget_2014_fe.pdf.
Blackstock, Cindy, Andrea Auger, Heather Ochalski, Jeannine Carrière, Sinéad Charbonneau,
and Cathy Richardson. “Is It Over Yet? Residential Schools, Child Welfare and the Mass Re-
movals of First Nations, Inuit and Métis Children from Their Families.” Unpublished paper
submitted to the Truth and Reconciliation Commission, April 2013.
Canada. Bank of Canada. Inflation Calculator. Accessed 15 May 2015. http://www.bankofcan-
ada.ca/rates/related/inflation-calculator/.
Elizabeth Fry Society. “Discrimination against Aboriginal Women Rampant in Federal Pris-
ons Claims the Native Women’s Association of Canada.” Press release, 14 May 2003. http://
www.caefs.ca/wp-content/uploads/2013/04/nwac1.pdf.
Indian Residential Schools Adjudication Secretariat. “Observations on Residential School
Experience Data Obtained from Claims Concluded under the Independent Adjudication
Process (IAP).” Unpublished report, 27 March 2015.
Human Rights Commission Complaint Form, filed against Indian and Northern Affairs
Canada by Regional Chief Lawrence Joseph and Cindy Blackstock. Accessed 8 August 2015.
http://www.fncaringsociety.com/sites/default/files/Caring%20Society_AFN%20HR%20
complaint%202007.pdf.
Missionary Oblates of Mary Immaculate. “An Apology to the First Nations of Canada by the
Oblate Conference of Canada.” 24 July 1991. Accessed 8 March 2015. http://www.cccb.ca/
site/images/stories/pdf/oblate_apology_english.pdf.
National Aboriginal Health Organization. “Announcement.” 5 April 2012. http://www.naho.
ca/wp-content/uploads/2012/04/NAHO-Announcement-5-APR-12.pdf.
Obomsawin, Alanis, dir. Richard Cardinal, Cry from a Diary of a Métis Child. Montréal: Na-
tional Film Board of Canada, 1985.
Ochalski, Heather. “Addressing Inuit Child Welfare in Canada: Traditional Inuit Parenting
Methods, Impact of European Contact, and Contemporary Challenges Facing Inuit Child
Welfare.” Notes from 2012 focus group. In “Is It Over Yet?” by Blackstock et al.
The Presbyterian Church. “The Confession of the Presbyterian Church as Adopted by the
General Assembly, June 9th, 1994.” Remembering the Children. Last modified 8 September
2008. http://www.rememberingthechildren.ca/press/pcc-confession.htm.
United Church of Canada. “Apology to First Nations People.” United Church Social Policy Po-
sitions. United Church of Canada, 1986. Accessed 8 March 2015. http://www.united-church.
ca/beliefs/policies/1986/a651.
United Church of Canada. “Fall 2013 Healing Fund Grants.” Accessed 21 May 2015. http://
www.united-church.ca/files/funding/healing/grants_2013-fall.pdf.
This is Exhibit “C” referred to in the Affidavit of Grand Chief

Transcultural Psychiatry 2014, Vol. 51(3) 320–338 ! The Author(s) 2014
Reprints and permissions: sagepub.co.uk/journalsPermissions.nav
DOI: 10.1177/1363461513503380 tps.sagepub.com
Article
The intergenerational effects of Indian

Residential Schools: Implications for the
concept of historical trauma
Amy Bombay
University of Ottawa
Kimberly Matheson
Carleton University
Hymie Anisman
Carleton University
Abstract
The current paper reviews research that has explored the intergenerational effects of
the Indian Residential School (IRS) system in Canada, in which Aboriginal children were
forced to live at schools where various forms of neglect and abuse were common.
Intergenerational IRS trauma continues to undermine the well-being of today’s
Aboriginal population, and having a familial history of IRS attendance has also been
linked with more frequent contemporary stressor experiences and relatively greater
effects of stressors on well-being. It is also suggested that familial IRS attendance across
several generations within a family appears to have cumulative effects. Together, these
findings provide empirical support for the concept of historical trauma, which takes the
perspective that the consequences of numerous and sustained attacks against a group
may accumulate over generations and interact with proximal stressors to undermine
collective well-being. As much as historical trauma might be linked to pathology, it is not
possible to go back in time to assess how previous traumas endured by Aboriginal
peoples might be related to subsequent responses to IRS trauma. Nonetheless, the
currently available research demonstrating the intergenerational effects of IRSs provides
support for the enduring negative consequences of these experiences and the role of
historical trauma in contributing to present day disparities in well-being.
Corresponding author:
Amy Bombay, Institute of Mental Health Research, University of Ottawa, 1145 Carling Avenue, Ottawa, ON
K1Z 7K4, Canada.
Email: abombay@uottawa.ca
Bombay et al. 321
Keywords
Aboriginal, historical trauma, Indian Residential School, intergenerational trauma,
stressors
There are various processes by which the experience of trauma in one generation
can influence subsequent generations, a perspective that seems to have resonated in
the literature related to Aboriginal health, as well as among Aboriginal peoples
living with the historical, collective traumas experienced by their ancestors (Evans-
Campbell, 2008; Gone, 2009; Whitbeck, Adams, Hoyt, & Chen, 2004). Although
much of the research assessing intergenerational trauma effects has been conducted
in the context of the Holocaust (Shoah), it is clear that comparable effects have also
occurred in other groups exposed to discrete or chronic collective trauma experi-
ences. To a considerable extent this research has focused on diagnosable disorders
and/or individual physiological, psychological, and emotional effects among the
offspring of trauma survivors (Evans-Campbell, 2008).
Although it is important to identify individual reactions to specific historically
traumatic events or periods, there has been less attention focused on the interrelated
effects of trauma experiences on family dynamics and on whole communities (Evans-
Campbell, 2008; Waldram, 2004). Furthermore, and particularly germane to
Aboriginal groups who had endured continuous assaults since the arrival of coloniz-
ing groups, research examining individual-level intergenerational effects typically
has not considered the larger context in which these traumatic events rest
(Kirmayer, Brass, & Tait, 2000). Just as the impact of a stressor on individual func-
tioning is influenced by a person’s past experiences and current environment, the
influence of a collective trauma on well-being needs to be considered in the context of
the group’s historical and contemporary stressor experiences. Although variations
exist concerning the precise conceptualization of the term, the concept of historical
trauma (Brave Heart, 1999; Brave Heart & DeBruyn, 1998) addresses this issue, as it
highlights the idea that the accumulation of collective stressors and trauma that
began in the past may contribute to increased risk for negative health and social
outcomes among contemporary Aboriginal peoples (Walters et al., 2011).
Despite the scholarly interest in historical trauma as an explanation for current
group-based health disparities (e.g., Brave Heart & DeBruyn, 1998), there is rela-
tively little empirical research documenting this phenomenon (Sotero, 2006). In part,
this likely stems from the differing conceptualizations of historical trauma, as the
term has been used both as a description of trauma responses, as well as a causal
explanation for them (Evans-Campbell, 2008; Walters et al., 2011). In attempt to
address this problem, Evans-Campbell (2008) identified three distinguishing char-
acteristics of historical trauma events, which can be discrete or more chronic
occurrences:
1. the event was widespread among a specific group or population, with many
group members being affected;
322 Transcultural Psychiatry 51(3)
2. the event was perpetrated by outgroup members with purposeful and often
destructive intent;
3. the event generated high levels of collective distress in the victimized group.
In addition, there also seem to be generally agreed upon characteristics of historical

trauma responses, which comprise the following:
1. historical trauma events continue to undermine well-being of contemporary

group members;
2. responses to historically traumatic events interact with contemporary stressors
to influence well-being;
3. the risk associated with historically traumatic events can accumulate across
generations.
In order to validate these theoretical constructs related to historical trauma, empir-

ical research is needed to provide evidence that the characteristic historical trauma
responses are, in fact, elicited by such events. However, this may prove to be
untenable, as it is exceedingly difficult to conceptualize and objectively measure
how traumatic events that took place in the distant past affect individuals currently.
This said, there are several relatively recent chronic collective traumas that spanned
generations and affected large portions of the Aboriginal population in Canada
which meet the criteria of historical trauma events that may provide empirical
support for the central tenets of this concept.
Indian Residential Schools as an example

of historical trauma
Although numerous historically traumatic events occurred earlier, the 19th century
in Canada was marked by government policies to assimilate Aboriginal peoples
based on the assumption that Whites were inherently superior to the “Indians” they
considered to be savage and uncivilized. The Indian Residential School (IRS)
system was one of the key mechanisms by which the government attempted to
achieve their goals of eliminating their “Indian problem” (Royal Commission on
Aboriginal Peoples [RCAP], 1996), which ran from the 1880s until the last school
closed in the mid-1990s. By 1930, roughly 75% of all First Nations children
between the ages of 7 and 15 attended IRS, as did significant numbers of Métis
and Inuit children (Fournier & Crey, 1997). It has been estimated that over 150,000
Aboriginal children in Canada attended IRSs (Barkan, 2003).
Children as young as 3 were forced, by law, to leave their families and commu-
nities to live at schools designed to “kill the Indian in the child” (RCAP, 1996).
These schools taught Aboriginal children to be ashamed of their languages, cultural
beliefs and traditions, and were largely ineffective at providing proper or even ade-
quate education (Deiter, 1999; Friesen & Friesen, 2002). In addition to the signifi-
cant number of mortalities and children who went “missing” from these schools,
Bombay et al. 323
many were also victims of chronic mental, physical, and sexual abuses and neglect
(RCAP, 1996). Not surprisingly, IRS Survivors have been more likely to suffer a
variety of mental and physical health problems compared to Aboriginal adults who
did not attend (First Nations Centre, 2005).
In addition to negative effects observed among those who attended IRS, accu-
mulating evidence suggests that the children of those who attended (IRS off-
spring) are also at greater risk for poor well-being. In the current paper, we
provide an overview of existing empirical research relating to intergenerational
effects of the IRS system, which is one example of a historically traumatic event
experienced by Aboriginal peoples in Canada. In this regard, although not all
communities were affected, a large proportion of Aboriginal children from across
Canada were forced to attend IRSs, which intentionally sought to assimilate
Aboriginal peoples and destroy their culture, and has resulted in individual
and community distress. Providing evidence that IRSs elicited the three charac-
teristic historical trauma responses previously outlined, the data currently avail-
able suggests that IRSs continue to undermine the health and well-being of
today’s Aboriginal population, and several potential mediators of these effects
have been identified. Providing evidence for the second and third criteria of his-
torical trauma responses, studies have also suggested that having a familial his-
tory of IRS attendance interacts with current stressors to influence well-being,
and that the risk associated with IRS trauma may accumulate across generations.
In addition to several smaller scale community-based studies, much of this
research stems from analyses using national-level data from the First Nations
Regional Longitudinal Health Survey (RHS; First Nations on-reserve) and the
Aboriginal Peoples Survey (APS; Aboriginal peoples living off-reserve).
To be sure, the studies that have been conducted are not without limitations.
Among other things, the data are often based on self-reports rather than objective
measures. For the community-based studies that are reviewed, participants were
often self-selected and the samples sizes were relatively small. Furthermore, the
relationship between historical trauma and current experiences may vary from one
region of Canada to another, and may even differ between different communities,
to say nothing of differences between individuals on- and off-reserve. Thus, it is
difficult to generate conclusions that apply broadly. Finally, the studies conducted
are invariably of a correlational nature, precluding the possibility of making causal
attributions regarding the impact of previous trauma. Nevertheless, although such
biases may raise questions about the directional nature of the relations, they do not
alter the fact that the relations were present and that IRS-affected individuals
appear to be at greater risk for poor health and social outcomes.
Historical trauma responses related to familial

IRS attendance
Most of the research assessing outcomes associated with familial IRS attendance
has focused on the psychological effects observed among the children and
grandchildren of IRS Survivors. In this regard, data from the 2002–2003 RHS
revealed that 37.2% of adults who had at least one parent who attended IRS
thought about committing suicide in their lifetime, compared to 25.7% of those
whose parents did not attend (Assembly of First Nations [AFN]/First Nations
Information Governance Committee [FNIGC], 2007, p. 37). As well, 20.4% of
adults who had at least one grandparent who attended IRS had attempted
suicide, compared to 13.1% who did not have grandparents who attended
(AFN/FNIGC, 2007, p. 37). Likewise, analyses of the Manitoba 2002–2003
adult RHS data revealed that having a parent or grandparent who attended
IRS was associated with a history of suicidal thoughts and attempts (Elias
et al., 2012). Consistent with these greater suicidal tendencies reported by
IRS offspring living on-reserve, in a sample (N ¼ 143) of First Nations adults
living predominately in rural and urban areas across Canada, higher levels of
depressive symptoms were also evident among IRS offspring relative to those
whose families were not intimately affected by IRSs (Bombay, Matheson, &
Anisman, 2011).
Analyses from the youth portion of the 2002–2003 RHS data revealed that
the greater risk for distress associated with parental IRS attendance may begin
to manifest itself during adolescence. In this regard, 26.3% of First Nations
youth with a parent who attended IRS had thought about suicide, whereas
18.0% of non-IRS youth reported such suicidal ideation (First Nations Centre,
2005, p. 217). Parental IRS attendance was also associated with attempted
suicide in a sample (N ¼ 605) of drug-using young Aboriginal peoples aged
14–30 in Vancouver and Prince George, British Columbia (Moniruzzaman
et al., 2009). Consistent with these findings, the 2008–2010 RHS revealed
that 31.4% of First Nations youth living on-reserve who had a parent
who attended IRS reported symptoms of depression, compared to 20.4% of
youth with neither parent who attended (Bombay, Matheson, & Anisman,
2012, p. 347).
Possibly related to their increased risk of psychological distress, youth RHS
respondents with a parent who attended IRS were also more likely to have
problems with respect to educational outcomes. Specifically, the 2002–2003
RHS revealed that First Nations youth who had a parent who attended IRS
were more likely to report having learning difficulties at school (48.7% of
youth whose parents attended vs. 40.4% whose parents did not attend) and
having had to repeat a grade (47.3% of youth whose parents attended vs.
35.2% whose parents did not attend; First Nations Centre, 2005, p.161).
Likewise, analyses of the 2006 APS revealed that Aboriginal children and
youth (aged 6–14) living off-reserve tended to have lower levels of school success
if their parent attended IRS (Bougie & Senécal, 2010). In addition to these effects
on mental health and educational outcomes, young Aboriginal drug users
(N ¼ 512, aged 14–30) who had a parent who attended IRS, were more likely
to contract Hepatitis C virus infection compared to those without a familial IRS
history (Craib et al., 2009).
Bombay et al. 325
Mediators between familial IRS attendance and well-being

In addition to the negative effects on well-being that have been documented among
descendants of IRS Survivors, research has begun to identify some of the potential
mechanisms by which IRSs exert intergenerational effects (although only some of
these have undergone explicit tests of mediation). For example, stress proliferation,
which refers to a process in which an initial challenge or adverse experience gives
rise to additional stressors (Pearlin, Aneshensel, & LeBlanc, 1997), appears to be a
significant pathway leading to increased vulnerability to poor well-being. This can
occur when difficulties in one domain of life seep into other aspects or when
childhood adversities favor the occurrence of other behaviors or circumstances
(e.g., elevated risk taking, poor socioeconomic status) that foster later stressor
encounters (Thoits, 2010). More recently, this concept has been expanded to
include intergenerational stress proliferation, where parental stress influences chil-
dren’s exposure to stressors indirectly through social disadvantages and directly by
altering parenting behaviors (Thoits, 2010; Wheaton & Clarke, 2003). For example,
the 2006 APS survey revealed that off-reserve Aboriginal children whose parents
attended IRS were more likely to grow up in larger households, in households with
lower incomes, and in households that experienced food insecurity (Bougie &
Senécal, 2010). In turn, the lower income among IRS parents, which may have
stemmed from deficiencies in functioning and lower educational achievement due
to their IRS experiences, partially accounted for the reduced school success of their
children (Bougie & Senécal, 2010).
It has frequently been suggested that the lack of traditional parental role models
among IRS Survivors impeded the transmission of positive child-rearing practices
and actually instilled negative parenting practices (Evans-Campbell, 2008).
Although tests of mediation were not conducted in this study, parental IRS attend-
ance and involvement with the child welfare system was associated with being a
victim of sexual abuse among a sample of young Aboriginal drug users (aged 14–30
years; N ¼ 543; For the Cedar Project Partnership et al., 2008). In a separate quali-
tative study among 43 service providers who have worked with individuals and
communities affected by IRSs, the widespread sexual abuse suffered by generations
of children while attending these schools were implicated as key factors that con-
tributed to high rates of sexual abuse in some communities. This was attributed, in
part, to the alteration of social norms generated by the IRSs, including the ten-
dency for individuals not to report these abusive incidents (Bombay, Matheson, &
Anisman, in press).
Although experiences of sexual abuse have been uniquely associated with sig-
nificant life-long negative effects on well-being (Chartier, Walker, & Naimark,
2010), large-scale studies in the general population have suggested that sexual
abuse rarely occurs in the absence of other forms of abuse (i.e., physical, emo-
tional), neglect (physical, emotional), and household dysfunction (e.g., parental
substance use, domestic violence; Dong et al., 2004; Turner, Finkelhor, &
Ormrod, 2010). The importance of considering the co-occurrence of various
types of adverse childhood experiences is highlighted by increasing evidence that

exposure to these experiences are cumulatively linked with a range of negative
outcomes that continue into adulthood (Chartier et al., 2010; Turner et al.,
2010). Indeed, among First Nations adults living primarily off-reserve (N ¼ 143),
relative to non-IRS adults, the IRS offspring reported greater cumulative child-
hood abuse, neglect, and indices of household dysfunction (e.g., being raised in a
household affected by domestic violence, substance abuse, criminal behavior, and
mental illness), which in turn partially accounted for their higher levels of depres-
sive symptoms (Bombay et al., 2011).
These findings are in line with the perceptions reported by IRS offspring in the
2002–2003 RHS that parental IRS attendance negatively affected the parenting
that they received as children (AFN/FNIGC, 2007, p. 36), which was likely influ-
enced directly through modeling of negative care-taking practices observed in IRSs.
As noted earlier, however, these effects on parenting also appeared to evolve indir-
ectly through the decreased health and socioeconomic factors stemming from their
IRS experiences that limited the resources and opportunities that could be provided
to their children. In addition to the effects on individuals and families who were
directly affected by IRSs, qualitative responses provided in the previously men-
tioned study conducted with service providers suggested that the consequences of
the resulting cycles of parenting deficiencies might have exacted a toll on whole
communities by altering social norms related to parenting and by sustaining factors
that promoted these deficiencies (e.g., high rates of trauma exposure, low educa-
tional achievement; Bombay et al., in press).
In addition to the proliferation of stressors across generations, stress-
proliferation processes throughout one’s own lifetime also appear to be involved
in contributing to greater distress among IRS offspring. In this regard, the greater
exposure to adverse childhood experiences among IRS offspring seemed to put
them on a trajectory for increased stressor exposure as adults. Specifically, the
number of adversities encountered by IRS offspring in childhood was associated
with greater exposure to traumatic experiences and higher levels of perceived dis-
crimination in adulthood. In turn, each of these stressors demonstrated unique
mediating roles in the relation between parental IRS attendance and depressive
symptoms in First Nations adults (Bombay et al., 2011). Consistent with these
findings, analyses of the 2002–2003 Manitoba RHS revealed that a history of
abuse or victimization as a child or adult was associated with having a parent or
grandparent who attended IRS (Elias et al., 2012).
In addition to their increased exposure to stressors, IRS offspring also seem to be
more affected by stressors. In this regard, the occurrence of depressive symptoms was
independently related to adverse childhood experiences, trauma experienced in
adulthood, and levels of perceived discrimination, and in each case, symptomatology
associated with these stressors were greater among IRS offspring compared to non-
IRS adults in the study carried out with First Nations adults from across Canada
(Bombay et al., 2011). It is known that stressful events may result in the sensitization
of biological stress systems (e.g., hypothalamic–pituitary–adrenocortical axis [HPA]
Bombay et al. 327
functioning as well as neurochemical functioning in limbic and frontal cortical

regions; Anisman, Merali, & Hayley, 2008) so that behavioral and biological
responses to later stressors are exaggerated. In this regard, both prenatal stressors
(i.e., stressors in pregnant women) and early life adverse events may have these
sensitizing effects (Hochberg et al., 2011). It was reported that dysregulation of
HPA axis functioning was observed in Holocaust offspring (Yehuda, Halligman,
& Grossman, 2001), and it is conceivable that similar outcomes would be apparent in
the children of IRS Survivors. In addition to the potential physiological explanations
for the increased vulnerability to the negative effects of stressors, the greater reactiv-
ity to stressors among IRS offspring may also stem from a variety of psychosocial
processes, such as altered appraisals of stressors and/or poor coping strategies.
Parental IRS attendance also seems to be linked with a number of negative
health behaviors, which might contribute to decreased well-being among descend-
ants of IRS Survivors. For example, having at least one parent who attended IRS
was associated with smoking among adults and youth in the 2002–2003 RHS (First
Nations Centre, 2005, pp. 111 and 205, respectively). Highlighting how these
behaviors can contribute to continued intergenerational effects, in both the
2002–2003 and the 2008–2010 RHS, mothers who had a parent or grandparent
who had attended IRS were more likely to smoke during pregnancy (First Nations
Centre, 2005, p. 248; Smylie, O’Campo, McShane, Daoud, & Davey, 2012, p. 432).
In turn, maternal smoking while pregnant was predictive of the birth weight of
their offspring in the 2008–2010 RHS (Smylie et al., 2012, pp. 431–432). Likewise,
in addition to their increased psychological distress and greater likelihood of con-
tracting Hepatitis C, young Aboriginal drug users in British Columbia (N ¼ 605)
who had a parent who attended IRS were more likely to progress to injection drug
use compared to users without a familial history of IRS attendance (Miller et al.,
2011), which could have contributed to either of these negative outcomes.
Ethnic and cultural identity is considered to be an important determinant of
health among minority group members (T. B. Smith & Silva, 2011). Considering
that the explicit goal of IRSs was to assimilate Aboriginal children and instill a
sense of shame regarding their culture, it might be expected that these experiences
had effects on aspects of Aboriginal identity. Although group identification com-
prises several components (e.g., Sellers, Smith, Shelton, Rowley, & Chavous, 1998),
identity centrality, which refers to the degree to which an individual feels that their
group membership is a central part of who they are, is one of the most commonly
explored aspects of identity (Cameron, 2004). In exploring levels of identity cen-
trality in a sample of Aboriginal adults living primarily off-reserve (N ¼ 399), IRS
offspring were particularly likely to consider their Aboriginal heritage as a central
or salient component of their self-concept relative to those without a familial his-
tory of IRS attendance (Bombay, Matheson, & Anisman, 2014). Although
explanations for this difference were not explored in this study, it is possible that
constant verbal and nonverbal reminders of IRSs that might be present in the lives
of IRS offspring could enhance the salience of their Aboriginal identity.
Alternatively, it might reflect a process observed among other minority groups,
in which outgroup rejection (in this case the knowledge that their group was the
target of historical trauma, such as IRS, that focused on their assimilation), leads
to greater identification with the ingroup (Branscombe, Schmitt, & Harvey, 1999).
Although other facets of cultural identity typically act as protective factors for
well-being (e.g., collective pride), the positive effects of having a strong cultural
identity may be mitigated by the fact that high levels of identity centrality appear to
be linked with greater levels of perceived discrimination (Sellers & Shelton, 2003),
which may put these individuals at greater risk for poor health and social out-
comes. Research in other minority groups suggested that the high levels of per-
ceived discrimination reported by group members high in identity centrality may be
due to an increased inclination to appraise an intergroup encounter as reflecting
discrimination because they are more sensitive to race-related cues (Operario &
Fiske, 2001; Sellers & Shelton, 2003). Indeed, in the previously mentioned study
(Bombay et al., 2014), it was found that IRS offspring were more likely to appraise
hypothetical intergroup scenarios as reflecting discrimination on the part of the
outgroup member involved in the interaction, which was mediated by their higher
levels of identity centrality and greater past experiences of discrimination.
Furthermore, IRS offspring were also more likely to appraise such discriminatory
events as a threat to their well-being, which in turn contributed to their relatively
greater depressive symptoms.
Considered to be another aspect of identity, it has been suggested that encul-
turation or immersion in one’s traditional culture can act as a protective factor for
Aboriginal peoples (Rieckmann, Wadsworth, & Deyhle, 2004; Whitbeck, Chen,
Hoyt, & Adams, 2004; Whitbeck, Hoyt, Stubben, & Lafromboise, 2001).
It might be expected that levels of enculturation would be lower among children
of IRS offspring since their parents grew up in a setting where their languages and
cultural practices were forbidden and disparaged. In contrast, however, adults and
youth in the 2002–2003 RHS who had a parent who attended IRS were equally
likely to speak their respective First Nations language (First Nations Centre, 2005,
p. 34), which is considered to be an important characteristic behavior associated
with enculturation (Park, 2007). This may be explained by the unanticipated find-
ing that IRS Survivors were more likely to speak a First Nations language com-
pared to non-IRS adults living on-reserve (First Nations Centre, 2005, p. 34).
It was suggested in this report that this may reflect the fact that IRS Survivors
were more likely to reside in isolated communities where language skills were found
to be stronger, and/or because of the resiliency of IRS Survivors who secretly spoke
their language as an act of rebellion or who sought to relearn their Aboriginal
languages as part of their healing process (First Nations Centre, 2005, pp. 38–39).
Although this did not seem to affect the ability to speak Aboriginal languages in
the children of those who attended, individuals with at least one grandparent who
attended were less likely to understand a First Nations language “relatively well” or
“fluently” (p. 34). Despite the lower proportion of adult grandchildren who were
able to understand First Nations languages, adults with at least one parent or
grandparent who attended IRS were more likely to regard cultural events as
Bombay et al. 329
somewhat or very important (First Nations Centre, 2005, p. 35). Thus, on the
whole, the IRS experience may not have had the intended effect of “taking the
Indian out of the child,” and although it effectively undermined various attributes
of well-being, may have actually increased certain aspects of their identity.
Research in other minority groups has revealed the intergenerational transmis-
sion of attitudes (e.g., prejudices and stereotypes) toward outgroup members
(O’Bryan, Fishbein, & Ritchey, 2004). Indeed, in a sample of Aboriginal adults
from across Canada (N ¼ 164), this was also observed among Aboriginal adults
who reported that they had a family member or loved one who attended IRS, as
these individuals reported greater perceived discrimination that, in turn, was asso-
ciated with lowered intergroup trust and forgiveness (Bombay, Matheson, &
Anisman, 2013). The low levels of intergroup trust and forgiveness, particularly
in relation to the Canadian government, in turn, predicted pessimistic attitudes
towards potential changes stemming from the IRS apology given to Aboriginal
peoples in 2008. This is not to say that the apology was rejected; rather, individuals
expressed the view that they thought this was a good first step, but that the apology
needed to be coupled with concrete actions that would benefit the well-being of
Aboriginal peoples (Bombay et al., 2013). Thus, in addition to interacting with and
influencing responses to contemporary stressors and discriminatory encounters,
having a family history of IRS attendance also is associated with reactions to
contemporary events related to intergroup relations and reconciliation.
Familial IRS attendance interacts with contemporary

stressors to influence well-being
Marion Hirsch (2008), in her photographic essays referring to the Holocaust, has
described how parental traumatic experiences can result in the children having
“post-memories” that are so well entrenched that they become recaptured mem-
ories, recalled as if they had happened to the individual. Historical trauma theory
similarly suggests that, like the person that experienced the original trauma, sub-
sequent generations might also be exceptionally reactive to stressors. Moreover,
when these post-memories comprise more than just a single experience, but a col-
lection of horrific events, it is possible that reactions to current injustices, or even to
unrelated stressors, would be greatly increased.
There have been attempts to measure this phenomenon empirically in
Aboriginal populations, and it appeared that thoughts of perceived losses (e.g.,
loss of language, loss of trust) stemming from historical trauma were common in a
sample of young American Indian adults, with up to half thinking about these
losses daily (Whitbeck, Adams, et al., 2004). In turn, having frequent thoughts of
these losses was associated with greater symptoms of emotional distress (Whitbeck,
Adams, et al., 2004), perceived discrimination, and alcohol abuse (Whitbeck, Chen,
et al., 2004). Although historical loss may be related to negative outcomes through
additional mechanisms, historical loss mediated the relationship between perceived
discrimination and alcohol abuse (Whitbeck, Chen, et al., 2004). It was suggested
that discriminatory acts may trigger a sense of loss or serve as a reminder of his-
torical traumas, and alcohol may serve to numb these negative feelings, or might
represent anger manifested in self-destructive behaviors. In light of the previously
discussed findings related to the increased perceptions and altered appraisals of
discrimination among IRS offspring (Bombay et al., 2011, 2014), it may similarly
be the case that thoughts of historical loss might be related to the greater likelihood
of ambiguous events or interactions being attributed to discrimination. In addition
to increased perceptions of discrimination, a familial history of IRS attendance
seems to place these individuals at risk for greater exposure to non-ethnicity-related
contemporary childhood and adulthood stressors (Bombay et al., 2011). Also
described previously, in addition to the relationship between parental IRS
attendance and increased stressor experiences, the relationships between depressive
symptoms and both ethnicity-related (i.e., perceived discrimination) and non-
ethnicity-related (i.e., adverse childhood experiences and adult traumas) stressors
were much stronger among IRS than non-IRS offspring (Bombay et al., 2011).
In effect, having a family history of IRS attendance may result in increased
vulnerability to the negative effects of contemporary stressors.
The risk associated with IRS attendance accumulates

across generations
A key feature of historical trauma theory is the emphasis on the cumulative impact
that historical trauma events have on populations who have endured a history of
numerous assaults against their group. Essentially, it is thought that the negative
effects emanating from group trauma experiences are not only transferred across
generations, but that these effects accumulate, such that events occurring at differ-
ent points in history are part of a single traumatic trajectory (Evans-Campbell,
2008). However, to our knowledge, there has been no empirical evidence to support
this claim, which is understandable considering the methodological difficulty in
obtaining such data. Although evidence is lacking with respect to the cumulative
nature of different types of historical traumas, the fact that the IRS system spanned
several generations of Aboriginal peoples permitted analyses using data from the
2008–2010 RHS1 exploring whether the intergenerational effects of IRSs appear to
accumulate across generations.
Specifically, analyses were conducted to assess differences between First Nations
adults who had one or more parents and grandparent who attended IRS (two pre-
vious generations attended), those who had a parent or grandparent who attended
(one previous generation attended), and those who did not have any parents or
grandparents who attended (non-IRS comparison group), in relation to levels of
psychological distress. Because we were focusing specifically on the intergenerational
effects of IRSs (as opposed to the direct effects of having attended), respondents who
attended IRS were not included in these analyses. Psychological distress in the RHS
was measured using the 10-item Kessler Psychological Distress Scale (Kessler &
Mroczek, 1994), in which respondents were asked how often they experienced
Bombay et al. 331
symptoms of anxiety or depression in the previous month on a scale ranging from 0

(“none of the time”) to 4 (“all of the time”). Responses were summed with possible
scores ranging from 0 to 40, with higher scores reflecting greater distress. According
to past research (Andrews & Slade, 2001; Schmitz, Wang, Malla, & Lesage, 2009),
scores ranging from 0–5 reflect low distress, scores 6–19 reflect moderate distress,
and scores 20 or higher are reflective of high psychological distress (although various
interpretations of scoring have been used).
Using the general linear model (GLM; analysis of covariance) within the
Complex Samples module of SPSS,2 levels of psychological distress were compared
between the non-IRS controls (weighted count ¼ 33,619.17; weighted per-
cent ¼ 38.5%), those who had one previous generation attend IRS (weighted
count ¼ 30,932.25; weighted percent ¼ 38.5%), and those who had two previous
generations attend (weighted count ¼ 22,860.38; weighted percent ¼ 26.2%), while
controlling for gender, age, and household income. A significant difference
appeared across these three groups, Wald F(2, 121) ¼ 14.16, p < .0001, and post
hoc analyses revealed significant differences between non-IRS adults versus those
with one previous generation who attended, Wald F(1, 122) ¼ 4.25, p < .04, and
between those with one versus two previous generations who attended, Wald F(1,
122) ¼ 22.42, p < .0001. In effect, the more generations that attended IRS, the
poorer the psychological well-being of the next generation. Although there is still
a need to demonstrate that the risk associated with historically traumatic experi-
ences can accumulate across different types of events, these findings provide pre-
liminary support for the cumulative nature of historical trauma across generations.
Conclusion
We reviewed the small, but growing literature assessing the intergenerational effects
of the IRS system, which has provided consistent evidence of the enduring links
between familial IRS attendance and a range of health and social outcomes among
the descendants of those who attended. Not only has this research provided know-
ledge about some of the specific individual and familial effects of a relatively recent
collective trauma that affected a large proportion of Canada’s Aboriginal popula-
tion, but it provides support for the proposed characteristics of historical trauma
responses. First, a growing literature has revealed consistent relationships between
familial IRS attendance and various forms of psychological distress, which appear
to occur through a variety of mechanisms. Second, the risk accrued from familial
IRS attendance appears to carry forward to influence the frequency of exposure to
new stressors through stress-proliferation and altered appraisals, as well as by
augmenting the impacts of contemporary stressors through increased psychological
and/or physiological stress reactivity. Of particular note is the relationship between
parental IRS attendance and perceived discrimination that, together with research
linking historical loss and consciousness with perceptions of discrimination, pro-
vides support for the interplay between historical and contemporary trauma.
Finally, although more research is needed to further explore this phenomenon,
individuals from families in which multiple generations attended IRSs reported

greater distress relative to those in which only one generation attended, consistent
with the view concerning the cumulative nature of historical trauma.
In considering additional factors relevant to historical trauma that should be
investigated, there has been a growing literature indicating that biological factors
might contribute to the intergenerational effects of traumatic experiences. In this
regard, stressful encounters may result in epigenetic changes in which the expres-
sion of certain genes might be suppressed, and these suppressed genes, provided
that they are present in germ cells (sperm or ova) could potentially be transmitted
from one generation to the next (McGowan & Szyf, 2010). It was, in fact, suggested
that biological expressions of historical trauma should be explored in light of the
emerging literature on epigenetics and the implications of this intergenerational
pathway (Walters et al., 2011). However, the ability to do this might be limited
by the understandable hesitation of Aboriginal peoples and groups to take part in
research (given past disappointments regarding the benefits accrued from research),
particularly studies that require collecting DNA samples (L. T. Smith, 2001).
As noted by Evans-Campbell (2008), community-level responses to historically
traumatic events are the least studied and understood. Indeed, the impact of IRSs
has been conceptualized as a trauma having community-wide intergenerational
effects, including the alterations of traditional social norms, social malaise, and
weakened social structures that have themselves become second-order stressors
(Adams, 1995; Duran, Duran, & Brave Heart, 1998). In support of this perspective,
although not specific to IRSs, elders attributed their community’s high rates of
alcoholism and child maltreatment to historically traumatic events (Whitbeck,
Adams, et al., 2004). As well, levels of historical loss were associated with responses
to a newly developed measure of community capacity, and to measures of social
capital and “community influence” among members of two southwest American
Indian tribes (Oetzel et al., 2011). This may suggest that communities less affected
by IRS or other historical traumas may have a greater capacity to achieve self-
government, as well as local control over child welfare, health, education, and
policing services. These have been considered to be measures of “cultural continu-
ity,” which in turn, have been linked with suicide rates in First Nations commu-
nities (Chandler & Proulx, 2008).
As emphasized earlier, in evaluating the effects of IRSs, it ought to be recognized
that this was only one example of a long series of injustices that were committed
towards Aboriginal people in Canada and elsewhere. Accordingly, although this
research provides support for the influence of historical trauma in contributing to
present day health disparities, the specific effects associated with IRS-related events
may not be applicable to communities who have faced other types of historical
traumas. Though based on preliminary research, it was suggested that historical
traumas that disrupt ties to family, community, or place, may be associated with
depressive symptoms, whereas events that caused direct physical harm to individ-
uals, communities, land, or sacred sites might be more likely to elicit symptoms of
anxiety or PTSD (Walters et al., 2011), although depression is a frequent comorbid
Bombay et al. 333
feature of PTSD. Exploration of historical traumas of a different nature (e.g., wit-

nessing a community massacre; the prohibition of whaling in northwestern coast
communities), and their interaction with other historical and contemporary traumas,
will enhance the understanding of how historical trauma comes to undermine health.
Although it might be considered that highlighting the link between historical
trauma and individual and collective well-being may deflect attention from the
impacts of more proximal stressors, the linkages found between IRSs and contem-
porary determinants of health actually allow for a greater understanding of these
variables and how they can be targeted in health promotion and interventions. For
example, the research that was reviewed emphasizes the importance of cultural
factors, such as identity, and thoughts about historical losses, in contributing to
poor health and social outcomes, which may otherwise be overlooked if one simply
considered the relationship between socioeconomic status and well-being. In this
regard, IRS-related alterations of cultural factors typically considered to be sources
of resilience, such as Aboriginal identity centrality, also contributed to and inter-
acted with stress-related pathways leading to increased risk of poor well-being.
Identification of risk and resilience factors discussed in this review, as well as
additional variables such as social support and community-level factors, can facili-
tate the development of effective treatments that target not only individuals
affected by IRSs, but families and communities as well.
In addition to facilitating the development of culturally effective treatments to
deal with the consequences of historical trauma, like the therapeutic effects of
having individual-level traumatic experiences validated and acknowledged
(Mueller, Moergeli, & Maercker, 2008), this knowledge and awareness of historical
trauma may also foster healing among Aboriginal peoples and communities. In our
studies, room is always made for comments by participants to enable qualitative
analyses. A poignant comment made by a First Nations woman informed us that
prior to participating in our study she was not aware that her mother had attended
IRS until she asked her mother directly when she was completing the study ques-
tionnaire. Since her participation, she has learned more about IRSs and gained a
deeper understanding of her mother’s behavior while growing up, which ultimately
helped to heal certain aspects of their relationship. Knowledge of these continued
consequences of historical trauma among non-Aboriginal Canadians may similarly
help foster improved intergroup relations by increasing understanding of the com-
plicated issues contributing to the health of Aboriginal peoples. Recognition of a
group’s collective history is often necessary to make sense of the current health and
social conditions. This was effectively acknowledged by the Assembly of First
Nations (1994, p. 141), whose view was that, “First Nations need to know their
history. History provides a context for understanding individuals’ present circum-
stances, and is an essential part of the healing process.”
Funding
This work was supported by the Canadian Institutes of Health Research (CIHR).
Notes
1. See the First Nations Regional Health Survey (RHS) 2008–10 National Report on Adults,
Youth and Children Living in First Nations Communities for further details regarding the
background, process, and methods used in the RHS (FNIGC, 2012).
2. Complex Samples module in SPSS was used to take into account the clustered, stratified,
multistage sample design of the RHS.
References
Adams, D. W. (1995). Education for extinction: American Indians and the boarding school
experience, 1875–1928. Lawrence: University Press of Kansas.
Andrews, G., & Slade, T. (2001). Interpreting scores on the Kessler Psychological Distress
Scale (K10). Australian and New Zealand Journal of Public Health, 25, 494–497.
Anisman, H., Merali, Z., & Hayley, S. (2008). Neurotransmitter, peptide and cytokine
processes in relation to depressive disorder: Comorbidity of depression with neurodegen-
erative disorders. Progress in Neurobiology, 85, 1–74.
Assembly of First Nations (AFN). (1994). Breaking the silence: An interpretive study of
Residential School impact and healing as illustrated by the stories of First Nations individ-
uals. Ottawa ON: AFN/First Nations Health Commission.
Assembly of First Nations (AFN)/First Nations Information Governance Committee
(FNIGC). (2007). First Nations Regional Longitudinal Health Survey (RHS) 2002/03:
The peoples’ report (Rev. 2nd ed.). Ottawa, ON: AFN/FNIGC.
Barkan, E. (2003). Genocides of Indigenous peoples: Rhetoric of human rights.
In R. Gellately, & B. Kiernan (Eds.) The specter of genocide: Mass murder in historical
perspective (pp. 130–131). New York, NY: Cambridge University Press.
Bombay, A., Matheson, K., & Anisman, H. (2011). The impact of stressors on second
generation Indian Residential School Survivors. Transcultural Psychiatry, 48(4), 367–391.
Bombay, A., Matheson, K., & Anisman, A. (2012). Personal wellness & after-school activ-
ities. In The First Nations Information Governance Centre (Ed.), First Nations Regional
Health Survey (RHS) Phase 2 (2008/10): National report on the adult, youth, and children
living in First Nations communities (pp. 340–357). Ottawa, Canada: The First Nations
Information Governance Centre.
Bombay, A., Matheson, K., & Anisman, H. (2014). Appraisals of discriminatory events
among adult offspring of Indian Residential School Survivors: The influences of identity
centrality and past perceptions of discrimination. Cultural Diversity and Ethnic Minority
Psychology, 20(1), 75–86.
Bombay, A., Matheson, K., & Anisman, H. (2013). Intergroup trust and forgiveness in
relation to the government apology to Aboriginal peoples in Canada. Political
Psychology, 34, 443–460.
Bombay, A., Matheson, K., & Anisman, H. (in press). Student-to-student abuse in Indian
Residential Schools: An exploratory investigation. Ottawa, Canada: The Aboriginal
Healing Foundation.
Bougie, E., & Senécal, S. (2010). Registered Indian children’s school success and interge-
nerational effects of Residential schooling in Canada. The International Indigenous Policy
Journal, 1(1). Retrieved from http://ir.lib.uwo.ca/iipj/vol1/iss1/5
Branscombe, N. R., Schmitt, M. T., & Harvey, R. D. (1999). Perceiving pervasive discrim-
ination among African Americans: Implications for group identification and well-being.
Journal of Personality and Social Psychology, 77, 135–149.
Bombay et al. 335
Brave Heart, M. Y. H. (1999). Oyate Ptayela: Rebuilding the Lakota Nation through
addressing historical trauma among Lakota parents. Journal of Human Behavior in the
Social Environment, 2(1–2), 109–126.
Brave Heart, M. Y. H., & DeBruyn, L. M. (1998). The American Indian holocaust: Healing
historical unresolved grief. American Indian and Alaska Native Mental Health Research,
8, 56–78.
Cameron, J. E. (2004). A three-factor model of social identity. Self and Identity, 3, 239–262.
Chandler, M. J., & Proulx, T. (2008). Personal persistence and persistent peoples:
Continuities in the lives of individual and whole cultural communities. In F. Sani (Ed.)
Self-continuity: Individual and collective perspectives (pp. 213–226). New York, NY:
Psychology Press.
Chartier, M. J., Walker, J. R., & Naimark, B. (2010). Separate and cumulative effects of
adverse childhood experiences in predicting adult health and health care utilization. Child
Abuse and Neglect, 34, 454–464.
Craib, K. J. P., Spittal, P. M., Patel, S. H., Christian, W. M., Moniruzzaman, A., Pearce,
M. E.,. . . the Cedar Project Partnership. (2009). Prevalence and incidence of Hepatitis
C virus infection among Aboriginal young people who use drugs: Results from the Cedar
Project. Open Medicine, 3(4). Retrieved from http://www.openmedicine.ca/article/
viewArticle/249/287.
Deiter, C. (1999). From our mothers’ arms: The intergenerational impact of Residential
Schools in Saskatchewan. Toronto, Canada: United Church Publishing House.
Dong, M., Anda, R. F., Felitti, V. J., Dube, S. R., Williamson, D. F., Thompson,
T. J., . . . Giles, W. H. (2004). The interrelatedness of multiple forms of childhood
abuse, neglect, and household dysfunction. Child Abuse and Neglect, 28, 771–784.
Duran, B., Duran, E., & Brave Heart, M. Y. (1998). American Indian and/or Alaska Natives
and the trauma of history. In R. Thornton (Ed.) Studying Native America: Problems and
prospects (pp. 60–76). Madison: University of Wisconsin Press.
Elias, B., Mignone, J., Hall, M., Hong, S. P., Hart, L., & Sareen, J. (2012). Trauma and
suicide behaviour histories among a Canadian Indigenous population: An empirical
exploration of the potential role of Canada’s Residential School system. Social Science
& Medicine, 74, 1560–1569.
Evans-Campbell, T. (2008). Historical trauma in American Indian/Native Alaska commu-
nities: A multilevel framework for exploring impacts on individuals, families, and com-
munities. Journal of Interpersonal Violence, 23(3), 316–338.
First Nations Centre. (2005). First Nations Regional Longitudinal Health Survey (RHS)
2002/03: Results for adults, youth, and children living in First Nations communities.
Ottawa, Canada: First Nations Centre.
First Nations Information Governance Centre (FNIGC). (2012). First Nations Regional
Health Survey (RHS) 2008/10: National report on adults, youth and children living in
First Nations communities. Ottawa, Canada: Author.
For the Cedar Project Partnership, Pearce, M. E., Christian, W. M., Patterson, K., Norris, K.,
Moniruzzaman, A., . . . Spittal, P. M. (2008). The Cedar Project: Historical trauma, sexual
abuse and HIV risk among young Aboriginal people who use injection and non-injection
drugs in two Canadian cities. Social Science and Medicine, 66(11), 2185–2194.
Fournier, S., & Crey, E. (1997). Stolen from our embrace: The abduction of First Nations
children and the restoration of Aboriginal communities. Toronto, Canada: Douglas and
McIntyre.
Friesen, J. W., & Friesen, V. L. (2002). Aboriginal education in Canada: A plea for integra-
tion. Calgary, Canada: Detselig.
Gone, J. P. (2009). A community-based treatment for Native American historical trauma:
Prospects for evidence-based practice. Journal of Consulting and Clinical Psychology, 77,
751–762.
Hirsch, M. (2008). The generation of post-memory. Poetics Today, 29(1), 103–129.
Hochberg, Z., Feil, R., Constancia, M., Fraga, M., Junien, C., Carel, J. C., . . . Albertsson-
Wikland, K. (2011). Child health, developmental plasticity, and epigenetic programming.
Endocrine Reviews, 32, 159–224.
Kessler, R., & Mroczek, D. (1994). Final version of our Non-Specific Psychological Distress
Scale. Ann Arbor: Survey Research Center of the Institute for Social Research,
University of Michigan.
Kirmayer, L., Brass, G., & Tait, C. (2000). The mental health of Aboriginal peoples:
Transformations of identity and community. Canadian Journal of Psychiatry, 45(7),
607–616.
McGowan, P. O., & Szyf, M. (2010). The epigenetics of social adversity in early life:
Implications for mental health outcomes. Neurobiology of Disease, 39(1), 66–72.
Miller, C. L., Pearce, M. E., Moniruzzaman, A., Thomas, V., Christian, W.Schechter, M. T.,
& for the Cedar Project Partnership. (2011). The Cedar Project: Risk factors for transi-
tion to injection drug use among young, urban Aboriginal people. Canadian Medical
Association Journal, 183(10), 1147–1154.
Moniruzzaman, A., Pearce, M. E., Patel, S. H., Chavoshi, N., Teegee, M., Adam,
W., . . . Spittal, P. M. (2009). The Cedar Project: Correlates of attempted suicide among
young Aboriginal people who use injection and non-injection drugs in two Canadian
cities. International Journal of Circumpolar Health, 68(3), 261–273.
Mueller, J., Moergeli, H., & Maercker, A. (2008). Disclosure and social acknowledgement as
predictors of recovery from posttraumatic stress: A longitudinal study in crime victims.
Canadian Journal of Psychiatry, 53(3), 160–168.
O’Bryan, M., Fishbein, H. D., & Ritchey, P. N. (2004). Intergenerational transmission of
prejudice, sex role stereotyping, and intolerance. Adolescence, 39(155), 407–426.
Oetzel, J., Wallerstein, N., Solimon, A., Garcia, B., Siemon, M., Adeky, S., . . . Tafoya, G.
(2011). Creating an instrument to measure people’s perception of community capacity in
American Indian communities. Health Education & Behavior, 38, 301–310.
Operario, D., & Fiske, S. T. (2001). Ethnic identity moderates perceptions of prejudice:
Judgments of personal versus group discrimination and subtle versus blatant bias.
Personality and Social Psychology Bulletin, 27(5), 550–561.
Park, I. H. K. (2007). Enculturation of Korean American adolescents within familial and
cultural contexts: The mediating role of ethnic identity. Family Relations, 56, 403–412.
Pearlin, L. I., Aneshensel, C. S., & LeBlanc, A. J. (1997). The forms and mechanisms of
stress proliferation: The case of AIDS caregivers. Journal of Health and Social Behavior,
38, 223–236.
Rieckmann, T. R., Wadsworth, M. F., & Deyhle, D. (2004). Cultural identity, explanatory
style, and depression in Navajo adolescents. Cultural Diversity and Ethnic Minority
Psychology, 10, 365–382.
Royal Commission on Aboriginal Peoples (RCAP). (1996). Looking forward, looking back:
Report of the Royal Commission on Aboriginal Peoples (Volume 1). Ottawa, Canada:
Communication Group.
Bombay et al. 337
Schmitz, N., Wang, J., Malla, A., & Lesage, A. (2009). The impact of psychological distress
on functional disability in asthma: Results from the Canadian Community Health
Survey. Psychosomatics, 50(1), 42–49.
Sellers, R. M., & Shelton, J. N. (2003). The role of racial identity in perceived racial dis-
crimination. Journal of Personality and Social Psychology, 84(5), 1079–1092.
Sellers, R. M., Smith, M. A., Shelton, J. N., Rowley, S. A. J., & Chavous, T. M. (1998).
Multidimensional model of racial identity: A reconceptualization of African American
racial identity. Personality and Social Psychology Review, 2(18), 18–39.
Smith, L. T. (2001). Decolonizing methodologies. New York, NY: Zed Books.
Smith, T. B., & Silva, L. (2011). Ethnic identity and personal well-being of people of color: A
meta-analysis. Journal of Counseling Psychology, 58(1), 42–60.
Smylie, J., O’Campo, P., McShane, K., Daoud, N., & Davey, C. (2012). Prenatal health.
In The First Nations Information Governance Centre (Ed.) First Nations Regional Health
Survey (RHS) Phase 2 (2008/10): National report on the adult, youth, and children living
in First Nations communities (pp. 424–439). Ottawa, Canada: The First Nations
Information Governance Centre.
Sotero, M. M. (2006). A conceptual model of historical trauma: Implications for public
health practice and research. Journal of Health Disparities Research and Practice, 1(1),
93–108.
Thoits, P. A. (2010). Stress and health: Major findings and policy implications. Journal of
Health and Social Behavior, 51, S41–53.
Turner, H. A., Finkelhor, D., & Ormrod, R. (2010). Poly-victimization in a national sample
of children and youth. American Journal of Preventive Medicine, 38(3), 323–330.
Waldram, J. B. (2004). Revenge of the Windigo: The construction of the mind and mental
health of North American Aboriginal peoples. Toronto, Canada: University of Toronto
Press.
Walters, K. L., Mohammed, S. A., Evans-Campbell, T., Beltrán, R. E., Chae, D. H., &
Duran, B. (2011). Bodies don’t just tell stories, they tell histories. Du Bois Review: Social
Science Research on Race, 8(01), 179–189.
Wheaton, B., & Clarke, P. (2003). Space meets time: Integrating temporal and contextual
influences on mental health in early adulthood. American Sociological Review, 68,
680–706.
Whitbeck, L., Adams, G., Hoyt, D., & Chen, X. (2004a). Conceptualizing and measuring
historical trauma among American Indian people. American Journal of Community
Psychology, 33(3–4), 119–130.
Whitbeck, L., Chen, X., Hoyt, D., & Adams, G. (2004b). Discrimination, historical loss and
enculturation: Culturally specific risk and resiliency factors for alcohol abuse among
American Indians. Journal of Studies of Alcohol, 65(4), 409–418.
Whitbeck, L. B., Hoyt, D. R., Stubben, J. D., & Lafromboise, T. (2001). Traditional culture
and academic success among American Indian children in the upper Midwest. Journal of
American Indian Education, 40, 48–60.
Yehuda, R., Halligman, S. L., & Grossman, R. (2001). Childhood trauma and risk for
PTSD: Relationship to intergenerational effects of trauma, parental PTSD and cortisol
excretion. Development Psychopathology, 13(3), 733–753.
Amy Bombay, PhD, currently holds a CIHR postdoctoral fellowship at the

University of Ottawa Institute of Mental Health Research and is an adjunct
professor in the Department of Neuroscience at Carleton University. Dr. Bombay’s

work explores determinants of well-being among Aboriginal peoples in Canada,
with much of her research examining the effects of contemporary and historical
ethnicity-related stressors such as perceived discrimination and the intergenera-
tional effects of Indian Residential Schools on mental health outcomes.
Kimberly Matheson, PhD, is a professor of the Department of Psychology and

Department of Neuroscience at Carleton University. Dr. Matheson researches
the impact of group-based stressors on the physical and mental health of members
of disadvantaged social groups. Her published works focus on discrimination
experiences and depression, coping strategies, social support, and the role of
belongingness in groups.
Hymie Anisman, PhD, FRSC, holds a Canada Research Chair in Behavioural

Neuroscience within the Department of Neuroscience at Carleton University.
His work entails the analyses of the neurobiological consequences of stressors,
and how these contribute to stress-related pathology such as depression and post-
traumatic stress disorder. The work conducted by his group includes research using
animal models of pathology as well as analyses of stress and gene polymorphisms
in human-related psychopathology.
This is Exhibit “D” referred to in the Affidavit of Grand Chief

Catalogue no. 85-002-X
ISSN 1209-6393
Juristat
Self-reported sexual assault in Canada,

2014
by Shana Conroy and Adam Cotter

Canadian Centre for Justice Statistics
Release date: July 11, 2017

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Juristat Article—Self-reported sexual assault in Canada, 2014
Self-reported sexual assault in Canada, 2014: Highlights
 According to the General Social Survey on Canadians’ Safety (Victimization), there were 22 incidents of sexual assault
for every 1,000 Canadians aged 15 and older in 2014. This represented approximately 636,000 self-reported incidents of
sexual assault.
 The rate of self-reported sexual assault in 2014 remained unchanged from 2004; however, declines were noted over the
same time period for all other types of violent and non-violent crime measured by the General Social Survey on
Victimization.
 A higher risk of sexual assault was noted among those who were women, young, Aboriginal, single, and homosexual or
bisexual, and those who had poorer mental health. In addition, individuals who had certain experiences—childhood
abuse and homelessness—and more evening activities outside the home also had a higher risk of sexual assault.
 Among the three types of sexual assault measured by the General Social Survey on Victimization in 2014, seven in ten
self-reported incidents were unwanted sexual touching, two in ten were sexual attacks and one in ten was sexual activity
where the victim was unable to consent.
 Victims of sexual assault often had negative perceptions of their neighbourhood, lower levels of trust in others and less
confidence in the police, compared to those who were not sexually assaulted. They were also less satisfied with their
personal safety from crime and less likely to feel safe in certain situations.
 Overall, sexual assault offenders were most often men, acting alone and under the age of 35. Just over half of victims
knew the person who sexually assaulted them.
 Most often, offenders were a friend, acquaintance or neighbour, then a stranger. Of all sexual assault incidents
perpetrated by someone other than a spouse, one in twenty was reported to the police, compared to one in three
incidents of other types of crime measured by the General Social Survey on Victimization.
 Most commonly, sexual assault victims reported feeling angry, or upset, confused or frustrated after the incident. One in
four victims reported that they had difficulty carrying out everyday activities because of the incident. Further, one in six
victims reported experiencing three or more longer-term emotional consequences, indicating the possibility of post-
traumatic stress disorder.
Statistics Canada—Catalogue no. 85-002-X 3

Self-reported sexual assault in Canada, 2014

by Shana Conroy and Adam Cotter
Sexual assault is one of the most underreported crimes (Benoit et al. 2015; Brennan and Taylor-Butts 2008; Kaufman 2008;
Luce et al. 2010). Research has attributed this to a wide range of reasons, including the shame, guilt and stigma of sexual
victimization (Johnson 2012; Sable et al. 2006), the normalization of inappropriate or unwanted sexual behaviour, and the
perception that sexual violence does not warrant reporting (Benoit et al. 2015).
Despite an increased societal awareness about sexual assault, it continues to be a persistent issue in Canada. In 2014, the
rate of self-reported sexual assault was similar to that reported a decade earlier; in contrast, the rates for other types of self-
reported violent and non-violent crime declined over the same time period (Perreault 2015). Sexual assault can have serious
and traumatic consequences for victims (Chen and Ullman 2010), including poorer health and weaker social supports
(Logie et al. 2014), feelings of anger, fear and anxiety, and substance abuse, depression and suicidal thoughts
(Cybulska 2007; Luce et al. 2010).
While anyone could be a victim of sexual assault, research has shown an elevated risk for women and young individuals
(Brennan and Taylor-Butts 2008; Bullock and Beckson 2011; Cybulska 2007; Kaufman 2008; Kong et al. 2003; Luce et al.
2010; Moreno 2015; Todahl et al. 2009), those who identify as non-heterosexual (Logie et al. 2014; Rothman et al. 2011),
and individuals with disabilities (Benedet and Grant 2014; Luce et al. 2010; Nosek et al. 2001) and mental health issues
(Cybulska 2007). Further, previous experiences such as childhood abuse (Daigneault et al. 2009; Elliot et al. 2004;
Luce et al. 2010) and homelessness (Kushel et al. 2003; Wenzel et al. 2000) have also been associated with an increased
risk of sexual assault.
Statistics Canada uses two main data sources to collect information on crime: the Incident-based Uniform Crime Reporting
(UCR) Survey for police-reported data, and the General Social Survey (GSS) on Canadians’ Safety (Victimization) for self-
reported data. Given that sexual assault is an underreported crime, self-reported data are essential for providing further
insight into the nature and extent of sexual assault. Using data from the 2014 GSS on Victimization, this Juristat article
presents information on self-reported sexual assault in Canada, including sexual attacks, unwanted sexual touching and
sexual activity where the victim was unable to consent. The GSS on Victimization collects information from Canadians aged
15 and older, and respondents are able to provide details about their experiences of victimization, whether they were
reported to the police or not.
The information presented in this Juristat article refers to incidents of sexual assault that occurred in the 12 months that
preceded the 2014 GSS on Victimization. Some data from the 2004 GSS on Victimization are also used to allow for a
comparison of sexual assault over time. This article examines the characteristics and experiences of sexual assault victims,
and their perceptions of safety. Characteristics of sexual assault offenders and incidents are discussed, in addition to the
emotional and physical consequences of sexual assault, and reporting sexual assault to the police. While this article provides
important information on the nature and extent of sexual assault in Canada, it should be noted that the numbers may still be
an underestimation due to the sensitive nature of sexual assault.
Self-reported sexual assault in Canada: 2004 and 2014
Rate of self-reported sexual assault remains unchanged since 2004
According to self-reported data from the 2014 GSS on Victimization, there were 221 incidents of sexual assault for every
1,000 Canadians aged 15 and older2 in the 12 months that preceded the survey (Table 1, Chart 1). This represented
approximately 636,000 incidents of sexual assault.3
4 Statistics Canada—Catalogue no. 85-002-X

The rate of self-reported sexual assault in 2014 remained unchanged from the rate reported in 2004 (22 versus 21 per 1,000
population).4 This was a marked contrast to all other types of crime5 measured by the GSS on Victimization (Perreault 2015).
For example, rates of self-reported robbery and physical assault—the other types of violent crime measured by the survey—
declined by 39% and 35%, respectively, over the same time period.
Text box 1
Measuring self-reported sexual assault
Estimates of sexual assault are derived from three questions in the 2014 General Social Survey (GSS) on Victimization. It
should be noted, however, that the questions are not a one-to-one match and do not correspond directly with the three levels
of criminal offences in the Criminal Code of Canada (see Text box 2) due to different definitions. The questions pertaining to
sexual assault in the 2014 GSS on Victimization were as follows:
 Sexual attack: “Has anyone forced you or attempted to force you into any unwanted sexual activity by threatening
you, holding you down or hurting you in some way?”
 Unwanted sexual touching: “Has anyone ever touched you against your will in any sexual way…anything from
unwanted touching or grabbing, to kissing or fondling?”
 Sexual activity where the victim was unable to consent: “Has anyone subjected you to a sexual activity to which you
were not able to consent…where you were drugged, intoxicated, manipulated or forced in ways other than
physically?”
The 2014 cycle of the GSS on Victimization measured three types of sexual assault. According to findings, 71% of sexual
assault incidents were unwanted sexual touching, 20% were sexual attacks and 9% were sexual activity where the victim
was unable to consent due to drugs, intoxication, manipulation or non-physical force. While the third type of sexual assault
was measured for the first time by the 2014 GSS on Victimization, analysis shows little impact on comparability to previous
cycles.6

Text box 2
Sexual offence legislation in Canada
The current Canadian laws surrounding sexual offences are the result of significant changes, most notably over the past four
decades (see Kong et al. 2003).
Major milestones in sexual offence legislation include:
 Prior to 1983: Certain rules applied to sexual violence that had a negative impact on victims. For example, a victim
was required to make a timely complaint following the incident in order to be believed, a victim’s sexual history could
have been used to question credibility and imply that sexual activity was consensual, a conviction required
corroboration by another person, and a husband could not be convicted of raping his wife.
 1983: A major reform of the approach to sexual violence began in 1983. These reforms created what are now
Canada’s sexual assault offences—level 1 (section 271), level 2 (section 272) and level 3 (section 273)—that focus
on the assailant’s level of violence rather than the type of sexual act committed. While ‘sexual assault’ is not defined
in the Criminal Code of Canada, the Supreme Court of Canada has interpreted it as an assault of a sexual nature
that, viewed objectively, violated the sexual integrity of the victim. These offences capture all non-consensual sexual
activity ranging from fondling to penetration. The rules requiring timely complaint and corroboration were repealed.
Further, it was clarified that a victim’s sexual history is inadmissible in relation to credibility and that a person could
be charged with sexual assault of a spouse. ‘Rape-shield’ provisions—preventing a victim’s sexual history from
being used to question credibility or imply that sexual activity was consensual—were also enacted to protect victims
from myths and stereotypes about the way they ‘should’ behave.
 1988: Reforms included the enactment of child-specific sexual offences. These offences include, but are not limited
to, sexual interference, invitation to sexual touching and sexual exploitation.
 1992: After the Supreme Court of Canada ruled that the 1983 ‘rape-shield’ provisions were unconstitutional (R. v.
Seaboyer 1991), the provisions were amended to create two distinct rules: one categorically excludes all evidence of
a victim’s prior sexual activity used to suggest that the victim should not be believed or that sexual activity was
consensual, and the other excludes such evidence for other purposes, unless specific criteria are met. Reforms also
included a clear definition of consent, a list of situations where consent is not obtained—if the complainant submits
or does not resist due to force, threat, fraud or authority—and limitations on the accused’s ability to advance a
mistaken belief in consent.
 1997: New provisions were enacted to prevent the accused from seeking private records to undermine the victim’s
credibility.
The Criminal Code of Canada outlines a wide range of behaviours of different severity under sexual assault (Criminal Code
1985). The offences specific to sexual assault are as follows:
 Sexual assault, level 1 (section 271): Prohibits assault of a sexual nature that violates the sexual integrity of the
victim.
 Sexual assault, level 2 (section 272): Prohibits a sexual assault in which the assailant uses a weapon, threatens to
cause bodily harm to a person other than the victim or causes bodily harm to the victim.
 Sexual assault, level 3 (section 273): Prohibits a sexual assault in which the assailant wounds, maims, disfigures or
endangers the life of the victim.
Characteristics and experiences of sexual assault victims
The vast majority of sexual assault victims are women
As has been the case historically, Canadian women were far more likely than men to report that they were sexually
assaulted.7 Women reported a rate of 37 incidents of sexual assault per 1,000 population, while men reported a rate of 5E
incidents per 1,000 population (Table 2, Chart 1). Of all sexual assault incidents, the vast majority (87%) were committed
against women. Women reported approximately 555,000 incidents of sexual assault in 2014, far more than the 80,000 E
incidents reported by men.
Among victims of sexual assault, men more commonly reported that they experienced one incident of sexual assault than
women (72% versus 49%). Among victims who were women, one-quarter (24%E) reported that they experienced two
incidents, while another quarter (26%E) reported that they experienced three or more in the 12 months that preceded the
survey.8

Victims are women aged 15 to 24 for nearly half of all sexual assault incidents
Overall, the rate of sexual assault was considerably higher for young Canadians—those aged 15 to 24—and this was
especially true for young women (Table 2, Chart 2). Of all sexual assault incidents, nearly half (47%) were committed against
women aged 15 to 24.9 Young women reported a rate of 134 incidents of sexual assault per 1,000 population. This rate was
about two times higher than for women aged 25 to 34 and about eight times higher than for women aged 35 to 44 (58E and
16E per 1,000 population, respectively).10 The rate among young women was also about 12 times higher than among men of
the same age group (134 versus 11E per 1,000 population).
In recent years, increased attention has been given to the issue of sexual assault and the corresponding rape culture on
Canadian campuses (Canadian Federation of Students n.d.; Metropolitan Action Committee on Violence Against Women
2016; Weikle 2016), which could be a contributing factor to the high rates of sexual assault noted among young women.
Results from the 2014 GSS on Victimization show that students, and especially women who were students, reported
relatively high rates of sexual assault. Overall, approximately 261,000 incidents of sexual assault—41% of all incidents—
were reported by students. This represented a rate of 73 incidents of sexual assault per 1,000 population. Of all sexual
assault incidents where the victim was a student, 90% were committed against women. However, rates of sexual assault
among young women who were students and those who were not students were relatively similar (137E versus 128E per
1,000 population). As such, age may be a larger factor than student status.

More than one in five young Aboriginal women is sexually assaulted
Aboriginal11 people—individuals who identified as First Nations, Métis or Inuit—were more likely than non-Aboriginal people
to report that they were sexually assaulted. The rate of sexual assault among Aboriginal people was approximately three
times higher than among non-Aboriginal people (58E versus 20 per 1,000 population) (Table 2, Chart 2). Of all sexual assault
incidents where the victim was Aboriginal, 94% were committed against women. Overall, Aboriginal women reported a rate of
113E incidents of sexual assault per 1,000 population,12 and among young Aboriginal women, more than one in five (22%E)
was sexually assaulted.
Findings from the 2014 GSS on Victimization are consistent with other research. Aboriginal people, and Aboriginal women in
particular, are more likely to experience violent victimization than their non-Aboriginal counterparts (Dylan et al. 2008;
Weinrath 2008).13
Rate higher among single individuals, especially women
The rate of sexual assault was higher among Canadians who were single, never married. In particular, the rate of sexual
assault among individuals who were single was approximately eight times higher than among those who were married or
common-law (57 versus 7E per 1,000 population) (Table 2, Chart 2). Single women reported a rate that was nine times higher
than the rate among married or common-law women and among single men (108 versus 12E each per 1,000 population).14
Sexual orientation associated with higher rate of sexual assault
While research on sexual assault among non-heterosexual individuals is a comparatively new area of study, research thus
far indicates that individuals who identify as homosexual or bisexual have an increased likelihood of being sexually assaulted
than those who are heterosexual (Rothman et al. 2011). Research suggests that this may be attributed to discrimination and
marginalization faced by the non-heterosexual community (Todahl et al. 2009).
Results from the 2014 GSS on Victimization show a similar pattern: Canadians who identified as homosexual or bisexual had
a rate of sexual assault that was six times higher than those who identified as heterosexual (102E versus 17 per 1,000
population) (Table 2, Chart 2).15 However, this difference was unlikely to be the result of discrimination only. The majority
(72%) of homosexual and bisexual victims of sexual assault did not believe the incident to be a hate crime. 16
Rates higher among individuals with mental disabilities and poorer mental health
Research has shown that individuals with disabilities—particularly women and those with mental disabilities—are at greater
risk of sexual violence, which may be partially attributed to greater vulnerability, negative social attitudes and perceptions,
and abuses of trust (Benedet and Grant 2014; Meer and Combrinck 2015; Nosek et al. 2001). Research has also pointed to
the unique needs and challenges individuals with disabilities may face when dealing with the criminal justice system (Benedet
and Grant 2014).
Results from the 2014 GSS on Victimization show that individuals with mental or physical disabilities 17 were more likely to
report that they were sexually assaulted. The rate of sexual assault among those with a disability was approximately two
times higher than those with no disability (37 versus 16 per 1,000 population) (Table 2, Chart 2).
As indicated by research, individuals with mental disabilities are especially more likely to be sexually assaulted. Individuals
with mental disabilities had a rate of sexual assault that was about five times higher than those with no such disability (83
versus 16 per 1,000 population), whereas the difference between individuals with physical disabilities and those with no such
disability was not statistically significant (25E versus 20 per 1,000 population).
Similarly, Canadians who rated their mental health lower had a relatively high rate of sexual assault. 18 Those who rated their
mental health as ‘fair or poor’ had a rate that was approximately 12 times higher than those who rated it as ‘excellent’ (121E
versus 10E per 1,000 population). However, it should be noted that, in some cases, poorer mental health may be a
consequence of sexual assault.
Substance use associated with higher rate of sexual assault, especially among women
Overall, individuals who reported substance use—that is, drug use19 or binge drinking20—in the past month had a higher rate
of sexual assault.21 For instance, the rate of sexual assault among Canadians who reported drug use in the past month was
about four times higher than among those who did not (71E versus 17 per 1,000 population) (Table 3). Similarly, the rate for
those who reported binge drinking in the past month was about two times higher than for those who did not (35 versus 16 per
1,000 population).

These patterns were especially pronounced among women. For instance, while there was no difference in the rates of sexual
assault between men who reported binge drinking in the past month and men who did not, the rate among women who
reported binge drinking in the past month was over three times higher than among women who did not (89 E versus 25 per
1,000 population).
Higher rates among those who reported substance use in the past month may be a reflection of the situational context in
which many incidents of sexual assault occur. Around one in four (27%E) sexual assault victims reported that the incident
occurred in a bar or a restaurant, and this increased to about four in ten (38%E) of those who reported substance use in the
past month. In terms of sexual activity where the victim was unable to consent, victims who reported substance use in the
past month reported a rate that was over three times higher than victims who did not report substance use (56 E versus 16 per
1,000 population).
Finally, it should be noted that research has shown that while substance use can be a risk factor for sexual assault
(Abbey et al. 2001), it can also be a coping mechanism following traumatic experiences (Ullman et al. 2013).
Frequent evening activity associated with higher rate of sexual assault, especially among women
Evening activities—such as going to work, night class, meetings or volunteering, or going to bars, clubs or pubs—were all
associated with higher rates of sexual assault. Overall, Canadians who stated that they go out in the evenings 21 times or
more per month reported 45 incidents of sexual assault per 1,000 population, over four times more than those who stated
that they go out 10 times or fewer (10 per 1,000 population) (Table 3). This is consistent with research that indicates that
individuals with increased activity outside the home, particularly at night, are more vulnerable to crime and have an increased
risk of victimization. This is largely due to the increased presence of offenders and the absence of other people who could act
as defenders (Franklin et al. 2011).
Similar to substance use, women who reported frequent evening activity had an even higher rate of sexual assault. Among
those who reported going out in the evenings 21 times or more per month, the rate of sexual assault among women was
about 12 times higher than among men (97 versus 8E per 1,000 population).
Rates higher among individuals who have experienced childhood abuse, homelessness and stalking
Childhood abuse—that is, physical abuse22 or sexual abuse23 experienced before age 15 perpetrated by an adult aged 18 or
older—has been identified as a serious social issue that has the potential to affect victims into adulthood. Consequences
include post-traumatic stress disorder (PTSD), depression and substance abuse (Collin-Vézina et al. 2010), and further
experiences of victimization later in life, including sexual assault (Daigneault et al. 2009; Luce et al. 2010). 24
Overall, Canadians who had experienced either type of childhood abuse reported a rate of sexual assault that was over two
times higher than those who had not experienced abuse during childhood (36 versus 15 per 1,000 population) (Table 4). This
difference was more pronounced among those who had experienced childhood sexual abuse as those individuals had a rate
that was about four times higher than those who had not been abused in this way (70E versus 17 per 1,000 population).
Looking at it differently, among those who had experienced either type of abuse during childhood, the rate of sexual assault
was over six times higher among women than men (65 versus 10E per 1,000 population).
Another life experience associated with higher rates of sexual assault was homelessness. 25 Canadians who reported that
they had ever experienced homelessness reported a rate of sexual assault that was three times higher than those who had
never been homeless (54E versus 18 per 1,000 population). This included individuals who had lived in a shelter, on the street
or in an abandoned building, and those who had experienced hidden or concealed homelessness—for example, that they
had lived with family or friends, or in a car because they had nowhere else to live.
Experience with stalking—repeated and unwanted attention that caused fear for personal safety or the safety of someone
else—was also linked to higher rates of sexual assault.26 Stalking behaviours included unwanted communication,27 following,
watching and threatening behaviours.28
Among Canadians who were victims of stalking in the 12 months that preceded the survey, the rate of sexual assault was
nearly 11 times higher than among those who were not stalked (182E versus 17 per 1,000 population). Women who had been
stalked in the 12 months that preceded the survey had a rate that was over eight times higher than women who were not
stalked (246E versus 29 per 1,000 population).29
In addition to stalking experiences in the 12 months that preceded the survey, the GSS on Victimization also asked detailed
questions about stalking in the five years that preceded the survey. Overall, those who had experienced stalking during that
time period reported a rate of sexual assault that was nearly seven times higher than those who were not stalked

(100E versus 15 per 1,000 population). This difference was greater for specific types of stalking.30 Most notably, the rate of
sexual assault among those who were watched—for example, someone waited outside their home, work, school or other
location—was nearly 11 times higher than among those who were not stalked (163E versus 15 per 1,000 population).
Among sexual assault victims who were stalked in the five years that preceded the survey, more than one in five (22% E)
reported that the stalker grabbed or attacked them at some point. However, it is not possible to determine from the GSS on
Victimization if the stalker and the sexual assault offender were the same individual.
After controlling for other factors, the risk of sexual assault is higher for certain individuals
After controlling for other factors, certain characteristics and experiences increased the risk of sexual assault, while others did
not. It should be noted that certain factors are closely associated to others—such as age, student status and evening
activities outside the home—and the combination of certain factors may have contributed to higher rates of self-reported
sexual assault. In order to account for this, the analysis included regression models and the results are presented in this
section. A full list of factors that were included for analysis are detailed in Model 1 and Model 2.
After controlling for individual characteristics only (Model 1), a large difference in the risk of sexual assault remained between
women and men: all else being equal, women were over six times more likely to be sexually assaulted than men. Self-rated
mental health was also associated with an increased risk of sexual assault among Canadians aged 15 and older: individuals
with ‘fair or poor’ self-rated mental health were about seven times more likely to be sexually assaulted than those who rated
their mental health as ‘very good’ or ‘excellent.’
The risk of sexual assault was impacted by marital status. Individuals who were single were about four times more likely to be
sexually assaulted than those who were married or common-law. Age also had an impact: individuals aged 15 to 24 were
over three times more likely to be sexually assaulted than those aged 35 and older.
Aboriginal identity also significantly impacted the risk of sexual assault after controlling for other factors. Individuals who
identified as Aboriginal were over two times more likely to be sexually assaulted than those who were non-Aboriginal.
A second model (Model 2) was created to control for the same characteristics as Model 1, as well as experiences of
childhood abuse and homelessness, and evening activities outside the home. All characteristics that significantly increased
the risk of sexual assault in Model 1 remained significant in Model 2, with one exception: Aboriginal identity did not increase
the risk of sexual assault when the new factors were introduced. This change may be attributed to—for instance—the
increased proportion of Aboriginal people who experience childhood abuse and homelessness.
Individuals who had experienced childhood abuse before age 15 were about two times more likely to be sexually assaulted
than those who had not. The same difference was noted between those who had experienced homelessness and those who
had not. Evening activity also had an impact: for every additional evening activity outside the home per month, the risk of
sexual assault increased by 3%.
A third model was created to control for the same characteristics in Model 1, in addition to sexual orientation, for Canadians
aged 18 and older.31 After controlling for other factors, individuals who identified as homosexual or bisexual were over two
times more likely to be sexually assaulted than those who identified as heterosexual.

Text box 3
Police-reported sexual assault
An important source of information on crime in Canada is the Incident-based Uniform Crime Reporting (UCR) Survey, which
includes individuals of all ages and covers approximately 99% of the Canadian population. The UCR measures crime that
has both come to the attention of the police and has been substantiated by the police. Research has shown, however, that
most incidents of sexual assault are not reported to the police and are therefore not captured by the UCR. For this reason,
self-reported information collected by the General Social Survey (GSS) on Victimization provides further insight into the
nature and extent of sexual assault in Canada.
In 2014, according to the UCR, there were 20,735 victims of police-reported sexual assault. Of these, 98% were victims of
sexual assault level 1 (20,311 incidents), 2% sexual assault level 2 (319 incidents) and 1% sexual assault level 3 (105
incidents). Among victims, 88% were women. Unlike the rate of self-reported sexual assault, police-reported sexual assault
declined between 2004 and 2014: level 1 declined by 19%, level 2 declined by 28% and level 3 declined by 50%
(Boyce 2015). Among all police-reported incidents of sexual assault captured by the UCR, a friend, acquaintance or
neighbour was the offender for 41% of incidents, while a stranger was the offender for 19% of incidents. Further, 22% of
incidents were perpetrated by a family member—such as a parent, child, sibling or extended family member—and 5% were
perpetrated by a current or former spouse or common-law partner.32
The police-reported data outlined above represent incidents of sexual assault that were reported by the police on the UCR
after it was determined through investigation that a violation of the law occurred. This excludes incidents that were deemed
‘unfounded.’ An incident is classified as unfounded if police investigation determined that the reported offence did not occur,
nor was it attempted. Since 2006, information on unfounded incidents has not been collected by Statistics Canada through
the UCR, and unfounded incidents of sexual assault are not reflected in the numbers above. Statistics Canada collected data
on unfounded incidents beginning in 1962 with the introduction of the UCR. Over time, inconsistent reporting led to poor data
quality. A review conducted in 2006 found that reporting of unfounded incidents was incomplete and Statistics Canada
stopped publishing this information (Statistics Canada 2017).
In April 2017, the Police Information and Statistics Committee (POLIS) of the Canadian Association of Chiefs of Police
recommended resuming the collection, analysis and dissemination of unfounded incidents, including sexual assault, by
Statistics Canada (Canadian Association of Chiefs of Police 2017; Department of Justice Canada 2017). POLIS further
recommended the adoption of a common approach to be taken by police services for the classification and reporting of
unfounded incidents. As a result, Statistics Canada will provide standards and guidelines to police services to ensure
standardized reporting of unfounded incidents to the UCR. The implementation of these changes will be phased in over time.
In July 2018, Statistics Canada will publish the first set of results on unfounded incidents for 2017, including sexual assault.
Perceptions of safety among sexual assault victims
The 2014 GSS on Victimization asked questions on perceptions of safety in a general sense and not in connection to
experiences of victimization; therefore, results among victims in this section may not be a direct outcome of the sexual
assault they experienced.
Victims of sexual assault often had negative perceptions of their neighbourhood, lower trust in others and less confidence in
the police compared to those who were not sexually assaulted. Victims were also less satisfied with their personal safety
from crime and were more likely to take safety precautions.
Sexual assault victims have negative perceptions of their neighbourhood
Victims of sexual assault were less likely to report that they lived in a welcoming community than those who were not
sexually assaulted (86% versus 92%) (Table 5). In addition, victims were more likely to report that there were one or more big
problems related to social disorder33 in their neighbourhood compared to those who were not victims of sexual assault (19%
versus 8%).
Victims of sexual assault were less likely to report that their neighbours were ‘very likely’ to call police if they witnessed
criminal behaviour (56%) than those who were not sexually assaulted (65%). In contrast, victims were about twice as likely to
report that crime in their neighbourhood was higher than in other areas of Canada (9% E) and that crime had increased in their
neighbourhood in the five years that preceded the survey (25%) compared to those who were not victims of sexual assault
(4% and 12%, respectively).

Trust in others lower among sexual assault victims
Victims of sexual assault had lower levels of trust in others. For instance, when asked if people in their neighbourhood were
trustworthy, victims were more likely to report that they ‘cannot be trusted’ (17%E) compared to those who were not victims of
sexual assault (8%) (Table 5). Further, when asked the same about strangers, victims were more likely to report that they
‘cannot be trusted’ (68%) compared to those who were not victims of sexual assault (58%).
Victims of sexual assault have lower confidence in the police, are less satisfied with their personal safety from crime
In addition to lower levels of trust in others, victims of sexual assault also reported lower levels of confidence in the police and
were less satisfied with their personal safety from crime. For example, victims were less likely to have ‘a great deal of
confidence’ in the police than those who were not sexually assaulted (29% versus 45%) (Table 5). Victims were also more
likely to have ‘no confidence at all’ in the police than those who were not victims of sexual assault (7% E versus 2%).
Victims of sexual assault were, in general, less satisfied with their personal safety from crime. Two in three (67%) victims
reported that they were ‘satisfied’ or ‘very satisfied’ with their personal safety, compared to almost nine in ten (89%) of those
who were not sexually assaulted (Table 6).
Victims of sexual assault were less likely to report that they feel safe in specific situations (Chart 3). Sexual assault victims
were more likely than victims of physical assault to state that they feel ‘somewhat or very worried’ when using public
transportation alone after dark (59% versus 34%),34 that they feel ‘somewhat or very unsafe’ when walking alone after dark
(25% versus 11%),35 and that they feel ‘somewhat or very worried’ when home alone after dark (30% versus 15%). 36 These
differences were more pronounced when sexual assault victims were compared to those who were not sexually assaulted.
Victims of sexual assault more likely to take safety precautions
In addition to different perceptions of safety, victims of sexual assault more commonly reported taking safety precautions in
the past compared to those who were not sexually assaulted.37 The greatest differences between the safety precautions of
victims and those who were not victims were related to changing routine, activities or avoiding certain people or places (61%

versus 27%), and carrying something for self-defence or to alert other people (40% versus 12%) (Table 7). Victims also more
commonly reported planning routes with safety in mind (60%), taking a self-defence course (32%) and checking the back
seat for intruders when alone and returning to a parked car (52%), compared to those who were not victims (39%, 11% and
35%, respectively). Among sexual assault victims, women were more likely than men to report that they carry something for
self-defence or to alert other people (43% versus 25%E).
Victims of sexual assault were more likely to report taking certain safety precautions than victims of physical assault: for
instance, those who were sexually assaulted were more likely to report that they used a car, taxi or public transportation
rather than walking for personal safety (49% versus 32%). In addition, a large proportion of sexual assault victims reported
planning routes with safety in mind (60%) and carrying something for self-defence or to alert other people (40%), compared
to those who were physically assaulted (44% and 24%, respectively).
Characteristics of sexual assault offenders and incidents
This article thus far includes information on all victims of self-reported sexual assault, including incidents perpetrated by a
friend, acquaintance or neighbour, a stranger or a spouse. The next three sections, however, focus on incidents of sexual
assault perpetrated by someone other than a spouse as information pertaining to spousal violence—including sexual
assault—is collected using a different methodology.38 In 2014, nearly all (96%) incidents of sexual assault were perpetrated
by someone other than a spouse.
Sexual assault offenders often known to victims
Sexual assault offenders were often known to their victims. A friend, acquaintance or neighbour was the offender for 52% of
sexual assault incidents, while a stranger was the offender for 44% of incidents (Table 8). Among victims, a friend,
acquaintance or neighbour was more often the perpetrator for men than women (62% versus 51%).
In contrast, physical assault39 was more commonly perpetrated by a stranger (47%) than a friend, acquaintance or neighbour
(33%). This was consistent among men as 63% were physically assaulted by a stranger while 29% were physically assaulted
by a friend, acquaintance or neighbour. Women, however, were more commonly physically assaulted by a friend,
acquaintance or neighbour (38%) than a stranger (28%).
Text box 4
Sexual violence perpetrated by dating partners
For the first time, the 2014 cycle of the General Social Survey (GSS) on Victimization included questions on experiences of
emotional, physical and sexual violence in the context of dating relationships. Those who were not in a spousal or common-
law relationship at the time, or who were in a spousal or common-law relationship of fewer than five years, were asked about
experiences of violence perpetrated by someone they were dating.
The 2014 GSS on Victimization asked the following questions:
 “In the past five years, has anyone you were dating tried to limit your contact with family or friends, called you names
to make you feel bad, or threatened to harm you or someone close to you?”
 “In the past five years, have you experienced physical violence by someone you were dating?” Physical violence
includes acts such as hitting, pushing, grabbing, kicking, biting, choking, throwing things to hurt you or threatening
you with a weapon.
 “In the past five years, have you experienced sexual violence by someone you were dating?” Sexual violence
includes acts such as forcing you into an unwanted sexual activity by threatening you, holding you down or hurting
you, or subjecting you to a sexual activity to which you are not able to consent.
Compared to emotional (7%) and physical violence (4%), sexual violence perpetrated by a dating partner was less common,
reported by 1% of those who had dated in the five years that preceded the survey. This represented approximately 138,000
Canadians aged 15 and older, 83% of whom were women.
Sexual assault offenders mostly men, acting alone, under the age of 35
Overall, the large majority (94%) of sexual assault incidents were perpetrated by a man (Table 8). However, a considerable
difference was noted depending on the sex of the victim. For instance, women almost exclusively reported that they were
sexually assaulted by a man (99%), while similar proportions of men reported that they were sexually assaulted by a man

(52%E) or a woman (48%E). Almost four in five (79%) victims reported that they were sexually assaulted by one offender
acting alone.
Similar to sexual assault victims, those identified as offenders were often young. 40 For about two-thirds of incidents (68%),
someone under the age of 35 was identified as the offender. More specifically, 31% of offenders were between the ages of
18 and 24, while 27%E were between the ages of 25 and 34, and 10%E were under the age of 18. Victims and offenders of
sexual assault were often in the same age group. For example, 68% of victims aged 15 to 24 reported that they were
sexually assaulted by someone under the age of 24. Similarly, 83% of victims aged 35 and older reported that they were
sexually assaulted by someone aged 35 or older.
For comparison, the characteristics of offenders of physical assault41 were considered. Over half (56%) of physical assault
offenders were under the age of 35: 23% were between the ages of 25 to 34, while 19% were between the ages of 18 to 24,
and 13%E were under the age of 18. Similar to victims of sexual assault, victims of physical assault were often in the same
age group as offenders. Also similar to sexual assault, physical assault incidents were most often perpetrated by a man
(82%) and by one offender acting alone (75%).
Majority of sexual assault victims believe that the incident was related to the offender’s alcohol or drug use
Just over half (54%) of sexual assault victims believed that the incident was related to the offender’s alcohol or drug use
(Table 8). Women who were victims of sexual assault believed that the offender’s alcohol or drug use was related to the
incident more commonly than men (58% versus 32%E).
Similar to sexual assault, half (51%) of physical assault victims believed that the incident was related to the offender’s alcohol
or drug use; however, men more commonly reported this than women (61% versus 38%).
Sexual assault most often occurs at a commercial or institutional establishment
Incidents of sexual assault most commonly occurred at a commercial or institutional establishment (43%)—such as a
restaurant, bar, school, office building or shopping mall—followed by a private residence of someone other than the victim
(22%E) (Table 8). The residence of the victim and the street or other public place were less common locations for sexual
assault (7%E and 14%E, respectively).
Emotional and physical consequences of sexual assault
As previously mentioned, this section provides information on incidents of sexual assault perpetrated by someone other than
a spouse as information pertaining to spousal violence—including sexual assault—is collected using a different
methodology.42
Many victims of sexual assault report emotional consequences, few report physical injury
The impact of violent crime on victims is not limited to physical injury, nor is physical injury the primary indicator of sexual
assault. Research has shown that sexual assault can have a profound psychological impact on victims (Chen and Ullman
2010; Cybulska 2007; Elliot et al. 2004; Logie et al. 2014; Luce et al. 2010). The 2014 GSS on Victimization asked about
physical injury, such as bruises, cuts and broken bones resulting from sexual assault, as well as emotional consequences.
Most sexual assault incidents did not involve the presence of a weapon (86%) and did not cause physical injury to the victim
(93%) (Table 8). In contrast to sexual assault, one-quarter (26%) of physical assault incidents caused physical injury to the
victim.
One in six sexual assault victims experiences symptoms consistent with post-traumatic stress disorder
Sexual assault resulted in negative emotional consequences for many victims. Most commonly, victims of sexual assault
reported feeling angry (35%) or upset, confused or frustrated (21%) as a result of the incident they experienced. These
emotional consequences were similar to those among victims of physical assault 43 (27% and 25%, respectively). Further,
one-quarter (25%) of victims of sexual assault stated that they had difficulty carrying out everyday activities because of the
incident they experienced, also similar to victims of physical assault (23%). However, while 26% of physical assault victims
reported that they were not affected emotionally by the incident they experienced, 13%E of sexual assault victims reported the
same.

Certain longer-term emotional consequences have been identified as possible signs of PTSD (see Text box 5). Overall, 15% E
of sexual assault victims reported experiencing three or more longer-term emotional consequences (Chart 4), similar to 12%E
of victims of physical assault. Among the four longer-term emotional consequences, trying hard not to think about the incident
or going out of the way to avoid situations that reminded the victim of the incident was most commonly reported (29%).

Text box 5
Primary Care Post-Traumatic Stress Disorder screening tool
Research has shown that victims of violence may experience post-traumatic stress disorder (PTSD) following physical or
psychological trauma (Burczycka and Ibrahim 2016; Logie et al. 2014; Luce et al. 2010). PTSD is characterized by feelings of
detachment, being constantly on guard, nightmares and avoidance behaviours. Further, PTSD has been associated with
impaired physical health (Cybulska 2007), decreased quality of life and increased mortality (Luce et al. 2010; Prins et al.
2003).
For the first time, the 2014 cycle of the General Social Survey (GSS) on Victimization included questions on longer-term
emotional consequences of victimization using four questions from the Primary Care PTSD (PC-PTSD) screening tool. The
PC-PTSD screening tool is designed to assess the PTSD-related symptoms of re-experiencing, numbing, avoidance and
hyperarousal (Prins et al. 2003).
To measure longer-term impacts of victimization, the 2014 GSS on Victimization asked the following questions:
 “In the past month, have you had nightmares about it or thought about it when you did not want to?”
 “In the past month, have you tried hard not to think about it or went out of your way to avoid situations that reminded
you of it?”
 “In the past month, have you felt constantly on guard, watchful or easily startled?”
 “In the past month, have you felt numb or detached from others, activities or your surroundings?”
Importantly, while these questions from the PC-PTSD screening tool cannot diagnose PTSD, they are used in frontline
settings to determine whether victims or patients should be referred for further assessment and possible diagnosis
(Burczycka and Ibrahim 2016; Prins et al. 2003). If an individual answers ‘yes’ to three of the four questions, it is suspected
that they have PTSD. Further evaluation would be required to determine a PTSD diagnosis.
Reporting sexual assault to the police
As previously mentioned, this section provides information on incidents of sexual assault perpetrated by someone other than
a spouse as information pertaining to spousal violence—including sexual assault—is collected using a different
methodology.44
Large majority of sexual assault not reported to the police
Research has widely documented that sexual assault is an underreported crime (Brennan and Taylor-Butts 2008; Kaufman
2008; Luce et al. 2010). According to the 2014 GSS on Victimization, more than eight in ten (83%) sexual assault incidents
were not reported to the police (Chart 5). This remained unchanged from 2004, when 88% of sexual assault incidents were
not reported to the police.45

In 2014, one in twenty (5%E) incidents of sexual assault was reported to the police, a proportion that also remained
unchanged from that which was reported in 2004 (8%E).46 Compared to other types of crime, sexual assault was particularly
underreported to the police: for example, among the seven other types of crime measured by the 2014 GSS on Victimization,
one in three (34%) incidents was reported to the police overall. Further, four in ten (38%) incidents of physical assault were
reported to the police. These proportions also remained unchanged from those which were reported in 2004 (36% and 39%,
respectively).47
Among the three types of sexual assault measured by the 2014 GSS on Victimization, 88% of incidents of unwanted sexual
touching, 74% of incidents of sexual activity where the victim was unable to consent and 66% of sexual attacks were not
reported to the police.48
Belief that crime was minor and not worth the time to report most common reason for not reporting sexual assault
Victims of sexual assault who did not report the incident to the police were asked why they did not do so.49 The most common
reasons provided were that the crime was minor and it was not worth taking the time to report (71%), that the incident was a
private or personal matter and it was handled informally (67%), and that no one was harmed during the incident (63%)
(Table 9). These were also common reasons among victims of physical assault50 who did not report the incident to the police
(66%, 59% and 45%, respectively).
In general, women and men provided similar reasons for not reporting incidents of sexual assault to the police. However,
women were more likely than men to state that they did not report to the police because no one was harmed during the
incident (66% versus 42%E) and because there was a lack of evidence (46% versus 18%E).
Victims of sexual assault more commonly stated that they did not report the incident to the police because of a lack of
evidence (43%) and because no harm was intended (39%) than victims of physical assault (22% and 21%, respectively). In
addition, a higher proportion of victims of sexual assault stated that they did not report the incident to the police because they
did not want others to find out about their victimization51 (30%) and because they were afraid that reporting would bring
shame and dishonour to their family (12%E), compared to victims of physical assault (11%E and 6%E, respectively).

Most victims of sexual assault spoke to others, did not consult support services
While many victims of sexual assault did not report the incident to the police because they did not want others to find out
about it, many did speak with someone. Nearly two-thirds (64%) stated that they talked to a friend or neighbour about their
victimization. Smaller proportions stated that they talked to a family member (41%), a co-worker (24%), or a doctor or nurse
(6%E). Victims of physical assault were more likely to report speaking to a family member (69%), a co-worker (58%), or a
doctor or nurse (13%) about their victimization.
Overall, 17%E of sexual assault victims reported that they consulted any support services—such as crisis centres or crisis
lines, victim services, counsellors or psychologists, or community centres—following the incident. More specifically, 19%E of
women who were victims consulted a support service. The corresponding proportion of men who were victims is too
unreliable to be published; however, research suggests that men are less likely to seek support after sexual assault. This
type of victimization may destabilize the self-identity and sexual identity of victims who are men (Elliot et al. 2004; Wall 2011),
and misconceptions about sexual assault, victims and gender roles may create further barriers for men to access support
services (Bullock and Beckson 2011; Elliot et al. 2004; Sable et al. 2006).
Summary
Self-reported data from the 2014 General Social Survey (GSS) on Canadians’ Safety (Victimization) show that all types of
violent and non-violent crime measured by the survey declined between 2004 and 2014 with one exception: sexual assault
remained unchanged. In 2014, there were 22 incidents of sexual assault for every 1,000 Canadians aged 15 and older,
similar to 2004. This represented approximately 636,000 incidents of sexual assault.
Some groups had a higher risk of sexual assault: those who were women, young, Aboriginal, single, and homosexual or
bisexual, and those who had poorer mental health. Certain experiences—childhood abuse and homelessness—and evening
activities outside the home were also associated with an increased risk of sexual assault.
Students had higher rates of sexual assault, as did individuals with mental or physical disabilities. These victim
characteristics, however, did not have a significant impact on the risk of sexual assault when other factors were controlled. It
should be noted that certain factors are closely associated to others—such as age, student status and evening activities
outside the home—and the combination of factors may have contributed to higher rates of sexual assault.
Victims of sexual assault often had negative perceptions of their neighbourhood, lower levels of trust in others and less
confidence in the police. They were also less satisfied with their personal safety from crime and less likely to feel safe in
certain situations.
One in four victims of sexual assault reported that they had difficulty carrying out everyday activities because of the incident,
and one in six reported experiencing three or more longer-term emotional consequences, indicating the possibility of post-
traumatic stress disorder.
The proportion of sexual assault incidents that was reported to the police (one in twenty) also remained unchanged from a
decade earlier. The most common reasons for not reporting were that the victim perceived the crime as minor and not worth
taking the time to report, that the incident was a private or personal matter and it was handled informally, and that no one was
harmed during the incident.
Survey description
General Social Survey on Canadians’ Safety (Victimization)
In 2014, Statistics Canada conducted the sixth cycle of the General Social Survey (GSS) on Canadians’ Safety
(Victimization). Previous cycles were conducted in 1988, 1993, 1999, 2004 and 2009. The purpose of the survey is to provide
data on Canadians’ personal experiences with eight offences, examine the risk factors associated with victimization, examine
rates of reporting to the police, assess the nature and extent of spousal violence, measure fear of crime, and examine public
perceptions of crime and the criminal justice system.
The 2014 GSS on Victimization was also conducted in Yukon, Northwest Territories and Nunavut using a different sampling
design. The GSS on Victimization was also conducted in the territories in 2009 and was preceded by test collections in 1999
and 2004.

In 2009, comparisons between the data from the territories and the provinces were to be made with caution primarily
because the Inuit population was underrepresented in the territories. In 2014, as a result of advancements made to the frame
and higher response rates, data in the territories can be compared, or combined, with data for the provinces. It is noteworthy,
however, to keep in mind differences in survey methods and weighting strategies for the provinces and territories when
analyzing GSS 2014 data at the Canada level. This report combined 2014 GSS on Victimization data from both the provinces
and territories in order to report on the victimization of Aboriginal people in Canada.
The target population for the GSS on Victimization is the Canadian population aged 15 and over, living in the provinces and
territories. Canadians residing in institutions are not included. Once a household was contacted an individual 15 years or
older was randomly selected to respond to the survey.
In 2014, the sample size for the 10 provinces was 33,127 respondents. Of that number, 2,787 were from the oversample. In
2014, the sample size for the three territories was 2,040 respondents, about twice the number of respondents in 2009
(1,094).
Data collection
Provinces
Data collection took place from January to December 2014 inclusively. Responses were obtained by computer-assisted
telephone interviews (CATI). Respondents were able to respond in the official language of their choice.
Territories
Data collection took place from August 2014 to January 2015 inclusively. The method of collection was a mixture of CATI and
personal interviews (CAPI). Most cases started as CATI at the regional office and could be transferred to a CAPI-interviewer
depending on the community and collection constraints. Respondents were interviewed in the official language of their
choice.
Response rates
Provinces
The overall response rate in 2014 was 52.9%, down from 61.6% in 2009. Non-respondents included people who refused to
participate, could not be reached, or could not speak English or French. Respondents in the sample were weighted so that
their responses represent the non-institutionalized Canadian population aged 15 and older.
Territories
The overall response rate was 58.7%, up from 50.7% in 2009. Non-respondents included people who refused to participate,
could not be reached, or could not speak English or French. Respondents in the sample were weighted so that their
responses represent the non-institutionalized territories population aged 15 and older.
Data limitations
As with any household survey, there are some data limitations. The results are based on a sample and are therefore subject
to sampling errors. Somewhat different results might have been obtained if the entire population had been surveyed. This
article uses the coefficient of variation (CV) as a measure of the sampling error. Estimates with a high CV (over 33.3%) were
not published because they were too unreliable. In these cases, the symbol “F” is used in place of an estimate in the figures
and data tables. Estimates with a CV between 16.6 and 33.3 should be used with caution and the symbol “E” is used. Where
descriptive statistics and cross-tabular analyses were used, statistically significant differences were determined using 95%
confidence intervals.
Incident-based Uniform Crime Reporting Survey
The Incident-based Uniform Crime Reporting (UCR) Survey collects detailed information on criminal incidents that have
come to the attention of and have been substantiated by Canadian police services. Information includes characteristics
pertaining to incidents (weapon, location), victims (age, sex, accused-victim relationship) and accused persons (age, sex). In
2014, data from police services covered 99% of the population of Canada. The count for a particular year represents
incidents reported in that year, regardless of when the incident actually occurred.

References
Abbey, A., Zawacki, T., Buck, P. O., Clinton, A. M. and McAuslan, P. 2001. “Alcohol and sexual assault.” Alcohol Research &
Health. Vol. 25, no. 1. p. 43-51.
Benedet, J. and I. Grant. 2014. “Sexual assault and the meaning of power and authority for women with mental disabilities.”
Feminist Legal Studies. Vol. 22, no. 2. p. 131-154.
Benoit, C., Shumka, L., Phillips, R., Kennedy, M. and L. Belle-Isle. 2015. Issue Brief: Sexual Violence Against Women in
Canada. December. Status of Women Canada.
Boyce, J. 2016. “Victimization of Aboriginal people in Canada, 2014.” Juristat. Vol. 36, no. 1. Statistics Canada Catalogue
no. 85-002-X.
Boyce, J. 2015. “Police-reported crime statistics in Canada, 2014.” Juristat. Vol. 35, no. 1. Statistics Canada Catalogue
no. 85-002-X.
Brennan, S. and A. Taylor-Butts. 2008. “Sexual assault in Canada, 2004 and 2007.” Canadian Centre for Justice Statistics
Profile Series. No. 19. Statistics Canada Catalogue no. 85F0033M.
Bullock, C. and M. Beckson. 2011. “Male victims of sexual assault: Phenomenology, psychology, physiology.” Journal of the
American Academy of Psychiatry and the Law. Vol. 39, no. 2. p. 195-205.
Burczycka, M. and S. Conroy. 2017. “Family violence in Canada: A statistical profile, 2015.” Juristat. Vol. 37, no. 1. Statistics
Canada Catalogue no. 85-002-X.
Burczycka, M. and D. Ibrahim. 2016. “Family violence in Canada: A statistical profile, 2014.” Juristat. Vol. 36, no. 1. Statistics
Canadian Association of Chiefs of Police. 2017. Recommendations Regarding the Collection of ‘Unfounded’ Incidents via the
Uniform Crime Reporting Survey. Press release, April 26, 2017.
Canadian Federation of Students. n.d. “A national vision for consent culture in post-secondary education.” Consent Culture.
Chen, Y. and S. E. Ullman. 2010. “Women’s reporting of sexual and physical assaults to police in the National Violence
Against Women Survey.” Violence Against Women. Vol. 16, no. 3. p. 262-279.
Collin-Vézina, D., Hélie, S. and N. Trocmé. 2010. “Is child sexual abuse declining in Canada? An analysis of child welfare
data.” Child Abuse & Neglect. Vol. 34, no. 11. p. 807-812.
Cotter, A. and P. Beaupré. 2014. “Police-reported sexual offences against children and youth in Canada, 2012.” Juristat.
Vol. 34, no. 1. Statistics Canada Catalogue no. 85-002-X.
Criminal Code, R.S.C. 1985. c. C-46.
Cybulska, B. 2007. “Sexual assault: Key issues.” Journal of the Royal Society of Medicine. Vol. 100, no. 7. p. 321-324.
Daigneault, I., Hébert, M. and McDuff, P. 2009. “Men’s and women’s childhood sexual abuse and victimization in adult
partner relationships: A study of risk factors.” Child Abuse & Neglect. Vol. 33, no. 9. p. 638-647.
Department of Justice Canada. 2017. Government of Canada Announces Measures to Combat Gender-Based Violence.
Press release, April 26, 2017.
Dylan, A., Regehr, C. and R. Alaggia. 2008. "And justice for all? Aboriginal victims of sexual violence." Violence Against
Women. Vol. 14, no. 6. p. 678-696.
Elliot, D. M., Mok, D. S. and J. Briere. 2004. “Adult sexual assault: Prevalence, symptomatology, and sex differences in the
general population.” Journal of Traumatic Stress. Vol. 17, no. 3. p. 203-211.
Franklin, C. A., Franklin, T. W., Nobles, M. R. and G. Kercher. 2011. Risk Factors Associated with Women’s Victimization.
Huntsville, Texas. Crime Victims’ Institute, Criminal Justice Center, Sam Houston State University.
Johnson, H. 2012. “Limits of a criminal justice response: Trends in police and court processing of sexual assault.” In E. A.
Sheehy (Ed.), Sexual Assault in Canada: Law, Legal Practice and Women’s Activism. p. 613-634. Ottawa, Ontario. University
of Ottawa Press.
Kaufman, M. 2008. “Care of the adolescent sexual assault victim.” Pediatrics. Vol. 122, no. 2. p. 462-470.
Kong, R., Johnson, H., Beattie, S. and A. Cardillo. 2003. “Sexual offences in Canada.” Juristat. Vol. 23, no. 6. Statistics
Kushel, M., Evans, J. and S. Perry. 2003. “No door to lock: Victimization among homeless and marginally housed persons.”
Archives of Internal Medicine. Vol. 163, no. 20. p. 2492-2499.

Logie, C., Alaggia, R. and M. Rwigema. 2014. “A social ecological approach to understanding correlates of lifetime sexual
assault among sexual minority women in Toronto, Canada: Results from a cross-sectional internet-based survey.” Health
Education Research. Vol. 29, no. 4. p. 671-682.
Luce, H., Schrager, S. and V. Gilchrist. 2010. “Sexual assault of women.” American Family Physician. Vol. 81, no. 4. p. 489-495.
Meer, T. and H. Combrinck. 2015. “Invisible intersections: Understanding the complex stigmatisation of women with
intellectual disabilities in their vulnerability to gender-based violence.” Agenda. Vol. 29, no. 2. p. 14-23.
Metropolitan Action Committee on Violence Against Women. 2016. Campus Safety: Considerations and Promising Practices.
House of Commons Canada.
Moreno, M. 2015. “Sexual assault and rape among college students.” Pediatrics. Vol. 169, no. 12. p. 1184.
Nosek, M. A., Foley, C. C., Hughes, R. B. and C. A. Howland. 2001. “Vulnerabilities for abuse among women with
disabilities.” Sexuality and Disability. Vol. 19, no. 3. p. 177-189.
Perreault, S. 2015. “Criminal victimization in Canada, 2014.” Juristat. Vol. 35, no. 1. Statistics Canada Catalogue no. 85-002-X.
Prins, A., Ouimette, P., Kimerling, R., Cameron, R., Hugelshofer, D., Shaw-Hegwer, J., Thrailkill, A., Gusman, F. and J.
Sheikh. 2003. “The Primary Care PTSD screen (PC-PTSD): Development and operating characteristics.” Primary Care
Psychiatry. Vol. 9, no. 1. p. 9-14.
R. v. Seaboyer. 1991. 2 S.C.R. 577.
Rothman, E. F., Exner, D. and A. Baughman. 2011. “The prevalence of sexual assault against people who identify as gay,
lesbian or bisexual in the United States: A systematic review.” Trauma, Violence & Abuse. Vol. 12, no. 2. p. 55-66.
Sable, M. R., Danis, F., Mauzy, D. L. and S. K. Gallagher. 2006. “Barriers to reporting sexual assault for women and men:
Perspectives of college students.” Journal of American College Health. Vol. 55, no. 3. p. 157-162.
Statistics Canada. 2017. Statistics Canada will Collect and Publish Data on Unfounded Criminal Incidents. Press release,
April 26, 2017.
Todahl, J. L., Linville, D., Bustin, A., Wheeler, J. and J. Gau. 2009. “Sexual assault support services and community systems:
Understanding critical issues and needs in the LGBTQ community.” Violence Against Women. Vol. 15, no. 8. p. 952-976.
Ullman, S. E., Relyea, M., Peter-Hagene, L. and A. L. Vasquez. 2013. “Trauma histories, substance use coping, PTSD, and
problem substance use among sexual assault victims.” Addictive Behaviors. Vol. 38, no. 6. p. 2219-2223.
Wall, B. 2011. “Commentary: Causes and consequences of male adult sexual assault.” Journal of the American Academy of
Psychiatry and the Law. Vol. 39, no. 2. p. 206-208.
Weikle, B. 2016. “Universities face increasing pressure to address campus sexual assault.” CBC News. September 13, 2016.
Weinrath, M. 2008. "Violent victimization and fear of crime among Canadian Aboriginals." Journal of Offender Rehabilitation.
Vol. 30, no. 1-2. p. 107-210.
Wenzel, S. L., Leake, B. D. and L. Gelberg. 2000. “Health of homeless women with recent experience of rape.” Journal of
General Internal Medicine. Vol. 15, no. 4. p. 265-268.
Notes
E
use with caution
1. Numbers in text, tables and charts may not add up to totals due to rounding.
2. Rates are calculated per 1,000 population aged 15 and older.
3. The 2004 General Social Survey (GSS) on Victimization collected information from respondents in the provinces only,
while the 2014 GSS on Victimization collected information from respondents in the provinces and territories. For comparison
over time, 2014 data from Yukon, Northwest Territories and Nunavut are excluded where 2004 data are discussed. For this
reason, the total number of incidents in Table 1 and Chart 1 do not equal the number that appears in the text for 2014.
4. The difference between the rate of self-reported sexual assault in 2004 and in 2014 was not statistically significant (p < 0.05).
5. The eight types of crime measured by the General Social Survey on Victimization are physical assault, sexual assault,
robbery, theft of personal property, breaking and entering, motor vehicle theft, theft of household property and vandalism.
6. An analysis of the impact of the additional question on sexual activity where the victim was unable to consent shows that
sexual assault data from the 2004 and 2014 cycles of the General Social Survey on Victimization remain comparable.
Excluding the newer question, the rate of self-reported sexual assault in 2014 remained unchanged from the rate in 2004
(20 versus 21 per 1,000 population). In 2004, 76% of incidents were unwanted sexual touching and 24% were sexual attacks.
7. In this article, ‘women’ refers to females aged 15 and older and ‘men’ refers to males aged 15 and older.

8. The proportion of men who experienced two incidents or three or more incidents of sexual assault is too unreliable to be
published.
9. It should be noted that the General Social Survey on Victimization collects information from respondents aged 15 and
older; therefore, self-reported sexual assault data for those aged 14 and under are unavailable. Police-reported data show
that sexual violence peaks between age 13 and 16 for victims (Cotter and Beaupré 2014).
10. The rate of self-reported sexual assault among men by age group is too unreliable to be published.
11. This article uses the term ‘Aboriginal’ instead of ‘Indigenous’ as ‘Aboriginal’ was used in the 2014 General Social Survey
on Victimization. The rates of self-reported sexual assault among the different Aboriginal groups are too unreliable to be
published individually.
12. The rate of self-reported sexual assault among Aboriginal men is too unreliable to be published.
13. Further information specific to Aboriginal victimization can be found in “Victimization of Aboriginal people in Canada,
2014” (Boyce 2016).
14. The rate of self-reported sexual assault among men who were married or common-law is too unreliable to be published.
15. Includes those aged 18 and older.
16. The corresponding proportion of victims who identified as heterosexual was 86%. The difference between victims who
identified as heterosexual and victims who identified as homosexual or bisexual was not statistically significant (p < 0.05).
17. Includes those who reported that they have a mental or cognitive condition (e.g., developmental, learning, psychological)
or a physical condition (e.g., sensory, mobility)—as well as those who reported that they experienced one or more other
unspecified health condition expected to last for six months or more—that limits their daily activities.
18. Questions on self-rated mental health were asked in a general sense and not in connection to experiences of
victimization; therefore, results among victims may not be a direct outcome of the sexual assault they experienced.
19. Drug use refers to using non-prescribed drugs including marijuana, hashish, magic mushrooms, cocaine,
methamphetamine, ecstasy and heroin.
20. Binge drinking refers to drinking five or more drinks on one occasion. Includes those who reported binge drinking at least
once in the past month.
21. Questions on substance use were asked in a general sense and not in connection to experiences of victimization;
therefore, results among victims may not be a direct outcome of the sexual assault they experienced.
22. Childhood physical abuse: been slapped or hit with something hard enough to have been hurt; been pushed, grabbed or
shoved; and/or been kicked, bitten, punched, choked, burned or otherwise attacked.
23. Childhood sexual abuse: been touched, grabbed, kissed or fondled in a sexual way; and/or been forced into unwanted
sexual activity by being threatened, held down or hurt.
24. Further information specific to childhood maltreatment—physical abuse, sexual abuse and/or witnessing parental
violence—can be found in Section 1 of “Family violence in Canada: A statistical profile, 2015” (Burczycka and Conroy 2017).
25. Questions on homelessness were asked in a general sense and not in connection to experiences of victimization;
therefore, results among victims may not be a direct outcome of the sexual assault they experienced.
26. Those who experienced both stalking and sexual assault were not necessarily victimized by the same offender.
27. Includes repeated, silent and obscene phone calls, unwanted email, text and social media messages, and unwanted
letters, gifts and cards.
28. Includes persistently asking for a date, posting unwanted information on social media, intimidating or threatening
someone close, attempting to intimidate or threaten by hurting pets, and attempting to intimidate or threaten by damaging
property.
29. The rate of self-reported sexual assault among men who were stalked in the past 12 months is too unreliable to be
published.
30. Respondents could report that they had experienced more than one type of stalking. Over half (55%) of stalking victims
reported that they had experienced one type of stalking, while the remaining 45% of stalking victims reported that they had
experienced more than one type of stalking.
31. The question on sexual orientation was not asked of those aged 15 to 17; therefore, sexual orientation was not included in
the model for Canadians aged 15 and older. The risk of sexual assault among those aged 18 and older who identified as
homosexual or bisexual was 2.51 times higher than those who identified as heterosexual.
32. The higher proportion of family relationships for police-reported incidents of sexual assault may be attributed to the fact
that the General Social Survey on Victimization is limited to individuals aged 15 and older. Further information specific to
police-reported crime can be found in “Police-reported crime statistics in Canada, 2014” (Boyce 2015).

33. Includes noisy neighbours or loud parties; people hanging around on the streets; garbage or litter lying around; vandalism;
people being attacked because of their skin colour, ethnic origin or religion; people using or dealing drugs; people being
drunk or rowdy in public places.
34. Excludes those who reported that they never used public transportation alone after dark or that public transportation was
unavailable to them.
35. Excludes those who reported that they never walked alone after dark.
36. Excludes those who reported that they were never home alone after dark.
37. Questions about protection from crime and safety from crime were not limited to the past 12 months; therefore, victims
may have taken safety precautions before they were sexually assaulted.
38. Information about non-spousal violence is collected by incident, whereas information about spousal violence—incidents
perpetrated by a current or former spouse or common-law partner—is collected as a grouping of incidents by victim and may
include incidents of non-sexual violence. Spousal violence often involves repeated victimization and it would therefore be too
burdensome to ask victims to recall each incident they experienced. It is not possible to provide details about a specific
incident of spousal violence. For this reason, information about sexual assault in the context of spousal violence is excluded
from this article. Where details about physical assault are provided for comparison, includes incidents of physical assault
perpetrated by someone other than a spouse. Information specific to spousal violence, based on the 2014 General Social
Survey on Victimization, can be found in Section 1 of “Family violence in Canada: A statistical profile, 2014” (Burczycka and
Ibrahim 2016).
39. Includes non-spousal physical assault.
40. Characteristics of sexual assault offenders are based on self-reported information provided by victims who may not have
had correct or precise information about offenders.
Ibrahim 2016).
Ibrahim 2016).
45. The difference between the proportion of incidents of sexual assault not reported to the police in 2004 and in 2014 was
not statistically significant (p < 0.05).
46. It is unknown if the remaining 12% of sexual assault incidents were reported to the police as responses of ‘don’t know’ or
refusal were given by respondents.
47. The difference between the proportion of incidents reported to the police in 2004 and in 2014 was not statistically
significant (p < 0.05). This applies to sexual assault, the seven other types of crime measured by the General Social Survey
on Victimization and physical assault.
48. The proportion of incidents of sexual assault reported to the police by type of sexual assault is too unreliable to be
published.
49. Respondents could provide more than one reason for not reporting to the police.
51. Includes publicity and news coverage.

Detailed data tables
Table 1
Self-reported sexual assault, by sex of victim, Canada, 1999, 2004, 2009 and 2014
1999 2004 2009 2014
number number number number
Sex of victim (000s) rate1 (000s) rate1 (000s) rate1 (000s) rate1
Women 410 33* 460 35* 472 34* 553 37*
Men† 92E 8E 86E 7E 204E 15E ** 80E 5E
Total 502 21 546 21 677 24 633 22
E
use with caution
* significantly different from reference category (p < 0.05)
** significantly different from 2014 (p < 0.05)
† reference category
1. Rates are calculated per 1,000 population aged 15 years and older.
Note: Includes spousal and non-spousal sexual assault. 'Victim' refers to those who reported that they experienced were sexually assaulted in the
past 12 months. For comparison over time, data from Yukon, Northwest Territories and Nunavut are excluded. As of 2014, includes sexual activity
where the victim was unable to consent due to drugs, intoxication, manipulation or non-physical force.
Source: Statistics Canada, General Social Survey.

Table 2
Self-reported sexual assault, by sex of victim and socioeconomic characteristics, Canada, 2014
Women Men Total
Characteristics rate1
Age group
15 to 24 years† 134** 11E 71
25 to 34 years 58E * F 32E *
35 to 44 years 16E * F 10E *
45 to 54 years 20E * F 13E *
55 years and older F F 4E *
Main activity
Student 127E *** 15E * 73*
Other2 17E F 11E
Employed† 26** 5E 14
Aboriginal identity3
Aboriginal 113E * F 58E *
Non-Aboriginal† 35** 5E 20
Marital status
Single, never married 108*** 12E 57*
Separated, widowed or divorced 17E F 13E
Married or common-law† 12E F 7E
Sexual orientation4
Homosexual or bisexual 155E * F 102E *
Heterosexual† 29** 4E 17
Disability5
Mental or physical 56* F 37*
None† 29** 4E 16
Self-rated mental health
Fair or poor 204E * F 121E *
Good 48E * F 28E *
Very good 23E * F 13E
Excellent† 16E F 10E
Immigrant status
Immigrant 16E * F 10E *
Non-immigrant† 42** 5E 24
Visible minority status6
Visible minority 33E F 21E
Non-visible minority† 37** 5 21
Total 37** 5E 22
E
use with caution
F too unreliable to be published
** estimate for women significantly different from estimate for men (p < 0.05) but not reference category
*** estimate for women significantly different from reference category (p < 0.05) and estimate for men (p < 0.05)
2. Includes those who reported their main activity as retired, caring for children, household work, looking for paid work, long-term illness, etc.
3. Includes those who identified as First Nations, Métis or Inuit. The rates of self-reported sexual assault among the different Aboriginal groups are
too unreliable to be published individually.
4. Includes those aged 18 and older.
5. Includes those who reported that they have a mental or cognitive condition (e.g., developmental, learning, psychological) or a physical condition
(e.g., sensory, mobility)—as well as those who reported that they experience one or more other unspecified health condition expected to last for six
months or more—that limits their daily activities.
6. Includes those who reported that they belong to one or more of the following groups: South Asian (e.g., East Indian, Pakistani), Chinese, Black,
Filipino, Latin American, Arab, Southeast Asian (e.g., Vietnamese, Cambodian), West Asian (e.g., Iranian, Afghan), Korean, Japanese, etc.
Note: Includes spousal and non-spousal sexual assault. 'Victim' refers to those who reported that they were sexually assaulted in the past 12 months.

Table 3
Self-reported sexual assault, by sex of victim and selected characteristics, Canada, 2014
Women Men Total
Characteristics rate1
Number of evening activities per month
0 to 10† 15E F 10
11 to 20 35E * F 19*
21 or more 97*** 8E 45*
Going to work, night classes, meetings or volunteering in the
evening
Less than once a month† 17E F 12E
One to ten times per month 35*** 5E 20*
More than 10 times per month 85E *** 8E 40*
Going to bars, clubs or pubs in the evening
Less than once a month† 23** 5E 15
One to ten times per month 72*** 5E 33*
More than 10 times per month F F F
Going to other activities outside the home in the evening 2
Less than once a month† 20E F 13E
One to ten times per month 31** 4E 18
More than 10 times per month 71E *** 7E 37E *
Drug use in the past month3
Yes 195E * F 71E *
No† 29** 4E 17
Binge drinking in the past month4
Yes 89E *** 5E 35*
No† 25** 5E 16
Total 37** 5E 22
E
use with caution
1. Rates are calculated per 1,000 population aged 15 years and older.
2. Includes going to restaurants, shops or sports practice, and visits with friends or family.
3. Drug use refers to using non-prescribed drugs including marijuana, hashish, magic mushrooms, cocaine, methamphetamine, ecstasy and heroin.
4. Binge drinking refers to drinking five or more drinks on one occasion. Includes those who reported binge drinking at least once.

Table 4
Self-reported sexual assault, by sex of victim and experiences, Canada, 2014
Women Men Total
Experiences rate1
Childhood physical or sexual abuse before age 152
Yes 65*** 10E 36*
No† 24 F 15
Childhood physical abuse before age 152
Yes 64*** 10E 33*
No† 28 F 17
Childhood sexual abuse before age 152
Yes 85E * F 70E *
No† 30** 5E 17
Homelessness3
Yes 100E * F 54E *
No† 31** 5E 18
Stalking in the past 12 months
Yes 246E * F 182E *
No† 29** 4E 17
Total 37** 5E 22
E
use with caution
2. Refers to abuse perpetrated by an adult aged 18 or older.
3. Includes those who reported that they had lived in a shelter, on the street or in an abandoned building, and those who had lived with family or
friends, or in a car because they had no where else to live.

Table 5
Perceptions of neighbourhood safety, by sex and self-reported sexual assault victimization, Canada, 2014
Women Men Total
Non- Non- Non-
Victims victims† Victims victims† Victims victims†
Perceptions of safety percent
Live in a welcoming community
Yes 85* 92 89 93 86* 92
No 13E * 6 F 5 13E * 6
Social disorder in the neighbourhood1
One or more big problems 18E * 8 24E * 7 19* 8
One or more moderate problems but no big
problems 18E 14 26E 14 19 14
One or more small problems but no moderate or
big problems 34 29 28E 31 33 30
No problems at all 27* 45 22E * 45 26* 45
Neighbours would call the police if they
witnessed criminal behaviour
Very likely 57 65 49E 65 56* 65
Somewhat likely 33 25 36E 27 34 26
Somewhat unlikely 7E 3 F 3 7E 3
Not at all likely F 3 F 3 F 3
Crime in the neighbourhood compared to other
areas in Canada
Higher 6E 4 24E * 4 9E * 4
About the same 28* 20 26E 19 28* 19
Lower 65* 74 50E * 74 63* 74
Crime in the neighbourhood compared to five
years ago2
Increased 25* 13 27E * 11 25* 12
About the same 65* 78 54E * 77 64* 78
Decreased 9E 8 F 11 10E 10
Trust in people in the neighbourhood
Cannot be trusted 16E * 9 26E * 8 17E * 8
Neutral 37* 25 28E 27 36* 26
Can be trusted 47* 64 45E * 64 47* 64
Trust in strangers
Cannot be trusted 69 60 61 56 68* 58
Neutral 28E 28 35E 31 29 29
Can be trusted 3E * 9 F 10 3E * 10
Confidence in the police
A great deal of confidence 29* 46 28E * 44 29* 45
Some confidence 50 46 47E 46 49 46
Not very much confidence 15E * 5 F 7 15E * 6
No confidence at all 5E * 1 F 3 7E * 2
E
use with caution
1. Includes noisy neighbours or loud parties; people hanging around on the streets; garbage or litter lying around; vandalism; people being attacked
because of their skin colour, ethnic origin or religion; people using or dealing drugs; people being drunk or rowdy in public places.
2. Excludes those who reported that they had not lived in their current neighbourhood long enough to assess.
Note: Includes spousal and non-spousal sexual assault. 'Victims' refer to those who reported that they were sexually assaulted in the past 12 months.
Responses of don't know/refusal are included in the calculation of percentages but are not displayed if they represent less than 5% of all responses.

Table 6
Perceptions of personal safety, by sex and self-reported sexual assault victimization, Canada, 2014
Women Men Total
Non- Non- Non-
Perceptions of safety percent
Satisfaction with personal safety from crime
Very satisfied 25E 32** 32E 44 26* 38
Satisfied 42* 53** 39E 47 41* 50
Neither satisfied nor dissatisfied 26* 10** F 6 25* 8
Dissatisfied or very dissatisfied 7E 3** F 2 8E * 3
Feeling of safety when walking alone after dark1
Somewhat or very unsafe 28E * 11** F 4 25* 7
Reasonably safe 48 50** 42E 32 47 40
Very safe 24*** 38** 46E 64 27* 53
Feeling of safety when using public
transportation alone after dark2
Somewhat or very worried 64* 48** F 21 59* 33
Not at all worried 35E * 50** 62E 78 39* 66
Feeling of safety when home alone after dark3
Somewhat or very worried 31* 16** F 5 30* 11
Not at all worried 69* 83** 80* 94 70* 89
E
use with caution
1. Excludes those who reported that they never walked alone after dark.
2. Excludes those who reported that they never used public transportation alone after dark or that public transportation was unavailable to them.
3. Excludes those who reported that they were never home alone after dark.
Responses of don't know/refusal are included in the calculation of percentages but are not displayed if they represent less than 5% of all responses.

Table 7
Safety precautions, by sex and self-reported sexual assault victimization, Canada, 2014
Women Men Total
Non- Non- Non-
Safety precautions1 percent
Lock windows and doors at home 93* 88** 90* 81 92* 85
Change routine, activities or avoid certain people
or places 59* 30** 71* 23 61* 27
Plan routes with safety in mind 62* 48** 48E * 29 60* 39
Check the back seat for intruders when alone and
returning to a parked car 54 46** 42E * 23 52* 35
Rather than walk, use a car, a taxi or public
transportation for personal safety 55* 38** F 18 49* 28
Carry something for self-defence or to alert other
people 43*** 15** 25E * 8 40* 12
Installed burglar alarms, motion detector lights or
a video surveillance system 35 33 F 32 33 32
Took a self-defence course 32* 12** 35E * 11 32* 11
Installed new locks or security bars 30 26** 38E 25 31 26
Obtained a dog 17E 11** F 8 17E * 9
Stay home at night because of fear of going out
alone 18E * 10** F 2 17E * 6
Changed residence or moved 6E 5** F 3 7E 4
E
use with caution
1. Questions on safety precautions were asked in a general sense and not in connection to experiences of victimization; therefore, results among
victims may not be a direct outcome of the sexual assault they experienced.

Table 8
Self-reported sexual and physical assault, by sex of victim and incident characteristics, Canada, 2014
Sexual assault Physical assault
Women Men† Total Women Men† Total
Incident characteristics percent
Sex of the offender1
Man 99* 52E 94 70* 92 82
Woman F 48E 6E 28* 7E 18
Age group of the offender1
Under 18 years old 8E F 10E 16E 11E 13E
18 to 24 years 33E F 31 20E 18E 19
25 to 34 years 28E F 27E 21E 26 23
35 to 44 years 8E F 8E 14E 21E 18
45 to 54 years 13E F 12E 12E 13E 12
55 years and older 10E F 10E 14E * 7E 10
Relationship of the offender to the victim2
Family F F F 11E * 3E 7E
Friend, acquaintance or neighbour 51 62 52 38 29 33
Stranger 45 34E 44 28* 63 47
Other F F F 21E * 4E 12
Number of offenders
One 81 67 79 82* 69 75
Two F F F F 10E 8E
Three or more F F F F 17E 14E
Don't know/refusal 11E F 13E 3E F 3E
Location of the incident
Residence of the victim 7E F 7E 29 21E 25
Other private residence 23E F 22E 7E 9E 8E
Commercial or institutional establishment 45 27E 43 48* 35 41
Street or other public place 14E F 14E 15E * 32 25
Other F F F F F 2
Don't know/refusal 9E F 12E F F F
Related to the offender's alcohol or drug use
Yes 58* 32E 54 38* 61 51
No 28 36E 29 54* 32 41
Don't know/refusal 14E 32E 17E 8E 8E 8
Presence of a weapon
Yes F F F 28 38 33
No 89 68 86 70 60 65
Don't know/refusal 10E F 13E F F F
Caused physical injury
Yes F F F 30 23 26
No 92 96 93 70 77 74
E
use with caution
1. Includes incidents where there was one offender acting alone.
2. Includes incidents where the victim identified the number of offenders. For incidents with multiple offenders, the relationship is that of the offender
with the closest relationship to the victim.
Note: Includes non-spousal sexual and physical assault. In 2014, nearly all (96%) sexual assault was non-spousal in nature. Excludes spousal
sexual and physical assault due to a different methodology used to collect information on characteristics of spousal violence. 'Victim' refers to those
who reported that they were sexually or physically assaulted in the past 12 months. Responses of don't know/refusal are included in the calculation
of percentages but are not displayed if they represent less than 5% of all responses.

Table 9
Reasons for not reporting sexual assault to the police, by sex of victim, Canada, 2014
Women Men† Total
Reasons for not reporting to the police1 percent
Crime was minor and not worth taking the time to report 71 75 71
Incident was a private or personal matter and it was handled
informally 68 62E 67
No one was harmed 66* 42E 63
Did not want the hassle of dealing with the police 47 33E 45
Police would not have considered incident important enough 43 43E 43
Lack of evidence 46* 18E 43
Offender would not be convicted or adequately punished 41 27E 40
No harm was intended 38 49E 39
Feared or did not want the hassle of dealing with the court
process 34 37E 34
Did not want the offender in trouble with the law 29 36E 30
Did not want others to find out about the victimization 2 32 F 30
Police would not have been efficient or effective 27E F 26
Fear of revenge by the offender or others 24E F 22E
Police would not have been able to find or identify the offender 22E F 21E
Police would be biased 13E F 13E
Received unsatisfactory service from the police in the past 13E F 13E
Afraid reporting would bring shame and dishonour to the family 13E F 12E
E
use with caution
1. Respondents were able to provide more than one reason for not reporting to the police.
2. Includes publicity and news coverage.
Note: Includes non-spousal sexual assault. In 2014, nearly all (96%) sexual assault was non-spousal in nature. Excludes spousal sexual assault due
to a different methodology used to collect information on characteristics of spousal violence. 'Victim' refers to those who reported that they were
sexually assaulted in the past 12 months.

Model 1
Logistic regression: Risk of sexual assault, by characteristics, Canada, 2014
Characteristics1 Canadians aged 15 and older2
(independent variables) odds ratio
Sex
Woman 6.54***
Man Reference category
Age group
15 to 24 years 3.43***
25 to 34 years 2.54***
35 years and older Reference category
Main activity
Student Not significant
Other 0.54**
Employed Reference category
Aboriginal identity
Aboriginal 2.19*
Non-Aboriginal Reference category
Marital status
Single, never married 3.78***
Separated, widowed or divorced 2.09**
Married or common-law Reference category
Fair or poor 7.14***
Good 2.46***
Very good or excellent Reference category
** significantly different from reference category (p < 0.01)
*** significantly different from reference category (p < 0.001)
1. Disability, immigrant status and visible minority status were included in the original model for sexual assault among Canadians aged 15 and older.
These factors were not significant so they were not retained in the model.
2. The question on sexual orientation was not asked of those aged 15 to 17; therefore, sexual orientation was not included in the model for
Canadians aged 15 and older.
Note: Only significant characteristics were retained in the final model.

Model 2
Logistic regression: Risk of sexual assault, by characteristics and experiences, Canada, 2014
Characteristics and experiences1 Canadians aged 15 and older2
(independent variables) odds ratio
Sex
Woman 7.39***
Man Reference category
Age group
15 to 24 years 4.05***
25 to 34 years 2.70***
35 years and older Reference category
Marital status
Single, never married 3.30***
Separated, widowed or divorced 2.02**
Married or common-law Reference category
Fair or poor 4.82***
Good 2.11***
Very good or excellent Reference category
Experienced childhood abuse before age 153
Yes 2.23***
No Reference category
Experienced homelessness
Yes 2.28***
No Reference category
Number of evening activities per month 1.03***
** significantly different from reference category (p < 0.01)
*** significantly different from reference category (p < 0.001)
1. Main activity, Aboriginal identity, disability, immigrant status, visible minority status, and drug use and binge drinking in the past month were
included in the original model for sexual assault among Canadians aged 15 and older. These factors were not significant so they were not retained in
the model.
2. The question on sexual orientation was not asked of those aged 15 to 17; therefore, sexual orientation was not included in the model for
Canadians aged 15 and older.
3. Includes physical and/or sexual abuse perpetrated by an adult aged 18 or older.
Note: Only significant characteristics and experiences were retained in the final model.

This is Exhibit “E” referred to in the Affidavit of Grand Chief

© First Nations Centre
ISBN: 0-9736623
For further information or to obtain additional copies, please contact:

First Nations Centre
220 Laurier Avenue West, Suite 1200
Ottawa, ON K1P 5Z9
Tel.: (613) 237-9462
Fax: (613) 237-1810
This report is available in English electronically at

http://www.naho.ca/firstnations/english/regional_health.php
November 2005
Program funded by Health Canada.
Les versions françaises de cette publication sont disponibles sur demande.

Community
Acceptance
Ownership, control, access, and possession
Table of Contents
1 RHS Cultural Framework
13 Process and Methods Summary
21 The Health of First Nations Adults

23 Chapter 1: Demographics, Education, Employment, and Education
32 Chapter 2: Language and Culture
41 Chapter 3: First Nations Housing and Living Conditions
52 Chapter 4: Disability and Chronic Conditions
69 Chapter 5: Diabetes
77 Chapter 6: Injuries
83 Chapter 7: Access to Dental Care and Treatment Needs
96 Chapter 8: Physical Activity, Body Mass Index, and Nutrition
105 Chapter 9: Non-Traditional Use of Tobacco (Smoking)
113 Chapter 10: Alcohol and Drug use
120 Chapter 11: Sexual Health Practices
125 Chapter 12: Healthcare Access
133 Chapter 13: The Impacts of Residential Schools
138 Chapter 14: Mental Health, Wellness and Personal Support
145 Chapter 15: Community Wellness
151 The Health of First Nations Youth

153 Chapter 16: Household Structure, Income, and Parental Education
159 Chapter 17: School Education
166 Chapter 18: Physical Activity, Body Mass Index, and Nutrition
175 Chapter 19: Disability and Chronic Conditions
Building capacity in First Nations reasearch
Our Voice
Our Survey
Our Future

189 Chapter 21: Dental Care and Treatment Needs
201 Chapter 22: Non-Traditional Use of Tobacco (Smoking), Alcohol, and Drug Use
207 Chapter 23: Sexual Health Practices
215 Chapter 24: The Impact of Parent and Grandparent Residential School Attendance
219 Chapter 25: Emotional and Social Well-being
226 The Health of First Nations Children

228 Chapter 26: Household Structure, Income, and Parent Education
234 Chapter 27: Language, culture and bi-cultural education among First Nations children
241 Chapter 28: Early measures of health: Birth weight, maternal smoking, and breastfeeding
255 Chapter 29: Physical activity, body mass index, and nutrition
264 Chapter 30: Disability and chronic conditions
278 Chapter 32: Dental treatment needs and use of dental services
295 Chapter 33: The impact of parent and grandparent residential school attendance
299 Chapter 34: Emotional and social wellbeing
Appendices
307 Appendix A: Acknowledgements
309 Appendix B: Report Contributors
310 Appendix C: Participating Communities
RHS 2002/03 – RHS Cultural Framework
The First Nations Regional Longitudinal Health

Survey (RHS) Cultural Framework
The First Nations Information Governance Committee Where the model comes from
determined that it was important to begin the
This section of the report is designed to help the reader to
development of a First Nations Cultural Framework for
understand that there is an underlying science behind the
the First Nations Regional Longitudinal Health Survey
cultural framework, and resulting organization of this
(RHS) 2002/03. We will refer to it as the RHS Cultural
report. This science has been handed down through
Framework. The goal of the RHS Cultural Framework is
generations of First Nations people as a cumulated body
to assist in achieving a culturally informed interpretation
of knowledge and beliefs.
process that can be presented back to communities in
ways that are usable and reinforce their ways of seeing, While it is recognized that Indigenous Knowledge is not
relating, knowing and being. A cultural framework will a uniform concept across all First Nations in Canada, for
assist in providing a more accurate interpretation of the most First Nations people there is a common belief in a
information shared by First Nations children, youth and connection with the natural world. For the purposes of
adults. Simply stated, the RHS Cultural Framework this report and the RHS Cultural Framework, we
encompasses the total health of the total person within represent the natural world with a circle.
the total environment.1
When we begin this report at the centre of the cultural
From the beginning, First Nations people have been model (see Figure 1) with a focus on First Nations
taught that we start with a focus on the people – by people, it is reflective of the reasons, rules and rationale
giving thanks for their caring, honesty, sharing, and that are incorporated in the underlying science of the
strength. Therefore, in keeping with the RHS cultural cultural model. In accordance with these rules, we will
framework, we wish to extend appreciation to all the then move from the Centre to the East, South, West,
First Nations people that participated and shared in this North, and East again. The meaning and content of each
process, before we begin to discuss the organization of quadrant will be elaborated in subsequent sections of this
the report. chapter.
2
Figure 1. RHS Cultural Framework
1
VISION (Ways of Seeing): Within an First Nations cultural the circular models can be representative of the diverse
paradigm, vision is considered the most fundamental of belief systems across First Nations.
principles. Visioning First Nations’ well-being involves
The First Nations Information Governance Committee
examining the complete picture of health including,
vision for this report, simply put, is to reflect the vision
physical, mental, emotional and spiritual health issues.
of the First Nation communities. The vision of the First
From an Indigenous Knowledge perspective, visioning
Nations people is to have cultural respect and
will examine what is the ideal state of First Nations
understanding entrenched throughout the RHS process.
health and wellness (what was the standard in the past
This vision includes First Nations collecting the
and what is the desirable/achievable in the future). In
information, as well as interpreting and organizing the
order to envision First Nations’ health and wellness, it is
information from a First Nations cultural perspective.
imperative to establish a baseline of the extent and
causes of the current situation. It is from that baseline The First Nations Information Governance Committee
that First Nation communities and stakeholders can move wants to make the information more relevant to the lives
forward towards the ideal vision. of First Nations people. We want to make this more than
just another survey/research report on First Nations
RELATIONSHIPS (Time/Ways Of Relating): Refers to the
people. The First Nations Information Governance
experiences that one encounters as a result of
Committee is moving on to the next step and interpreting
relationships built over time and examines how we relate
the information received from First Nations people from
to people. It provides an opportunity to gain an
a First Nations perspective.
understanding of the attitudes and awareness that exist at
this particular point of time, regarding the individual, RHS Interpretative Framework:
community and national wellness issues.
This section of the report will introduce and explain the
REASON (Analysis/Reason): Also referred to as learned RHS Interpretative Framework. Jim Dumont, Traditional
knowledge. It is where we become reflective, meditative Teacher, prepared a research document to assist in
and self-evaluative. It is in this direction, that the broader developing a cultural interpretative framework for the
determinants of health are examined. First Nations Information Governance Committee. Dr.
Mark S. Dockstator further elaborated on this model.
ACTION (Behaviours): Also referred to as movement and
represents strength. This direction explores what has The interpretative framework begins with the
been done about previously identified barriers and how understanding that First Nations people use the concept
to nurture us as First Nations. This component is of Wellness while within a Eurocentric viewpoint is more
important in that it activates positive change to improve commonly referred to as Health. While it is important to
the program so that it better achieves the vision note that there are different philosophical understandings
(expectations) of First Nations. Resulting in the healthy between the concepts of Health and Wellness, the
development of their children, families and communities. philosophies are not necessarily mutually exclusive. The
concepts are not absolutes or adversarial in nature…they
It is important to note that the circular models presented
are simply different.
in the RHS cultural framework are not medicine wheels.
Medicine wheels are related to sacred teachings and Wellness is a very complex and multilayered philosophy,
understandings that are not discussed in the cultural which we have tried to simplify through the following
framework, primarily because of the diversity of diagrams. However, it is important to articulate the
Indigenous Knowledge across First Nations. The models complexity of this understanding in order to understand
presented in this report are designed for use as the significance of what questions to ask and how to
interpretation tools and are sometimes referred to as interpret the information received by the First Nations
“working wheels” or “four directional wheels”. We are people. Figure 2 attempts to illustrate, at the simplest
presenting working tools that can be used to understand level, a First Nation concept of wellness.
the RHS cultural framework. It is within this context that
2
Figure 2
Level 1 represents all of Creation – which is infinite:

Level 2 represents the known universe (a human perspective) – which is only a small part of creation;
Level 3 represents one small part of the universe – Earth. Referred to as “Mother Earth” by First Nations people, it is
comprised of animals, sun, water and air;
Level 4 represents “Humankind” which is one small part of the animals found on Mother; Earth. The four colours
depicted in this level are not racial characterizations; rather they reflect different human philosophies or ways of
thinking;
Level 5 illustrates one small part of humankind – “First Nations people” – and how we organize ourselves, as individual,
family, community and nation;
Level 6 represents Indigenous intelligence and;
Level 7 represents a First Nations person, and how an individual is composed of body, mind, spirit and heart.
We pull out the cultural framework (like an accordion) in Figure 2 to demonstrate from this perspective of First Nations
health, human beings are connected to the natural world, and thus to Creation through many different levels, or layers,
of understanding. Each level represents only a small portion of the preceding one. All levels are interconnected.
This approach to health and wellness is based on BALANCE…of seeking balance, of achieving balance and of
maintaining balance. To visualize this model of health, imagine each level as a wheel, with each of these wheels
rotating on a common axis. If one wheel is out of balance, it will affect the balance of the other wheels and also the
overall balance of the system. Thus, when we speak of First Nations health, we are referring to the BALANCE of this
system.
The RHS Cultural Framework encompasses the total health of the total person within the total environment.3 This is a
holistic and rather complex understanding of First Nation Wellness.
3
Figure 3
Figure 3 attempts to illustrate the dynamic and multilayer relationships associated with First Nations’ Wellness.
Level 1 shows that most First Nations people have a common belief in their connection with Creation.
Level 2 represents how we as First Nations people, were given our spirituality from Creation and from the Creator, when
the known universe was created. Spirituality formulates our belief systems (however they are expressed) and is our
direct connection to Creation (both the Act of Creation and the Creator – however they may be expressed and named by
the diverse First Nations cultures and societies). Spirituality is connected to Creation and that is why it is found in the
centre of the circle and why it is of key importance to First Nations. (Note: Spirituality surrounds the connection to
Creation – Level 1 – as represented by the straight line connecting level 1 to level 2).
Level 3 represents that when the Earth was created, as one small part of the universe, humans were created, and this is
the stage at which we get our worldview. That is, this is how we as humans understand or make sense of our world. Our
worldview connects us to Creation and is expressed in Spirituality.
Level 4 expresses how as different races of humankind were created, each with their different worldviews – each race is
connected to Creation through their language. First Nations Peoples are connected to and express their worldview
through their language, which is in turn connected to their spirituality.
Level 5 depicts how as First Nations People, we are connected to Creation through our culture, which is expressed
through our language, which contains our worldview, which is an expression of our spirituality.
Level 6 shows as individuals, First Nations People are connected to Creation through the knowledge that we have –
which is termed Indigenous Knowledge. These different knowledge systems (they are not the same for all First Nations)
are an expression of our cultures, which are expressed in our languages, which are expressions of our worldviews and
spirituality … which all connect us to Creation.
Level 7 illustrates that as First Nations individuals we all develop our own identity, which is formed by that which we
know (Indigenous knowledge), which in turn is connected to our culture, which is an expression of our worldview and
spirituality. …all of which connects us to Creation.
That is why when we speak of First Nation Wellness; we speak of Indigenous Knowledge, Culture, Language,
Worldview and Spirituality as indicators of “health”. These indicators are “core” to an understanding of how we, as a
People, keep ourselves “balanced” and therefore “healthy”. This reinforces the need for the RHS Cultural Framework to
be used in interpreting the information collected by First Nations People.
4
How do we use the RHS Cultural Framework: indicator of wellness for First Nations People’s Health
without also discussing culture, language, worldview,
The issue identified by the First Nations Information
and spirituality.
Governance Committee is that an abundance of
information have been collected in a way that respect The RHS is designed to be a longitudinal study and
First Nations research ethics and principles of produce consistent data for First Nations across the
Ownership, Control, Access and Protection of country. Since the RHS data will be collected and
Indigenous Knowledge. The goal of the First Nations interpreted by First Nations, the interpretations will be
Information Governance Committee is to replace the well informed by First Nations culture and settings, thus
Western Based Analytical Framework with one based on eliminating risks of misinterpretations. In so doing, the
principles common to all First Nations principles. This RHS will serve as a useful and realistic model for
technical report is just beginning to articulate a First culturally appropriate, community-based research. In
Nations Culturally Appropriate Interpretation Model as a choosing a longitudinal study the objective is to develop
basis for analysis. This model is by no means complete, baseline data during the initial phases. The baseline data
but represents a starting point that will be expanded and then sets the foundation against which comparisons can
developed over time and with the building of be made in later years.
relationships.
Upon the completion of the subsequent rounds of the
The model is important for explaining why we ask the RHS, analysis can take place to see what impacts
questions we do in the RHS questionnaires. The RHS different approaches to improving First Nations health
asks questions about language and culture in a “Health have made on this population. For example, have
Survey”. Articulating the First Nations Wellness model education campaigns reduced the number of women who
begins to respond to the need for the questions by smoke during pregnancy? This is the true nature of a
defining wellness. It illustrates that you can’t have an longitudinal study.
Figure 4
5
Figure 4 elaborates on the planned First Nations Balance

Regional Longitudinal Health Survey using the RHS
The RHS Cultural Framework will assist in bringing
Cultural Framework rather than a linear framework.
balance to the previous research by also drawing out the
Although each cycle will discuss all four quadrants:
positive changes related to First Nations Peoples
Vision; Time and Relationships; Reason; and Changes
Wellness. For example, a large proportion of First
(Movement), each cycle will also place a particular
Nations who quit smoking did so because they became
emphasis on one quadrant of the model. For example, the
pregnant. This is a positive indicator of wellness, where
emphasis for the 2002/03 RHS was on establishing
women placed the wellness of their children first, and
baseline data and focus on the vision; that is,
quit smoking not just during pregnancy but permanently.
development of the cultural framework.
In addition to provide balance to the reporting by
In the 2006 cycle of the RHS, the Cultural Based
discussing positive changes, it is important for the
Framework will be used to explain the impact of time
information presented to be useful to the First Nations
and relationships. The focus on the 3rd cycle of the RHS
reading the report to facilitate positive changes in
will be the reasons and rationales related to
behaviours. The information needs to be presented in
Health/Wellness issues and the 4th cycle will focus on
such a way as to clearly identify warning signs for
changes—particularly over the 12-year period from the
possible wellness issues and what parents, for example,
establishment of the baseline data.
can do about it.
It is important to remember that a longitudinal study is
Time and relationship
designed to measure change over time between the same
groups of First Nations people (as opposed to In the context of First Nations issues, the key to
comparisons with mainstream society). Over the past understanding the future is to have a deep and detailed
thirty years, extensive research has taken place about appreciation of the past. However, providing a singular
First Nations health and the relationship of First Nations interpretation of history is a challenging task when
health to the mainstream of Canada. They usually have a confronted by the complexity of the relationship between
negative focussed, and rarely lead to movement or First Nations Peoples and Federal government relations
action. The intent of this longitudinal study is not to and the negative impact it has had on the health and
simply repeat other studies, but to document something wellness of First Nations people. Policies implemented
unique – for example, the impact that health approaches by the Federal government have had a negative impact
within a holistic framework, are having on improving on the spirituality, worldview, language, culture and
First Nations health and well-being. Indigenous Knowledge of First Nations People.
6
Organization of the Report

The RHS 2002/03 collected vast amounts of information regarding the health of First Nation Peoples. This information
has been summarized in 34 chapters of the technical report related to Adults, Children and Youth. If we simplify the
framework, by compressing the seven levels of understanding into one and overlay all the questions asked in the RHS
survey, then we can illustrate the information collected in the following way4:
7
VISION: Within an First Nations cultural paradigm, vision is considered the most fundamental of principles. Visioning
First Nations’ well-being involves examining the complete picture of health including, physical, mental, emotional and
spiritual health issues. Research shows that First Nations people suffer from poor health. They do not always access
mainstream (non–First Nations) social systems, such as health care services (i.e. hospitals and community health
programs and services). It is impossible to cover all of the health conditions in this report. We have limited our analysis
to address the most common health conditions and chronic diseases which include heart disease, hypertension,
arthritis/rheumatism, asthma, and cancer. In addition, the report looks extensively at diabetes, a leading cause of death
amongst the First Nations population as well as contributing to secondary health complications also leading to death.
Injuries and accidents are explored in this quadrant. Activity limitations are examined in detail. It is important to
understand the impact of disability on adults because many adults with disabilities are not fully included in all aspects of
society. Finally, dental care is explored in this quadrant.
The following list guides the reader as to where to locate these indicators of health in the technical report.
Health Conditions and Chronic Diseases
• Chapter 4: Disability and Chronic Conditions (Adult Survey)
• Chapter 19: Disability and Chronic Conditions (Youth Survey)
• Chapter 30: Disability and Chronic Conditions (Child Survey)
Diabetes
• Chapter 5: Diabetes (Adult Survey)
Injuries
• Chapter 6: Injuries (Adults Survey)
• Chapter 20: Injuries (Youth Survey)
• Chapter 31: Injuries (Child Survey)
Activity Limitations
• Chapter 4: Disability and Chronic Conditions (Adult Survey)
• Chapter 19: Disability and Chronic Conditions (Youth Survey)
• Chapter 30: Disability and Chronic Conditions (Child Survey)
Dental Care
• Chapter 7: Access to Dental Care Needs (Adult Survey)
• Chapter 21: Dental Care and Treatment Needs (Youth Survey)
• Chapter 32: Dental Treatment Needs and Use of Dental Services (Child Survey)
8
RELATIONSHIPS: Refers to the experiences that one encounters as a result of relationships built over time and examines
how we relate to people. The key categories within this paradigm include mental health, personal wellness and support
among First Nations adults, youth and children. Emotional wellness was also examined to ascertain if there was any link
to depression or suicide attempts and the data report no correlation. Another critically important category that is
examined is the residential school impacts. Residential schools were often located in isolated areas and the children
were allowed little or no contact with their families and communities. In addition, there was a regime of strict discipline
and constant surveillance over every aspect of their lives including cultural expressions through language, dress, food,
or beliefs. Suppression of culture was a mandate of the schools. Finally, the importance of language and culture cannot
be overlooked. Language embodies all values, attitudes, beliefs and truths and consequently has historically played a
significant role in the lives of First Nations Peoples.
Personal Wellness
• Chapter 14: Mental Health, Wellness, and Personal Support (Adult Survey)
• Chapter 25: Emotional and Social Wellbeing (Youth Survey)
• Chapter 34: Emotional and Social Wellbeing (Child Survey)
Residential Schools
• Chapter 13: The Impacts of Residential Schools (Adult Survey)
• Chapter 24: The Impact of Parent and Grandparent Residential School Attendances (Youth Survey)
• Chapter 33: The Impact of Parent and Grandparent Residential School Attendances (Child Survey)
Languages and Culture
• Chapter 2: Language and Culture (Adults Survey)
• Chapter 27: Language, Culture, Headstart, and School (Child Survey)
• Chapter 31: Injuries (Child Survey)
Community Wellness
• Chapter 15: Community Wellness (Adult Survey)
9
REASON: Also referred to as learned knowledge, it is where we become reflective, meditative and self-evaluate. It is in
this direction, that the broader determinants of health are examined, such as demographics, income, education, family
structure, housing and living conditions as well as health care access. Demographics, Housing and Living Conditions
are important determinants to consider when reviewing the status of First Nations health. Equally important are the level
of Income and Education attained, both of which contribute to overall health. Finally, Access to Health Care is an
important category as it reports on selected indicators of access to preventive primary health care measures, including
respondents’ rating of their access to health care in comparison to other Canadians, access to screening and preventive
measures, barriers to accessing health care, and access to Non-Insured Health Benefits (NIHB).
Demographics
• Chapter 1: Demographics, Education and Employment (Adult Survey)
• Chapter 16: Household Structure, Income, and Parental Education (Youth Survey)
• Chapter 26: Household Structure, Income, Parental Education (Child Survey)
Income, Employment and Education
• Chapter 17: School Education (Youth Survey)
Housing
• Chapter 3: First Nations Housing and Living Conditions (Adults Survey)
Healthcare Access
• Chapter 12: Healthcare (Adult Survey)
10
ACTION: Also referred to as movement and represents strength. This direction explores what has been done about
previously identified barriers and how to nurture us as First Nations people. Non-Traditional Tobacco Use will describe
some of the ways in how smokers and non-smokers are living their lives with their families and in their communities in
relation to non-traditional tobacco use. Specifically, tobacco use during pregnancy, initiation, cessation, current and
former use as well as consumption amounts are reviewed. The proportion of Alcohol Use by various demographic
variables and community size is examined and of note is a consistent decrease in drinking with age. Frequency and type
of Drug Use is also examined. The number of obese and morbidly obese respondents in all age categories is a concern
for health issues as indicated in the Nutrition, Physical Activity and Body Mass Index data. Of particular concern is the
difference between perception of good health and the Body Mass Index results.
Smoking
• Chapter 9: Non-Traditional Use of Tobacco (Smoking) (Adult Survey)
• Chapter 22: Non-Traditional Use of Tobacco (Smoking), Alcohol, and Drug Use (Youth Survey)
• Chapter 28: Early Measures of Childhood Health: Birth weight, Maternal Smoking, and Breastfeeding
(Child Survey)
Income, Employment and Education
• Chapter 17: School Education (Youth Survey)
Alcohol and Drugs
• Chapter 10: Alcohol and Drug Use (Adults Survey)
• Chapter 22: Non-Traditional Use of Tobacco (Smoking), Alcohol, and Drug Use (Youth Survey)
Exercise and Nutrition
• Chapter 8: Physical Activity, Body Mass Index, and Nutrition (Adult Survey)
• Chapter 18: Physical Activity, Body Mass Index, and Nutrition (Youth Survey)
• Chapter 29: Physical Activity, Body Mass Index, and Nutrition (Child Survey)
Sexual Health Practices
• Chapter 11: Sexual Health Practices (Adults Survey)
• Chapter 23: Sexual Health Practices (Youth Survey)
According to the RHS model of health developed for this report, we now return to the eastern direction and vision.
Having completed a full circle of summarizing some of the information collected by the Survey, the next step will be to
look into the future, to determine the next steps of the process. The next step in this research process is to revisit our
vision, in light of the materials gathered and lessons learned, listen to the community and begin the process of
improving the process for the next data gathering cycle, scheduled to begin in 2006.
1
Ibid
2
Dumont, Jim,
3
Ibid
4
We are using the FNC / NAHO model to organize the information – there are many other FN approaches that can be used to illustrate the
information differently.
11
RHS Survey 2002/03 – Process Methods Summary
Process and Methods Summary

First Nations Regional Longitudinal Health Survey (RHS) 2002/03
Introduction
The First Nations Regional Longitudinal Health Survey (RHS) traces its origins back to 1995. Although initially
proposed to fill data gaps, the project has evolved considerably.
Ten years later, in keeping with its mandate from the Assembly of First Nations’ Chiefs Committee on Health, the RHS
has disseminated results from two rounds of data collection and has emerged as the only national research initiative
under complete First Nations control.
Results from the 1997 round were released in 1999. Based on the 2002/03 round, two major reports were completed in
2005: this one, containing 34 thematic chapters, and the culture-based “Peoples’ Report”.
This section includes a summary of the process and methods used in the 2002/03 survey and in the preparation of this
report. More complete information is contained in the full “Report on Process and Methods.” A quick overview is
provided in Table 1 and a brief timeline is presented in Table 2.
Table 1. 2002/03 RHS at a glance

Title First Nations Regional Longitudinal Health Survey
Acronym FNRLHS or RHS
Mandate Assembly of First Nations Chiefs Committee on Health
National Governance First Nations Information Governance Committee
Regional Coordination First Nations Regional Organizations
National Coordination First Nations Centre, National Aboriginal Health Organization
Number of Regions 10 First Nations Regions (including all provinces and territories except Nunavut)
Target population First Nations communities across Canada
Longitudinal cohort Second round for Nova Scotia; First round for all other regions
Sample design Largely standardized
Sample size 22,602 surveys: 10,962 adults, 4,983 youth and 6,657 children
Communities 238 included

Length of National
“Core” Components 84 minutes median interview time (for adult, youth and child surveys combined)
Region-specific
questions Additional modules of varying length in 7 of 10 regions
13
Table 2. RHS timeline

1994 Three Canadian longitudinal surveys launched, excluding First Nations and Inuit communities
First round of the survey
Funding for first round by Health Canada. Indian Affairs and Human Resources Development Canada
1995
decline.
1996 Mandate from Assembly of First Nations
1996 Direct First Nations and Inuit control established
1996 Development of instruments and methods
1997 Data collection in 9 regions: 14,008 surveys (9,870 adults, 4,138 children)
1997 Code of Research Ethics adopted
1998 Ownership, Control, and Access (OCA) principles first articulated
1999 Final report based on 1997 survey released
Second (current) round of the survey
2000/01 Proposals and long-term plans submitted for funding and potential Treasury Board submission
2000/02 Development of instruments and methods for 1st wave of longitudinal survey
2002 Coordination transferred to the First Nations Centre (NAHO)
2002/03 Data collection in 10 First Nations regions: 22,602 surveys (10,962 adults; 4,983 youth; 6,657 children)
2004 Data processing
2004 Preliminary results released
2005 Major reports released
Coordination and governance

The RHS is coordinated and governed by First Nations through their regional and national organizations and
representatives. As of 2005, the survey partners were:
National
• Assembly of First Nations (Coordination of First Nations Information Governance Committee)
• First Nations Centre of the National Aboriginal Health Organization (National coordination and data
stewardship)
Regional coordination and data stewardship
• Union of Nova Scotia Indians
• Union of New Brunswick Indians
• First Nations of Quebec and Labrador Health and Social Services Commission
• Chiefs of Ontario
14
• Assembly of Manitoba Chiefs

• Federation of Saskatchewan Indian Nations
• First Nations Adult and Higher Education Consortium (Alberta)
• First Nations Chiefs’ Health Committee (B.C.)
• Dene National Office
• Council of Yukon First Nations
The RHS National Steering Committee has been renamed the First Nations Information Governance Committee
(FNIGC). It is made up of members of the partner organizations and is a standing committee of the Chiefs Committee
on Health at the Assembly of First Nations. Within most regions a research advisory committee or similar entity
parallels the work of the FNIGC, including oversight and direction of the survey.
2002/03 Survey Instruments and Methods
Data collection was conducted between August 2002 and November 2003 in First Nations communities across Canada.
A total of 22,602 surveys were administered. Three age-specific questionnaires were completed for:
• 10,962 adults, 18 years of age and over (by interview);
• 4,983 youth, 12 to 17 years of age (self-administered); and
• 6,657 children, 0 to 11 years of age (the parent or guardian responded).
As shown below, the surveys addressed a range of priority First Nations issues related to health.
Adult Survey (> 18 years old) • HIV/AIDS, STD’s and sexuality

• Age, gender, marital status, community • Pregnancy, fertility
• Languages—comprehension, use • Preventative health practices
• Education • Wellness, supports & mental health
• Employment • Suicidal ideation and attempts
• Income and sources • Residential schools—impacts
• Household— composition, income • Community wellness
• Housing—condition, crowding, mold • Culture, spirituality, religion
• Water quality • Community development
• Services (phone, water, smoke detector,
internet etc.) Youth Survey (12-17 years old)
• Height, weight • Age, gender, household/family composition
• 28 health conditions—duration, treatment, • Education—level, performance, personal
effects goals
• Diabetes—type, treatment, effects • Language—comprehension, use
• Physical injuries • Food and nutrition
• Dental care • Activities—physical, social
• Disabilities, limitations • Height, weight, satisfaction with
• Physical activity • Diabetes—type, treatment
• Food and nutrition • 19 health conditions—duration, treatment,
• Home care—use, need effects
• Health services—use, access, NIHB • Injuries
• Traditional medicines, healers • Dental care
• Smoking, alcohol, drugs—use, cessation, • Smoking, alcohol, drugs
treatment
15
• Sexuality • Smoking, second hand smoke exposure—pre

• Preventative health practices & post natal
• Personal wellness, supports & mental health • Language—comprehension, use, interest
• Suicidal ideation, attempts • Food and nutrition
• After school activities • Activities—physical, social, after school
• Traditional culture—importance, learning • 19 health conditions—duration, treatment,
effects
• Residential school (parents, grandparents)
• Injuries
Child Survey (0-11 years old)

• Disabilities, limitations
• Health service access—NIHB
• Age, gender, household/family composition
• Dental health, baby bottle tooth decay
• Parental education
• Traditional culture—importance, learning
• Education—level, performance, Head Start
• Emotional & social well-being
• Height, weight—at birth, current
• Childcare -babysitting
• Breastfeeding history
• Residential school (parents, grandparents)
In 7 of 10 regions, questionnaire modules addressing regional priorities were also administered, immediately following
the national questions.
First Nations fieldworkers were trained to administer the surveys within their communities, usually in the respondent’s
home. The fieldworkers used customized software on laptop computers to collect 90.2% of the surveys. The remainder
were completed on paper and subsequently data-entered. Surveys were encrypted and transferred by phone lines from
the communities to secure, dedicated servers.
The 2002/03 survey sample was designed to represent the First Nations population living in First Nations communities
in all provinces and territories except Nunavut. Overall, 238 communities were included and 5.9% of the target
population was surveyed. The sampling rate was 4.9%; among youth, 10.0% and for children, 6.0%. The higher
proportions of children and youth allow for statistical precision similar to the level possible with the adult data. The
regional breakdown is shown in Figure 1.
16
Figure 1. Number of sub-regions and communities and proportion of on-reserve* Residents sampled,
by region
*Figures show the proportion of all First Nations living in First Nations communities that were included in the sample.
Communities of different size categories were selected within each First Nations ‘sub-region (see Table 3) to provide
representative samples at the regional and national levels. Locally, individuals were randomly selected within
age/gender groups. In 199 communities locally updated band membership lists were used. In 39 communities a
household-based frame was adopted.
17
Table 3. First Nations “sub-regions”

Yukon Ontario
4 Regions 5 Territorial Organizations
Dakh-Ka Association of Iroquois and Allied Indians
Independents Union of Ontario Indians
Northern Tuchtone Nishnawbe-Aski Nation
Southern Tuchtone Independent First Nations
Northwest Territories Manitoba

5 Regions 8 Tribal Councils
Akaitcho Swampy Cree
Deh Cho South East
Dogrib West Region
Gwitch'in Dakota Ojibway
Sahtu Island Lake
Interlake
British Columbia Keewatin
4 Geographic Regions Northa nd South Independents
Coastal Region
Northern Interior Quebec
Southern Interior 8 Nations
Vancouver Island Abenakis
Algonquins
Alberta Attikameks
3 Treaty Areas Hurons
Treaty 6 (Central) Micmacs
Treaty 7 (South) Mohawks
Treaty 8 (North) Montagnais
Naskapis
Saskatchewan (James Bay Cree did not participate)
11 Tribal Councils
Agency Chiefs Newfoundland
Battlefords File Hills Qu'Appelle 1 Region
Meadow Lake Labrador Innu did not participate
Prince Albert Grand Council
Saskatoon Nova Scotia
Touchwood Agency 1 Region
Yorkton
Peter Ballantyne New Brunswick and Prince Edward Island
Lac LaRonge 1 Region
Independents
Preparation of the thematic chapters for this report

The report was designed to provide a high-level overview of national results for all subject areas from the three surveys.
A proposal-based competition was used to select contributors to help develop 36 chapters (subsequently reduced to 34).
The competition’s review panel selected contributors, usually with supporting teams, to draft between one and three
chapters each. The majority of those selected were First Nations individuals.
An orientation session, detailed writing guidelines and on-going communication helped to ensure standardization of
chapters in terms of: type of content, organization/sections, length, format, integration of the cultural framework,
18
reporting of statistics, presentation of graphs and tables, and so on. The following statistical specifications / standards
were established:
• To protect confidentiality and decrease the risk of misinterpretation, statistics based on cell sizes with less than
30 records were suppressed (and sometimes identified with a dash within tables);
• Confidence intervals were reported for figures with a coefficient of variation greater than 33%;
• No statement indicating or implying a difference between groups or categories was included unless the
difference was statistically significant. Non-significant differences were identified, usually with “NS”.
Differences were considered significant if the confidence intervals of the results for the groups/categories
compared did not overlap at the 95% confidence level (after Bonferroni adjustmenti).
In five of the 34 chapters, different thresholds for significance were used. The standards adopted are noted within each
of these chapters.
Non-overlap in confidence intervals was adopted instead of other methods of assessing statistical difference (e.g. chi
square test) because it permits specific group-by-group comparisons. For example, this makes it possible to report that
adults under 30 years old are more likely to have a certain characteristic but that the other age groups (30-39, 40-49, 50-
59 and 60+) were not statistically different from each other in terms of that characteristic.
Differences between RHS results and those for other populations (e.g. Canadians overall) were not assessed for
statistical significance, as confidence intervals were not available for the other populations. Relative statements about
differences between First Nations and other populations should be interpreted cautiously, particularly when the
estimates are close or the groups are small.
Most RHS analyses were based on two-way and three-way cross-tabulations. Age-adjustment and other types of
complex analyses and modeling were also used, but multivariate analyses were not developed as the report aims to
disseminate only high level statistics.ii
To enhance quality, there was a multi-stage review and revision process. This process consists of the following steps:
1. First draft
2. 2 peer reviews
3. Draft 2
4. External technical review
5. Internal technical review and update
6. Internal copy-edit
7. External copy-edit
Although all RHS-derived results and statistical statements were verified as part of the technical review, it was the
responsibility of individual authors to verify results and statements based on sources other than the RHS. Additional
verification by the First Nations Centre was not practical given the range and number of references, including some that
would not have been accessible in a timely manner.
SPSS version 13 was used for most of the analysis. Estimates were weighted and confidence intervals were calculated
using the SPSS Complex Samples module.iii The module goes beyond the simple-random-sampling assumptions of
standard statistical analyses, producing estimates based on the relevant details of the sample’s design. The weights and
specifications of the RHS’s complex stratified sample were programmed into the module to enhance the validity of
results.
In addition to statistical conventions for reporting and interpreting data, a First Nations cultural framework was
developed to help guide the interpretation of statistical results and organize the findings. The framework, described in
the introduction, is applied more consistently within the “Peoples’ Report”. Finally, First Nations review and the
guidance of the First Nations Information Governance Committee helped to ensure that the meaning brought to the
numbers was based on community-based knowledge and expertise.
i
The Bonferroni adjustment or correction is a more conservative method of assessing statistical significance, particularly for analyses with many
cells/groups.
ii
In future, more focused reports will include multivariate analyses.
iii
http://www.spss.com/complex_samples/brochures.htm
19
The Health of
First Nations Adults
Chapter 1
Demographics, Education, Employment, and Education
Abstract
Evidence in this study supports previous findings that adults in First Nations communities have less
education, higher unemployment rates and lower incomes than other First Nations adults (not living in
communities), and other Canadian adults. There is evidence that if educational attainment increased
then employment rates would also increase. Nonetheless, in comparison with the non-First Nations
adult population, earnings of First Nations adults were lower even when education levels were
equivalent. The apparent ‘glass ceiling’ on First Nations incomes exists despite educational attainment
of individuals. These types of demonstrative patterns become even more important to consider and
address with the increasing number of young people in First Nations communities.
23
RHS 2002/03 Adult Survey – Chapter 1: Demographics, Education, Employment, and Education
than 20 years old. Men were 50.9%iii of the adult population

Introduction
and women were 49.1%.
This chapter lays part of the foundation for interpreting the Figure 1. Age pyramid based on population estimates from RHS
health of First Nations adults living in First Nations surveys
iv
communities by describing their personal and household Age group

resources. Some of these situation descriptors have been Male Female
3.2% 60+ 3.4%
shown to be influential determinants of health. The enquiry is
intended to describe the extent to which these adults have 3.4% 50-59 3.3%
resources to participate fully in their families, communities,
traditional culture and Canadian society’s economic 6.1% 40-49 6.0%
structure. Given the connections between these types of

7.1% 30-39 7.1%
resources and health/wellness, these kind of explanations are
important.
7.4% 20-29 7.0%
As with others in this volume, this chapter is written

11.8% 10-19 11.0%
primarily from the First Nations perspective. Early on in
research process Jim Dumont gave a presentation to authors 12.0% 0-9 11.2%
in which he began to articulate a First Nations cultural
framework for the RHS. Dumont’s main starting points -15% -10% -5% 0% 5% 10% 15%
included considering the total health of the total person in the According to the Indian Registry, the 2001 First Nations
total environment. population size in Canada was 690,1012. Of those, 57.5%
If we try to understand and sensibly appreciate Native percent or 396,688 people lived in First Nations
myth and legend we must be willing, first of all, to communitiesv (and on Crown Land), while 42.5% percent
accept that there is involved here a very special way of lived elsewhere outside First Nations communities.
‘seeing the world’. Secondly, and a necessary further Given that this RHS sampling strategy and weighting scheme
step, we must make an attempt to ‘participate’ in this took into account age, gender, community size and sub-
way of seeing.1 region of the population in First Nations communities, the
This chapter focuses mainly on, population projections, population pyramid of the sample should resemble the Indian
personal characteristicsi, personal and household incomes Registry statistics of First Nations individuals living in First
and community characteristicsii of First Nations adults in Nations communities.
First Nations communities. The age distribution shown in Figure 1, shows a significant
increase in the proportion of children and youth compared to
Results and Discussion adults. This has powerful implications for the education
system and the supply of health care for young children and
Population projections youth in the near future (and subsequently, for adults and
Population projections are a very important part of seniors). In contrast, the age distributions of First Nations
understanding the present and future resources of First people who do not reside in First Nations communities
Nations communities. The current patterns and the (Figure 2) shows less contrast between the proportion of
projections that they give rise to suggest a growing demand children and youth/adults in the past 20 years. A distribution
for services—social, educational and health—in First Nations for the Canadian population (Figure 3) shows a similar
communities. They also point to the impact of Bill C-31 on pattern.
the future diminishing resources of the communities as their The population of First Nations communities has been
populations grow. The following discussion examines the increasing for many years, but there has been a more
current situation and compares it to Statistics Canada accelerated increase in the past ten years. 3 It is a common
estimates of First Nations people living outside First Nations mistake to attribute this to increased levels of fertility or to
communities, and the Canadian population as a whole. migration back to First Nations communities. First Nations
The RHS data on population size reflects a growing women have more children than other Canadian women, but
population with a large proportion of the population younger
iii
To simplify the text, confidence limits are only reported for overall youth estimates with a co-
efficient of variation of greater than 33.3%. A statistical appendix including confidence intervals for
all reported figures is available at www.naho.ca/fnc/rhs.
iv
It was necessary to estimate the number of males and females who were ages 18 and 19 in order to
use the same age categories as the other age pyramids in this chapter.
v
The term ‘First Nations communities’ is used in this chapter instead of ‘on-reserve’ except where
part of a citation.
i vi
Personal characteristics explored include gender, age, educational attainment, marital status and The exclusion of these two groups decreased the target number of communities by 10 and the
employment sources and status. population by 3.3 percent relative to the Indian Register overall.
ii
Community characteristics that might affect resources and/or extent of exposure to Western culture
are community size and extent of the community’s geographic isolation.
24
they would have to have 10 children each to account for the mixed marriages and unstated paternity, under Bill C-31, it is
growth in the 1980s and 1990s.4 Migration back to First predicted that it could eventually lead to a dramatic reduction
Nations communities is not a viable explanation because in the size of the Registered Indian population.
there was a net increase in both populations at the same time.
5 With the above assumptions, it is projected that there will be
As for international migration, the contribution … may be
an increase in the size of the First Nations populations for
considered nil.6
two generations, but that after that there will be a decline.14
Figure 2. Age pyramid (from INAC, Registered Indian population
off reserve, Dec. 31, 2001)7 The number of survivors and descendants who do not
Age group qualify for registration is expected to increase from the
Male Female current level of about 21,700 to nearly 400,000 within
3.0% 60+ 5.3%
two generations. After three generations (year 2074),
3.3% 50-59 5.2%
individuals who are not entitled to registration are
projected to form the majority of the population.15
6.2% 40-49 8.4%
Another contrast between the Canadian population and First
8.8% 30-39 10.0% Nations in 2001 is seen in the proportion of the population
that was over 60 years of age. While this is due, in part, to
8.0% 20-29 8.5% the reasons cited above, it may also reflect the health status
and death rates of First Nations adults.
9.0% 10-19 8.7%
From a sample of 10,962 adults, this chapter is generalizing
7.9% 0-9 7.7% to 223,928 adults, ages 18 and over, who lived in First
-15% -10% -5% 0% 5% 10% 15%
Nations communities in Canada (except for the Quebec Cree
and Labrador Innu).vi The remaining findings in this chapter
Figure 3. Age pyramid (from StatsCan, Canadian population, are generally limited to this sample of adults although clearly
2001) identified comparable statistics from studies of other
Age group populations are sometimes included.
Male Female
7.9% 60+ 9.7%
Personal characteristics
6.4% 50-59 6.6%
Education
8.3% 40-49 8.3%
The following educational patterns should not be assumed to
7.3% 30-39 7.2%
represent the highest potential lifetime educational
attainment of the adults, especially the younger ones. It has
7.0% 20-29 6.7% been shown that many First Nations adults return to school
for post-secondary education after a break of several years.16
6.8% 10-19 6.5%
About half of the adults in the survey had graduated from
5.8% 0-9 5.5% high school.vii About half of those who had graduated from
high school had gone on to obtain a diploma from a
-15% -10% -5% 0% 5% 10% 15%
university, college, technical or vocational school. A
minority had obtained a bachelor’s or master’s degree or
In actuality, ethnic mobility explains much of the increase in doctorate.
two ways:
Age ranges included in the comparative education statistics
• the choice of ethnic identity for newborns in Table 2 make it difficult, but not impossible, to compare
• the change to self-reporting as First Nations during the populations. While RHS statistics measured adulthood
one’s lifetime. from age 18, the comparable age statistics from First Nations
adults who did not reside in First Nations communities was
Ethnic mobility has been attributed to increased pride in
15 and older. The same age, 15+, was used for the statistics
heritage as a result of positive public attention paid to
for the Canadian population as both sets came from the 2001
Aboriginal concerns and to the motivation to be registered
census.
that came from Bill C-31. At the end of 2000 (December 31),
a total of 114,512 individuals had (re)acquired registration12
vii
High school graduation could mean completion of Grade 11 through CEGEP (usually 2 years
Population projections depend on what assumptions are made beyond Grade 11) in Quebec or Grades 12 or 13 in Ontario
about the future. 13 Unless the political forces are modified,
viii
Comparisons between groups reported in this chapter are all significant unless “NS” – not
significant – is specified in brackets. In this chapter, estimates are considered significantly different if
the most likely scenario is that Bill C-31 definitions of who is their confidence intervals do not overlap (95% confidence level).
a Registered Indian will prevail. Given the current pattern of
25
Figure 4. Education of adults in First Nations communities Table 2. Education of adults in First Nations communities
(n = 10,812) compared to those First Nations not living in communities and
the Canadian population
Masters or
Doctorate, 0.6%
RHS First
Bachelors, 4.5% First Nations
Nations adults Canadian
Highest level adults not living
in First Nations population,
of formal in First Nations
Post-secondary communities, 2001, ages
diploma, 22.9% schooling communities,
ages 18+ 15+18
2001, ages 15+17
(n=10,812)
Did not graduate
high school, 52.4% < high school 52.4 44.1 33.2
High school 19.6 25.0 23.0
High school Diploma 22.9 25.4 28.4

graduate, 19.6%
Bachelors 4.5 4.7 11.7

Masters or
0.6 0.8 3.7
doctorate
There were no differences in the educational attainment
patterns of men and women.viii There were, however, A study based on census data from 1996 and 2001 showed
differences by age as might be expected. Younger and older that between 1996 and 2001 the proportion of the Registered
adults had highest rates of not completing high school. First Nations population with either a trades skill, college or
Adults over 60 had the highest rates of not completing high a university certificate or degree increased from 20 to 24%.19
school. Adults in the 18–29 year age category had not yet While this increase is impressive, the impact is mitigated
attained the rates of completion of post-secondary education somewhat by the fact that during the same period the
that adults had in the 30–59 age category. Given the pattern proportion of the non-First Nations population with a trades
of intermittent schooling that many First Nations adults skills, college or university certificate or degree increased
follow, it may be assumed that those in the youngest age from 35% to almost 41%.20 Interpretation of all statistics
category will close the gap. Adults ages 30–59 had higher comparing census data of 1996 to figures in 2001 should be
rates of completing post-secondary diplomas and degrees. interpreted with caution because of the ethnic mobility factor
Table 1. Age and education of Adults in First Nations discussed earlier.
communities (n = 10,812)
Age group (years) Marital status

Age and education About half of adults in First Nations communities were
18-29 30-59 60+ married or in common law relationships.
Figure 5. Marital status of adults in First Nations communities (n
< HS Grad 57.0% 46.1% 70.8% = 10,906)
40%
Completion of post- 37.2%
secondary diplomas and 15.4% 37.1% 19.3%
degrees 30.7%
30%
There is a large gap between the formal educational

attainment of adults in First Nations communities and the
Canadian population (Table 2). This is an issue which is 20% 19.0%
getting attention in First Nations communities and in the

federal and provincial governments. Education rates of First
Nations adults not living in First Nations communities had a 10%
pattern that fell between the First Nations community 4.9%

3.8% 4.4%
average and the Canadian one. If the RHS adult statistics had
included 15, 16 and 17 year olds, as the other two did, the 0%
Single Common law Married Separated Divorced Widowed
comparative gaps would be even greater. Marital status
Gender differences in the marital status of adults in First

Nations communities showed more men reporting that they
were single and more women reporting that they were
previously married. Age patterns, as expected, showed that
more younger adults were single and in common law
26
relationships and older adults were married or previously Figure 6. Employment patterns by gender, age and education
(n=10,773)
married.
Table 3. Marital status patterns by gender and age
Gender and Marital Status Men Women
Single 40.7% 33.5%
Previously married 4.9% 11.6% Full time, 41.3%
Age and Marital Status 18-29 30-59 60+ Not workiing, 51.2%
Single 65.7% 28.5% 13.9%

In common law relationships 23.8% 18.9% 6.4%
Married
8.0% 41.2% 42.1%
Previously married (divorced, Part time, 7.5%
- 8.2% 30.1%
widowed)
The overall pattern of marital status was approximately the

same as the Canadian population. The greatest difference was
found with the First Nations adults who did not live in First
Nations communities.
Table 5. Employment patterns (%) by gender, age and education,
Table 4. Marital status of adults in First Nations communities, (n=10,659)
compared
Gender and employment Men Women
RHS First Nations First Nations
adults in First adults not Canadian
Worked for pay, part time. 5.7 9.4
Marital Nations living in First pop.,
Status Communities, Nations 2001, ages
ages 18+ Communities, 15+22 Age and employment 18-29 30-59 60+
(n=10,773) 2001, ages 15+21
Employed at the time of the
Single 37.2 53.0 41.7 39.8 59.2 22.1
interview.
Common
19.0 17.5
Law
Education and <HS HS Dip. Uni.
Married 30.7 54.6 11.8 34.7 49.0 employment grad grad etc. deg.
Separated 4.9 5.4
Employed at the time of the
Divorced 3.8 34.3 59.2 65.6 83.0
8.2 12.21 9.3 interview.
Widowed 4.4
Table 6. Employment of adults in First Nations communities,

Employment compared
About half of adults in First Nations communities are First Nations

RHS First
adults not Canadian
working for pay and most of those are employed full time. Employment
Nations adults
living in pop.,
in First Nations
Status (at time of First Nations 2001, ages
Detailed information about the number of hours worked per communities,
interview) communities 15 + 24
week was collected in the RHS adult surveys, and it showed ages 18+
2001, ages (2004)
(n=10,773)
the following patterns for gender, age and education: 15+23
More women worked part time, younger and older adults Working for pay 48.8 50.2 57.0
were less likely to be working for pay than those from 30 to Full time 41.3
59 years, and the higher the education, the higher the Part time 7.5
percentage of those who worked for pay.
It would not be wise to compare 1996 and 2001 census data
Employment rates of adults in First Nations communities on the issue of labour force participation nor on other
were about the same as for First Nations adults who do not employment or income measures because the risk of error
live in First Nations communities, but they lag behind those from the ethnic mobility factor (people declaring First
of the Canadian population by about 8%. Nations identity in the 2001 census who had not declared it
in 1996). It was however possible to compare employment
rates as they varied by educational attainment. Table 5
showed that for the RHS data, labour force participation rates
27
increase as educational attainment increases. Using census higher levels of education. The gaps were greater for men
data, it is possible to demonstrate that when educational than for women.28
attainment is taken into account, there is little difference Table 8. Income patterns by age and education
between First Nations and non-First Nations identity groups
in labour force participation rates, especially at higher levels Age and Personal
of educational attainment.25 and Household 18-29 30-59 60+
Incomes
Personal and household incomes
The findings for income, especially household income must Median personal
<$10,000 $21,783 $12,991
be used with caution. About 16% of the sample knew neither incomes.
their personal nor their household income. In addition, 6.9%
Median household
refused to answer the personal income question and 33.3% incomes.
$27,114 $32,878 $24,650
refused to answer the household income question. Although
those who did not know income levels tended to be younger, Education and HS Dip.,
<HS grad Uni. Deg.
those who refused to answer that question tended to be not Personal Incomes grad etc.
working for pay or of lower educational attainment. Those Median personal
$11,718 $17,656 $21,807 $36,725
who refused to answer question for personal income usually incomes
refused or did not know their household income.
Figure 7. Number of income Sources during 2001 (n=10,962)
The median personal income in 2001 of RHS adults in First
Nations communities was $15,667. The median household
Four or more
income = $29,897. Men and women had essentially the same sources, 6.6% No sources, 6.2%
income levels.
Three sources,
16.5%
Table 7. 2001 Personal and household income levels
RHS First
RHS First Nations
Nations Adults’ One source, 36.0%
Income categories Adults’ Household
Personal Income
Income (n=5301)
(n=8067)
<$10,000 or income loss 33.2 11.7

$10,000-$14,999 16.4 10.7
Two sources, 34.7%
$15,000-$19,999 10.2 8.3
$20,000-$29,999 19.7 19.5
$30,000-$49,999 15.5 25.6
$50,000-$79,999 4.4 18.2 Sources of income from employment included paid
$80,000 plus 0.6 6.0 employment (wages or salary) and self employment earnings.
Median income $15,667 $29,897 Government sources of income included employment
insurance, social assistance, basic Old Age Security, benefits
As expected, adults who were under 30 and over 59 had from the Canada or Quebec Pension Plan, veterans pension,
lower personal incomes than those in the middle range. The worker’s compensation, disability allowance, and Child Tax
pattern was not as clear for reported household incomes. Benefit.
Education was related to income levels —as expected also.
Adults with higher levels of formal education had higher Other sources of income included royalties, trusts, land,
median incomes than adults with less formal education. retirement, pensions, superannuation, annuities, child
support/alimony, education or training allowances.
Median personal income for Canadian income earners was
$40,000 for men and $24,800 for women.26 First Nations More men, more adults ages 30 to 59 and more of those with
adult income earners, age 15 and over and living outside First higher education had income from employment sources.
Nations communities had a median income of $14,879 in the More women, more older and younger adults and fewer
year 2000.27 adults with a university degree had income from government
sources.
Other researchers compare Aboriginal and non-Aboriginal
median incomes and their findings help with the
interpretation of RHS data. With regard to the comparative
median income levels for men and women (ages 15+)
relative to education levels, findings were similar for men
and women. The gaps between the incomes of Registered
First Nations and non-First Nations adults were larger at
28
Figure 8. Types of income sources during 2001, (n=10962) More adults ages 30–59
80%
71.0%
• had higher rates of completion of post-secondary
70% diplomas and degrees
60% 56.6%
• had income from employment sources
More younger adults were:
50%
40%
• single
• in common law relationships
30%
More older adults were:
20%
14.0% • married
10%
• previously married
0%
Other Government Employment
Summary of education patterns
Table 9. Income source patterns by gender, age and education More adults with higher levels of formal education than
Gender and income adults with less formal education were employed, had higher
Men Women
sources median personal incomes and had incomes from employment
Income from employment
60.8% 52.1%
sources.
sources
Income from government Fewer adults with university degrees had incomes from
62.4% 79.8%
sources government sources than those with less than a bachelors
Age and income sources 18–29 30–59 60+ degree.
Income from employment
sources
49.0% 66.8% 27.8% Community Characteristics
Income from government Communities were classified into three size categories by
74.0% 67.4% 79.7%
sources.
population. Sampling was proportional to the populations in
Education and income <HS HS Dip., Uni. these community size categories.
sources grad grad etc. degree
Table 10. Population estimates by community size. (n = 10,962)
Income from employment Community size category: number of
42.9% 67.0% 73.7% 82.7% Survey respondents
sources residents
Income from government
74.9% 71.5% 67.1% 49.2% <300 9.6%
sources.
300-1499 56.2%
1500 + 34.2%
Summary of age patterns
Most of the patterns of personal characteristics by age that Community size was related to only one of the demographics
were cited above were to be expected from a population that: discussed in this chapter, household income. Adults from
spans the ages 18 to over 60; and that has a pattern of seeking small communities had the higher median household income,
post secondary education well into their late twenties, thirties $24,083 (n = 704) while adults from the midsize and larger
and beyond. communities had median household incomes of $19, 550
(midsize, n = 3070) and $21,544 (larger, n = 1527). This
More younger and older adults had: could not be explained by number of adults in the household
as there were fewer adults in the small community
• had the highest rates of not completing high school
households.
• had the lowest rates of being employed at the time of the
interview Communities were also classified according to their degree
of isolation as defined in Table 11. There were few patterns
• had the lowest median personal incomes to report. Remote isolated communities seem to have higher
• came from households with lowest median household median household incomes. They undoubtedly have higher
incomes expenses as well.
• had income from government sources
29
Table 11. Population estimates by degree of isolation of upgrading their skills through education of some form then
communities (n = 10,543)
employment rates should follow.
Community size category (number of
Survey respondents First Nations adults surveyed in the RHS with higher
residents)
Remote-isolated 2.8%
educational attainment had higher median incomes than their
Isolated 15.4% counterparts. Other researchers in a position to compare First
Semi-isolated 5.9% Nations and non-First Nations data found the same, but
Non-isolated 76.0% showed that Registered First Nations men and women had
lower median incomes than non-First Nations men and
Table 12. Adults’ incomes and sources of income variations by
degree of isolation of community women. The fact that the gaps were greater at higher income
levels suggests a glass ceiling for First Nations incomes.
Isolation status
Another study in the United States has shown that the
Remote Semi- Non-
isolated
Isolated
isolated isolated
collective educational attainment in a community has an
impact on two important behaviour patterns of youth. When
a community has between 5 and 40 percent of adults in
HH income median
$39,572 $31,980 $27,301 $29,947 professional, managerial or teaching positions, teen
(n=5071)
pregnancy rates and school drop-out rates are fairly uniform.
Sources of income (n=10543) When the percentage of higher status role models drops by as
little as 2% and is less than 5%, drop-out rates and teen
Employment 63.7* 45.9 50.6 59.5* pregnancy rates double. It has been described as an epidemic
Government 68.2 74.5 74.0 69.8
in US neighbourhoods where the rates were observed.
Other 24.2 7.5 14.0 15.4* Recommendations

* significantly different from isolated communities.
There is a need for First Nations communities to plan ahead
for both their changing demographics and potential changes
Conclusions and Recommendations in community income from federal sources. Those not
already addressing the future potential changes may find a
Conclusions future crunch in community resources. The increase in First
Nations population for the next two generations is
For a variety of reasons that go beyond such factors as
accompanied by an increase in the number who do not
increased fertility, First Nations communities have more
qualify to be registered. There are serious implications for
young people relative to adults. Whatever the reason, this
the increasing need for services followed or accompanied by
increase in population has significant implications for family
a possible decline in federal funds flowing to the community.
income, education systems, and health and social services
There may be no corresponding decline in population in the
accessibility.
First Nations communities, just a decline in the number of
While the gap between adults in First Nations communities children who qualify under Bill C-31. This is not new news,
and adults in the broader Canadian community (with regard but it is further underscored by the RHS data.
to educational attainment, employment rates and incomes)
Due to factors such as this, providing services to First
has been well documented in this report and elsewhere,
Nations communities in the future may be challenging and
evidence of changes over time is difficult to measure. No
complex. The level of educational resources needed for the
such comparisons are available from the 1997 First Nations
increased number of children is current. Today’s children
and Inuit Regional Longitudinal Health Survey (much briefer
will be the seniors of the second half of the century and the
than the 2002 survey reported here). Due to the increase in
need for health care resources will appear as a bulge at that
the number of First Nations claiming their identity from 1996
time. If the educational attainment challenge and the
to 2001 census, researchers are still uncomfortable making
subsequent employment challenge is not addressed
comparisons.
adequately, the social and income services needed will
Educational attainment is greater for 30–59 year old adults impact the resources of the communities even sooner.
than for the younger adults. Increasing educational
Although current education and employment models rarely
attainment rates are important (especially when combined
reflect a First Nations world view, th RHS findings and other
with the fact that when education is taken into account, there
research studies confirm that they are the key to increasing
is little difference in labour force participation rates between
personal, family and community resources. Some success has
First Nations and non-First Nations adults). The lower
been demonstrated that supports this approach for members
employment rates of First Nations adults compared to non-
of non-dominant cultures. Individuals may need the support
First Nations adults would, therefore appear to be due to their
of their communities in understanding the process of leading
lower educational attainment. If more First Nations adults are
30
a bi-cultural life. Current drop out rates for youth in First

Nations communities are so high that they increase the risk
that large portions of some communities will be unemployed
or earning a poverty level income for some time to come.
Recommendations for the next survey include a more precise
analysis of information on whether the respondent was a
parent and/or living with his/her children. While there was
information on marital status, number of adults/children in a
household, more information on the particulars of household
composition (and their interrelationships) could have made
the chapter richer.
Lastly, in addition to the questions about a person’s
employment status, it would have been helpful to know
whether the respondent was enrolled in any school or training
(full or part time) at the time of the interview.
Notes to Chapter 1
1. James Dumont, “Journey To Daylight-Land Through Ojibwa Eyes”, The First Ones: Readings
in Indian/Native Studies, edited by David Miller, et al.(Saskatchewan: Saskatchewan Indian
Federated College Press, 1992), pp. 75-80.
2. Indian and Northern Affairs Canada, Registered Indian Population by Sex and Residence, 2001
(Gatineau, Que.: Indian and Northern Affairs Canada, 2002), p. 13.
3. Eric Guimond, “Fuzzy Definitions and Population Explosion: Changing Identities of
Aboriginal Groups in Canada,” Not Strangers in These Parts, Urban Aboriginal Peoples,
edited by D. Newhouse and E. Peters, [online]. [Gatineau, Que.]: Research and Analysis
Directorate, Indian and Northern Affairs Canada, 2003, pp. 35-50. Available from World Wide
Web: http://www.ainc-inac.gc.ca/pr/ra/pub3_e.html.
4. Ibid., p. 40.
5. Ibid., p. 42.
6. Ibid., p. 41.
7. Ibid.
12. Ibid., p. 44.
13. Stewart Clatworthy, Re-assessing the Population Impacts of Bill C-31 [online]. [Gatineau,
Que.]: Indian and Northern Affairs Canada, 2001, p. 38. Available from World Wide Web:
<http://www.ainc-inac.gc.ca/pr/ra/rpi/index_e.html>.
14. Ibid.
15. Ibid.
16. Jeremy Hull, Post-Secondary Education and Labour Market Outcomes, Canada, 2001
[online]. [Canada]: Indian and Northern Affairs Canada and Statistics Canada, 2005, p. 37.
Available from World Wide Web: <http://www.ainc-inac.gc.ca/pr/ra/pse/01/01_e.pdf>.
17. Statistics Canada, 2001 Census: Nation Tables (Ottawa, Ont.: Statistics Canada, April 2004,
cat. no. 97F0011XCB010), Tables 40, 42, 44 and 46.
18. Table, Population 15 years and over by highest degree, certificate or diploma (1986-2001
Censuses) [online]. [Ottawa, Ont.]: Statistics Canada, 2003. Available from World Wide Web:
<http://www40.statcan.ca/l01/cst01/educ42.htm>.
19. Hull, Post-Secondary Education and Labour Market Outcomes, Canada, 2001 [online].
20. Ibid.
21. Statistics Canada, 2001 Census: Nation Tables.
22. Table, Population by Marital Status and Sex [online]. [Ottawa, Ont.]: Statistics Canada, 2003.
Available from World Wide Web: <http://www40.statcan.ca/l01/cst01/famil01.htm>.
24. Table, Full-time and part-time employment by sex and age group [online]. [Ottawa, Ont.]:
Statistics Canada, 2003. Available from World Wide Web:
<http://www40.statcan.ca/l01/cst01/labor12.htm>.
25. Hull, Post-Secondary Education and Labour Market Outcomes, Canada, 2001 [online], p. 79.
26. Table, Average earnings by sex and work pattern (All earners) [online]. [Ottawa, Ont.]:
Statistics Canada, 2003. Available from World Wide Web:
<http://www40.statcan.ca/l01/cst01/labor01a.htm>.
28. Hull, Post-Secondary Education and Labour Market Outcomes, Canada, 2001 [online], pp.
104-108.
29. Ibid.
30. Jonathan Crane, 1989, The epidemic theory of ghettos and neighborhood effects on dropping
out and teenage childbearing, American Journal of Sociology, 95, 5: 1226-1259, as reported in
The Tipping Point: How Little Things Can Make a Big Difference by Malcolm Gladwell (New
York, N.Y.: Little, Brown and Co., 2000), pp. 12-13.
31. Douglas E. Foley, 1991, Reconsidering anthropological explanations of ethnic school failure,
Anthropology and Education Quarterly, 22: 62-86.
Further Reference
Douglas E. Foley, 1991, Reconsidering anthropological explanations of ethnic school failure,
Anthropology and Education Quarterly, 22: 62-86.
Susan Ledlow, May 1992, Is cultural discontinuity an adequate explanation for dropping out?, Journal
of American Indian Education, 31, 3: 21 - 35.
31
Chapter 2
Language and Culture
Abstract
This chapter provides information about the state of First Nations languages and culture and explores
the relationships between language and culture, on one hand, and health services and health on the
other. The results show that First Nations languages, overall, are in rapid decline but are strongest in
large and remote communities. Contrary to what was expected, those who attended residential school
were more likely to understand and speak First Nations languages.
The vast majority of respondents consider traditional cultural events important. The same is true for
traditional spirituality and for religion. Those who consider traditional cultural events important are
more likely to have positive perceptions of their community’s progress.
Those who speak First Nations languages and those who perceive cultural events as important are
more likely to report difficulties and barriers accessing health care. Difficulties accessing culturally
appropriate care, traditional forms of care and certain Non-Insured Health Benefits (NIHB) services
represent particular challenges for these groups. Health risk factors and health status outcomes were
not statistically different for those who could speak First Nations languages nor among those who
consider traditional cultural events important.
The decline in First Nations languages, the unexpected findings about residential school and the
widespread valuing of culture are discussed and a series of recommendations are made.
32
RHS 2002/03 Adult Survey – Chapter 2: Language and Culture
Ojibway, secure from extinction in the long run because of

Introduction
the large populations that speak them.
Language and culture are intertwined. They are intrinsic to
In 2001, more than 10,000 people reported Cree as their
the total health of the total person and they are related to all
mother tongue and more than 10,000 reported Ojibway. Dene
other aspects of health. This chapter explores the current
and Montagnais-Naskapi each had more than 10,000 able to
state of languages, the importance of traditional culture, and
speak well enough to carry on a conversation.12
how each of these relates to health care access and various
conventional measures of health. In Canada, residential schools are considered a primary
instrument in the erosion of First Nations language.
A 1996 UNESCO report described Aboriginal languages in
Recognizing its vital role in the transmission of culture, those
Canada as being “among the most endangered in the world.”1
responsible for “civilizing” First Nations children expressly
In 2004, the Assembly of First Nations (AFN) described First
targeted language. Replacing First Nations languages with
Nations languages as being in “crisis.”2 The decline and loss
one seen as capable of conveying the values and notions of
of First Nations languages are documented in various ways.
“civilization” was considered of paramount importance.13
A 1990-91 survey of 171 First Nations communities3 found According to the 1995 annual report of the Department of
that in 41% of them the local language was either Indian Affairs, without English, the Aboriginal person is
“endangered” or “critical.”i The study noted that the level of “permanently disabled” and “so long as he keeps his native
First Nations language use in public venues (such as schools, tongue, so long will he remain a community apart."14
social events or community meetings) was a good barometer
Language is the principle means for transmitting history,
of the status of the language.
culture, knowledge and values. Indigenous knowledge is
Between 1996 and 2001, the proportion of Aboriginal embedded in indigenous language.15,16 As stated by the
peopleii able to carry on a conversation in an Aboriginal RCAP:
language decreased from 29% to 24%. In the same period,
The threat of their languages disappearing means that
the proportion reporting an Aboriginal mother tongue fell
Aboriginal people's distinctive world view, the wisdom
from 26% to 20%. The trend varied from one language to
of their ancestors and their ways of being human could
another. Some showed increases while others showed
vanish as well.”17
decreases in the total number of speakers.4 Among First
Nations living off-reserve, the proportion of people who both The AFN goes further:
were able to carry on a conversation and had an Aboriginal
Language is our unique relationship to the Creator, our
mother tongue both started lower and declined as well. The
attitudes, beliefs, values and fundamental notions of
use of an Aboriginal language at home, a key measure, fell
what is truth. Our Languages are the cornerstone of
from 8% to 6% among First Nations living off-reserve.5
who we are as a People. Without our Languages our
As noted in the 1996 Royal Commission on Aboriginal cultures cannot survive.”18
Peoples (RCAP), when a language is no longer spoken at
home, it cannot be passed along to the next generation. When And for Leroy Little Bear, language is the foundation of
children do not speak the language, it is likely to disappear.6 sovereign nations:
The disappearance of languages is an international We have all those attributes that comprise sovereign
phenomenon. In the 1990s, the UNESCO Ad Hoc Expert nations: a governance structure, law and order,
Group on Endangered Languages estimated that about 4% of jurisprudence, a literature, a land base, spiritual and
the world’s languages are spoken by 97% of the world’s sacred practice, and the one attribute that holds all of
populations and that 96% of all languages are only spoken by these…together: our languages. So once our languages
only around 3% of the people.7 An international agency disappear, each one of these attributes begins to fall
classified 516 of the world’s languages as “nearly extinct.” apart until they are all gone.”19
Included in the list are 16 of the 53 to 70iii First Nations
languages in Canada.8,9, 10 A Canadian report identifies 13 of Language and culture have also been associated with quality
these as “nearly extinct.”11 Although several languages and access to health care.20, 21 Linguistic and cultural barriers,
spoken by small populations may be viable, the report as well as racism and stereotypes, lead not only to
considers only two First Nations languages, Cree and misunderstandings and frustration, but can result in inferior
diagnosis, care and outcomes.22,23,24,25 The solutions are
increasingly being discussed in terms of “cultural safety” for
i
“Critical” was defined as less than 10 speakers living in the community and “endangered” referred to
communities either with less than 50% of the adult population speaking the language and few or no
clients and “cultural competency” of health care workers and
young speakers, or communities with no identified speakers under 45 years old, even if over 80% of facilities.26,27,28 According to a Health Canada report that
the older population did speak the language.
ii
Including First Nations, Inuit and Métis, both on and off-reserve. summarizes research on language barriers in health:
iii
The variation in number of languages reflects the differing classification standards, including
distinctions between dialects and languages.
33
There is solid evidence from Canadian programs that (59.2% vs. 45.5%).iv The isolated communities may have
patients who do not speak an official language do not experienced less influence and contact with English and
receive the same standard of ethical care as other French speakers and the large communities may have a
Canadians.”29 “critical mass” of First Nations language speakers to help
support language continuity.
Language connects people to their past and provides spiritual Figure 2. Proportion who understand a First Nations language
and emotional grounding.30 The Royal Commission “relatively well” or “fluently” by age (n=19,574 including youth
explicitly identified revitalization of languages as a key to and children)
healthy individuals and communities.31
80%
70.5%
Results
60%
Speaking and understanding First Nations languages 54.2%
As shown in Figure 1, about half (49.7%) of respondents

39.0%
understand at least one First Nations language “relatively 40%
32.6%
well” or “fluently.” Slightly fewer (43.9%) could speak a
25.5%
First Nations language at that level, while 22.3% reported
that their First Nations language was the one they used most 20%
often in daily life. About one in fifty (2.2%) were categorized

as First Nations unilingual, speaking a First Nations
language, but neither English nor French “relatively well” or 0%
6-11 12-17 18-34 35-54 55+
“fluently”. Age group (years)
Figure 1. How well respondents understand a First Nations

language (n=10,962)*
First Nations languages and residential school history
The relationships between residential school history and First
Relatively well,
16.3% Nations language comprehension were unanticipated. Those
who attended residential school were actually more likely to
Fluently, 33.4% understand a First Nations language “relatively well” or
“fluently” compared with those who did not attend (74.8%
vs. 43.6%). This association held within each age group (18–
Not at all, 20.9%
34, 35–54 and 55+ years old) and also persisted when other
potentially confounding measuresv were factored out in
cross-tabulations. Residential school attendance was also
positively associated with the other language measures
tested: speaking a First Nations language relatively well or
A few words, 29.4%
fluently, speaking fluently (only) and having a First Nations
language as primary language.
*If participants understood more than one, their strongest language is counted. Also somewhat unexpectedly, those with at least one parent
who attended residential school were no more or less likely
First Nations languages and age
to have a strong understanding of a First Nations language
First Nations language comprehension decreases steadily as than those whose parents did not attend. Again, this pattern
age decreases (moving to the left in Figure 2). The rapidly held true for different age groups.
declining rates of comprehension indicate rapid loss of
Finally, and more consistent with general expectations, those
language. This erosion is occurring in First Nations
with at least one grandparent who attended were less likely to
communities, despite the fact that they are the places where
understand a First Nations language “relatively well” or
the concentration of speakers is highest.
“fluently” (38.6% vs. 56.2%).
First Nations languages and community characteristics
The proportion who understand a First Nations language iv
For this chapter, isolated communities include those that lack road access to physician services
“relatively well” or “fluently” is considerably higher in within 90 kilometres and small communities have local populations between 300 and 1,499 while
communities that are isolated than in those that are not larger ones have 1,500 or more.
v
Highest level of education, personal income, importance of traditional cultural events, self-reported
(76.1% vs. 44.0%) and is higher in larger communities health, presence of a health condition, parent who attended residential school, measure of life balance
and community isolation status.
34
Importance of culture, spirituality and religion areas, as shown in Table 1. This may reflect an overall more
positive perspective.
As shown in Figure 3, 44.5% considered traditional cultural
events “very important” in their lives, and a further 36.1% Interestingly the culture-oriented group’s relatively positive
said “somewhat important” for a total of 80.6%. About as assessment of community progress is most pronounced in
many (76.4%) considered traditional spirituality and religion areas closely related to culture. They are twice as likely to
(70.3%), such as Christianity, important in their lives. perceive progress in the renewal of First Nations spirituality
Figure 3. Importance of traditional cultural events (n=10,427)
and 1.8 times as likely to identify progress in traditional
ceremonial activity, renewal of relationship with the land and
traditional approaches to healing.
Not important, 9.0% Differences in perceptions between those with and without
Not very important, good First Nations language comprehension were less
10.3%
pronounced.
Very important, Table 1. Proportion identifying community progress (compared)
44.5% Important of traditional cultural
“Some” or “Good” events
Community Progress in:
Important* Not important** Ratio
Renewal of First Nations
61.7% 30.4% 2.0
Somewhat spirituality
important, 36.1%
Traditional ceremonial activity 68.3% 37.8% 1.8
Renewed relationship with the
58.9% 33.1% 1.8
land
Traditional approaches to
63.9% 34.8% 1.8
Of those who indicated that cultural events were important, healing
almost all (90.8%) also said that traditional spirituality was Reduction in alcohol and drug
39.0% 26.6% 1.5
abuse
important to them. Those who considered traditional
spirituality important were more likely to consider religion Use of First Nations language 65.0% 46.5% 1.4
important (74.0%) than those who didn’t consider traditional Availability of First Nations
63.0% 47.5% 1.3
spirituality important (57.2%). Overall, 54.5% considered all health professionals
three important. Cultural awareness in schools 80.4% 64.1% 1.3
First Nations control over health
66.5% 57.5% 1.2
Importance of culture, personal characteristics and services
residential school history Education and training programs 80.2% 71.8% 1.1
Considering traditional cultural events “very” or “somewhat” Water and sewage facilities 71.0% 61.9% 1.1
important was not associated with any of the personal and *Includes those indicating “very important” and “somewhat important.”
**Includes those indicating “not important” or “not very important.”
community factors examined. There were no significant
differences related to gender, age group, personal income Language, Culture and First Nations Spirituality
level, formal education level, First Nations language
comprehension, and community size or isolation status. Despite the language-culture connection discussed in the
introduction, language comprehension and interest in culture
Residential school history was, however, related. As with the appear to not always go together at the individual level. As
language findings, those who attended residential school shown in Table 2, about 4 in 10 (40.8%) respondents both
were more likely to consider traditional cultural events either understand a First Nations language and consider traditional
somewhat or very important (85.8% compared with 79.2% of cultural events important, and about an equal proportion
those who did not attend). Those who had one or both (39.8%) consider cultural events important but do not
parents who attended residential school were also more likely understand a First Nations language.
to consider traditional cultural events important, as were
those who had one or more grandparents who attended. Looked at another way, those who understand a First Nations
language (relatively well or fluently) are just as likely as
Importance of culture and perceptions of community those who don’t to consider traditional cultural events
progress important (82.3% vs. 78.9%, a non-significant difference)
Likewise, those who consider traditional cultural events
The survey asked respondents whether their communities had important are no more or less likely to understand a First
made any progress in various areas over the previous 12 Nations language. Culture, it seems, is important to almost
months. Those who consider traditional cultural events everyone.
important were more likely to perceive progress in many
35
Table 2. Language comprehension* and importance of A comparison of those who spoke a First Nations language as
traditional cultural events**
their primary language revealed fewer significant differences.
Proportion of Averaging across all items reported in Table 3, that group
respondents
was 1.3 times more likely to experience difficulties/barriers.
Both understand a First Nations language* and A comparison with unilingual First Nations language
40.8%
consider traditional cultural events important** speakers was not possible. Results were below reportable
Understand a First Nations language* but thresholds for most items due to the small number of
don’t consider traditional cultural events 8.8% unilingual individuals in the database.
important
Don’t understand a First Nations language but Although not necessarily identified by the largest proportion
do consider traditional cultural events 39.8% of First Nation language speakers overall, the ratios (i.e. the
important** increased burden) among that group were highest for the
Neither understand a First Nations language nor following indicators:
10.6%
consider traditional cultural events important
• Difficulty accessing a hearing aid through NIHB (2.8);
Total 100%
*Includes those who understand a First Nations language ”relatively well” or ”fluently.”
• Difficulty accessing escort travel through NIHB (1.9);
**Includes those indicating “very important” and “somewhat important.”
• Difficulty accessing “other medical supplies” through
Nonetheless, given what is understood about the critical role NIHB (1.7);
of language in culture, values and spirituality, there would • Felt that service was not culturally appropriate (1.6).
seem to be some advantage to having both an orientation to
culture as well as language skills. A group was identified of Health Canada’s Non-Insured Health Benefits (NIHB)
those who understand a First Nations language (relatively program appears to be an area of special difficulty among
well or fluently) and also consider both spirituality and those who speak First Nations languages.
traditional culture important. These individuals are potential Among those who consider traditional cultural events
leaders in the transmission and retention of First Nations important, the ratios were highest for the following:
knowledge.
• Felt that service was not culturally appropriate (3.2);
Based on the RHS data, 37.6% of adults are in this group.
Although they can be found in all categories, statistically, • Experienced difficulty getting traditional forms of care
these potential leaders were more likely to be older (52.0% of (2.6);
those 55 or older compared with 28.4% of those 18–34 years • Experienced difficulties accessing transportation
of age), to live in large communities (1,500+ population) and services or costs (air or road) through NIHB (2);
in isolated communities. They were more likely to have
• Experienced difficulties accessing dental care services
attended residential school (60.4% vs. 31.3%) (a pattern that
through NIHB (2.0).
held true for each age group examined [18–34, 35–54 and
55+]) and were less likely to have had a grandparent who Not surprisingly, the group that considers cultural events
attended residential school. important is much more likely to identify difficulties related
to the lack of culturally appropriate and traditional care. They
Language, culture and health care access also appear to disproportionately experience difficulties with
First Nations report a variety of difficulties and barriers in the NIHB program.
accessing health care services. Table 3 shows the proportion
experiencing barriers and difficulties, comparing those who
speak and don’t speak First Nations languages, and those
who do and don’t consider traditional cultural events
important.
There is clear pattern. Those who speak a First Nations
language and those who consider traditional cultural events
important are more likely to experience barriers. The effect
was strongest for the culture-oriented group, which was 1.7
times more likely to report difficulties/barriers when all
ratios were averaged. This compares with an average ratio of
1.4 among those who understood a First Nations language.
36
Table 3. Proportion reporting health care access barriers and difficulties

Speaks FN language Considers cultural events important
Yes* No Ratio Yes^ No Ratio
Feel they have less health care access than other Canadians 42.5% 30.2% 1.4 36.4% 30.2% 1.2 NS
One or more difficulties accessing traditional medicines 33.0% 33.2% 1.0 NS 35.6% 22.6% 1.6
Reported one or more barriers to health care access 62.1% 51.0% 1.2 59.3% 43.6% 1.4
Specific barriers reported:
• doctor or nurse not available in area 22.7% 15.2% 1.5 18.3% 15.8% 1.2 NS
• health facility not available 13.4% 8.8% 1.5 10.6% 9.1% 1.2 NS
• waiting list too long 39.2% 28.6% 1.4 34.8% 26.5% 1.3
• unable to arrange transportation 17.4% 12.3% 1.4 15.4% 9.9% 1.6
• difficulty getting traditional care 16.6% 10.9% 1.5 15.2% 5.8% 2.6
• not covered by Non-Insured Health Benefits (NIHB) 22.0% 18.5% 1.2 NS 21.7% 13.0% 1.7
• approval for NIHB services denied 18.2% 14.7% 1.2 NS 17.9% 9.2% 1.9
• could not afford direct cost of care, service 16.0% 11.0% 1.5 14.7% 8.2% 1.8
• could not afford transportation costs 16.9% 11.2% 1.5 14.8% 9.0% 1.6
• could not afford childcare costs 8.5% 6.0% 1.4 7.7% 4.1% 1.9
• felt health care provided was inadequate 20.4% 14.2% 1.4 17.9% 12.2% 1.5
• felt service was not culturally appropriate 17.1% 10.6% 1.6 15.5% 4.8% 3.2
• chose not to see health professional 11.6% 10.4% 1.1 NS 11.6% 7.5% 1.5
• service not available in area 18.0 12.1 1.5 15.7% 11.1% 1.4 NS
Had any difficulty accessing NIHB services 36.2% 32.3% 1.1 NS 37.2% 24.1% 1.5
Specific difficulties accessing NIHB services:
• medications 20.1% 16.0% 1.3 NS 19.0% 12.4% 1.5
• dental care 17.6% 16.9% 1.0 NS 19.0% 9.6% 2.0
• vision care 19.8% 15.2% 1.3 18.6% 11.7% 1.6
• hearing aid 5.4% 1.9% 2.8 3.5% 2.0% 1.8 NS
• other medical supplies 8.4% 5.0% 1.7 6.7% 4.1% 1.6 NS

• escort travel 10.7% 5.7% 1.9 NS 8.3% 5.3% 1.6 NS
• transportation services or costs (air or road) 11.0% 7.5% 1.5 NS 9.7% 4.8% 2.0
*Includes those speak a First Nations language relatively well or fluently.
Încludes those who consider traditional cultural events “very important” and “somewhat important.”
NS refers to differences that are not statistically significant.
37
Language, culture and health • Those who consider traditional cultural events important
vi vii are more likely to have positive perceptions of their
A set of five risk factors and seven health measures were
community’s progress;
analyzed, comparing first those who do and do not speak a
First Nations language and second those who do and do not • There is a potentially important group, representing
consider traditional cultural events important. Although some more than one-third of adults, that understands a First
associations were initially present,viii after adjusting for age, Nations language and considers both traditional cultural
there no were statistically significant differences on any of events and traditional spirituality important;
the twelve measures. • Those who perceive cultural events as important are
more likely to experience difficulties/barriers to health
Summary and Discussion care access, especially related to culturally appropriate,
A survey database is inadequate to explore the relationships traditional care and NIHB services; and
between language, culture and health. Still, some findings are • This culture-oriented group is no more or less likely to
clear and others provide interesting points of departure for report health risk factors or problems.
further research and consideration.
The dramatically lower levels of language comprehension
To summarize the key findings with respect to language: with each successive generation, supports the Assembly of
First Nations’ characterization of languages in “crisis.”32 The
• Based on age trends, First Nations languages, overall,
small proportion of people who are unilingual may, in some
are in rapid decline;
respect, be a more important measure of the decline. The
• Only about one in fifty people are unilingual First disappearance of unilingual First Nations language speakers
Nations speakers. can be seen as the loss of a vital source of knowledge and
• First Nations languages are strongest in large and remote understanding. Important First Nations concepts and ways of
First Nations communities; thinking are embedded in the words and structure of the
language. The increased reliance on bilingual speakers to
• Unexpectedly, those who attended residential school are
transmit language (thus, knowledge and culture) may result
more likely to understand and speak First Nations
in loss of meaning and the unwitting introduction of foreign
languages, although those with grandparents who
concepts and meanings.33
attended residential school are less likely to;
• Those who speak First Nations languages report more The unexpected association between residential school
difficulties and barriers accessing health care, especially attendance and language is intriguing. One possible
related to NIHB services; and explanation is that, as part of the drive to “civilize,” there
may have been preferential recruitment of children consider
• Health risk factors and health status is similar among less “assimilated,” the children who were more likely to
those who do and do not speak First Nations languages. speak their language in the first place. This is partly
To summarize the key findings with respect to culture: supported by the data. Those who attended residential school
reside disproportionately in isolated communities (where
• The belief that traditional cultural events are important is language skills are stronger). About one in four people now
widespread. The same is true for traditional spirituality living in isolated communities attended residential school
and for religion. More than half consider all three (26.9%) compared to one about one in six (17.3%) of those
important; from non-isolated communities. Nonetheless, the association
• Traditional cultural events are important to most people, between residential school attendance and First Nations
regardless of their age, gender, income, education, First language comprehension persists, albeit to different degrees,
Nations language skills or their community’s size or for both isolated and non-isolated communities. Overall,
isolation; those who attended residential school were 1.7 times as
likely to understand a First Nations language (relatively well
• Somewhat unexpectedly, those who attended residential
or fluently). The comparable ratios were 1.3 for isolated
school as well as those whose parents and/or
communities and 1.9 for non-isolated communities.
grandparents attended are more likely to consider
traditional cultural events important; Contrary to the clear intent of many schools and their
administrators, and contrary to widely held views, could the
residential school experience have actually done less to
vi
vii
Physical activity, overweight/obesity, smoking, heavy alcohol consumption, hashish use. damage First Nations languages than other types of schools
Self-reported health, presence of one or more chronic conditions, presence of a disability, injury in
the previous year, suicidal ideation (ever), suicide attempt (ever), feeling sad, depressed or blue for at and environments?
least two consecutive weeks in the previous year.
viii
Before taking age into account, those who spoke a First Nations language were more likely to have Although residential school students were generally
one or more health conditions, more likely to have a disability and less likely to have used hashish.
Also, before factoring out the effect of age, those who considered traditional cultural events important discouraged, either gently or forcibly, from speaking their
were more likely to have had suicidal thoughts at some time in the past and were more likely to have
felt sad, depressed or blue for 2 weeks (or more) in a row in the reference year. languages, most children likely continued to speak among
38
themselves, possibly in secret, possibly in active defiance. levels of intervention (noting that they are not always
Meanwhile, those who did not attend residential schools may possible):
have been in schools where First Nations speakers were in
the minority (e.g., in neighbouring towns)—schools in which • From infancy within the family;
First Nations language and culture were often ignored. In • In language immersion daycare programs;
those settings, the First Nations children may have had no • In schools; and
one to talk to in their First Nations language.
• In the community-at-large.
Another possible explanation for the unexpected association
School-based approaches, such as the Kahnawake Survival
may relate to (re)learning one’s First Nations language later
School,36 can be valuable, as can on-the-land/in-the-bush
in life. As adults, many people have sought, particularly
cultural immersion. Opportunities for receptive children and
through healing, to re-learn their languages and have
youth to spend time with elders can be valuable as well.
developed or regained interest in their traditional cultures and
spirituality. Although language is learned in the community and within
the family, some regional and national strategies may be
Although there were no apparent associations with risk
promising.
factors or health outcomes, this may be due to the limited
scope of the data. • Enhancing project funding, through programs such as
the Aboriginal Language Initiative37, 38 and build on
It is unclear exactly what considering traditional cultural
successes of language support programs, such as the
events or traditional spirituality important in one’s life might
Woodland Cultural Centre;39
mean in practice or how this may vary from person to person.
Nonetheless, based on the numbers, traditional culture and • Finally passing legislation to protect and support First
spirituality appear to be strong. The fact that traditional Nations languages, similar to the private members bill
cultural events are considered important by the vast majority initially introduced in 1989 or others proposed since;40,41
regardless of gender, age, income, education, First Nations • Expanding research and training initiatives focused on
language skills or the type of community they live in, language revitalization strategies, such as the one at the
suggests a pervasive undercurrent of shared values. The University of Victoria;42 and
culture-orientation also appears to coincide with more a more
• Further developing public school curricula.43
positive attitude about the community.
Holistically, we view language and culture as part of well- Health services
being overall at both the individual and community/nation There are numerous health care service problems to be
levels. The rapid loss of language creates imbalance. The addressed, including accessibility, cost, types and
apparent strength of culture, on the other hand, suggests appropriateness of care. While addressing all of the access
resilience and offers hope. issues is critical, those that disproportionately affect First
Nations language speakers and those who value traditional
Recommendations cultural events are of special concern here. Ensuring
improvements in those areas is a matter of equity and cultural
Language respect.
The RCAP report indicates that language protection involves NIHB services in particular were identified as inadequate.
maintaining or increasing the number of fluent speakers and Appropriate funding and policy revisions are needed to
using Aboriginal language in everyday life. A seminal report properly meet the needs. The fact that certain groups are
on Aboriginal language retention makes an important and more affected than others also suggests that policies are not
obvious observation: consistently or evenly applied. Further development of
The simplest way to keep a language alive is to ensure guidelines, increased training and improved quality control
that the children speak it, and the simplest way to or oversight may be needed to ensure that everyone receives
accomplish this is to teach them when they are the same level of care. Based on the excess burden
infants.34 experienced by First Nations language speakers and those
who are culturally oriented, the following NIHB services
Unfortunately, this is no longer possible for an increasing require special attention:
number of families. If languages are to be retained and
revitalized, urgent remedial action is required. Multiple • Dental services;
mutually reinforcing strategies will have the greatest chance • Transportation services and costs;
of success. Under the heading “what works and why,” an • Escort travel; and
Assembly of First Nations (AFN) report35 identifies four
• Provision of hearing aids and other medical supplies.
39
Traditional forms of care need to be expanded and supported,

and existing “mainstream” services need to be made more 11
Mary Jane Norris, Lorna Jantzen. From Generation to Generation: Survival and Maintenance of
Canada's Aboriginal Languages Within Families, Communities and Cities. (January 2004) Accessed
culturally appropriate. Cultural competency of health care October 21, 2005 at http://www.ainc-inac.gc.ca/pr/ra/fgg/
12
Statistics Canada. 2001 Census: analysis series - Aboriginal peoples of Canada: A demographic
providers needs to be developed through training, and profile. Accessed September 29, 2005 at
cultural safety needs to be incorporated into the curricula of http://www12.statcan.ca/english/census01/products/analytic/companion/abor/pdf/
96F0030XIE2001007.pdf
nursing, social work and medical school programs. 13
Indian and Northern Affairs Canada. Volume 1 - Looking Forward Looking Back: PART TWO
False Assumptions and a Failed Relationship Chapter 10 - Residential Schools. Accessed October 25,
Professional development courses and guidelines for 2005 at http://www.ainc-inac.gc.ca/ ch/rcap/sg/sg28_e.html#99
practitioners, such as the one developed for the Society of 14
15
Ibid
Leanne R. Simpson. “Anticolonial Strategies for the Recovery and Maintenance of Indigenous
Obstetricians and Gynaecologists of Canada44 are also Knowledge.” American Indian Quarterly, Vol 28, No 3 &4. (Summer & Fall 2004) p 373-384.
16
Bruce E. Johansen. “Back from the (Nearly) Dead: Reviving Indigenous Languages across North
important tools to help raise awareness. America.” American Indian Quarterly. Vol 28, No 3&4, (Summer & Fall 2004) p 566-582.
17
Indian and Northern Affairs Canada. Highlights of the Royal Commission on Aboriginal People,
Gathering Strength. Accessed October 19, 2005 at http://www.ainc-inac.gc.ca/ch/rcap/rpt/gs_e.html
Further research 18
Assembly of First Nations. “Languages Sector Update.” Accessed October 25, 2005 at
http://www.afn.ca/article.asp?id=122
19
Leroy Little Bear, quoted in Bruce E. Johansen. “Back from the (Nearly) Dead: Reviving
Additional research is needed into the unexpected Indigenous Languages across North America.” American Indian Quarterly. Vol 28,No 3&4.Summer
associations between residential school attendance and both & Fall (2004) p 566-582.
20
Janet Smylie. Society of Obstetricians and Gynaecologists of Canada Policy Statement - A Guide
language skills and the valuing of culture. More information for Health Professionals Working with Aboriginal Peoples: Executive Summary. (2000) Accessed
October 30, 2005 at http://sogc.org/sogcnet/sogc_docs/common/guide/pdfs/ps100_sum.pdf
about the development of language skills through all stages 21
Benoit C, Carroll D, Chaudhry M. “ In search of a healing place: Aboriginal Women in Vancouver's
of life as well as a better understanding of all the factors Downtown Eastside.” Social Science and Medicine. Vol 56. (2003) p 821-33.
22
H. Jack Geiger. “Racial stereotyping and medicine: the need for cultural competence.” Canadian
influencing language, especially among those who did not Medical Association Journal, (June 12 2001) Accessed October 25, 2005 at
http://www.cmaj.ca/cgi/content/full/164/12/1699
attend residential school, would be instructive. 23
Xavier Cattarinich, Nancy Gibson, Andrew Cave. “Assessing Mental Capacity in Canadian
Aboriginal Seniors.” Social Science and Medicine. Vol 53. (2001) p 1469-1479.
Research into what happens when culture remains strong but 24
Sana Halwani. “Racial Inequality in Access to Healthcare Services.” Accessed October 25, 2005 at
http://www.ohrc.on.ca/english/consultations/race-policy-dialogue-paper-sh.shtml
language fades would also be useful. If indigenous 25
Physicians for Human Rights. “Racial Discrimination and Health Care.” Accessed October 25,
knowledge is embedded in indigenous language, what 2005 at http://www.phrusa.org/research/domestic/race/race&health.html
26
Vicki Smye, Annette Browne. “ 'Cultural safety' and the analysis of health policy affecting
actually happens to the knowledge when the language is aboriginal people.” Nurse Researcher. Vol 9, No 3 (2002) p 42-56.
27
National Aboriginal Health Organization. “Cultural Safety not Limited to Healthcare.” NAHO Bull
diminished or gone? How do First Nations cultures and tin, Vol.3, No. 10. (October 2004) p 4-6. Accessed November 1, 2005 at
values change and how do they endure in the face of http://www.naho.ca/english/pdf/bulletin_nov_2004_eng.pdf
28
Queensland Government. Library Module 8.1. - Cultural Safety- About Cultural Safety. Accessed
language decline? November 1, 2005 at http://www.health.qld.gov.au/capir/library_modules/lmodule_08-01.asp
29
Sarah Bowen. Language Barriers in Access to Health Care. (November 2001) Accessed October
25, 2005 at
Finally, from a First Nations perspective, language and http://www.hc-sc.gc.ca/hcs-sss/pubs/care-soins/2001-lang-acces/index_e.html
culture mean health. Can further investigation of health 30
M.J Norris. "Canada's Aboriginal Languages." Canadian Social Trends. Winter, No. 51 (1998)
Statistics Canada, Cat. No. 11-008
outcomes show the same from an epidemiological 31
Royal Commission on Aboriginal Peoples. Report of the Royal Commission on Aboriginal Peoples:
Perspectives and Realities Vol. 4. (1996) p 163. Minister of Supply and Services Canada.
perspective? More focused research is needed to investigate 32
Assembly of First Nations. “Getting Results for First Nations.” Accessed November 1, 2005 at
cultural and linguistic differences in diagnosis, treatment and http://afn.ca/article.asp?id=140
33
James Lamouche, personal communication (2005)
outcomes among patients with similar symptoms and 34
James J. Bauman. A Guide to Issues in Indian Language Retention. Washington, D.C.: Center for
Applied Linguistics, 1980.
conditions. 35
Mark Fettes. A Guide to Language Strategies for First Nations Communities. Assembly of First
Nations Language and Literacy Secretariat. (December 1992) Available at
http://collections.ic.gc.ca/afn/langu.html
36
Kahnawake Survival School. Accessed September 30, 2005 at
Notes to Chapter 2 http://www.schoolnet.ca/aboriginal/survive/index-e.html
37
Canadian Heritage. “Aboriginal Languages Initiative.” Accessed October 28, 2005 at
1 http://www.canadianheritage.gc.ca/progs/pa-app/progs/ila-ali/index_e.cfm
UNESCO, Atlas of the World’s Languages in Danger of Disappearing (1996). Ed. Stephen A. 38
Assembly of First Nations. “Aboriginal Languages Initiative.” Accessed October 28, 2005 at
Wurm, Paris, UNESCO, p.23
2 http://www.afn.ca/article.asp?id=826
Assembly of First Nations. “Getting Results for First Nations.” Accessed October 28, 2005 at 39
Woodland Cultural Centre. “About the Aboriginal Language Program.” Accessed September 30,
http://afn.ca/article.asp?id=140
3 2005 at http://www.woodland-centre.on.ca/languages.html#anchor253209
Marianne B. Ignace. Handbook for Aboriginal Language Program Planning in British Columbia. 40
Assembly of First Nations. “Chronology of Language & Culture Activities & Events.” Accessed
Section 2.2: Numbers and Statistics. Accessed September 30, 2005 at
November 1, 2005 at http://www.afn.ca/article.asp?id=833
http://www.schoolnet.ca/aboriginal/fnesc/part02-2-e.html 41
4 First Nations Confederacy of Cultural Education Centres. “Protective Legislation for Aboriginal
Statistics Canada. 2001 Census: analysis series - Aboriginal peoples of Canada: A demographic
Languages in Canada.” (July 1997) Accessed October 25, 2005 at
profile. Accessed September 30, 2005 at
http://www.schoolnet.ca/aboriginal/ab-lang/noframes/index-e.html
http://www12.statcan.ca/english/census01/products/analytic/companion/abor/pdf/ 42
University of Victoria Continuing Studies. “Certificate in Aboriginal Language Revitalization.”
96F0030XIE2001007.pdf
5 Accessed November 1, 2005 at http://www.uvcs.uvic.ca/calr/courses.aspx
Statistics Canada. Aboriginal Peoples Survey 2001 – Initial Findings: Well-being of the non-reserve 43
Western Canadian Protocol for Collaboration in Basic Education. The Common Curriculum
Aboriginal population. Accessed October 13, 2005 at http://www.statcan.ca/english/freepub/89-589-
Framework for Aboriginal Language and Culture Programs : Kindergarten to Grade 12. (June 2000)
XIE/
Accessed October 30, 2005 at
language.htm#lang_strength
6 http://www.wncp.ca/languages/abor.pdf
Indian and Northern Affairs Canada. VOLUME 3 Gathering Strength: Chapter 6 - Arts and Heritage. 44
Janet Smylie. Society of Obstetricians and Gynaecologists of Canada Policy Statement - A Guide
Section 1.3: Intellectual Property. Accessed October 2005 at http://www.ainc-
for Health Professionals Working with Aboriginal Peoples: Executive Summary. (2000) Accessed
inac.gc.ca/ch/rcap/sg/si57_e.html
7 October 30, 2005 at http://sogc.org/sogcnet/sogc_docs/common/guide/pdfs/ps100_sum.pdf
UNESCO. “The world's top experts in endangered languages meet at UNESCO.” (June 6, 2004)
Accessed September 29, 2005 at http://portal.unesco.org/en/ev.php-
URL_ID=10176&URL_DO=DO_TOPIC&URL_SECTION=201.html
8
“Nearly Extinct Languages.” Accessed November 1, 2005 at
http://www.ethnologue.com/nearly_extinct.asp#Americas
9
“Languages of Canada.” Accessed November 1, 2005 at
http://www.ethnologue.com/show_country.asp?name=CA
10
Indian and Northern Affairs Canada. VOLUME 3 Gathering Strength: Chapter 6 - Arts and
Heritage. Section 1.3: Intellectual Property. Accessed October 19, 2005 at http://www.ainc-
inac.gc.ca/ch/rcap/sg/si57_e.html
40
Chapter 3
First Nations Housing and Living Conditions
Abstract
This chapter considers what the RHS data add to our understanding of the housing conditions, and the
general living conditions, faced by First Nations (FN) people. It examines some of the more
interesting observations in five areas of special interest:
The Nature of Home Occupancy. The 2001 Census reports that over 65% of Canadian families own
their home. Most of the rest rent their accommodation. Social housing plays a minor role. This is
reversed in the FN context: 61.9% of on-reserve families live in band-owned housing which is
analogous to social housing. Of First Nations situated in the provinces, 74.1% of under-$10,000
households are thus in social housing, as are 64.4% of under $30,000 households. Over half (57.2%)
of households reporting $30,000 to $79,999 income live in band houses, and 39.5% of the (few) over-
$80,000 households also live in band houses. These figures —radically different from the general
population —are explained by factors like: extreme poverty; banks not giving on-reserve mortgages
without a federal guarantee; and sometimes-prohibitive geography related construction costs.
Physical Condition of Housing. One third (33.6%) of FN homes need major repairs, up from the one
quarter figure cited in 1985 by the Neilson Task Force. Another third (31.7%) need minor repairs.
These are higher rates for necessary repairs than the Auditor General’s 2003 estimates. First Nations
adults are pessimistic about progress in improving the quality of their housing: 40.3% report there has
been ‘no progress’; 46.2% report ‘some progress’; and only 13.5% report ‘good progress’.
Housing Supply and Occupant Density. The mean room density rate in FN communities is 0.76
persons per room, almost double the national rate of 0.4 persons per room. The average Canadian
house has 2.6 occupants while the average FN house has 4.2 occupants; 17.2% of FN houses meet the
accepted definition of “overcrowded” (i.e., they exceed 1 person per room). The occupant density in
the FN context appears to be increasing, while in the general population it has declined over two
decades. The highest number of occupants recorded is 18 persons.
Basic Infrastructure and Amenities Found in Houses. A fifth (21.8%) of adults report no access to
garbage collection services while 9.0% of FN homes lack a septic tank or sewage service. Only two-
thirds of respondents (67.8%) consider their water safe to drink. Water delivery by pipe is the primary
source for most respondents (63.2%). Of those, only 71.4% consider their water safe to drink despite
this water having been treated. Although the main water supply may be piped water, bottled water is
the main drinking water (61.7% of respondents). Nearly all FN homes have “necessary amenities”:
electricity (99.5%); hot running water (96.3%); cold running water (96.5%); flush toilet (96.5%);
refrigerator (98.7%); and cooking stove (99.3%). Income has little bearing on whether a home has
these amenities. Only 21% of under-$10,000 homes have computers, rising with income to 81.6% of
over-$80,000 homes. Only 29.8% of FN homes are connected to the Internet, and the more isolated
the community, the lower the connectivity.
Indoor Environmental Health. Of the 2.9% of respondents once diagnosed with TB, almost 1 in 3
(31.0%) live in an overcrowded house. Almost half (48.5%) of respondents living in band-owned
housing report mould or mildew in their home Fewer (36.9%) of respondents in other types of
accommodation report mould or mildew. Preliminary tabulations of RHS environmental health data
raise intriguing questions, e.g.: although under 10% of respondents suffer from asthma, 43.5% of
those sufferers report mould or mildew. Only 3.2% of respondents reported having chronic bronchitis,
but 52.2% of these people report mould or mildew.
41
RHS 2002/03 Adult Survey – Chapter 3: First Nations Housing and Living Conditions
more likely to be band-owned in communities of 300-1,499

Introduction
people, but the significance level and possible explanations
This chapter considers what the First Nations Regional are insufficient to support such a conclusion.
Longitudinal Health Survey (RHS) data adds to our Table 1. Nature of home occupancy by community size
understanding of the housing conditions and the general (n=10,566)
iii
living conditions faced by First Nations people. The RHS < 300 persons 300–1499 persons 1500+ persons Total
contains a great deal of data relevant to housing and living
conditions. In this chapter we are able to consider only a few 54.1% 65.6% 57.9% 61.9%
of the more interesting observations in the following areas:
• The Nature of Home Occupancy Table 2. Nature of home occupancy by remoteness factor – all
regions (n=10,566)
• Physical Condition of Housing
Remote- Semi- Non-
• Housing Supply and Occupant Density Isolated
Isolated
Isolated Isolated
Total
• Basic Infrastructure and Amenities Found in Homes

36.6% 80.2% 63.0% 58.2% 61.3%
• Indoor Environmental Health
Housing and living conditions are among the more tangible Table 2 answers whether home ownership varies with the
determinants of population health. They would be classed by remoteness of the community. The answer is “yes” but the
the Population Health Determinants Framework1 of the reasons are not immediately clear. There is no simple
World Health Organisation (WHO) as being within the high- gradient between living in band housing and the remoteness
level determinant “physical environment.” They fall under of the community. We see that the most remote (remote-
the determinant “living conditions” in NAHO’s (2002) isolated) communities have by far the lowest reliance on
elaboration of the WHO framework.2 band housing, while the second most remote (isolated) have
The Nature of Home Occupancy by far the greatest reliance (statistically significant). Part of
the answer to this puzzle comes to light when we isolate the
It is well known that the majority of on-reserve housing is responses from First Nations in the provinces from responses
social housing owned and administered by the community.3 from First Nations in the two territories (Yukon Territory
This is mostly, depending upon the community, low-income and Northwest Territories).iii
housing. The legal landscape on reserves makes private
Table 3. Provincial vs. territorial First Nations reliance on band –
home-ownership relatively uncommon. It is not unusual for owned housing (n=10,566)
most, or all, of the dwellings to have been provided by the
band, a delivery agency such as a school board, or a Provincial Territorial Total
“government” agency such as Health Canada or the RCMP.
63.3% 30.0% 61.9%
Furthermore, a relatively high level of welfare dependency
in most First Nations4 necessitates a high level of low-
income housing. Factors such as these mean that families Table 3 shows that we do indeed see significant differences
usually live in a house owned by someone else. between provincial and territorial responses. The percentage
of “band-owned” responses is double in the provinces. A
The 2001 Census reports that over 65% of families in the major part of the explanation may be the fact that there is
general population own their home. Most of the rest of the less First Nations administration of housing in the two
general population lives in rental accommodation. The vast territories, where non-First Nation governments and NGOs
majority of rental housing in Canada is owned and operated (e.g., territorial housing corporations) have a significant role
by the private sector. Communal or municipal social housing in social housing.6 Note also that First Nation communities
account for the rest. Table 1 shows that this is reversed in the in the territories are disproportionately remote-isolated or
First Nation context: the RHS estimates that 61.9% of all on- isolated.
reserve families live in band-owned housing. Individuals
living in communities with less than 300 people were less
likely to live in band-owned housing than their counterparts
in communities of 300-1,499 people.
“Band housing” is more than simply social housing to low- i
To simplify the text, confidence intervals are not reported for estimates unless the coefficient of
income families such as those receiving social assistance. It variation is greater than 33.3%.
ii
Comparisons between groups or categories are statistically significant except where “NS” —not
can also be housing provided as a benefit of employment, significant— is noted. Differences, in this chapter, are considered significant when confidence
intervals do not overlap at the 95% confidence level (after Bonferroni adjustment).
with or without formal rental or wage deductions. iii
The territories differ from the provinces in that territorial housing corporations, direct management
“Government housing” (which today is often provided by the of social housing by CMHC, and government-owned housing are involved to varying extents in First
Nations communities. Particularly, there is only one reserve in the NWT (Hay River) and elsewhere in
First Nation) for teachers, nurses, and police are examples.5 the NWT most First Nations communities have municipal government. For these and other reasons,
there is more variation in the nature of band involvement in housing, and the combined territorial level
Caution: One might imagine from Table 1 that homes are of band ownership is lower.
42
Table 4. Nature of home occupancy by remoteness factor – We also see something that is uncommon in the general
provincial regions (n=8,944)
population: over half (57.2%) of households reporting
Remote- Semi- Non- income of between $30,000 and $79,999 live in band houses,
Isolated Total
Isolated Isolated Isolated
and over one third (39.5%) of the (few) households with
61.3% 80.4% 68.7% 58.6% 62.6% over $80,000 income also live in band houses. The point is
that a higher household income does not necessarily
Do the RHS data tell us anything about home ownership predicate independence from relying on band-owned
patterns in First Nations situated in the provinces, where housing. This may reflect increases in household income
many communities vary across all four remoteness after the housing was allocated to the family. It may also
categories? From Table 4 we see that there is no simple reflect occupancy by professionals such as nurses and
gradient between remoteness and living in band housing. We teachers in “government houses” rather than band houses per
can, however, say two things with confidence. First, band se, or the policies of some First Nations to allocate band
housing shelters almost two-thirds (62.6%) of First Nation houses on a universal basis. Both practices may reflect the
families in the provinces. Second, significantly fewer lack of a housing market and difficulty in obtaining personal
families in non-isolated communities rely on band housing home financing.
than in all the more remote communities (Table 5). Is educational achievement a factor in whether a First Nation
Table 5. Nature of home occupancy by grouped remoteness person lives in band housing or owns his or her own house?
factor– provincial regions (n=8,944) Table 7 suggests that people of all levels of education reside
Isolated Non-isolated Total
in band houses. The only markedly elevated group is persons
without high school education. This statistically significant
76.6% 58.6% 62.6% higher percentage suggests that, while band housing is
important generally, it is of most importance to the less
educated. The fact that half of respondents with a post-
In the general population it is assumed that most or all social
secondary diploma and 45.8% of those with a bachelor’s
housing occupants have low income. In fact, as a rule
degree live in band houses reinforces our earlier comments
applicants must demonstrate their low income in order to
that lack of housing market and other challenges make band
qualify for social housing. To what extent is this true about
housing important to all income groups and classes.
First Nations situated in the provinces? Are the lower-
income households the households who tend to live in band Table 7. Nature of home occupancy by highest formal education
housing? Consider Table 6. level attained, all regions (n=6,771)
Education Lives in band-owned housing
Table 6. Nature of home occupancy by household and personal
income, provincial regions (n=4,608) Did not graduate high school 74.1%
Income range Lives in band-owned housing High school graduate 66.9%
< $10,000 74.1% Post-secondary diploma 70.7%
$10,000-14,999 66.9% Bachelor’s degree 63.9%
$15,000-19,999 70.7% Graduate degree -

*suppressed due to small cell size
$20,000-29,999 63.9%
According to a commonly applied formula, housing is
$30,000-49,999 57.2%
considered unaffordable when more than 30% of total
$50,000-79,999 54.8% household income goes towards rent, mortgage, or
maintenance.iv The National Aboriginal Housing Association
$80,000+ 39.5%
estimates that 37% of off-reserve Aboriginal people inhabit
housing that they cannot afford by this definition. Of these
As with social housing in the general population, we see people, 15% spend 50% or more of their total income on
from Table 6 that, in the provinces, there is a correlation rent.7 Unfortunately, we know almost nothing about the
between the amount of household income and residency in affordability situation on-reserve where a unique legal
band-owned housing. Band housing is also overwhelmingly landscape and economic conditions prevail, housing
occupied by families with low income. As household income
increases, the percentage living in band housing decreases.
Seen another way, band housing is predominantly occupied
by low-income families. No less than 74.1% of households
iv
reporting under-$10,000 income and two thirds (64.4%) of “The measure of 30% is a widely used threshold (norm) used to identify affordability. It is the basis
for the CMHC affordability measure in its core need model (albeit with an income modifier) and is
families with under-$30,000 income live in band houses. the basis for subsidy payments in most social housing programs across Canada.” National Aboriginal
Housing Association, 2004.
43
construction costs can be much higherv and the rents charged body of on-reserve housing research is particularly lacking in
to band housing occupants are unknown. cohesion. It is possible, using RHS data, to correlate certain
health status data with housing data. However, given the
Poverty, by which we mean extremely low income, is a
limited understanding of the housing–health relationship
particularly strong determinant of the affordability of
generally and the limitations of the data, we are reluctant to
housing. There is no official poverty line in Canada.
risk drawing too many inferences. Let us instead consider
However, on the basis of low income cut-offs, in 2001 the
what the RHS tells us about the physical condition of First
Fraser Institute suggested that 8% of Canadians live in
Nations housing, and leave it to the reader to infer the broad
poverty, with a mean income of between $18,000 and
health impacts that our housing condition statistics imply.
$22,000.8 There is no compelling reason to think that the
housing affordability threshold, 30% of household income, The housing and living conditions faced by most First
does not apply on-reserve just as it does off-reserve. The Nation people are significantly poorer than in the provincial
RHS suggests that a far greater proportion of First Nations and national general populations.11 The housing stock is
households qualify by this definition as living in poverty. diverse, even including trailers and very old houses that were
Consider the distribution of household income in First relocated from elsewhere by bulldozer or barge.12 Much of
Nation communities (Figure 1). the on-reserve housing stock is aged. There is a backlog of
Figure 1. Distribution of household income within First Nations
essential renovations and upgrades to existing units. The
(n=5,301) stock varies from small-roomed “matchbox” type
government houses dating from the first housing programs of
80,000+ 6.0% the 1940s and 1950s, to larger modern units, which may or
may not be well engineered for the local conditions. It is also
50,000-79,000 18.2%
not news that on-reserve housing units are often
insufficiently maintained.
30,000-49,999 25.6%
Household income
The existence of wide and unacceptable gaps in this diverse

20,000-29,999 19.5% housing stock has been well documented over many years.
The 1985 Neilson Task Force Report13 observed that on-
15,999-19,999 8.3%
reserve housing was still the poorest in Canada. One-quarter
of the units required major repairs and one third were
10,000-14,999 10.7%
overcrowded. In 1992 the Standing Committee on
<10,000 11.7%
Aboriginal Affairs observed that only half of the 70,000 on-
reserve housing units were fit to live in.14 In 2003 the
0% 10% 20% 30% Auditor General observed that “around 44% of existing units
required renovations.”15
We see from Figure 1 that one half (50.2%) of FN
households have income under $30,000 per year and 11.7% What does the RHS add to our knowledge of the physical
have income under $10,000. conditions of the First Nations housing stock? (See Table 8.)
Perhaps the most interesting is that one-third (33.6%) of
Physical Condition of Housing homes are reported to need major repairs, an increase from
A recent research bulletin from Canada Mortgage and the one-quarter figure cited in 1985 by the Neilson Task
Housing Corporation (CMHC) has this to say of the role of Force. Another third (31.7%) are reported to need minor
housing in overall population health: repairs while the remaining third (34.7%) is in acceptable
condition. This also suggests a higher rate for necessary
It thus appears that socio-economic factors largely renovations than the 44% estimated by the Auditor General
shape [population] health. Housing is likely a in 2003.
crucial component since it is a pivotal point of
Table 8. Reported condition of housing (n=10,603)
everyday life, but its role is little understood. While
there has been a significant amount of research, it Only regular
Major repairs Minor repairs No repairs
maintenance
has been independently initiated and, as a body of needed needed
needed
needed
work, lacks cohesion.9
33.6% 31.7% 24.0% 10.7%
Our understanding of the housing-health relationship in First
Nations communities is even less developed than our Is household income a factor in the physical condition of
understanding of the housing-health relationship in the housing? Table 9 shows that the picture is not as simple as,
general population.10 Although we see disproportionate say the lower the income the more run-down the house. The
housing challenges in many First Nations communities, the situation appears clearer in Table 10 where we apply a
$20,000 cut-off. Major repairs are more likely to be needed
v
Construction costs, like costs of living, tend to increase with geographic isolation. As a rule, the in the homes of those with household incomes below
most expensive communities are the more northerly ones without year-round all-weather road access.
44
$20,000 per year, compared with those in higher income better. When asked about progress in improving the quality
brackets. Likewise, households above $20,000 were more of housing in the community, 40.3% of RHS respondents felt
likely to only require regular maintenance. there has been “no progress,” 46.2% report “some progress,”
and only 13.5% report “good progress”.
Most First Nations adults are not satisfied with the pace at
which housing quality in their community is changing for the
Table 9. Reported condition of housing by household income category (n=5,233)

Income range
Primary type of household repairs
needed. $10,000- $15,000- $20,000- $30,000- $50,000-
< $10,000 + $80,000 Total
14,999 19,999 29,999 49,999 79,999
Major repairs needed 38.9% 35.9% 40.1% 28.3% 26.5% 26.4% 17.4% 29.9%
Minor repairs needed 32.2% 39.7% 34.8% 35.0% 35.5% 31.4% 30.1% 34.3%
Only regular maintenance needed
17.7% 17.3% 19.9% 26.6% 27.2% 33.9% 40.2% 26.3%
No repairs needed
11.3% 7.1% 5.2% 10.1% 10.8% 8.3% 12.3% 9.5%
Table 10. Reported condition of housing by household income

category under $20,000 and over $20,000 (n=5,233) In 2005, INAC is describing the situation as follows:
Income range According to the most recent census, about 12% of
Primary type of household houses in First Nation communities are overcrowded,
repairs needed.
<$20,000 >$20,000 Total compared to one percent elsewhere in Canada. Data, as
of March 31, 2005, indicates that of the almost 96,800
Major repairs needed 38.2% 26.2% 29.9% houses in First Nation communities, more than 21,200
(21.9%) are in need of major repairs and about 5,500
(5.7%) need to be replaced.18
Minor repairs needed (NS) 35.5% 33.8% 34.3%
Estimates of the backlog in units vary. The Assembly of
Only regular
18.1% 29.9% 26.3%
First Nations (AFN) estimates the backlog at 80,000 units19,
maintenance needed at the upper end of the range. The estimates vary from
No repairs needed (NS) 6.4% 10.1% 9.5% guesswork to figures based on modelling, because they do
not reflect the actual numbers of families on the waiting lists
held by First Nations housing authorities. Despite this
Housing Supply and Occupant Density
limitation, few would dispute that the backlog numbers in
In 2003, the Auditor General used direct terms in describing the tens of thousands.
a problematic First Nations housing supply situation:
The survey nature of the RHS makes it unable to count the
In 2001, Indian and Northern Affairs Canada (INAC) number of housing units or estimate the need for additional
estimated that there was a shortage of about 8,500 housing units. However, it is able to provide an indirect
houses on reserves and about 44% of the existing 89,000 measure of housing need by measuring occupant density, a
houses required renovations. The growth rate of the on- term which refers to the number of people residing in a
reserve population is twice that of the Canadian average, house or per room of a house. Occupant density is
with more than half the population under 25 years of sometimes described as “crowding.” When there are too
age.16 many people in a house the term “overcrowding” is
sometimes used.
In 2001… there were about 89,000 housing units on
reserves to accommodate about 97,500 households, a A house where the density exceeds one person per room is
shortage of 8,500 units. In addition, around 44% of considered overcrowded.vi The 2001 Census suggests an
existing units required renovations. About 4,500 new overall Canadian room density of 0.4 persons per room. The
households are expected to be formed every year for at RHS suggests a mean room density rate in First Nation
least the next 10 years. Current federal funding is
expected to support the construction of about 2,600 vi
The occupant density of a house is simply the number of people in the household divided by the
houses and the renovation of about 3,300 houses a number of rooms. The RHS uses the accepted 1.0 crowding index and the accepted conventions for
year.17 which rooms to count or not to count: kitchens, bedrooms, living rooms, and finished basements.
Bathrooms, halls, laundry rooms, and attached sheds are not counted.
45
communities of 0.76 persons per room, almost double the Garbage Collection Services
general population rate.
More than one fifth (21.8%) of adults report that they have
Table 11. Average occupant density (persons per household), no access to garbage collection services. Access to garbage
First Nations houses vs. Canadian houses
services varies by the remoteness of the community.
Census Proportionately, the fewest people lacking garbage services
2003
1981 1986 1991 1996 2001 (RHS) are in remote-isolated communities (7.5%). The poorest
level of access to these services is in isolated communities
First Nations 3.5 4.8 (38.1%). Semi-isolated communities show a 13.0% no-
Canada 2.9 2.8 2.7 2.6 2.6 access rate and non-isolated communities show a 19.8% no-
access rate.
The 2001 Census (Table 10) suggests that the average The RHS does not allow us to explain this geographic
occupant density among houses in Canada today is about 2.6 pattern. The garbage disposal possibilities for the 21.8% of
persons per house. The RHS estimates the occupant density homes without garbage service include self-transporting
of First Nation houses at almost double (4.8 persons) that of garbage to a garbage site, periodically paying someone to
houses in Canada overall (about 2.6 persons). Furthermore, remove the garbage to a garbage site, disposing of the
the density in the First Nation context appears to be garbage on the property, or no community garbage site at all.
increasing, while in the mainstream context the density has The public health implications of the 21.8% of homes
been declining over two decades. In some instances the without garbage collection service strongly imply further
number of occupants in First Nations houses can be very investigation. It would be interesting to see the extent to
high. The largest number of occupants recorded by the RHS which nearby off-reserve communities also lack this service.
is 18. Sewage Service
Table 12. Percentage estimates of overcrowding by community
size category (n=10,545) The RHS indicates that 9.0% of homes in First Nation
communities lack either a septic tank or sewage service. The
300–1499
<300 persons 1500+ persons Total association with community remoteness parallels that seen
persons
for garbage services; homes in isolated communities are
12.6% 15.5% 21.4% 17.2% many times more likely to be lacking a septic tank or sewage
service than those in other types of communities (Table 13).
Table 13. Presence of septic tank or sewage service waste
Table 12 shows that 17.2% of First Nation houses meet the disposal by remoteness factor (n=10,332)
definition of overcrowded.vii Moreover, of all households
with children, nearly a quarter (24.6%) were overcrowded. Remote-
Isolated Semi-isolated Non-isolated
isolated
There is a strong inverse correlation between community
size and overcrowding of housing; the largest communities 12.1% 29.5% 8.0% 5.0%
exhibit an overcrowding rate almost double that of the
smallest. The answer to this may lie in the methodology used Water Supply and Quality
by INAC to determine the distribution of capital construction
The RHS points to large variations in the confidence First
funding. Whether this or another reason is the determinant,
Nation people have in the safety of their domestic water
the connection between crowding and community size is a
supply. Only two thirds of respondents (67.8%) consider
question worthy of further research.
their water safe to drink (Table 14).
Basic Infrastructure and Amenities Found in Those people who draw water themselves from a river, lake,
Homes or pond are most likely to consider their water safe (80.3%,
RHS provides household level information for two important NS). Their choice of this water source may, or may not, be
socio-sanitary indicators of special relevance in Public based on distrust of other water sources in the community.
Health: waste disposal and water quality. Community Water delivery by pipe from a local or community source is
infrastructure, more broadly, will be addressed in an RHS the primary source for the majority of respondents (63.2%).
community-level (“ecological”) survey, which is currently Of those, only 71.4% consider their water safe to drink,
being completed. despite the fact that the water has presumably been treated.
vii
The RHS Adult Preliminary Report gives a higher overcrowding figure of 24.6%. This previous
figure only included on households with children. The 17.2% figure report here is correct in the
current context, that is, all households.
46
Table 14. Perception of water safety by source of supply

Source of drinking water
Collect it
Piped in - local Well - Collect it From a
yourself from
Water Supply or community Trucked Individual or yourself from neighbour's Other Total
river, lake, or
water supply shared water plant house
pond
Proportion 63.2% 15.9% 16.5% 0.9% 1.8% 0.7% 1.1% 100%
Felt that source

71.4% 59.0% 63.4% 80.3% 65.6% - 36.6% 67.8%
was unsafe
concentrated in these communities. We can say that 7.9%
Although the main water supply may be piped water, based seems low in light of one-sixth of communities being
on a different question, we find that the main source of advised to boil their water; the answer may be in the
drinking water for First Nation people is bottled water population distribution of these communities.
(61.7% of respondents). This might be viewed as further
Table 15. Homes with “necessary amenities” and
testament to distrust or other concerns about the main water
“telecommunications amenities”
source. It would be interesting, in a future study, to correlate
this seemingly reliance on high bottled water with other Percentage of homes with
Amenity
and (without) amenity
factors such as stomach problems and the availability of
water from different sources. “Necessary amenities”
It is a fact that “boil water advisories” are in effect in many
First Nation communities. These advisories are issued upon Hot running water 96.3% (3.7% without)
evidence of actual bacterial, chemical, or mineral
Cold Running Water 96.5% (3.5% without)
contamination beyond a threshold level. The number
fluctuates as problems arise and may be addressed. The
Flushing toilet 96.5% (3.5% without)
“official” numbers are politically charged, and indeed
uncertain, since the evacuation of the Ontario Cree Refrigerator 98.7 % (1.3% without)
community of Kashechewan in October 2005. Media reports
such as the following attest to the level of public interest: Stove for cooking 99.3% (0.7% without)
A report based on Health Canada data that shows 30% of
Electricity 99.5% (0.5% without)
Ontario's First Nations reserves are under boil-water
advisories actually understates the extent of the problem,
“Telecommunications amenities”
the leader of the province's New Democrats said
Thursday. The Ministry of Natural Resources released Telephone with service 81.7% (18.3% without)
data showing 37 of the 123 Ontario native reserves
surveyed by Health Canada have boil-water advisories in Internet connection 29.3% (70.7% without)
place, some going back as far as February 2002. 20
Computer 40.8% (59.2% without)
We can say that there are serious and widespread problems
in First Nations water systems. One of the more credible
reports is a 2003 study by INAC. This concluded that 16% of The RHS captures whether First Nations households have
community waste water systems are at high risk of certain amenities which Canadian society, as a whole,
contaminating community drinking water systems. Another considers necessities (Table 15). Almost all (99.5%) homes
44% were medium risk. “Less than” 10% of communities were reported to have electricity. It would be interesting to
had “boil water advisories” in effect, nonetheless a high know how many of these homes rely on electricity from the
percentage. The same study found that 39% of total assessed public grid, from a local diesel plant or from a home
water systems exceeded one or more of the risk indicator generator. Practically all homes reporting electricity also
thresholds “occasionally or continuously.” 21 have a refrigerator and cooking stove.
Almost the same percentage (32.2%) of RHS respondents It is encouraging that 96.3% of homes reported hot running
consider their drinking water unsafe. However, until the data water and 96.5% reported cold running water, although we
are analysed further we cannot link these respondents with must temper this optimism against the fact that over 3% of
the communities where the risk is found to be high based on homes have no running water at all. The percentages of
laboratory or other assessments. Nor can we say, yet, homes with running water include homes with mains water
whether the 7.9% of respondents who boil their water are supply, homes with well water supply and homes with
47
trucked water stored in an indoor tank. Running water would Table 16. Necessary amenities and telecommunications
amenities by remoteness factor
almost certainly be drawn by an electric pump in the cases of
Percentage Estimates of Amenities by Remoteness
trucked and well water. It is thought that nowadays very few Factor
First Nation homes in organised communities still obtain Remote- Isolate Semi- Non-
Total
their water manually, but this is probably another matter in isolated d isolated isolated
the case of homes situated in the bush.
Necessary Amenities
A high percentage (96.5%) of homes reported having a flush Hot running
toilet. We presume that the remaining 3.5% have indoor 97.1% 83.2% 98.1% 98.6% 96.2%
water
chemical toilets, primitive indoor solid waste arrangements, Cold running
97.2% 83.9% 97.6% 98.8% 96.4%
or outdoor privies. Increasing the prevalence of indoor flush water
toilets is another area where great strides have occurred in Flushing
96.8% 84.4% 98.1% 98.7% 96.4%
recent decades. Progress in this area reduces sewage-related toilet
public health risks, such as gastro-enteritis, which for Refrigerator 99.0% 95.5% 97.6% 99.4% 98.7%
decades were very problematic in some First Nation
communities. Stove for
97.1% 98.2% 98.6% 99.6% 99.3%
cooking
The RHS suggests that income has practically no bearing on Electricity 99.8% 98.7% 98.0% 99.8% 99.5%
whether a home has the “necessary amenities” shown in the
table above. These necessities of life are usually provided in Telecommunications Amenities
“government housing” as well as in band and other social
Telephone
housing. Otherwise, income assistance, such as social 65.6% 76.7% 75.6% 83.9% 81.8%
with service
assistance and pensions, probably ensure that almost all First Internet
Nation households possess these necessary amenities. 15.5% 20.8% 26.1% 32.4% 29.8%
connection
The telecommunications amenities (telephone, Internet, and Computer 22.2% 32.0% 31.6% 44.7% 41.4%
computer) are essential from the perspective of participation
in the modern economy.viii Unlike the so-called necessary
More than three quarters (77.3%) of households in First
amenities, possession of the telecommunications amenities
Nation communities report that their homes have a working
depends strongly on household income. This stands to reason
smoke detector. This is higher than the 70% “Aboriginal”
considering the relative prevalence of poverty and the fact
figure for all Aboriginal people reported in of the 1991
that these items are seldom furnished through assistance
Aboriginal Peoples Survey (APS), but it is not possible to
programs. Computer ownership is strongly correlated with
say whether the difference represents change over time or
income. Only 21% of homes with income under $10,000
the fact that the APS included people living outside of First
have computers; this rate rises steadily through the other
Nations communities. Only 18.2% of First Nation homes
income categories to 81.6% of homes with income over
have a carbon monoxide detector. The risk associated with
$80,000.
this low figure is not necessarily high; it depends on whether
The low-seeming 29.8% Internet connectivity figure, shown combustion-based appliances (e.g. wood stove, oil furnace or
in the table above, has strong determinants other than water heater) are in use. The RHS indicates that less than
household economics; many First Nation communities are half (47.5%) of homes in First Nation communities have a
far away from Internet service providers and many fire extinguisher.
communities lack broadband services. Table 16 shows the
following proportion reporting Internet access in different Indoor Air Quality and Health
types of communities: remote-isolated communities (15.5%),
isolated communities (20.8%), semi-isolated communities The quality of air inside a dwelling affects the health of the
(26.1%) and non-isolated communities (32.4%). The Internet occupants. For over a century, the Indian health service
and computer possession percentages for remote-isolated limited its concerns over indoor air quality to the effect of
communities are half the corresponding percentages for non- overcrowding in the spread of contagious diseases.
isolated communities. For those communities where Internet Tuberculosis (TB) was the focus of this concern.
is available, home Internet access is strongly related to Interestingly, the RHS indicates that of the 2.9% diagnosed
income and, of course, to possession of a computer. with TB, almost one in three (31.0%) live in a technically
overcrowded house. Although TB remains a feared disease,
it is not the only disease whose spread is aided through
situations with multiple people living in close quarters. The
common cold and common influenza are obvious examples.
The spread of shigellosis and hepatitis A are also associated
with overcrowding, including in the First Nations context.22
viii
See the RHS Adult Preliminary Report for a discussion of the “digital divide.”
48
Nevertheless, the RHS figure of 31.0% of once-diagnosed correlated by geography and other factors. Nearly one in five
TB sufferers living in overcrowded houses is food for (18.3%) of adult respondents report allergies and one in ten
thought. Active cases of this disease, almost unheard of in (9.7%) report asthma. The effects of indoor air quality in
the general population, still flare up in First Nation exacerbating these conditions requires further research
communities. When this happens, crowded housing because the RHS did not gather detailed information on all
conditions make the containment efforts of Public Health the factors influencing those conditions. For instance, the
officials all the more difficult. RHS could not incorporate air testing for any of the indoor
environmental contaminants associated with chronic or acute
Notwithstanding that the spread of TB is still more likely in
respiratory or other conditions. We could not measure the pet
overcrowded dwellings, the field of Public Health nowadays
detritus, such as hair and skin cells, responsible for allergies
accepts that environmental contamination of indoor air is a
to pets. Likewise we could not sample building materials
significant health determinant. This concern recognises the
which can be problematic in cases of contact allergy, or
fact that most people spend most of their time indoors. The
which emit vapours. These may create responses in all
indoor tendency of modern society is a factor in the
residents or just individuals with sensitivities. It is also
increasing prevalence of respiratory conditions. Recent rises
possible for chronic exposure to lead to sensitivity.
in asthma affliction and allergies are particularly
noteworthy.23 The RHS measures certain indoor factors with The RHS inquired about the presence of two major indoor
potential to cause respiratory problems. Before discussing contaminants, moulds and cigarette smoke (as indicated by
these statistics, we must balance the role of home whether smoking occurs in the house). In this chapter we
contamination in this trend against the role of air pollution consider the mould question. Smoking is another indoor
generally. contaminant, which is addressed elsewhere in other chapters
of this RHS Report.
First, the average house offers little protection against
aerosol, particulate, and gas contamination of the general air. Toxic moulds, a contaminant of indoor air, are common and
Take, for example, Fort Frances in Ontario, where chimneys persistent in houses across Canada.25 The moulds of special
of paper mills release gases such as hydrogen sulphide. concern are those which live in, or on, the structure of the
Portions of the town and the adjacent First Nation building itself. Some are similar to the familiar bread mould
community often experience foul-smelling air. Quite simply, or blue cheese mould, but structural mould problems are not
the air stinks indoors as well as out. This is hardly an the result of food mould getting out of control. The spores
isolated example. Also, particularly in southern Canada, are all-pervasive in trace concentrations. The question is
weather conditions can create high concentrations of smog at whether the house’s structure offers them a good
ground level. The more extreme smog events have been environment to “take” and to multiply into problem
correlated with increased reporting of respiratory problems, concentrations. Some moulds can produce allergens,
including higher respiratory-related inpatient and outpatient irritants, or toxins singly or in combination. Rhinitis, asthma,
admissions. Fortunately for First Nations, the majority of the alveolitis and other allergies are associated with moulds. So
First Nations population resides in comparatively remote too is decreased immunity which may lead to sensitivity and
communities outside of main smog zones. This suggests a to secondary afflictions. Sensitive individuals are prone to
greater potential role of home contamination in statistics eye and throat irritation, fatigue, and headache.26, 27
about First Nations respiratory ailments.
Mould can make a house uninhabitable to persons with or
We do not know, because it has not been tried, whether the without sensitivity. Municipal and provincial Public Health
RHS can correlate respiratory and other ailments with living authorities periodically declare houses unfit for habitation
in communities where industrial pollutants are a particular due to high measured mould concentrations. In such cases
problem. This is a research area worthy of exploration, they sometimes issue orders to vacate. These standards and
following collection of data from the community-level measures do not apply on reserves, probably in large
survey currently underway. This is not specifically an indoor measure because First Nation community health authorities
environmental health question, but it would be valuable to usually lack the ability to test for mould concentrations in the
isolate the effects of contaminants of indoor origin from air. Besides, such evacuation orders mean nothing if no
those of outdoor origin. alternative accommodation exists; the inhabitants of mouldy
houses on reserves seldom have the option of relocating.
The groups considered most vulnerable to outdoor and
indoor air pollution are the elderly, young children, and the Moulds need warmth, moisture, still air, and a food source.
chronically ill. This vulnerability is partially explained by Many can metabolize organic building materials such as
clinical factors like fitness, resistance, and pre-existing wood beams, plywood, and even wallpaper. Homes with
conditions. These groups also tend to spend the vast majority high humidity levels and water seepage are ideal places for
of their time at home exposed to whatever contaminants are moulds to grow. Therefore, while homes in poor overall
there.24 The RHS does capture some chronic ailments, like physical condition tend to be the ones with mould problems,
general allergies and bronchitis, by age. These can be age and dilapidation of a house does not always result in
49
mould. In order to have a mould problem the house foremost and specific respiratory ailments. The toxic respiratory
has to have a moisture problem.28 As discussed earlier, the affects of moulds are accepted; what is not as clear is how
RHS suggests that two thirds of houses in First Nation these moulds influence specific respiratory conditions rather
communities require major or minor repairs. This hints at a than general respiratory health. One quantitative 2001
higher risk of problem levels of mould. The RHS does not survey, of the Cree community of Chisasibi in Northern
capture evidence of elevated moisture levels in homes, but a Quebec, is revealing. The survey revealed that over half of
future RHS could, because moisture questions can be easily the “problem” homes studies had structural problems, and
answered. that there was an average of 7.2 people per house who often
shared one bathroom. The health questionnaire found a
It is impractical to eliminate all growing mould and its
strong association between the presence of moulds and
spores from a house. The best way to control indoor mould
health problems of an acute and chronic nature. The authors
is to control the moisture level, but a house may be so
were able to reasonably conclude that “measures to reduce
severely mould-ridden that expensive physical removal of
mould problems in houses are urgently required, and may
contaminated materials is necessary. Usually this also
lead to improved acute and chronic health of Chisasibi
requires costly measures to lower the humidity level,
residents.”29
including stopping the entry or puddling of water.
Sometimes the cost is uneconomic compared with Almost one half (48.5%) of the RHS respondents who
demolition and rebuilding. It is typically difficult to find the reported living in band-owned housing reported mould or
money needed to correct mould problems or to relocate or mildewix in their home. Recall that two thirds of respondents
demolish and rebuild. The usual result is continued report living in band-owned homes. A significantly lesser
habitation and suffering the health implications of mould. percentage (36.9%) of respondents in other types of
accommodation reported mould or mildew. Does this mean
The moulds with adverse health effects are typically able to
that band housing, which is predominantly social housing for
survive for years in a dormant state, as spores, if the
lower income people, has more mould or mildew? It appears
conditions are dry. Expensive corrective measures can still
so, although we can only speculate at the reasons. A likely
leave an intolerable level of dormant spores in dry air. These
part of the explanation might be a tendency of communities
will bloom and grow as soon as the indoor humidity
to use scarce funding to build new units at the expense of
increases. Seasonal basement seepage is a common reason
construction quality or essential maintenance. This would be
for mould to reach problem concentrations again. So too is
an interesting hypothesis to test, but additional data would be
inadequate ventilation coupled with bathing and cooking.
needed.
Many First Nation homes are too old or rudimentary in
design to have proper vents, extraction fans, or even Finally, the RHS captures respiratory conditions data (e.g.,
strategically placed windows which can be opened. incidence of asthma) which can be correlated against data
Particularly in remote communities, over-clothes, boots, and about housing conditions (e.g., crowding, mould or mildew,
laundry are commonly hung to dry around a wood stove or necessary repairs), but we are reluctant to draw any
over heat registers. This significant source of humidity arises conclusions based on preliminary cross-sectional study. The
from practical necessity and cultural norms. Likewise, reason is that we do not want to issue statistics that should
steaming kettles and pots are a constant feature of many First not be read in isolation from others, but we can say that the
Nation households. Sometimes it is necessary to heat large RHS data raise fascinating questions about respiratory
quantities of water over a stove in the absence of a water health.
heater. This would be a useful data item for a future RHS to
Caution: these are tabulations and not necessarily actual
capture.
relationships between data items. We give these examples
Problem concentrations of mould in First Nations housing only to illustrate that interesting results suggest a need for
have been documented in many communities over the years. further research. For instance, although less than 10% of
So too have elevated rates of respiratory diseases such as respondents report suffering from asthma, 43.5% of those
bronchitis and asthma. The truth remains that there are sufferers report mould or mildew in their home. The RHS
factors other than mould that are able to cause respiratory indicates that 18.3% of adult respondents report allergies.
diseases such as these. This, and a disconnect between those Almost a quarter of these adults were over age 50. This
with the clinical medical data and those who would use it to should not be interpreted without considering the proportion
test for mould–disease linkages, mean that there is little of people with allergies in mouldy houses vs. proportion
empirical evidence in the public realm about mould toxicity without allergies in mouldy houses. Only 3.2% of
in First Nation houses. It is therefore easy for the federal
players in the First Nations housing sector to downplay or
ignore complaints about prevalence of mould. ix
It is uncertain whether respondents knew the difference between mould and mildew. Moulds that
generate the indoor biotoxins are of greater concern. A future RHS could explain, in the survey
Not many medical studies, anywhere, have drawn a direct instrument, what a mould looks like.
link between mould, poor physical condition of the housing,
50
respondents report chronic bronchitis, but 52.2% of these

people reported mould or mildew in their homes. 21. Indian and Northern Affairs Canada, National Assessment of Water and Wastewater Systems in
First Nations Communities (Gatineau, Que.: Indian and Northern Affairs Canada, 2003).
22. • “The Built Environment,” Health and Environment (Ottawa, Ont.: Health Canada, 1997).
But what should we compare this with: the percentage of • Ted Rosenberg et al., The Relationship of the Incidence of Shigellosis to Crowded Housing,
persons without bronchitis? Would this be statistically Lack of Running Water and Inadequate Sewage Disposal, unpublished 1995 report prepared
for Medical Services Branch, Manitoba Region, Department of Health and Welfare.
different? Is there a link medically between chronic Note: “The Built Environment,” Health and Environment, provides an enlightening discussion
on the health effects of the modern indoor lifestyle. The Relationship of the Incidence of
bronchitis and mould? Are the proportions who have mould Shigellosis to Crowded Housing, Lack of Running Water and Inadequate Sewage Disposal
and mildew significant among those who do have a disease details an informative study about the shigellosis-housing link in the First Nations context.
This study also observes that 81% of observed hepatitis A cases were First Nations people.
and who do not? These are among the useful questions that 23. Canadian Institute for Health Information et al., Respiratory Disease in Canada (Ottawa, Ont.:
Health Canada, 2001).
further analysis of the RHS data can help answer. 24. “The Built Environment,” Health and Environment.
25. R. E. Dales et al., 1991, Adverse health effects among adults exposed to home dampness and
molds, American Review of Respiratory Disease, 143: 505-509.
——— et al., 1997, Indoor air quality and health: validity and determinants of reported home
dampness and moulds, International Journal of Epidemiology, 26, 1: 120-125.
Notes to Chapter 3 ——— et al., 1991, Respiratory health effects of home dampness and molds among Canadian
children, American Journal of Epidemiology, 134, 2: 196-203.
26. J. D. O'Neil, Housing Conditions and Health: A Review of the Literature (Montreal, Que.:
Grand Council of the Crees [Eeyou Istchee], 2000). Note: See this publication for an overview
1. http://www.phac-aspc.gc.ca/ph-sp/phdd/case_studies/appendix_1/analysis.html. Accessed 15
of the knowledge on the relationship between housing conditions and health (such as
October 2005.
respiratory ailments).
2. NAHO, Evidence-Based Decision Making Framework, unpublished [online]. 2002. Available
27. Institut national de santé publique du Québec, Les risques à la santé associés à la présence de
from World Wide Web: <http://www.naho.ca/firstnations/english/faq.php>.
moisissures en milieu intérieur (Québec, Que.: Institut national de santé publique du Québec,
3. Royal Commission on Aboriginal Peoples, "Housing," Report of the Royal Commission on
2002). Note: Readers will discover here an excellent discussion of the risks associated with
Aboriginal Peoples, Vol. 3 (Ottawa, Ont.: Royal Commission on Aboriginal Peoples, 1996).
indoor mould. See this work, and O’Neil (2000) for the basis of our background discussion on
Note: Although written a decade ago, this chapter still provides the best overview of the on-
the indoor toxicology of moulds.
reserve housing landscape, including a useful discussion on social housing.
28. Canadian Mortgage and Housing Corporation, “About Your House,” Fighting Mould—The
4. • Andrew Webster, Trends and Growth Factors in First Nations Social Assistance, report
Homeowner’s Guide [online]. Bulletin CE 08. Accessed 3 November 2005. Available from
prepared by Atelier Pika Ltd. for the Department of Indian Affairs and Northern Development,
World Wide Web:
1996.
<http://www.cmhc-schl.gc.ca/en/burema/gesein/abhose/abhose_ce08.cfm>.
• Four Directions Consulting Group, Implications of First Nations Demography—Final
Note: There are many good discussions on what physical conditions cause mould and what can
Report, report prepared for Indian and Northern Affairs Canada [online]. [Gatineau, Que.]:
realistically be done about mould. This is one particularly concise source.
Indian and Northern Affairs Canada, 1997. Accessed 2 November 2005. Available from World
29. J. D. O'Neil and R. Tate, Chisasibi Housing and Health Report (Montreal, Que.: Grand
Wide Web: <http://www.ainc-inac.gc.ca/pr/ra/execs/serv-2_e.html>.
Council of the Crees [Eeyou Istchee], 2001).
Note: See Trends and Growth Factors in First Nations Social Assistance for an exhaustive
discussion on the dependency problem. The grim social assistance forecasts in that work are
further illustrated in Implications of First Nations Demography—Final Report.
5. J. Torrie et al., The Evolution of Health Status and Health Determinants in the Cree Region
(Eeyou Istchee): Eastmain-1-A and Rupert Diversion Sectoral Report. Volume 2—Detailed
Analysis, report prepared by the Public Health Department of the Cree Board of Health and
Social Services of James Bay for Hydro Quebec (Montreal, Que.: Cree Board of Health and
Social Services of James Bay, 2005). Note: See this report for a detailed historical discussion
on the nature and types of on-reserve housing, including ‘government’ units.
6. • Northwest Territories Housing Corporation, Annual Report of the Northwest Territories
Housing Corporation, 2003/04 (Yellowknife, N.W.T.: Northwest Territories Housing
Corporation, 2005).
• Yukon Housing Corporation, Yukon Housing Corporation Annual Report, 2003/04
(Whitehorse, Yukon: Yukon Housing Corporation, 2005).
Note: See these reports for a picture of the territorial housing landscapes.
7. National Aboriginal Housing Association, A New Beginning: The National Non-Reserve
Aboriginal Housing Strategy (Ottawa, Ont.: National Aboriginal Housing Association, March
2004).
8. C. A. Sarlo, Critical Issues Bulletin—Measuring Poverty in Canada (Ottawa, Ont.: Fraser
Institute, 2001).
9. Canada Mortgage and Housing Corporation, Housing and Population Health—Research
Framework, research highlights, socio-economic series 04-016, March 2004 (Ottawa, Ont.:
Canada Mortgage and Housing Corporation, 2004).
10. • E. D. Fuller-Thomson et al., 2000, The housing/health relationship: what do we know?,
Environmental Health, 15, 1-2: 109-133.
• T. Kue Young et al., The Health Effects of Housing and Community Infrastructure on
Canadian Indian Reserves, report: quantitative analysis and socio-demographic research,
finance (Ottawa, Ont.: Department of Supply and Services, 1991).
Note: A good discussion of the state of the knowledge of the general housing-health
relationship is in “The housing/health relationship: what do we know?,” Environmental
Health. For a discussion of the housing-health relationship in the First Nations context, see The
Health Effects of Housing and Community Infrastructure on Canadian Indian Reserves.
11. Royal Commission on Aboriginal Peoples, Report of the Royal Commission on Aboriginal
Peoples. Note: The socio-economic gulf between First Nations and other populations is widely
acknowledged. A thorough treatment of these disparities is contained in the volumes of the
Report of the Royal Commission on Aboriginal Peoples. Few would argue that little progress
has occurred in the subsequent decade in reducing these gaps.
12. “Federal Government Support to First Nations—Housing on Reserve,” Report of the Auditor
General (Ottawa, Ont.: Office of the Auditor General of Canada, April 2003). Note: This
chapter provides a general discussion of the housing situation.
13. Eric Neilson, Report of the Task Force on Program Review (Ottawa, Ont.: Government of
Canada, 1985).
14. The Standing Committee on Aboriginal Affairs to the House of Commons, A Time for Action,
report (Ottawa, Ont.: Standing Committee on Aboriginal Affairs, 1992).
General, news release s. 6.1.
General.
17. Ibid.
18. Indian and Northern Affairs Canada, First Nations Housing [online]. Accessed 27 October
2005. Available from World Wide Web: <http://www.ainc-inac.gc.ca/pr/info/info104_e.html>.
19. Note: Estimates provided by the AFN’s Housing and Infrastructure Technical Committee.
20. Leslie Keith, “Thirty per cent of Ont. First Nations reserves having to boil water: report,”
Canadian Press, Nov. 4, 2005.
51
Chapter 4
Disability and Chronic Conditions
Abstract
This chapter explores disability and long-term health conditions among First Nations adults 18 years
and older.
The research found that there is a higher prevalence of disability among First Nations adults than in
the general adult population in Canada. Disability becomes more common as First Nations people
age. First Nations adults with disabilities generally fare less well than their counterparts without
disabilities in terms of formal educational attainment, income, employment and health. They fare
considerably less well in these areas than the broader adult population in Canada.
First Nations women with disabilities are about as likely as First Nations men with disabilities to
report fair or poor health. Older First Nations adults with disabilities and adults with disabilities and
low personal incomes are more likely than younger people and people with higher incomes to report
fair or poor health. Like their counterparts without disabilities, First Nations people with disabilities
report good diet, social supports, sleep, being happy/content and reduced stress among the factors that
contribute to excellent or very good health. They are less likely to report physical activity or
participation in sports.
The most prevalent long-term health conditions facing First Nations adults with and without
disabilities are arthritis/rheumatism, chronic back pain, allergies, diabetes and high blood pressure.
These are also leading long-term health conditions in the general adult population in Canada. First
Nations women are more likely than their male counterparts to report multiple long-term health
conditions. When age-adjusted by gender, arthritis/rheumatism, high blood pressure, asthma and heart
disease appear to be more prevalent among First Nations adults than in the Canadian population
overall.
First Nations adults with disabilities are more likely than their non-disabled counterparts to face a
range of barriers and other difficulties gaining access to health-related services. Cost, affordability and
lack of coverage by publicly funded programs are widespread issues. Women with disabilities face
particular difficulties concerning access to health services. The chapter concludes with
recommendations.
52
RHS 2002/03 Adult Survey – Chapter 4: Disability and Chronic Conditions
Note: Due to spacing issues, some tables have been placed at activity they can do at home, school, work or in other
the end of the chapter. activities (such as transportation to or from work or school,
or leisure time activities) or if they said they have a long-
Introduction term disability or handicap. The NPHS did not ask whether
respondents were limited “sometimes” or “often.” Most
Chapter overview respondents who indicated that they had a long-term
This chapter explores disability and long-term health-related disability or handicap also reported an activity limitation on
conditions among First Nations and Inuit adults 18 years and one of the other questions.vi The CCHS and NPHS define a
older. It looks at general demographics (e.g., prevalence of “long term” condition as one that has lasted or that is
disability, gender, age, marital status, education, expected to last six months or more. The RHS did not
employment, income, general health) as well as specific stipulate that the activity-limiting condition had to be long-
health-related conditions and issues of access to health- term.
related services. The chapter provides selected comparisons These surveys all use somewhat different approaches to
of First Nations adults with and without disabilities, as well flagging respondents as having disabilities. The federal
as comparisons with the broader adult population in Canada. Office for Disability Issues has developed a helpful
The chapter draws statistical data from the First Nations document that explores some of the complex differences in
Regional Longitudinal Health Survey (RHS) of 2002–2003, survey design and how these play out in terms of disability
the Canadian Community Health Survey (CCHS)i of 2003, estimates.1 Subtle differences in broad-level disability
the National Population Health Survey (NPHS)ii of 1998–99, indicators include the RHS and NPHS asking whether
and, to a limited extent, the Participation and Activity respondents are limited in the amount or kind of activity they
Limitation Survey (PALS) of 2001 and the Health and can do, whereas the CCHS asks whether a condition reduces
Activity Limitation Survey (HALS) of 1991.iii the amount or kind of activity the respondent can do.
Statistics Canada has speculated that respondents may be less
For comparisons between First Nations adults and other inclined to indicate that they are personally limited in
adults in Canada, the research provides tables that show activities than to indicate that a condition reduces their
results for the RHS, CCHS and NPHS. The discussion activities.2
focuses on the CCHS for points of comparison because this
is a more recent survey than the NPHS. Other disability variables are available on the RHS and
CCHS, which the research has not used to any great extent.
Working definition of disability The research did not use the general CCHS question that asks
For the RHS, the research defines respondents 18 years and respondents whether they experienced any difficulties seeing,
older as having a disability if they said that, because of a communicating, walking, climbing stairs, bending, learning
physical or mental condition or health problem, they are or doing any similar activities. The research adopted the
limited in the kinds or amount of activity they can do at present approach because this was the best possible “fit” that
home, work or school, or in other activities such as leisure or could be achieved between the RHS, CCHS and NPHS in
travelling. Respondents could indicate that they feel limited terms of disability indicators.
“often” or “sometimes.” For the CCHS the research defines Results
respondents 20 years and olderiv as having a disability if they
said the amount or kind of activities they can do at home, Basic demographics of disability
work or school or other activities (such as leisure or Prevalence
travelling) has been reduced because of a long-term health
condition or problem. Again, such reductions of activity may There are significant challenges to comparing the prevalence
occur “sometimes” or “often.” For the NPHS, respondents 20 of disability among First Nations and other adults in Canada.
years and olderv are defined as having a disability if they said In part the difficulties are due to differences in the designs
that, because of long-term physical or mental condition or a and contexts for population surveys such as the RHS, the
health problem, they are limited in the amount or kind of Census, CCHS, NPHS and PALS. Survey design, context
(e.g., whether it is a health-oriented survey, a general Census,
i
a disability-specific survey or a labour market survey) and
The CCHS provides a wealth of information on the health and health-related behaviours of
Canadians. The CCHS did not survey people in the northern territories, on military bases, in placement of disability questions (e.g., at the beginning, in
institutional collective dwellings or living on First Nations reserves.
ii
The NPHS is the forerunner to the CCHS. The research drew from both the General and Health files.
the middle or towards the end of a survey) all affect response
The General file has a larger sample but does not provide the detail on health and income available on patterns.
the Health file. The research used the file that had the largest sample size for any given research
question.
iii
PALS and HALS are Statistics Canada’s “flagship” surveys with a specific focus on disability. Table 1 provides results based on the RHS, CCHS of 2003
PALS did not survey people in the northern territories, on military bases, in institutional collective
dwellings or living on First Nations reserves. HALS did survey people in the northern territories.
and the NPHS of 1998–99. Unadjusted and age-adjusted
iv
In the CCHS public use file, respondents are grouped into 5-year age categories. The research
selected 20 – 24 as the youngest age group on that data set. The public use file does not facilitate
vi
disaggregating 18– 9 year-olds from the 15 – 20 age group. The NPHS public use file does not allow for disaggregation of the question on handicap or disability
v
The research followed the same approach to age cut-off in the NPHS as with the CCHS. from the questions on activity limitations.
53
totals are provided for First Nations adults.vii Age adjustment Age and gender and disability
provides a more accurate picture because the age structure of
Disability becomes more common as people age. For
First Nations adults is considerably different than that of the
example, roughly half (49.7%) of First Nations people in the
general population. Among First Nations adults, only
60 + age group have a disability,xii compared with 13.1% in
23.0%viii are 50 years or older compared with 35.2% in the
the 18–29 age group (Table 1). In part, the increase of
general population. Totals not adjusted for age reflect a bias
disability with age is due to increased exposure to factors that
towards younger First Nations adults, amongst whom the
place people at risk of disability across the lifespan, such as
prevalence of disability is relatively low.
accidents, the natural aging process, illnesses and other
Table 1 shows that the age-adjusted prevalence of disability conditions (e.g., arthritis, heart conditions and progressive
amongst First Nations adults ranges between 27.8% and hearing loss).
28.4% and between 1.1 and 1.6 times the prevalence of
Roughly the same proportion of women and men report
disability in the general population.
disabilities (24.6% of First Nations women have disabilities
The NPHS rather than CCHS figures for general prevalence compared with 21.2% of First Nations men (NS).xiii Table 2
of disability are likely more comparable with the RHS shows the prevalence of disability by gender after age-
because the “high level” disability questions asked on the adjustment in contrast to the results for the CCHS and NPHS
NPHS are more similar than those in the CCHS to the results for the Canadian population overall.xiv
questions asked in the RHS. Like the RHS, the NPHS asked Table 2. Prevalence of age-adjusted disability among First
whether, because of a long-term physical, mental or health Nations and other adults in Canada, by gender
condition, respondents are limited in the kind or amount of
Canada
activity they can do at home, school or work or in other Gender
First Nations Canada
(NPHS
activities such as leisure or travelling. The CCHS asked (RHS) (CCHS)
General file)
whether respondents feel that a long-term condition reduces
the kind or amount of activity they can do in such situations. Male 25.7% 23.2% 18.3%
Female 31.3% 28.2% 20.3%
Using unpublished data based on disability questions from
the 2001 Census, Social Development Canada’s Office for Total 28.5% 25.8% 19.3%
Disability Issues (ODI) recently reported that the age-
adjusted prevalence of disability is one and a half times Marital status
higher amongst Aboriginal people than in the general adult Table 3 shows the marital status of First Nations adults. It
population in Canada.3xi That finding is in keeping with the shows that a lower proportion of First Nations adults with
figures using the NPHS as the comparator as shown on Table disabilities are single than is the case among their
1 (end of chapter). counterparts without disabilities (27.5% compared with
ODI also reported higher prevalence of disability among 40%). In part, this finding is likely due to the fact that the
Aboriginal peoples based on the disability questions in the onset of disability tends to occur in adulthood for many
Canadian Community Health Survey of 2001.4 Statistics people, that is, sometime after people have a chance to enter
Canada’s flagship survey on disability, that is, the into a long-term relationship with a spouse or partner.
Participation and Activity Limitation Survey (PALS) of First Nations women with disabilities are particularly likely
2001, did not include enough First Nations, Inuit or other to be widowed (16.4% compared with 4.4% of all First
Aboriginal people in its sample to allow for comparative Nations adults taken together). In part, this finding may be
analysis of disability among First Nations people and the due to the lower life expectancy of men and the late onset of
general population. However, an earlier report based on the disability among women who are pre-deceased by their
Aboriginal Peoples Survey of 1991 and the Health and husbands/partners. The rate of divorce and separation is
Activity Limitation Survey (HALS) of that year, which was similar among men and women with disabilities (9.7% vs.
the forerunner to PALS, also found significantly higher 15.8%; NS) and among men and women without disabilities
prevalence of disability among First Nations and other (8.1% vs. 7.0%).
Aboriginal peoples.5
vii
Age adjusted totals were calculated by multiplying the age-specific prevalence rates for First
Nations adults by the total numbers of people of those ages in the general population to establish the
numbers of people in the general population who would be expected to have disabilities in the age
xii
categories based on First Nations’ rates. The expected figures were then added to arrive at the total That estimate is likely conservative. Unpublished data received from ODI based on the Census of
number of people expected to have disabilities in the general population if the rates for First Nations 2001 indicates disability prevalence of 60.3% among First Nations seniors 65 years and older and
adults prevailed. We then divided that total by the total adult population 20 years and older. This 54.4% among Inuit seniors in this age group.
xiii
approach was replicated using the CCHS and the NPHS. Comparisons between groups reported in this chapter are all significant unless “NS” —not
viii
To simplify the text, confidence limits are only reported for overall adult estimates with a co- significant— is specified in brackets. In this chapter, estimates are considered significantly different if
efficient of variation of greater than 33.3%. A statistical appendix including confidence intervals for their confidence intervals do not overlap (95% confidence level).
xiv
all reported figures is available at www.naho.ca/fnc/rhs Reported differences between First Nations (RHS) and for Canadians overall could not be assessed
xi
The term “Aboriginal people” as used by ODI includes First Nations, Métis and Inuit people. for statistical significance as confidence intervals were not available for the Canadian estimates.
Relative statements about differences between First Nations and Canadians should be interpreted
cautiously, particularly when the estimates are close or the groups are small.
54
Table 3. Marital status of First Nations adults, by disability status 5 (end of chapter) shows that First Nations adults with
and gender (%)
disabilities have less personal income on average than their
non-disabled counterparts. Some 58.7% of First Nations
With
Non-disabled
disability
Total people with disabilities had personal incomes of less than
$15,000 or no income in the year before the RHS was
Male
Married 29.1 36.2 30.6
conducted. The same was true for 46.9% of First Nations
Common-law 19.8 16.6 19.1 adults without disabilities. Taking adults with disabilities in
Widowed 1.1 5.2 2.0 the general population as the baseline, First Nations adults
Separated/ divorced 7.0 9.7 7.6 with disabilities are 1.7 times more likely to have incomes
Single/ never married 42.9 32.3 40.7
less than $15,000 or no income at all.
Total 100.0 100.0 100.0
Female
Married 31.6 28.3 30.8 Employment
Common-law 19.6 16.4 18.8
Widowed 3.8 16.4 6.9 The low incomes of First Nations adults with disabilities are
Separated/ divorced 8.1 15.8 10.0 in part a reflection of their lower levels of paid employment.
Single/ never married 36.9 23.1 33.5
Total 100.0 100.0 100.0
Table 6 shows that, consistent with the broad trend in the
All general population, First Nations adults with disabilities are
Married 30.3 32.0 30.7 less likely to be employed than their non-disabled
Common-law 19.7 16.5 19.0 counterparts (37.3% compared with 52.2%). Where
Widowed 2.4 11.1 4.4
Separated/ divorced 7.5 12.9 8.8
employed, they tend to work fewer hours per week (35.5
Single/ never married 40.0 27.5 37.2 compared with 38.1 hours on average).xvi
Total 100.0 100.0 100.0
Taking people with disabilities in the general population as
Education the baseline (CCHS), First Nations adults with disabilities are
a little more than 0.6 as likely to be employed.
Taking less than high school graduation as an indicator of
low formal educational attainment, Table 4 (end of chapter) The RHS doesn’t enquire into specific factors that, aside
shows that the spread in educational attainment between from disability, impede the paid employment of First Nations
adults with and without disabilities is not so pronounced adults with disabilities. Owing to data capture problems
among First Nations adults as in the general population. For Statistics Canada suppressed the PALS 2001 data on issues
instance, in the 30 – 59 age groups, First Nations adults with that discourage the search for work among people with
disabilities are about as likely as their non-disabled disabilities in the general population. However, the Health
counterparts to have less than high school graduation. In the and Activity Limitation Survey (HALS) of 1991, provides
general population in these age groups (CCHS), adults with some useful information. It reveals that the top four reasons
disabilities are between 1.3 and 1.4 times less likely to have why people with disabilities were out of the labour force
graduated high school. Overall, First Nations adults with when HALS was conducted, aside from various and sundry
disabilities fare less well in terms of educational attainment responses that Statistics Canada classified as “other,” were
than adults with disabilities in the general population. concern about loss of current income support, inadequate
training, lack of available jobs and concern about loss of
The less pronounced spread in educational attainment additional supports such as housing or drug plans.7 Other
between First Nations adults with and without disabilities reasons included family responsibilities, discrimination, lack
occurs in a context where educational attainment is lower of accessible transportation, worry about being isolated on
overall for First Nations adults compared with adults in the the job by other workers, lack of accessible information
general population. This suggests that First Nations people, about available jobs and family/friends who discouraged
regardless of disability, face considerable challenges in working.
securing formal education.
As well, education level, the need for and availability of
Income and employment various job accommodations, the need for and availability of
disability supports such as assistance with daily activities or
Income aids/devices (e.g., for mobility, seeing, communicating), and
Canadians with disabilities tend to have lower personal access to workplaces with intentional strategies to hire,
incomes than others and are more than twice as likely to be promote and retain people with disabilities, all have a bearing
living below Statistics Canada’s Low-Income Cut-Off on their employment situation.8
(LICO),xv an unofficial measure of household poverty.6 Table It is likely that these and perhaps further factors (e.g.,
cultural, environmental, geographical, human, technological,
xv
I.e., where a household spends 20% more of its income on food, shelter and clothing than an
average family of the same size living in a community of the same size. Families that fall beneath the
xvi
LICO are considered by Statistics Canada to be in “straitened circumstances”. Some individuals with disabilities may prefer fewer hours of work as a job accommodation.
55
community size and remoteness) have a bearing on the Similarly, among First Nations adults with disabilities, the
employment situation of First Nations people with relationship between income and health is systematically
disabilities. linear when looking at the proportions that report fair or poor
health. Sampling variability is too high for First Nations
Health status
adults with disabilities and incomes of $50,000 or more to
Disability and general health establish a clear connection between income and excellent or
very good health for these people.
Table 7 (end of chapter) shows that First Nations adults with
disabilities are nearly four times more likely than their non- To some extent, health and income are mutually reinforcing
disabled counterparts to report that their general health is in the sense that the higher the income, the greater the
only fair or poor (45.9% compared with 12.8% respectively). chances people can shield themselves from adverse health
effects through proactive prevention, e.g., by means of good
First Nations adults with disabilities are nearly 1.5 times and varied diet, safe drinking water, safe and healthful
more likely than adults with disabilities in the general housing and other general living circumstances. There are
population (CCHS) to report fair or poor health (45.9% also greater chances of being able to afford therapeutic
compared with 31.1%). Among First Nations adults who measures such as medications and other treatments that may
report fair or poor health, 51.5% have disabilities.
not be covered under programs such as the Non-insured
Health Benefits program to stem adverse health symptoms
Disability, health and gender upon diagnosis. On the other hand, the lower the income the
First Nations women with disabilities are about as likely as less likely that people will be able to avail themselves of
First Nations men with disabilities to report fair or poor preventative and non-insured therapeutic measures.
health (45.5% compared with 46.4%). In the general Accordingly, people with lower incomes tend to be more
population women with disabilities are also about as likely as susceptible to accidents, chronic respiratory disease,
men with disabilities to report fair or poor health (32.2% pneumonia, tuberculosis and other adverse health
compared with 29.7%). conditions.9 They tend to have less control over stressors and
Disability, health and age other personal circumstances, which can compromise the
immune and hormonal systems, resulting in adverse health
Table 8 (end of chapter) shows that, at any given age, First effects.10
Nations adults with disabilities are considerably more likely
than their counterparts without disabilities to report fair or However, even at higher levels of income, there remains a
poor health. For example, 30.2% of First Nations adults 18 to significant health gap between First Nations and other adults
30 years old with disabilities report fair or poor health, in Canada, whether with or without disabilities; lower
compared with 11.0% of non-disabled individuals of the proportions report excellent or very good health regardless of
same age. Similarly, 64.5% of First Nations seniors 60 years income bracket or disability status. This finding points to
and older with disabilities, contrasted with 18.3% of First health determinants beyond income that influence First
Nations seniors without disabilities, report fair or poor Nations health.
health. The same general pattern prevails in the broader adult Selected personal determinants of good health
population in Canada, but in any given age group fair or poor
health is not as widespread as among First Nations adults. When respondents with excellent or very good health were
asked about the things that make them so healthy, First
Taking the adult population in Canada with and without Nations adults with and without disabilities who took part in
disabilities in a given age group as the comparator (CCHS), the RHS were about as likely to report good social supports
First Nations adults with disabilities are between 2.6 and 6.6 (60% compared with 59.5% respectively) and good sleep
times more likely to report that their health is fair or poor (61.4% compared with 60.6%). Adults with disabilities were
(Table 8, Column C1). slightly, but not significantly more likely to report reduced
stress (38.5% compared with 32.4% - NS), being in physical,
Disability, health and income emotional, mental and spiritual balance (53.5% compared
Table 9 (end of chapter) shows that, generally speaking, with 49.4%- NS) and good diet (67% compared with 59.2%
people with higher rather than lower incomes tend to report respectively - NS). First Nations adults were somewhat less
better health. Among First Nations people as a whole, the likely to report happiness and contentment (60.9% compared
relationship between income and general health is with 65.3% - NS) yet were significantly less likely to report
systematically linear when looking at the proportions that physical exercise or being active in sports (38.7% compared
report fair or poor health. The pattern is not quite so clear-cut with 57.7%).
when looking at the proportions that report excellent or very The present chapter does not explore other health
good health. determinants such as non-traditional use of tobacco, specific
nutritional intake and physical activities or obesity.
56
Long-term health conditions Prevalence of long-term health conditions by gender

Prevalence by disability status Some 22.3% of First Nations adults reported one of the
conditions shown on Table 10. Another 20.1% reported two
The RHS asked respondents about long-term health-related
or three of those conditions and 11.3% reported four or more
conditions that have lasted, or that are expected to last, six
to a maximum of 14.
months or more and that have been formally diagnosed by a
professional. Table 10 provides a summary. The top five First Nations women are more likely than men to be dealing
most widely reported conditions among First Nations adults with multiple conditions, with 13.2% of women reporting
are arthritis/rheumatism, allergies, high blood pressure, four or more of the conditions compared with 9.3% of First
diabetes and chronic back pain (conditions that are also Nations men.
prevalent in the general adult population).
Prevalence of long-term health conditions by age
The RHS also asked respondents whether they are limited in
Figure 1 shows the increase in the prevalence of long-term
their activities because of any of the conditions shown in the
conditions by age group. There is an almost perfectly linear
left hand column of Table 10 (end of chapter). In effect,
drop by age group in the prevalence of those who reported
those questions could serve as a further “layer” of disability
having none of the conditions, declining from 67.2% in the
indicators. The percentages of respondents with activity
youngest age group to 13.6% among First Nations seniors 60
limitations stemming from each health condition are not
years and older. Among First Nations seniors, 40.8%
shown on the table because there are no similar indicators of
reported four or more such conditions compared with only
condition-specific disability in the CCHS. The general
1.8% in the 18–29 age group. The reporting of two or three
approach to disability that has been used throughout this
conditions increases with age until age 60 and older, after
chapter has been applied to the table, that is, people are
which it is more common that respondents will report four or
classified as having disabilities if they reported limited
more conditions. The prevalence of one long-term condition
activities at home, school or work or other situations. The
holds relatively constant regardless of age, ranging from
table shows the extent to which people with disabilities (in
18.9% to 25.6%.
that sense of the term) reported long-term conditions.xvii
Figure 1. Percentage of First Nations adults reporting long-term
The table shows that First Nations adults with disabilities are health conditions by age group
more likely than their counterparts without disabilities to 40.8%
report any given health condition presented. Figures for First 60+
18.9%
26.7%
Nations adults have been age-adjusted by gender. 13.6%
24.8%
More than half (52.2%) of First Nations adults with 50-59
33.8%
no. conditions
20.4%
disabilities reported arthritis or rheumatism compared with 21.0%
Age group (years)
4
14.6% of their non-disabled counterparts. Chronic back pain 10.9% 2-3
28.3% 1
is about four times more widespread among First Nations 40-49
24.5% 0
36.4%
adults with disabilities (34.5% compared with 9.6%). Heart
3.9%
disease is about six times more common (18.8% compared 30-39
16.0%
25.6%
with 3.2%) and high blood pressure is more than twice as 54.5%
prevalent (34.7% compared with 14.7%). Long-term stomach 1.8%
10.7%
and intestinal problems also stand out for First Nations adults 18-29
20.4%
with disabilities, who are more than twice as likely as their 67.2%
non-disabled counterparts to report such conditions (16.6% 0% 20% 40% 60% 80%
compared with 6.4%). Diabetes, for which a separate chapter

has been dedicated, is about twice as common among First Prevalence of long-term conditions by total household
Nations adults with disabilities (30.9% compared with income
15.3%). Allergies are also considerably more prevalent Figure 2 shows the prevalence of long-term health conditions
among First Nations adults with than those without by total household income from all sources. Although not
disabilities (25.3% compared with 17.6%), as is asthma statistically significant at each level, overall there is an
(14.6% compared with 9%). upward trend in the reporting of “no such conditions” as
household incomes increase. For instance, 55.6% of First
Nations adults with household incomes in the highest bracket
reported no long-term health conditions compared with
40.1% with household incomes of less than $10,000 (NS).
xvii
10.7% of First Nations adults indicated that they have activity limitations stemming from one or Similarly, although not significant at each level, there is a
more of the long-term conditions shown on Table 10 but did not report activity limitations at home,
school or work or other situations due to a long-term health or other condition. The three broad general but downward trend in the reporting of three or more
disability questions on the RHS, then, likely understate the full dimensions of disability among First such conditions as household incomes increase. Among First
Nations adults.
57
Nations adults in households with incomes in the $80,000+ This may reflect the need of some people with long-term
bracket, 8.4% reported three or more such conditions conditions to move closer to services.
compared with 24.1% with household incomes less than
Prevalence of selected conditions by age and gender
$10,000. These findings are consistent with the findings
earlier in the chapter that linked better general health with Figure 3 shows the prevalence of arthritis, high blood
higher incomes. pressure, asthma and heart disease by age group. Totals have
Figure 2. Percentage of First Nations adults reporting long-term been age-adjusted by gender.
health conditions by total household income
Arthritis/rheumatism is a joint disorder featuring
E
8.4% inflammation and is often accompanied by joint pain
80000+
21.7% (arthralgia). Forms of arthritis range from those related to
14.3%
55.6%
wear and tear of cartilage (such as osteoarthritis) to those
associated with inflammation resulting from an over-active
17.5%
immune system (such as rheumatoid arthritis). Causes
15.1%
50000-79999
26.8% depend on the form of arthritis and include injury, abnormal
40.6% metabolism (such as gout), hereditary susceptibility,
12.9%
infections and reasons that remain unclear.11Rheumatoid
12.8% arthritis is an autoimmune disease that causes chronic
30000-49999
24.1% inflammation of the joints; it can also cause inflammation of
50.3%
the tissue around the joints and of other organs. Autoimmune
Income group ($)
18.3% diseases are illnesses that occur when the body’s immune
13.6%
20000-29999 system mistakenly attacks its own tissues. Rheumatoid
21.4%
46.7% arthritis is typically a progressive illness that has the potential
to cause joint destruction and functional disability.12 The
24.8%
16.8%
research grouped RHS respondents who had arthritis or
15000-19999
16.4% rheumatism.
42.0%
High blood pressure or hypertension means high pressure
22.4% no. conditions
23.6%
(tension) in the arteries. An elevation of the blood pressure
3+
10000-14999
19.6% 2
increases the risk of developing heart disease, kidney disease,
34.3% 1 hardening of the arteries, eye damage and stroke (brain
24.1%
0 damage). Risk factors include excess salt intake, age, obesity,
<10000 (inc;. loss)
13.6% hereditary susceptibility and kidney failure (renal
22.3% insufficiency).13
40.1%
Asthma is a chronic inflammation of the airways that causes
0% 20% 40% 60%
swelling and narrowing of the airways, resulting in difficulty
E High sampling variability. Use figure with caution.
breathing. The bronchial narrowing is usually either totally or
Prevalence of long-term conditions by isolation status of at least partially reversible with treatments. Triggers include
community of residence allergens and irritants (respiratory infections, tobacco smoke,
smog and other pollutants, Aspirin, other nonsteroidal anti-
The RHS flags respondents according to the isolation status inflammatory drugs, physical exercise and various other
of their community of residence. The definitions of isolation environmental, emotional and hormonal factors).14
status follow.
Heart disease includes any disorder that affects the heart.
• Remote isolated: no scheduled flights Sometimes the term is used narrowly and incorrectly as a
• Isolated: flights, good telephone, but no road access synonym for coronary artery disease. Heart disease is
synonymous with cardiac disease but not with cardiovascular
• Semi-isolated: road access, greater than 90 km to disease which is any disease of the heart or blood vessels.
physician services Heart disease includes conditions such as angina, arrhythmia,
• Non-isolated: road access, less than 90 km from congenital heart disease, coronary artery disease, dilated
physician services cardiomyopathy, heart attack (myocardial infarction), heart
Although differences between groups are not statistically failure, hypertrophic cardiomyopathy, mitral regurgitation,
significant, there is a general trend towards fewer conditions mitral valve prolapse and pulmonary stenosis.15 Risk factors
as isolation increases. In non-isolated communities, 55.4% of include age, heredity, gender (male sex), tobacco smoke,
adults had one or more long-term condition. This compares high blood cholesterol, high blood pressure, physical
with 51.2% in semi-isolated communities, 48.6% in isolated inactivity, obesity, diabetes, stress and excess alcohol
communities and 38.9% in remote isolated communities. consumption.16
58
Figure 3 shows that the prevalence of all these conditions First Nations women are more likely than women in the
generally increases with the aging of First Nations adults. general population to report asthma (13.2% compared with
8.7%).
The prevalence rates of arthritis and high blood pressure
among First Nations adults increase in a linear pattern with Figure 3. Prevalence of selected long-term health conditions
among First Nations adults by age group (total age adjusted)
increases in age. So does heart disease, although that pattern
becomes most noticeable among adults 30 years and 19.5%
older.xviii
11.5%
Arthritis/rheumatism is more prevalent among First Nations Heart disease 3.4%
adults than in the general population in Canada (25.3% 1.4% E
60+
compared with 19.1% respectively). It is more prevalent -E 50-59
among First Nations adults in the 30–39 age group (12.7% 40-49
30-39
compared with 6.6%), in the 40–49 age group (21.4% 13.4% 18-29
compared with 13%) and in the 50–59 age group (39% 13.3%
compared with 25.7%).
Asthma 9.0%
High blood pressure is somewhat more prevalent among First 7.2%

Nations adults overall when comparing with the general 9.4%
population (20.4% compared with 16.4%). The rates are
higher among First Nations adults in the 30–39 age group 3.4%
(7.8% compared with 4.2%), in the 40–49 age group (16.3% 9.0%
compared with 10%) and in the 50–59 age group (30.5% High blood pressure 16.3%
compared with 22.4%). 7.8%
Asthma is less clearly related to age than the other conditions 5.0%
(Figure 3). The rates ranged between 7.2% and 9.4% among
adults younger than 50 years and between 13.3% and 13.4% 45.5%
among older adults. The only significant difference was 38.0%
between the lowest rate (7.2% among 30-39 year olds) and Athritis/rheum 22.1%
the two highest rates. In the general Canadian adult 13.0%
population, asthma fluctuates between 6.9% and 9.7% among 5.4%
adults younger than 50 years and between 7.2% and 7.7%
among adults in the 50–59 and 60+ age groups. Overall, 0% 10% 20% 30% 40% 50%
there is a slightly higher prevalence of asthma among First E High sampling variability. Use figures with caution.
Nations adults than in the general adult population in Canada – E Sampling variability too high for release of data.
(9.7% compared with 7.8%).

The prevalence of arthritis/rheumatism is higher among First
Heart disease is slightly more prevalent overall among First Nations than other women (30.1% compared with 17.4%),
Nations adults than in the general adult population (7.6% with the differences being most notable among women
compared with 5.6%). However, it is considerably more younger than 60 years. For instance, the rates are similar
widespread among First Nations adults in the 50–59 age among First Nations and other women 60 years and older
group than in the general population this age (11.5% (54.1% compared with 51.6%). However, in the 50–59 age
compared with 5.5%). group, 43.2% of First Nations women reported these
conditions compared with 32.9% of other women; in the 40–
Figure 4 shows the prevalence of the same conditions by age
49 age group 24.7% of First Nations compared with 15.8%
group and gender. First Nations women are more likely than
of other women reported these conditions. In the 30–39 age
men to report the conditions shown. The somewhat higher
group, 16.2% of First Nations women compared with 7.6%
proportion of First Nations women than men with heart
of other women reported these conditions, and 6.4%
disease (8% compared with 7.3%) is not statistically
compared with 2.5 % younger than 30.
significant.
The overall prevalence rates for arthritis/rheumatism, high
blood pressure, asthma and heart disease are higher for First
Nations women than for women in the general population.
xviii
The figure for prevalence of heart disease in the 30 – 39 age group should be used with caution
owing to high sampling variability. The prevalence figure for the 18 – 29 age group has been
suppressed owing to very high sampling variability.
59
Figure 4. Prevalence of selected long-term health conditions among First Nations men and women by age group (total age adjusted)
60.0
50.0
40.0
30.0
20.0
10.0
0.0
Male Female Male Female Male Female Male Female Male Female Male Female
18 - 29 30 - 39 40 - 49 50 - 59 60 + Total
E
Arthritis/rheum 4.5 6.4 9.8 16.2 19.4 24.7 32.7 43.2 35.3 54.1 20.3 30.1
E
High blood pressure 3.7 6.4 7.1 8.4 14.9 17.8 26.4 34.8 34.9 44.0 17.4 23.2
Asthma 7.4 11.5 5.4 9.0 5.7 12.5 10.0 17.0E 11.2 E 15.6 E 7.9 13.2
Heart disease –E –E –E –E 3.5 E 3.3 E 14.2 E 8.6 E 16.6 22.4 7.3 8.0
E High sampling variability. Use figures with caution.

– E Sampling variability too high for release of data.
Access to health-related services
Similarly, high blood pressure is more prevalent among First
Nations than other women (23.2% compared with 17.4%). In General difficulties for people with disabilities
the 60 + age group the figures are similar for First Nations Given that the general health situation of First Nations adults
and other women (44% compared with 44.6%). However, is poorer on average than that of their counterparts in the
First Nations women in the 50–59 age group were more general population, and that people with disabilities face
likely to report this condition (34.8% compared with 22.3%), additional health challenges, how do First Nations adults fare
as were women in the 40–49 age group (17.8% compared in terms of access to health-related practices/services? Table
with 9.2%) and in the 30–39 age group (8.4% compared with 11 shows the extent to which First Nations adults with and
3.2%). Some 6.4% of First Nations women 18–29 years without disabilities reported difficulties on the RHS in
reported high blood pressure compared with only 1.8% of accessing various treatments and services, and the reasons for
other women 20–29 years. the difficulties.
Heart disease is more prevalent among First Nations women In all cases the “universes” for figures reported in the
than other women in Canada (8% compared with 5.1%). The bulleted rows are people who didn’t decline to answer the
rate is higher among First Nations than other women 60 RHS question for a given row or who reported something
years and older (22.4% compared with 15.6%), in the 50–59 other than “don’t know.” Figures shown on the non-bulleted
age group (8.6% compared with 3.9%) and in the 40–49 age rows are totals of any “yes” responses across the bulleted
group (3.3% compared with 2%). Given high sampling items underneath concerning difficulties accessing traditional
variability for First Nations women with heart disease in the medicines, barriers to health care access and difficulties
latter two age categories, the findings are probably not be accessing services under the Non-Insured Health Benefits
statistically significant for those age groups. (NIHB) program for First Nations and Inuit people.
Generally speaking, then, one can expect to find higher Table 11 (end of chaper) shows that, overall, First Nations
prevalence of asthma among First Nations women than other adults are more likely than their counterparts without
women, especially among First Nations women 40 years and disabilities to report difficulties with most of the services
older. The higher prevalence of arthritis and high blood presented.
pressure among First Nations women is particularly evident
among women younger than 60 years. The higher prevalence Issues for which First Nations adults with disabilities are at
of heart disease among First Nations women is most notable least 1.5 times more likely than their counterparts without
among those 50 years and older. disabilities to encounter difficulties follow.
60
Cost, affordability and eligibility for public program traditional medicines and that they have difficulties with
coverage transportation or related costs under the NIHB program;
and
• Unaffordable traditional medicines
• 1.3 times more likely to report various other difficulties
• Unaffordable direct cost of other health care services arranging transportation for health care, affording
• Unaffordable transportation to health care services transportation costs, getting traditional care and
• Unaffordable childcare so health care can be accessed accessing vision services under the NIHB.
• Sought-after traditional medicines not covered by NIHB
Summary of Key Findings
• Other needed health care services not covered by NIHB
This chapter has explored disability and long-term health
• Denial of approval for service under NIHB conditions among First Nations and Inuit adults 18 years and
• Difficulties accessing medications, dental care, medical older, and has drawn selected comparisons with the broader
supplies and transportation services (or cost coverage for adult population in Canada.
transportation) under the NIHB
The research found that there is a higher prevalence of
• Difficulties accessing other “medical supplies” under the disability among First Nations adults than in the general adult
NIHB. These include disability-specific items such as population in Canada. As in the general population, disability
wheelchairs, magnifying aids, walkers, crutches, canes, becomes more common as First Nations people age.
artificial limbs, modified kitchen utensils, modified
clothing or shoes and special cushions. First Nations adults with disabilities are more likely than
adults without disabilities to be never-married, single people.
Availability
In part this finding may be due to the fact that the onset of
• Unavailability of traditional medicines through the disability occurs in adulthood for many people, that is,
respondent’s health centre sometime after they have entered into a long-term
relationship with a spouse or partner. First Nations women
• Lack of doctor or nurse in the respondent’s area
with disabilities are particularly likely to be widowed, which
• Non-available health facility may in part be due to the lower life expectancy of men and
• Other needed health care service is not available in the late onset of disability among women pre-deceased by their
respondent’s area. husbands/partners.
Transportation and distance First Nations adults with disabilities generally fare as well as
their counterparts without disabilities in terms of formal
• Too far to travel for traditional medicines
educational attainment, yet less well in terms of income,
• Difficulties arranging transportation to health care employment and health. They fare considerably less well in
Adequacy and suitability these areas than the broader adult population in Canada.
• Health care services are perceived as inadequate or not First Nations women with disabilities are about as likely as
culturally appropriate their male counterparts to report fair or poor health. Older
• Concern about the effects of traditional medicines First Nations adults with disabilities and First Nations adults
with low personal incomes are more likely to report fair or
• The respondent chose not to see a health professional for poor health than younger people or people with higher
unspecified reasons. incomes.
General
The top five long-term health conditions facing First Nations
• Difficulties getting traditional care adults with and without disabilities are arthritis/rheumatism,
chronic back pain, allergies, diabetes and high blood
Particular healthcare access difficulties for First Nations pressure. These are also leading health conditions in the
women with disabilities general adult population in Canada. Diabetes is much more
Overall, First Nations women are more likely than First widespread among First Nations adults with disabilities than
Nations men to report difficulties with the issues shown on among both their non-disabled counterparts and the adult
Table 11. For example, they are: population more broadly in Canada.
• 1.9 times more likely to report that they cannot afford Nearly a quarter (22.3%) of First Nations adults reported at
childcare so they can access health care; least one of the 27 long-term health conditions shown on
Table 10 in this chapter. Another 20.1% reported two or
• 1.4 times more likely to report the lack of a doctor or three of those conditions and 11.3% reported four or more to
nurse in their area, that a health facility is not available a maximum of 14 conditions. First Nations women are more
in their area, that they do not know enough about likely to report multiple (four or more) conditions.
61
The prevalence of these conditions increases with the aging genetic/congenital factors and various other causes. An RHS
of First Nations adults, with 67.2% aged 18–29 years question that mirrors the ones in the CCHS or PALS about
reporting no such conditions compared with only 13.6% cause of disability could help shed light on why disability is
among First Nations seniors 60 years and older. The occurring among First Nations people, which in turn could
prevalence of multiple conditions increases with age. inform prevention and amelioration efforts.
The research explored arthritis, high blood pressure, asthma Improving education, employment, Income Security and
and heart disease. It found that, when age-adjusted by Health
gender, these conditions are more prevalent among First
It is difficult to imagine how the educational, employment,
Nations adults than in the general adult population in
income and general health situation of First Nations adults
Canada. First Nations women are more likely than both First
with disabilities can be improved without concerted efforts
Nations men and women in the general population to report
by policy makers and other leaders within and beyond First
these conditions.
Nations communities to more broadly improve the social and
The higher prevalence of asthma among First Nations economic situation of First Nations people.
women compared with other women is most noticeable
In the process, adults with disabilities need to be recognized
among women 40 years and older. The higher prevalence of
as constituting a large share of First Nations adults and
arthritis and high blood pressure among First Nations women
should be brought explicitly into the foreground in strategies
is particularly evident among women younger than 60 years.
to improve health, education, employment and income
The higher prevalence of heart disease among First Nations
security.
women is most notable among those 50 years and older.
Health risk behaviours (for example obesity, physical
First Nations people face a range of health challenges. First
inactivity, non-traditional use of tobacco and food intake that
Nations adults with disabilities are more likely than their
results in high blood cholesterol and other factors) that
counterparts without disabilities to face a range of barriers
contribute to high prevalence conditions (such as
and other difficulties gaining access to health services. Issues
arthritis/rheumatism, asthma, high blood pressure and
of cost, affordability and lack of coverage by publicly funded
diabetes), could be targeted by preventative health and health
programs are widespread. However, First Nations adults with
promotion strategies to ensure a focus on reaching First
disabilities are also more likely than their counterparts
Nations adults with disabilities. Allergies among First
without disabilities to experience barriers and other
Nations people probably require more research into the
difficulties with the availability, adequacy and cultural
nature and causes, with due attention to allergies among First
appropriateness of services and with issues of distance and
Nations adults with disabilities. Stomach/intestinal problems
transportation.
and asthma among First Nations adults need further research
Women with disabilities face particular difficulties in the and practical attention, again with some focus on disability.
area of health services, including women’s concern about the
Personal health strategies used by First Nations adults with
effects about traditional medicines, not having enough
disabilities in excellent or very good health could be
information about traditional medicines and difficulties
researched and made widely available in “user-friendly”
getting traditional care; the affordability of child care so
formats.
health care can be accessed; lack of doctors, nurses and
facilities in their area; and difficulties arranging and paying Issues of health care access require serious attention for First
for transportation services. Nations adults with disabilities, who disproportionately face
difficulties gaining access to a wide range of health-related
Recommendations
services. Some of the difficulties (such as those that relate to
Disability indicators NIHB services) fall within the jurisdiction of the federal
government. Other issues fall to provincial/territorial
A more consistent approach to disability indicators in the
governments or to First Nations Bands to which
RHS and Statistics Canada population surveys would better
responsibility for health care service delivery has been
facilitate comparisons of the situations of First Nations adults
transferred (e.g., general supply of facilities, doctors, nurses
and other adults in Canada across a range of measures drawn
and ensuring the services provided are adequate and
from the surveys.
culturally appropriate). Federal, provincial/territorial and
As well, the RHS could add a question about the cause of the
First Nations governments, and health authorities need to
condition that results in reduced activities. Only about one-
work closely with First Nations people with disabilities and
third of adult disabilities are caused by illness or disease,
long-term health conditions in addressing their barriers and
which RHS question 34 explores in some detail. The rest are
other challenges.
caused by factors such as accidents (e.g., at home or work,
motor vehicle and other accidents), the natural aging process, Particular difficulties that First Nations women with
emotional or mental health problems, work conditions, disabilities face need to be explored and understood in
62
greater depth. For example, a better understanding of the

challenges and barriers women with disabilities experience in
relation to women’s health and access to health services
could inform the development of differential strategies to
improve women’s health and well-being. As many First
Nations men with disabilities also face difficulties in the area
of health and health care access, measures to improve the
situation of women could be modified and extended to
address the needs of men as well.
Notes to Chapter 4
1. Human Resources Development Canada, Office for Disability Issues, Technical Report,
Annexes: Advancing the Inclusion of Persons with Disabilities (Ottawa, Ont.: Human
Resources Development Canada, Office for Disability Issues, 2002), appendix 3.
2. Ibid., p. 27.
3. Social Development Canada, Office for Disability Issues, Advancing the Inclusion of
Persons with Disabilities—2004 (Ottawa, Ont.: Social Development Canada, Office for
Disability Issues, 2004), p. 9 and Endnote 14, p. 96.
4. Human Resources Development Canada, Office for Disability Issues, Technical Report:
Advancing the Inclusion of Persons with Disabilities, 2002 (Ottawa, Ont.: Human
Resources Development Canada, Office for Disability Issues, 2002), p. 22.
5. E. Ng, “Disability among Canada’s Aboriginal Peoples in 1991,” Health Reports 8, 1
(Summer 1996), pp. 25-32.
6. Social Development Canada, Advancing the Inclusion of Persons with Disabilities, 2004
(Ottawa, Ont.: Social Development Canada, 2004), p. 54.
7. Statistics Canada, Adults with Disabilities: Their Employment and Education
Characteristics—1991 Health and Activity Limitation Survey (Ottawa, Ont.: Minister of
Industry, 1993), Table 3.3.
8. The Roeher Institute, Improving the Odds: Employment, Disability and Public Programs in
Canada (Toronto, Ont.: The Roeher Institute, 2004).
9. Health Canada, Health Policy and Communications Branch, Achieving Health for All: A
Framework for Health Promotion [online]. [Ottawa, Ont.]: Health Canada, Health Policy
and Communications Branch, 2001. Cited 13 September 2005. Available from World
Wide Web: <http://www.hc-sc.gc.ca/hcs-sss/pubs/care-soins/2001-frame-plan-
promotion/index_e.html>.
10. Canadian Council on Social Development, Are poor people less likely to be healthy than
rich people? [online]. [Ottawa, Ont.]: Canadian Council on Social Development, 2004.
Cited 13 September 2005. Available from World Wide Web: <http://www.canadian-
health-network.ca/servlet/ContentServer?cid=1005632&pagename=CHN-
RCS%2FCHNResource%2FFAQCHNResourceTemplate&c=CHNResource&lang=En&re
pGroupTopic=Determinants+of+Health+KS>.
11. MedicineNet.com, Arthritis [online]. Cited 29 September 2005. Available from World
Wide Web: <http://www.medicinenet.com/arthritis/article.htm>.
12. MedicineNet.com, Rheumatoid Arthritis [online]. Cited 2 October 2005. Available from
World Wide Web: <http://www.medicinenet.com/rheumatoid_arthritis/article.htm>.
13. MedicineNet.com, High Blood Pressure [online]. Cited 29 September 2005. Available
from World Wide Web: <http://www.medicinenet.com/high_blood_pressure/article.htm>.
14. MedicineNet.com, Asthma [online]. Cited 29 September 2005. Available from World Wide
Web: <http://www.medicinenet.com/asthma/article.htm>.
15. MedicineNet.com, Definition of Heart Disease [online]. Cited 29 September 2005.
Available from World Wide Web:
<http://www.medterms.com/script/main/art.asp?articlekey=31193>.
16. American Heart Association, Risk Factors and Coronary Heart Disease [online]. Cited 29
September 2005. Available from World Wide Web:
http://www.americanheart.org/presenter.jhtml?identifier=4726.
63
Table 1. Prevalence of disability based on the RHS, CCHS 2003 and NPHS 1998-99, showing First Nations totals
1
unadjusted and adjusted for age
Canada – First Nations to First Nations to
First Nations - First Nations -
Age group Selected CCHS Canada Canada - NPHS Canada
RHS RHS
indicators Differential Differential
<301 13.1% 16.2% 0.8 13.1% 8.8% 1.5
30-39 16.0% 18.7% 0.9 16.0% 11.7% 1.4
40-49 22.7% 24.2% 0.9 22.7% 14.9% 1.5
50-59 38.2% 29.9% 1.3 38.2% 21.1% 1.8
60+ 49.7% 38.1% 1.3 49.7% 31.8% 1.6
Total - Unadjusted for age 22.9% 25.8% 0.9 22.9% 17.8% 1.3
Total - Age adjusted 28.5% 25.8% 1.1 27.8% 17.8% 1.6
1 Age 18 – 29 for First Nations; age 20 – 29 for other adults.
Table 4. Percentage of First Nations and other adults in Canada with less than high school graduation, by age and disability status
First Nations/Inuit (RHS) Canada (CCHS) Canada (NPHS General file)
Age group Non- With Non- With Non- With
Total Total Total
disabled disability disabled disability disabled disability
<301 45.3 38.7 44.4 8.4 13.5 9.2 10.3 18.9 11.1
30-39 25.6 27.8 26.0 8.7 11.0 9.1 12.1 16.2 12.6
40-49 24.2 26.4 24.7 11.8 16.4 12.9 15.1 18.0 15.5
50-59 33.2 32.5 32.9 17.5 22.2 18.9 24.0 28.6 24.9
60+ 58.5 61.2 59.8 40.6 46.3 42.8 45.9 50.8 47.4
All adults 35.6 38.7 36.3 16.7 26.3 19.2 20.2 32.2 22.5
1 Age 18 – 29 for First Nations; age 20 – 29 for other adults.
Table 5. Personal incomes of First Nations/Inuit and other adults in Canada, by disability status
First Nations/Inuit (RHS) Canada (CCHS) Canada (Health file)
Income group Non- With Non- With Non- With
Total Total Total
No income1 7.1 9.1 7.6 4.5 4.5 4.5 5.3 4.7 5.2
Less than $15,000 39.7 49.5 42.0 19.4 29.4 22.0 24.9 39.5 27.7
$15,000-$29,999 31.1 26.2 30.0 23.4 26.0 24.1 27.4 26.2 27.1
$30,000-$49,999 16.4 12.4 15.5 27.2 21.9 25.8 25.7 18.1 24.2
$50,000 or more 5.6 2.7 E 4.9 25.5 18.1 23.6 16.8 11.5 15.8
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
1 Includes income loss.
Table 6. Percentage of First Nations and other adults employed, by age group and disability status
First Nations (RHS) Canada (CCHS)1
Age group
Non-disabled With disability Total Non-disabled With disability Total
<302 40.1 37.7 39.8 77.4 70.2 76.2
30-39 61.7 45.6 59.1 85.4 77.3 83.9
40-49 64.3 55.9 62.4 87.4 75.9 84.6
50-59 62.3 40.5 53.9 77.4 59.8 72.1
60+ 29.3 12.9 21.3 26.5 19.0 24.0
All adults 52.2 37.3 48.8 74.1 58.7 70.4
1 For the CCHS, percentage at work in the week before the survey, or had a job but were absent. The NPHS has no similar variable
2 Ages 18 – 29 for First Nations; ages 20-29 for the general population.
1
Owing to differences in survey methodologies, these estimates need to be treated with caution when using other surveys to compare the prevalence of disability across First Nations and non- Aboriginal people.
64
Table 7. General health of First Nations and other adults in Canada, by disability status
First Nations (RHS) Canada (CCHS) Canada (NPHS Health file)
General health Non- With Non- With Non- With
Total Total Total
Excellent or very good 46.7 16.6 39.9 66.3 32.9 58.0 71.3 27.8 62.9
Good 40.5 37.4 39.8 28.3 36.0 30.2 24.6 36.0 26.8
Fair or poor 12.8 45.9 20.3 5.4 31.1 11.8 4.1 36.3 10.3
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Table 8. General health of First Nations and other adults in Canada, by disability status and age
First Nations (RHS) Canada (CCHS) Canada (NPHS Health file) Factor
C2: First
C1: First
Nations/
Nations
Inuit with
with
Age group and Non- With Non- With Non- With disability ÷
Total Total Total disability ÷
general health disabled disability disabled disability disabled disability Canada
Canada
(CCHS)
(CCHS)
non-
total
disabled
<301
Excell't or v good 51.9 27.5 48.7 72.7 47.4 68.6 77.3 43.8 73.8 0.4 0.4
Good 37.1 42.3 37.8 24.1 37.1 26.2 20.2 39.8 22.2 1.6 1.8
Fair or poor 11.0 30.2 13.5 3.2 15.5 5.2 2.5 16.4 4.0 5.9 9.5
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
30-39
Excell't or v good 48.4 21.6 44.1 72.6 44.2 67.3 77.3 34.6 71.5 0.3 0.3
Good 41.9 42.2 41.9 24.9 37.3 27.2 20.9 36.8 23.0 1.6 1.7
Fair or poor 9.7 36.3 14.0 2.5 18.5 5.5 1.9 28.6 5.5 6.6 14.3
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
40-49
Excell't or v good 45.9 18.8 39.7 67.6 37.5 60.3 73.3 33.8 67.2 0.3 0.3
Good 41.9 42.1 41.9 28.2 37.7 30.5 23.5 35.6 25.4 1.4 1.5
Fair or poor 12.2 39.1 18.4 4.2 24.8 9.2 3.2 30.6 7.4 4.2 9.2
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
50-59
Excell't or v good 35.3 13.4 26.9 63.6 28.4 53.1 67.9 27.2 57.9 0.3 0.2
Good 39.3 33.7 37.1 30.3 35.3 31.8 27.6 33.0 29.0 1.1 1.1
Fair or poor 25.4 53.0 36.0 6.1 36.3 15.1 4.4 39.9 13.1 3.5 8.7
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
60+
Excell't or v good 31.5 –E 18.8 50.8 20.4 39.2 57.1 18.3 44.4 – –
Good 50.2 29.6 40.0 36.8 34.8 36.1 33.1 36.4 34.2 0.8 0.8
Fair or poor 18.3 64.5 41.2 12.4 44.8 24.7 9.8 45.4 21.4 2.6 5.2
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
1 Ages 18 – 29 for First Nations; ages 20 – 29 for the general population.
65
Table 9. General health of First Nations and other adults in Canada, by disability status and personal income
First Nations (RHS) Canada (CCHS) Canada (NPHS Health file)
Income group and general health Non- With Non- With Non- With
Total Total Total
1
No income
Good 39.8 34.3 38.3 30.4 38.5 32.5 28.5 29.4 28.7
Fair or poor 18.2 51.7 27.6 6.8 38.6 15.0 5.5 40.4 11.7
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Less than $15,000
Good 41.9 36.2 40.3 31.4 33.6 32.2 30.1 36.2 31.8
Fair or poor 15.2 49.5 24.6 8.9 44.1 21.1 6.9 46.4 17.8
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
$15,000-$29,999
Good 36.9 37.2 37.0 29.9 36.2 31.7 24.6 37.7 27.1
Fair or poor 10.3 41.5 16.7 5.9 33.0 13.5 5.1 35.7 10.8
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
$30,000-$49,999
Good 44.3 35.8 42.6 27.1 37.6 29.4 22.0 34.9 23.9
Fair or poor 8.0 36.3 13.4 3.5 21.4 7.4 1.8 24.0 5.0
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
$50,000 or more
Excellent or very good 58.9 –E 53.1% 74.2% 46.8% 68.8% 80.8 45.2 75.8
Good 38.3 –E 40.0% 23.3% 38.4% 26.3% 17.8 38.3 20.7
Fair or poor –E –E 6.8 E 2.5% 14.8% 4.9% 1.4 16.5 3.5
Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0 100.0 100.0
All income groups
Good 40.5 37.4 39.5 28.3 36.0 30.2 24.6 36.0 26.8
Fair or poor 12.8 45.9 19.9 5.4 31.1 11.8 4.1 36.3 10.3
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
1 Includes income loss.
66
Table 10. Specific health conditions of First Nations (age adjusted) and other adults in Canada, by disability status
First Nations (RHS) Canada (CCHS)
With With
Long-term conditions Non-disabled Total Non-disabled Total
disability disability
Arthritis or rheumatism 14.6 52.2 25.3 11.9 39.8 19.1
Chronic back pain1 9.6 34.5 16.7 14.1 42.4 21.4
Osteoporosis 1.6 12.4 4.7
Asthma 9.0 14.6 10.6 6.1 12.8 7.8
Chronic bronchitis 2.5 6.9 3.7 1.7 5.9 2.8
Emphysema2 0.5 E 2.4 E 1.0 0.6 3.4 1.4
Allergies 17.6 25.3 19.9 27.5 38.5 30.3
Cataracts 4.3 E 15.3 7.4 2.9 9.0 4.5
Glaucoma – E 3.6 E 2.7 E 1.2 3.4 1.8
Blindness or serious vision problems 2.2 8.3 4.0
Hearing impairment 8.5 18.7 11.4
Epilepsy 0.6 E 2.3 E 1.1 0.4 1.1 0.6
Psychological or nervous disorders 1.7 6.5 3.1
Cognitive or mental disability – E 2.8 E 1.1
ADD or ADHD 0.3 2.0 E 0.8 E
Learning disability 1.4 3.0 E 1.9 1.1 3.9 1.8
Heart disease 3.2 18.8 7.6 3.1 12.9 5.6
High blood pressure 14.7 34.7 20.4 13.1 25.8 16.4
Effects of stroke (brain haemorrhage) 0.8 5.4 2.1 0.4 3.4 1.2
Thyroid problems 3.5 8.6 5.0 5.1 9.5 6.2
Cancer 1.4 4.9 2.4 1.2 4.0 1.9
Liver disease (excluding Hepatitis) 1.1 3.1 1.7
Stomach and intestinal problems3 6.4 16.6 9.3 2.1 5.9 3.1
HIV-aids – E – E – E
Hepatitis 0.9 2.1 E 1.2
Tuberculosis (TB) 3.3 5.5 3.9
Diabetes 15.3 30.9 19.7 3.8 9.2 5.2
1 For the general population in the CCHS, back problems excluding fibromyalgia and arthritis
2 For the general population in the CCHS, emphysema or chronic obstructive pulmonary condition
3 For the general adult population in the CCHS, stomach or intestinal ulcers
67
Table 11. Percentage of first Nations adults facing difficulties accessing health-related services, and barriers
to health care access
First Nations (RHS)
Ratio (With
Non-disabled With disability Total disability ÷
non-disabled)
Had any difficulties accessing traditional medicines 30.9 40.5 33.1 1.3
Specific difficulties accessing traditional medicines:
• do not know where to get them 15.0 19.3 16.0 1.3
• can't afford it 2.3 6.6 3.3 2.9
• too far to travel 5.2 12.7 7.0 2.4
• concerned about effects 2.8 5.5 E 3.4 2.0
• do not know enough about them 19.2 20.5 19.5 1.1
• not available through health centre 7.8 13.1 9.4 1.7
• not covered by Non-insured Health Benefits 6.6 13.9 8.3 2.1
Use traditional medicines 36.5 44.6 38.3 1.2
Faced any barriers to health care access 51.6 70.3 55.9 1.4
Specific barriers to health care access:
• doctor or nurse not available in respondent's area 16.7 24.4 18.5 1.5
• health facility not available 9.2 16.2 10.8 1.8
• waiting list too long 30.8 41.2 33.2 1.3
• unable to arrange transportation 11.9 23.3 14.5 2.0
• difficulty getting traditional care 11.3 20.4 13.4 1.8
• not covered by Non-insured Health Benefits 16.9 30.3 20.0 1.8
• approval for services under NIHB was denied 13.4 25.6 16.1 1.9
• could not afford direct cost of care, service 10.5 22.4 13.2 2.1
• could not afford transportation costs 10.9 23.1 13.7 2.1
• could not afford childcare costs 6.2 10.3 7.1 1.7
• felt health care provided was inadequate 14.2 25.8 16.9 1.8
• felt service was not culturally appropriate 11.3 20.7 13.5 1.8
• chose not to see health professional 9.9 14.5 10.9 1.5
• service was not available in respondent's area 12.4 22.2 14.7 1.8
Had any difficulty accessing NIHB services 30.1 47.5 34.1 1.6
Specific difficulties accessing NIHB services:
• medications 14.0 30.1 17.8 2.1
• dental care 15.2 23.6 17.2 1.6
• vision care 15.9 21.5 17.2 1.3
• hearing aid 3.0 E 5.1 E 3.4 E 1.7
• other medical supplies 4.6 12.6 6.5 2.7
• escort travel 6.8 11.3 7.8 1.7
• transportation services or costs (air or road) 7.2 15.3 9.1 2.1
68
Chapter 5
Diabetes
Abstract
Diabetes has been identified as a serious nationwide health problem among First Nations populations
in Canada. The First Nations Longitudinal Regional Health Survey (RHS) was designed to track
health issues —including the health impacts directly attributable to having diabetes and the extent to
which diabetes education and treatment are reaching those diagnosed with diabetes in First Nations
communities.
The diabetes epidemic is growing; 19.7% of First Nations adults have been diagnosed with diabetes
(mainly type 2). The prevalence increases with age and is higher among adults living in isolated
communities and those speaking or understanding a First Nations language. There is no longer a
difference in prevalence between men and women due to a large increase in diabetes in middle-aged
men. Although diabetes and being overweight go hand in hand, no significant relationship was
observed in this survey between diet and physical activity. The rate of diabetes among First Nations
adults continues to be higher than among the general population and the rate of increase in prevalence
by age is steeper.
Diabetes poses a high burden to health. Almost all diabetics report adverse health consequences and
over one-quarter experience activity limitations. The rates of heart disease and other co-existing
conditions are higher among diabetics than among other First Nations adults. The majority are being
treated, primarily by medication or lifestyle changes, but a lack of access to diabetes education is an
issue for more than one in ten. Half of adult diabetics monitor their blood glucose every day; (one in
five did not do so in the previous 2 weeks).
A comprehensive, culturally appropriate diet and physical activity strategy is needed that is and that
includes promotion, policy and environmental change strategies. Early detection, treatment and
control are essential to stem the personal and public health burden of diabetes in the community.
69
RHS 2002/03 Adult Survey – Chapter 5: Diabetes
been told you have …diabetes?”). In doing so, it explores

Introduction
whether some groups are experiencing higher prevalence
The 1997 First Nations and Inuit Regional Longitudinal rates than others. An ecological or holistic perspective is
Health Survey (FNIRLHS)1 signalled an important reality. used to identify such groups considering factors related to the
Diabetes had become an increasingly serious nationwide individual and their community. In particular, rates are
health problem among Aboriginal populations in Canada. At examined among groups differing in age, sex, household
that time,2 the prevalence of diabetes increased by age group income, education and language status (understood or spoke
and was higher among women than men. a First Nations language) and between communities of
differing population sizes, degree of isolation and health
The first evidence that diabetes might be an issue came in the
transfer status. In addition, associations with obesity, diet and
mid 1950s.3 In the 1980s, the Pima Indians had a very high
physical activity are considered by comparing the prevalence
incidence rate of diabetes with the prevalence rate being as
rates of these with those reporting diabetes and those who did
high as 40% to 50% among adults 35 years and
not.
older.4Obesity was then linked to diabetes, with incidence
rates of diabetes being 90 times higher among those morbidly The health impact of diabetes among First Nations adults is
obese than among those with low body weight (72.2 cases investigated by considering the number and type of adverse
per 1,000 among those morbidly obese compared to .8 cases consequences directly related to diabetes (problems with
per 1,000 among those with body mass index less that 20 vision, heart problems circulation problems, kidney function,
kg/m2).5 Moreover, having one or more parents with diabetes infections, problems with lower limbs, problems with feeling
substantially increased the risk of incidence of diabetes, in hands or feet, and amputations). In addition, activity
taking obesity into account. This might indicate a genetic limitation directly related to diabetes is described. General
susceptibility to diabetes, or a “thrifty” genotype in which fat health status, and co-morbidities or co-existing conditions
stores are efficiently stored and maintained to aid in survival round out the components considered to quantify the
when food is relatively scarce or available intermittently.6,7 personal health impacts of diabetes. Finally, the impact on
In addition, gestational diabetes led to higher rates of obesity the family is considered to some extent by examining one
among offspring,8 which indicates that the problem could indicator, namely receipt of home care by family members.
worsen in successive generations.
A range of topics related to the detection, treatment and
The diabetes story of the Pima Indians is not unique; the secondary prevention of diabetes is explored. Differences in
prevalence of diabetes is consistently higher among other the prevalence of a range of diagnostic tests are examined
First Nations populations in North America (for example between those diagnosed with diabetes and those who were
among the Plains Indians9 and Algonquins10) than the non- not. Self-monitoring practices are also described (frequency
Aboriginal population. Obesity, a prevalent risk factor, is over a two week period). In addition, adults’ current
located mainly on the trunk (in at least one group) and is a experiences with diabetes education are described and issues
significant predictor of diabetes.11 Furthermore, as with the related to lack of education (lack of access, cost, inadequate
Pima Indians, high birth weight is associated with mothers’ or culturally inappropriate services) are investigated. Finally,
diabetes during pregnancy among First Nations children in treatment regimes are outlined and access to treatment differs
Saskatchewan12, 13 and, judging by the studies of the James between those with diabetes versus others seeking access to
Bay Cree, one in eight women may have gestational the health system is compared.
diabetes.14 If higher birth weights later translate into higher
As with trends in diabetes, differences in the health impact,
rates of obesity among offspring, these children could face an
detection, education and treatment of diabetes are described
increased risk of diabetes.
according to the individual’s age, sex, household income,
The 1997 FNIRLHS measured diabetes prevalence among education, and language status (understood or spoke a First
First Nations adults. The new Longitudinal Regional Health Nations language) and by communities of differing
Survey (RHS) was designed to track changes in the populations, degree of isolation and health transfer status.
prevalence of diabetes among First Nations adults every 4
years from 2002–03 through 2014. In addition, it was Results
designed to gather in-depth information not generally
available from health surveys in Canada on the health Current situation
impacts directly attributable to having diabetes and the extent
to which diabetes education and treatment are reaching those Overall, 19.7%iii of First Nations adults have been diagnosed
with diabetes. Of those having diabetes, most (78.2%) have
diagnosed with diabetes.
Approach
i
This chapter describes the current situation by examining the variation is greater than 33.3%.
prevalence rate of self-reported diabetes (“Have you ever
70
Healthy weight represents body mass index >=18.5 and <25; Overweight represents body mass index
been diagnosed with type 2 diabetes, 9.9% with type 1 >=25 and <30; Class I obesity represents body mass index >=30 and <35; Class II obesity represents
diabetes and 9.8% have been told they are in a pre-diabetes body mass index >=35 and <40; Class III obesity represents body mass index is >=40
state. One in eight First Nations women (11.9%) report

Personal and public health burden of diabetes
having gestational diabetes.
The higher prevalence of diabetes among First Nations adults
The prevalence of diabetes is lowest among 18–29 year-olds
than the general adult population in Canada imposes a
(3.0%∗) and doubles each decade to a high of about one in
relatively higher public health burden on First Nations
three adults among those 55 years and older (36.4% among
communities. As illustrated in Figure 2, in both 1997 and
those 55–64 years and 35.2% among those 65 years and
2002, the prevalence of diabetes was higher among
older).
Aboriginal men and women in every age group than it was
Relatively fewer adults who have graduated from high school among the general population. Moreover, this age-related gap
have diabetes compared to both those not graduating and appears to have widened between First Nations adults and the
those with college or university graduation. A higher general population, particularly among men aged 45–54 and
prevalence rate of diabetes is observed among adults who 55–64 years.
live in isolated communities that have flights but no road
Roughly one-quarter of those diagnosed with diabetes
access, compared to those in non-isolated communities.
experience activity limitations due to this condition.
Understanding or speaking one or more First Nations
Experiencing limitations is more prevalent among those with
languages was associated with rates almost 3 times higher,
high school education (or less) than among college graduates
and this was evident when controlling for degree of isolation
(The small sample size precludes comparison to those with
and age (although the magnitude of the difference was less
university education).
pronounced). There were no significant differences by
gender, income, community size or health transfer status. Although only 28.6% of adult diabetics report activity
limitation, 88.7% report one or more adverse consequences
A major risk factor for diabetes is being overweight or obese.
related to their diabetes, including: problems with feeling in
Figure 1 compares the distribution of body weight among the
hands or feet (37.1%), vision (36.8%), circulation (21.6%),
population with and without diabetes. Being diagnosed with
lower limbs (20.9%), kidney function (15.9%), infections
diabetes is associated with excess body weight in First
(14.7%), and heart (11.3%). One-quarter (24.1%) report
Nations adults. Whereas most adults without diabetes are
having 4 or more of these adverse consequences, 30.1%
classified as being of a healthy weight or overweight, most
report 2–3 consequences and 34.5% report one such
adults with diabetes are classified as being obese. Only about
consequence. Problems with lower limbs are more prevalent
one in twenty (6.6%) adults with diabetes have a healthy
among older than younger adults. Adults who understand or
weight, compared to almost one in three adults (29.7%)
speak at least one First Nations language were more likely to
without diabetes. Despite this, adults with diabetes are just as
report adverse consequences related to kidney function. This
likely as those without to report almost always eating a
was particularly noticeable among those 55 to 64 years of
balanced nutritious diet and being active.
age, in that those who speak or understand a First Nations
Figure 1. Distribution of body mass index among those with and language were less likely than others to report no problem
without diabetes (n=8,610) related to kidney function.
40% 37.9%
36.4% Consistent with the number and range of adverse
consequences, relatively more adults diagnosed with diabetes
30%
29.7% 29.6% with diabetes rate their health as “”poor”, “fair” or “good” than do other
without diabetes
Proportion with diabetes
adults (85.0% versus 55.9% respectively), whereas only

2.7% of those with diabetes say their health is “excellent”
20.2%
20%
17.7%
compared to 15.2% of other adults. Furthermore, heart
disease and hypertension are roughly four times as prevalent
among adults with diabetes than others (14.9% versus 3.3%
10%
9.4% respectively for heart disease; 42.0% versus 10.3%
6.6% 7.0%
4.0%
respectively for hypertension), indicating that co-existing
conditions may also pose a higher health burden among this
0% group than among other First Nations adults.
Healthy weight Overweight Class I obesity Class II obesity Class III obesity
Body mass index group

Roughly three in ten adults with diabetes receive some home
care from family, which is more than twice the rate of that
∗
significant— is noted. Differences, in this chapter, are considered significant when confidence
among those without diabetes (29.0% versus 12.2%
intervals do not overlap at the 95% confidence level (after Bonferroni adjustment). respectively). Of this 29.0%, half often receive help.
71
Figure 2. Diabetes trends among First Nations and the general adult population in Canada
50%
1997 FNIRHS
40.2%
40% 2002/3 RHS
36.1% 36.7%
1996 NPHS
34.0%
2000/1 CCHS 32.0%
30.4%
30% 28.6%
27.5%
22.3%
21.1%
20%
17.7% 17.7%
15.7%
14.7%
12.7% 12.5%
11.1%
10.0%
10% 8.7% 8.5% 9.0%
7.8% 7.3%7.8% 7.3%
5.6%
4.6% 4.0%
3.5% 2.9%
2.4%2.5% 2.0%
1.2% 0.9%1.1% 1.4%1.9%
0.4%0.9%
0%
25-34 35-44 45-54 55-64 65+ 25-34 35-44 45-54 55-64 65+
Males Females
Age and gender group
FNIRHS: 1997 First Nations and Inuit Regional Health Survey

RHS: 2002/3 Regional Health Survey
NPHS: National Population Health Survey, Statistics Canada
CCHS: Canadian Community Health Survey, Statistics Canada
Figure 3. Number of adverse consequences of diabetes
Education, treatment and control (n=1,400)
Four in ten diabetics (41.3%) currently attend a diabetes

clinic or see someone for diabetes education. Among the six None, 11.3%
4+, 24.1%
(in ten) who are not, half (50.9%) stated that they did not
require diabetes education and 31.2% did not state a reason.
Access (22.2%) is the main reason that those needing
education did not receive it, and this was more apparent
among those living in isolated communities (47.2%) 1, 34.5%
compared to non-isolated (12.9%). It was also more apparent
among those understanding or speaking a First Nations
2-3, 30.1%
language compared to those who did not. Compared to those
without diabetes, a higher percentage of adults diagnosed
with diabetes report that lack of Non-Insured Health Benefits
(NIHB) (27.0% versus 18.7%) and denial of approval for Almost all those diagnosed with diabetes (89.8%) are
services under NIHB limit access to health care (21.2% receiving some form of treatment. A combination of regimes
versus 15.2%). In particular, those with diabetes are more are used to control diabetes; the most prevalent are
likely than others to report difficulty accessing medication, medication and diet (68.0% and 65.5% respectively),
other medical supplies and hearing aids. Other reasons for followed by exercise (52.9%), insulin (16.7%), traditional
not attending a clinic or seeing someone for diabetes medicines (12.9%), and seeing a traditional healer or taking
education are cost (6.2%), insufficient available information part in traditional ceremonies (6.0%). Diet is more likely to
(4.7%), and culturally inappropriate or inadequate services be used as a treatment among those with college education
(3.3%). compared to those with less education, and by those residing
in communities where the health services were transferred
directly to the community. Adults under 40 years of age
(66.2%) are more likely than adults over 60 years of age
(43.6%) to control their diabetes with exercise. Adults who
understand or speak a First Nations language and those living
72
in smaller communities (< 1,500 residents) are more likely regularly eat a balanced nutritious diet, those with diabetes
than others to take traditional medicines. are less likely than others to report often eating added sugar
Figure 4. Diabetes education: Proportion receiving education
or soft drinks. With the exception of consuming coffee or tea
and reasons for its lack (n=762) more frequently than others, there were no differences with
regard to other aspects of diet (such as fatty foods, salt or
Lnappropriate or
% 2.8
inadequate traditional foods).
Lack information, services, 1.9%
Cost, 3.6 %
Discussion
Lack of access, 13.0 %
Currently attending
a clinic or seeing
Diabetes continues to be a major health issue for First
someone, 41.3 % Nations. Its prevalence rate is high and growing, particularly
among older women and among men 45 to 64 years old. Not
Reason not stated
for lack of only is this condition more pervasive than among the general
education, 18.3 %
adult population, the difference between the two groups has
increased, alarmingly so among middle-aged men and, to a
lesser extent, older women. Furthermore, the rate of 19.7% is
Education not
required, 29.9 %
likely an underestimate. The rates of diabetes reported in
other Aboriginal studies (such as self-reports among Métis)
have proven to be lower than rates in healthcare databases,15
Figure 5. Treatment of diabetes (n=1,301) and the rate of undiagnosed diabetes may be significant.
80%
In the general population, the likelihood of being diagnosed
68.0%
65.5%
with diabetes is 1.6 to 2.0 times higher among men and
women who are overweight, and 7.2 to 10.8 times higher
60%
52.9% among men and women who are considered morbidly obese
(after controlling for socio-demographic and lifestyle
40%
factors).16 Obese Aboriginal children may be 5 times more
likely to have impaired fasting glucose than leaner children.17
This suggests that, with three-quarters of First Nations adults
20% 16.7%
classified as overweight or obese (see Chapter 8) and high
12.9% rates of childhood and youth obesity (see Chapters 18 and
6.0%
29), the overall situation can be expected to worsen before it
0% improves, particularly taking into account the likely stronger
Pills Diet Exercise Insulin Traditional Traditional
medicines healers or relationship between obesity and the subsequent risk of
Type of treatment
ceremonies
diabetes among Aboriginals.5 This underscores the urgent
need for widespread implementation of strategies to prevent
Adults with diabetes are more likely than other adults to have
diabetes and reduce the potential for adverse health
received the full range of diagnostic and monitoring tests that
consequences.
were queried in the RHS. Not surprisingly, this difference is
largest for blood sugar tests (92.1% versus 47.1%). Rates are Preventing and controlling the impact of diabetes requires a
also higher for cholesterol tests, blood pressure tests, vision comprehensive strategy that focuses on primary prevention
or eye examinations, complete physical examinations, and of obesity, early detection and treatment of diabetes
rectal examinations. (including detection of impaired glucose tolerance), and
prevention of adverse consequences. Given the pervasiveness
Half of those diagnosed with diabetes monitor their blood
of the disease, a population-wide strategy is required. With
sugar levels regularly; 27.6% do so about daily and 22.8%
one third of adults 50 and older currently diabetic and with
more than once a day. One in five did not check their blood
the prevalence likely to continue to increase in the next five
sugar in the two weeks prior to the survey. Regular
years, almost all adults will be touched by the disease, either
monitoring is more prevalent among older adults, those
directly or through family, friends and neighbours. Each
living in low-income households, and those who understand
aspect of a comprehensive strategy (prevention, detection,
a First Nations language. However, the association with
treatment and control, research and surveillance) requires
language was not evident when age was taken into account.
urgent attention.
Consistent with diet’s use as a means to control diabetes,
more adults with diabetes cite having a good diet as one of Primary Prevention
the things that personally “makes them so healthy” compared
with those without diabetes. The other thing cited more Diet and physical activity are key considerations in
frequently is “good sleep”. Although just as likely to preventing diabetes, both directly and arising from obesity.
Compared to the typical North American diet, a diet that was
73
relatively high in complex carbohydrates, dietary fibre, the duration of diabetes despite increasing treatment level
insoluble fibre, and vegetable proteins was found to be and that those who had diabetes longer experienced higher
associated with the lower risk of developing diabetes among rates of hypertension, dyslipidemia, and both microvascular
Pima Indians.18 Similarly, controlling for body mass, it was and macrovascular complications.28 The researchers
found that after six years, the incidence rate for diabetes was concluded that current treatment approaches are not intensive
generally lower among more active men and women19and is enough for many patients with diabetes of longer duration.
associated with lower insulin concentrations.20 Moreover, This implies that, with higher prevalence rates among
these results appear applicable to First Nations adults in younger adults than previously, more adults will be living
Canada.21 with diabetes longer, so the prevalence of these co-existing
conditions may be expected to increase among First Nations
A holistic strategy addressing obesity and diabetes in First
adults. It is therefore essential that diabetes be detected early
Nations communities is needed that focuses on improving
and that treatment begin without delay. Furthermore, the
diet and increasing physical activity (see Chapter 8). It
condition needs to be regularly monitored and, if necessary,
should focus on policy and environmental approaches as well
more progressive treatment instituted.
as tailored individualized strategies.22 Raine has provided an
evidence-based framework outlining these types of Routine identification and treatment may be difficult in
approaches that could provide a basis for designing, communities without access to regular diagnostic services. A
customizing and enhancing local action to prevent obesity mobile diabetes clinic, supported by interactive electronic
and diabetes.23 Due to the high prevalence of being health services from doctors, successfully increased access to
overweight and obese, strategies should target First Nation diabetes care in remote areas of British Columbia.29 Similar
adults, especially women of childbearing years. A diet and approaches may prove helpful in other isolated or remote
physical activity strategy to prevent obesity and diabetes communities to increase access to diabetes education,
must also place emphasis on prevention efforts for children diagnosis and treatment.
and youth.
Research and Surveillance
Culturally appropriate strategies need to be developed at the
community level, which take into account local conditions The RHS has provided valuable information on the current
and history. However, it is important that approaches, tools prevalence of diabetes and its impact on First Nations adults.
and resources are shared between communities so that Monitoring the situation is critical to determining whether or
successful programs may be adapted. The National not progress is being made to contain rising prevalence rates,
Aboriginal Diabetes Association’s handbook of Healthy and this will require continued investment in national
Living Activities for Grades 4 to 624 that is targeted for use monitoring programs.
by parents, caregivers and educators is an example of one
such resource. Their ongoing efforts to document the success More detailed information is required within First Nations
stories of communities in developing diabetes prevention communities to track the prevalence locally and monitor
programs may help others learn from each other and network progression of the disease. The Cree have used computerized
to share approaches.25 databases to track diabetes.30 This approach provides a model
and lays the foundation for much-needed prospective
research on diabetes.31 Locally based information is also
Education, Treatment and Control
helpful in devising relevant solutions to promote nutritious
Manitoba data has shown that about 50% of diabetes cases diets, physical activity and healthy body weights by
are undiagnosed in the general adult population.26 This addressing specific socio-cultural and environmental
means that 7% of First Nations adults may currently have influences on these. Evaluation results of successful (and
diabetes without knowing it. To address this issue, the unsuccessful) programs need to be shared between
adoption of screening programs has been recommended to communities so that promising solutions can be quickly
improve detection among those at higher risk of diabetes adapted and integrated in programs elsewhere.
(that is those having high abdominal adiposity (among men),
high triglycerides (among women), hypertension or parental Aboriginal Diabetes Initiative
history of diabetes). Although typically recommended only
every three years among those 40 years and older,27 The epidemic of diabetes among Aboriginals has been
widespread early screening programs for diabetes are needed recognized in recent years. In the Federal Government, the
Canadian Diabetes Strategy has earmarked support for local
given higher rates of diabetes occurring at younger ages,
particularly among 35–44 year olds. programs under the Aboriginal Diabetes Initiative. The
program respects the principle of self-determination by
Although the vast majority of those with diabetes are supporting programs for diabetes programs for prevention
receiving some form of treatment to control the condition, and treatment that are “community-based, culturally
almost one in ten are not. This is cause for concern, as a appropriate, holistic in nature and more accessible”.32 An
recent study has found that glycemic control decreased with environmental scan conducted by the National Aboriginal
74
Diabetes Association revealed that 84% of communities were diabetes are essential to stem the personal and public health
involved in prevention activities.33 This clearly demonstrates burden of diabetes in the community. Community-wide
that most communities are aware of the need. As well, many screening and education programs are needed, given the
are developing a solid base for prevention education. pervasiveness of risk factors in the population. Access to
However, access to treatment may be even more limited than progressive treatment regimes is necessary to ensure
the data from the RHS would suggest; 56% of those surveyed glycemic levels are controlled and adverse conditions
in the environmental scan were diagnosed off-reserve, avoided. Surveillance is needed to monitor the scope of the
perhaps suggesting that, although treatment is available, it is problem and the prevalence of risk factors. Research and
not readily accessible.33 evaluation of programs are needed to understand what works
and why, so that promising approaches can be quickly shared
Finally, the data from the RHS supports many of the
between communities.
recommendations from the consultations leading to the
development of the Aboriginal Diabetes Initiative. In
particular, it recommends that:
Notes to Chapter 5
• Prevention and education activities be community-wide
as most adults are affected by diabetes, either directly or 1. First Nations and Inuit Regional Health Survey National Steering Committee, First Nations
and Inuit Regional Health Survey [online]. ISBN 0-9685388-0-0. Available from World Wide
indirectly through family, friends and neighbours; Web: <http://www.naho.ca/firstnations/english/first_survey_facts_pdf_sheets.php>.
• Screening programs be community-wide among adults 2. Statistics Canada, 1991 Aboriginal Peoples Survey [online]. Available from World Wide Web:
<http://www.phac-aspc.gc.ca/publicat/dic-dac99/d12_e.html>.
and youth at risk (overweight or obese) as the 3. B. M. Cohen, March 1954, Diabetes mellitus among Indians of the American Southwest: its
prevalence and clinical characteristics in a hospitalized population, Annals of Internal
prevalence of diagnosed diabetes is higher at younger Medicine, 40, 3: 588-599.
4. W. C. Knowler et al., December 1987, Diabetes incidence and prevalence in Pima Indians: 19-
ages than previously; fold greater incidence than in Rochester, Minnesota, American Journal of Epidemiology, 108,
6: 497-505.
• Women of child bearing years be screened for diabetes 5. W. C. Knowler et al., February 1981, Diabetes incidence in Pima Indians: contribution of
obesity and parental diabetes, American Journal of Epidemiology, 113, 2: 144-156.
as part of regular physical examinations; 6. W. C. Knowler et al., September 1983, Diabetes mellitus in the Pima Indians: genetic and
• Nutrition and physical education programs be taught in

evolutionary considerations, American Journal of Physical Anthropology, 62, 1: 107-114.
7. E. Ravussin, January 1993, Energy metabolism in obesity, studies in the Pima Indians,
Diabetes Care, 16, 1: 232-238.
schools with promotional components targeting parents 8. D. J. Pettitt et al., February 1983, Excessive obesity in offspring of Pima Indian women with
as well as children; diabetes during pregnancy, New England Journal of Medicine, 308, 5: 242-245.
9. D. Gohdes et al., June 2004, Diabetes in Montana’s Indians: the epidemiology of diabetes in
• Comprehensive diet and physical activity strategies be 10.
the Indians of the Northern Plains and Canada, Current Diabetes Reports, 4, 3: 224-229.
H. F. Delisle, M. Rivard and J. M. Ekoe, September 1995, Prevalence estimates of diabetes
developed in each community, that include and of other cardiovascular risk factors in the two largest Algonquin communities of Quebec,
Diabetes Care, 18, 9: 1255-1259.
environmental and policy initiatives to reduce barriers to 11. T. K. Young and G. Sevenhuvsen, May 1989, Obesity in northern Canadian Indians: patterns,
accessing enjoyable, safe opportunities for physical 12.
determinants and consequences, American Journal of Clinical Nutrition, 49, 5: 786-793.
R. F. Dyck, August 2005, Tracking ancient pathways to a modern epidemic: diabetes end-stage
activity and healthy affordable foods; renal disease in Saskatchewan aboriginal people, Kidney International Supplement, 97: S53-
57.
• Community wide education be provided on the adverse 13. R. F. Dyck, H. Klomp and L. Tan, September-October 2001, From "thrifty genotype" to "hefty
fetal phenotype": the relationship between high birthweight and diabetes in Saskatchewan
consequences of diabetes and its early warning signs; Registered Indians, Canadian Journal of Public Health, 92, 5: 340-344.
14. S. Rodrigues, E. Robinson and K. Gray-Donald, May 4, 1999, Prevalence of gestational
• Trained personnel be available to help with diabetes diabetes mellitus among James Bay Cree women in northern Quebec, Canadian Medical
Association Journal, 160, 9: 1293-1297.
screening and education, and with training and support 15. S. G. Bruce et al., 2003, Diabetes among the Metis of Canada: Defining the population,
for home care givers; estimating the disease, Canadian Journal of Diabetes, 27, 4: 439-441.
16. C. L. Craig, C. Cameron and A. Bauman, Socio-Demographic and Lifestyle Correlates of
• The role of mobile clinics and telemedicine be further Obesity—Technical Report on the Secondary Analyses Using the 2000-2001 Canadian
Community Health Survey [online]. 2005. (Ottawa, Ont.: Canadian Institute of Health
investigated as a means of providing increased service to Information). Available from World Wide Web:
<http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=PG_450_E&cw_topic=450&cw_rel=AR
remote and isolated communities; _1265_E>.
17. T. K. Young et al., March 2000, Childhood obesity in a population at high risk for type 2
• The problem be regularly monitored through a diabetes diabetes, Journal of Pediatrics, 136, 3: 365-369.
18. D. E. Williams et al., May 2001, The effect of Indian or Anglo dietary preference on the
surveillance system involving administrative records and incidence of diabetes in Pima Indians, Diabetes Care, 24, 5: 811-816.
19. A. M. Kriska et al., October 1, 2003, Physical activity, obesity, and the incidence of type 2
on-going surveys such as the RHS; and diabetes in a high risk population, American Journal of Epidemiology, 58, 7: 669-675.
• Promising approaches be rigorously evaluated to 20. A. M. Kriska et al., July 2001, Association of physical activity and serum insulin
concentrations in two populations at high risk for type 2 diabetes but differing in BMI,
understand what works and why, so that they may be 21.
Diabetes Care, 24, 7: 1175-1180.
T. M. Wolever et al., December 1997, Low dietary fiber and high protein intakes associated
successfully adapted to and adopted by other with newly diagnosed diabetes in a remote aboriginal community, American Journal of
Clinical Nutrition, 66, 6: 1470-1474.
communities. 22. World Health Assembly 57.17 (agenda item 12.6, WHA 22n d May 2004), Global strategy on
diet and physical activity, Geneva: World Health Organization.
23. K. D. Raine, Overweight and Obesity in Canada: A Population Health Perspective (Ottawa,
In sum, the diabetes epidemic among First Nations adults is Ont.: Canadian Institute for Health Information, ISBN 1-55392-422-3, 2004), pp. 41-61.
24. Manitoba Association of Community Health, Diabetes Prevention Project for Children and the
growing. A comprehensive diet and physical activity strategy National Aboriginal Diabetes Association, Healthy Living Activities for Grades 4 to 6 [online].
is needed that is culturally appropriate and includes Available from World Wide Web:
<http://www.nada.ca/resources/pdf/April5_ActivityBook_Gr%204-6.pdf >. Also, a variety of
promotion, policy and environmental change strategies ‘How-to’ resources [on-line]. Available from World Wide Web:
<http://www.nada.ca/resources/resources_howto.php>.
particularly for middle-aged men who have emerged as a key 25. National Aboriginal Diabetes Association with the National Indian & Inuit Community Health
at-risk group. Early detection, treatment and control of Representatives Organization, Sharing Successes Resource Directory—2004 [online].
Available from World Wide Web: <http://www.nada.ca/resources/resources_directory.php>.
75
26. T. K. Young and C. A. Mustard, January 2001, Undiagnosed diabetes: does it matter?
Canadian Medical Association Journal, 164, 1: 24-28.
27. Clinical Practice Guidelines Expert Committee, December 2003, Canadian Diabetes
Association 2003 clinical practice guidelines for the prevention and management of diabetes in
Canada, Canadian Journal of Diabetes, 27, 2: p. S12.
28. S. B. Harris et al., October 2005, Glycemic control and morbidity in the Canadian primary care
setting (results of the diabetes in Canada evaluation study), Diabetes Research and Clinical
Practice, 70, 1: 90-97.
29. A. J. Jin et al., 2004, Evaluation of a mobile diabetes care telemedicine clinic serving
Aboriginal communities in Northern British Columbia, Canada, International Journal of
Circumpolar Health, 63, 2: 124-128.
30. D. Dannenbaum et al., 1999, Comprehensive computerized diabetes registry: Serving the Cree
of Eeyou Istchee (Eastern James Bay), Canadian Family Physician, 45: 364-370.
31. D. Maberley, Diabetes and Diabetic Retinopathy in Canadian Aboriginal Peoples: a
Literature Review [online]. Available from World Wide Web:
<http://www.interchange.ubc.ca/bceio/DR_paper.html>.
32. Health Canada, Aboriginal Diabetes Initiative, First Nations On-reserve and Inuit in Inuit
communities: Program Framework [online]. July 2000. Available from World Wide Web:
<http://www.hc-sc.gc.ca/fnih-spni/alt_formats/fnihb-dgspni/pdf/pubs/diabete/2000_reserve-
program_e.pdf>.
33. Health Canada, Aboriginal Diabetes Initiative: Consultation summary report [online]. Cited
September 2005. Available from World Wide Web: <http://www.hc-sc.gc.ca/fnih-
spni/pubs/diabete/consult-sum-sommaire/index_e.html>.
76
Chapter 6
Injuries
Abstract
Injuries are a serious public health problem in Canada, and even more so in many First Nations
communities. Like previous studies, the First Nations Regional Longitudinal Health Survey (RHS)
results show that First Nations injuries tend to follow a similar pattern to the rest of the Canadian
population but occur with much greater frequency. Falls, sports, motor vehicle crashes and violence
are all frequent causes of injury. Alcohol contributes to some types of injuries, particularly suicide
attempts and violence. Certain groups are at higher risk of injury, including younger adults, men,
people living in lower-income households, people with problems such as depression or substance
abuse, and those living in isolated communities. Preventing injuries is likely to require action at
several levels: attacking the root causes (e.g., reducing social inequities, strengthening families);
modifying the environment or equipment (e.g., enforcing seatbelt laws); and introducing programs to
modify lifestyles (e.g., education on risks, treatment for substance abuse).
77
RHS 2002/03 Adult Survey – Chapter 6: Injuries
concussion. Each of these questions was answered with “yes”

Introduction
or “no,” so the resulting numbers reflect how many people
Injuries are a serious public health problem throughout experienced a given type of injury, rather than how many
Canada. Research indicates that in addition to death and injuries happened in total. The different types of injury are
disability, injuries (including sexual violence) contribute to a not mutually exclusive; some respondents might have been
variety of other health problems including depression, injured more than once during the year.
alcohol and substance abuse, eating and sleeping disorders, Figure 1. Leading causes of death in First Nations, 2000
and HIV and other sexually transmitted diseases.1 The 120
consequences of these deaths and disabilities affect not only 105.4 104.9
the victim, but their families, communities and societies at
Number of deaths (per 100,000 people)

100
large.
80
Injuries can be broadly classified according to whether they 69.5
are intentional or unintentional. Unintentional injuries are
60
those for which there is no intent to harm, either from the
victim or someone else for example, falls or car crashes.
40
Intentional injuries include self-inflicted injuries (suicide or 26.5 25.4
self-harm) and those inflicted by someone else (homicide or 22.7
20
assault).
Injuries involve a complex interaction of factors.2 3 4 5At a 0
Circulatory Injury Cancer Respiratory Digestive Endocrine and
societal level, these include low socioeconomic status, disease disease disease immune
cultural norms that support violence to resolve conflict, and Cause of death
rigid gender roles.6 A community’s commitment to injury Source: First Nations and Inuit Health Branch, Health Canada: unpublished statistics.
prevention is another factor unsafe roads, easy access to The second set of questions asked about the causes of injury,
firearms and poor enforcement of seat belt use contribute to such as falls or car crashes. Again, these were yes/no
injuries.7, 8 At the individual level, there is evidence to questions. For each “yes” answer, a third follow-up question
suggest that injury risk is linked to income and education as asked if the incident was alcohol-related. Because of the way
well as alcohol and substance abuse.9, 10 the questions were structured, some assumptions had to be
In First Nations communities, injury is an even more made when analysing the alcohol responses. Many people
pressing issue than in the rest of Canada. It is one of the refused the alcohol questions; under-reporting is likely
leading causes of death for First Nations people, and is because of the stigma associated with alcohol use. In short,
responsible for approximately one quarter of all deaths and the numbers on alcohol involvement should be treated as
over half the potential years of life lost.11 Rates of injury estimates only.
death for First Nations were almost triple the Canadian
average in 2000,12 and injuries are among the most common Results
reasons for hospitalisation.13 However, although injury death
rates in First Nations remain high, they have decreased Types and causes of injuries
considerably since 1979 especially for unintentional According to the RHS, 28.8%i of First Nations adults
injuries.14, 15 sustained an injury serious enough to require medical care in
Injuries can be looked at in various ways. Many studies use the year prior to the survey. This rate is far above the
mortality data, while others focus only on injuries serious Canadian average: in 2003, the proportion of Canadians age
enough to require hospitalisation. In contrast, surveys allow 12 or older that was injured seriously enough to limit their
for a more detailed picture of the smaller day-to-day injuries. normal activities was only 13.1%.ii16 Rates for Aboriginal
The RHS asked about any injury in the preceding year that peoples living outside First Nations communities appear to
was serious enough to require care from a health be halfway between the RHS and general Canadian figures.
professional. This chapter presents the resulting information Over the 2000-2003 period, 20% of Aboriginal people living
on what types of injuries people are experiencing what off-reserve sustained an injury serious enough to limit their
caused these injuries and which groups are at greatest risk. normal activities.iii 17
Interpretation Methods
i
The RHS asked three sets of questions on injury. The first set variation is greater than 33.3%.
ii
The comparison is not perfect, because the age groups are not identical and also because of
focused on the nature of injury. People were asked if, in the differences in question wording: RHS asked about injuries that required medical care, whereas the
year prior to the survey, they had experienced any of a list of Canada-wide survey asked about injuries that limited the person’s usual activities. Note also that
these figures are not age-standardized.
injuries such as major cuts, sprains, broken bones or iii
This figure is for people with any First Nations ancestry living off-reserve in any of the provinces.
It does not cover the Territories.
78
What are these injuries? In the RHS, the most commonly Groups at greater risk of injury
reported types were major cuts, scrapes, or bruises; major
Injuries are not random: certain people may be particularly at
sprains; and broken bones or fractures. The picture among
risk because of their age, sex, personal characteristics,
other Canadians, and among First Nations people off-reserve,
occupations, or living environment. The RHS results show
was similar; sprains/strains and broken bones were among
that males are at much higher risk than females;iv 33.6% of
the most common types of injury.
males and 23.8% of females reported being injured in the
Figure 2 Proportion of respondents who sustained various types previous year. In particular, men were significantly more
of injuries (n=10,877)
likely than women to have an injury caused by sports, bicycle
Major cut, scrape, bruise 14.3% accidents, or environmental factors (such as insect stings or
Major sprain or strain 12.7%
frostbite). This pattern is frequently found in injury statistics,
and is often attributed to men being more likely to engage in
sports and to work in higher-risk occupations.19
Broken bones 9.0%
Burns or scalds 4.3%

The RHS results show that rates of injury are lowest in
Nature of injury
Dental injury 3.9%

children, and are far higher in youth and young adults (18–
Dislocation 3.4% 34) than in older age groups. In the adult age ranges, younger
Concussion 2.9%
men are at significantly greater risk than other age/sex
groups; almost half (42.8%) of men between the ages of 18
Hypothermia, frostbite 1.6%
and 34 report having had some type of injury in the previous
Injury to internal organ 1.5% year. These findings are consistent with studies of the
Poisoning 1.1% Canadian population as a whole, which usually find the
0% 2% 4% 6% 8% 10% 12% 14% 16%
highest injury rates in youth and young adults.20
Table 1. Proportion of respondents who reported one or more
The causes of injury most frequently mentioned by injuries in the previous year, by age group (n=22,543)
respondents were falls, sports injuries, incidents with motor Age group with 1+ injuries
vehicles (cars, snowmobiles, ATVs), and violence (family
violence or other assault). 0-11 17.5%
Figure 3. Proportion of respondents reporting various causes of 12-17 49.5%

injury (n=10,962) 18-34 35.3%
Fall/trip 10.7%
35-54 24.2%
Sport 6.2% 55+ 22.1%
* All differences statistically significant except between adults 35-54 and those 55+.
Motor vehicles 5.4%
There appears to be a general decrease in injury rates with

Cause of injury
Violence 4.8%
higher levels of formal education, this finding was not

Burns/scalds 2.3%
statistically significant. Moreover, the RHS results suggest
Bicycle 1.8% that lower-income people are at greater risk of injury; 30.9%
Environmental 1.7%
of people in the lower-income households, but only 23.4% of
those in higher-income households,v reported having been
Suicide attempt/self-
injury
1.0% injured. Studies elsewhere in Canada have come to
Other 8.3%
conflicting conclusions on the relationship between income
and injury.21 Some have found that high-income people are
0% 2% 4% 6% 8% 10% 12%
at greater risk, presumably because they can afford risky
* Collisions between bicycles and motor vehicles would be placed in the Motor vehicles group.
activities such as skiing;22 others have found that people in
Overall, alcohol was said to be involved in just 5.1% of all low-income groups are at greatest risk.23
the incidents that people mentioned but it contributed
disproportionately to certain types of incidents. Thus, while
alcohol was rarely mentioned in connection with burns or
sports incidents, it was implicated in about a quarter of the
motor vehicle crashes and falls (27.6%, 25.7%), over half
(56.9%) the instances of violence, and fully 80% of the iv
suicide attempts. The same associations between alcohol use significant— is noted. Differences, in this chapter, are considered significant when confidence
and violence or suicide have been documented in other intervals do not overlap at the 95% confidence level (after bonferroni adjustment).
v
“Lower income” was defined as a household income that fell into these ranges: under $15,000 for 1-
populations.18 2 person households; under $20,000 for 3-4 person households; and under $30,000 for households
with five or more people. All remaining incomes were placed in the “higher” group. Note that many
people did not respond to the income question.
79
Figure 4. Proportion of respondents who reported one or more that are most common. For instance, the presence or absence
injuries in the previous year, by age group and sex (n=10,903)
of roads, and the condition of those roads, will affect the risk
50%
of motor vehicle crashes. A community’s size might be
42.8% reflected in its recreational facilities, and hence in its
Male
40%
Female
incidence of sports injuries. The extent to which a
community controls its own services, cultural facilities and
land base has been shown to be related to suicide rates.24
30% 27.6%
26.5%
24.9%
Arguably, community control might also be associated with
21.6% lower rates of other intentional injuries such as assault or
19.4%
20% family violence.
In the RHS results, injury rates did not seem to be associated
10% with either a community’s size or its transfer status.
However, a community’s level of isolation did seem to have
0%
an effect: the more isolated communities had higher injury
18-34 35-54 55+ rates compared to non-isolated communities.
Age group
* Percentages shown are within each age/sex group. Table 4. Proportion of respondents with an injury in the previous
year, by isolation of community (n=10,543)
Table 2. Proportion of respondents who reported one or more Isolation status with 1+ injuries
Injuries, by education (n=10,812)
Isolated (no road access) 34.6%
Education with 1+ injuries
Semi-isolated (more than 90 km to a
Did not graduate high school 30.5% 32.2% (NS)
physician)
High school graduate 29.9% Non-isolated (within 90 km of a physician) 27.1%
Post-secondary 25.2%
Falls and trips
University degree(s) 23.8%
Falls were the cause of injury most frequently mentioned by
the adults who answered the RHS. This is consistent with the
Unexpectedly, injury rates were not associated with personal picture for other Canadians and for First Nations people who
characteristics such as life control (the degree to which the live off-reserve. In both of these groups, falls are similarly
person believes they control events in their own life) or the the leading cause of injury.25
perception of being “in balance” in the physical, mental,
emotional and spiritual aspects of life. They were, however, The RHS results show that rates of falls are significantly
associated with a series of factors indicative of a troubled life higher in young adults (18–34) than in adults aged 35–54
and/or residence in a troubled community. Thus, injury rates years. Possible explanations for the higher rates in young
were significantly higher in people who had used illegal adults might include more risk-taking behaviour, higher
drugs in the previous year; in people who are frequent, heavy levels of participation in sport, and perhaps more use of
drinkers; in people who had been depressed, or had ever alcohol. Unlike many types of injury, falls appear to be
considered suicide; and in people who had had a close friend equally common in men and women.
or family member who committed suicide in the previous Table 5. Proportion of respondents who reported falling in
year. previous year, by age group (n=10,903)
Table 3. Proportion of respondents who were injured in the Age group (years) % reporting fall
previous year, by indications of problems in life (n=10,313)
18-34 years 13.6%
Type of problem Yes No
35-54 years 8.2%
Used illegal drug(s) in the past year 40.3% 22.8%
55+ years 8.7% (NS)
Is a frequent, heavy drinker 39.5% 31.6%
Total 10.6%
Felt depressed for two weeks or more in
38.8% 24.2%
past year
Considered suicide at some time in Sports injuries
36.3% 25.1%
his/her life
Close friend or family member Sports injuries are common: 6.2% of RHS respondents
41.0% 26.3% indicated that they had incurred one or more injuries due to
committed suicide in past year
sports in the year prior to the survey. Predictably, sports
The community environment and injury injuries are far more likely to happen to men than to women:
The community environment both physical and social can 9.3% vs. 3.0% respectively. There is also a clear age pattern:
affect both the likelihood of injury, and the types of injuries
80
10.8% of adults age 18–34 had a sports injury, compared to known about other forms of assault. At an individual level,
just 2.7% of the people age 35–54. family violence is said to be more common in people who are
young, who have low income and education levels, who have
Motor vehicle crashes personality traits like insecurity and low self-esteem, and
who experienced abuse in their own families of origin.34 At a
In the RHS, 5.4% of all adults reported that they had been social level, it is believed that women are especially
involved in one or more accidents involving a motor vehicle vulnerable in societies where there are marked gender
in the previous year. Men were significantly more likely than
inequalities, rigid gender roles, and general acceptance of a
women to have been injured in a motor vehicle crash (6.8% man’s right to inflict violence on his partner.35 Efforts to
vs. 3.9%). However, there were no statistically significant prevent family violence typically involve support for victims
differences in crash rates among the various age groups.
(such as shelters, legal assistance and job training) and legal
Throughout Canada, rates of fatal motor vehicle crashes have reforms such as criminalizing family violence. Treatment
dropped steadily over the past twenty years. This decline programs for abusers have also been tried, but often suffer
results from a combination of factors, including mandatory from high drop-out and no-show rates.36
seat-belt laws, more crashworthy car designs, safety features Overall, 4.8% of adults told the RHS that they had suffered at
like airbags and child restraints, road improvements and
least one instance of violence in the preceding year. This
decreases in the proportions of people who drink and proportion did not differ significantly by gender. It can be
drive.26,27 Like other Canadians, First Nations people have speculated that the lack of a gender difference in instances of
been part of this trend; First Nations death rates from motor
violence is because, although women suffer more domestic
vehicle crashes have been decreasing since 1979.28 violence, men are more likely to suffer other types of assault
Despite the decreases, First Nations people are still at greater as a result of fights and brawls.
risk than other Canadians of being involved in a fatal crash.
For instance, a recent study in British Columbia showed that Conclusions
“Natives” were 4.3 times more likely to die from motor
By identifying the common causes of injuries, the RHS
vehicle crashes than other residents of the province.29
results can help communities to plan programs that reduce
However, figures from Alberta show that First Nations
injury rates. As well, the results clearly show that certain
people are only slightly more likely than other Albertans to
groups are at greater risk, and should perhaps be targeted in
need emergency room care for a crash30 and the motor
any intervention. Men, younger adults, people living in low-
vehicle injury rates reported to the RHS, while not directly
income households, and people with problems such as
comparable to Canadian ones, do not appear to be radically
depression, thoughts of suicide, illegal drug use or frequent,
higher than average. In short, it may be that the gap between
heavy drinking behaviour are amongst these groups.
First Nations and other Canadians is widest for fatal crashes.
How can injuries be prevented? It is useful to think of
Why would First Nations people be at greater risk of a motor
making changes at three levels: the person (education), the
vehicle crash, fatal or otherwise? A large part of the
equipment, and the environment.37 Often, a combination of
explanation probably lies in their living situation. Motor
all three levels is most effective. For instance, experience has
vehicle crashes have been observed to occur more frequently
shown that education programs have little or no impact on
in areas of low per capita income and in rural areas in
their own38 and work best when paired with action at other
Canada.31 Many First Nations communities are located far
levels. Some of the more successful initiatives in Canada
from centres that provide everyday services or activities, so
have involved a combination of education and legislative
people travel frequently and they may need to travel over ice
action. Death and disability rates have declined appreciably
or on roads that are in poor condition—icy, flooded or with
because of seat belt laws, designated-driver programs, and
animals crossing them.32 Bad weather, mechanical failure, a
regulations governing fire-retardant clothing and upholstery.
lack of driver training, carrying too many passengers and
driving under the influence of alcohol raise the risks of a Other strategies can be implemented at the level of the family
crash. And low use of seatbelts raises the risk that any crash or community. For example, many falls (especially by
that does happen will be fatal.33 Finally, people in rural areas seniors) can be prevented by simple modifications to the
are more likely to use vehicles such as snowmobiles and environment, such as removing loose rugs, adding handrails
ATVs that are hard to manoeuvre and to see on public roads. to stairs, or removing snow and ice from walkways.39 Rates
of sports injuries can be reduced through education (e.g.
Violence skiing lessons), creating safer environments (e.g. bike paths)
and promoting use of protective equipment (e.g.: helmets,
Violence in this analysis included both family violence and elbow protectors for skateboard users).40 Sidewalks, one-way
other types of assault although both types are likely to be
streets and reflective clothing all help to reduce the number
under-reported in a survey. The risk factors for family of collisions between pedestrians and cars41 and enforcing
violence have been extensively studied, although less is
81
laws on speeding and driving under the influence help

prevent motor vehicle crashes of all types. 33.
34.
Ibid.
World Health Organization, Intimate Partner Violence [online].
35. Ibid.
Violence may be harder to prevent than other types of injury. 36. Ibid.
37. W. Haddon, 1980, The basic strategies for reducing damage from hazards of all kinds, Hazard
Its root causes are said to be unemployment, feelings of Prevention, 16: 8-11, as described in A Journey: Strengthening Aboriginal Communities
powerlessness caused by racism and discrimination, and past through Injury Prevention: Facilitator’s Guide by the Alberta Centre for Injury Prevention and
Control (Edmonton, Alta.: Alberta Centre for Injury Prevention and Control, revised 2001).
experience of violence in the home.42 However, communities 38. Insurance Institute for Highway Safety, May 2001, Status Report, 36, 5.
39. Gordon Trueblood, Prevention of falls and fall-related injuries among First Nations and Inuit,
may find it easier to tackle intermediary factors that are more draft document (Ottawa, Ont.: First Nations and Inuit Health Branch, Health Canada, 2002).
directly under their control such as alcohol abuse, exposure 40. Direction de la santé publique de Montréal-Centre et al, Prévenons les blessures chez nos
enfants: guide à l’intention des intervenants (Montreal, Que. : Régie régionale de la santé et
to violence and deterioration of “buffer” services like des services sociaux de Montréal-Centre, 2001).
41. Ibid.
schools, recreation centres, libraries and mental health 42. Larry Cohen and Susan Swift, October 1993, A public health approach to the violence
programs.43 epidemic in the United States, Environment and Urbanization, 5: 50-66. Also available from
World Wide Web: <www.preventioninstitute.org>.
43. Ibid.
Many injuries are preventable, and First Nations people do
not have to accept injury as an inevitable part of life. Even a
small reduction in injury rates would have a substantial effect
on the health and quality of life of First Nations people.
Notes to Chapter 6
1. World Health Organization, Intimate Partner Violence [online]. 2002,WHO. Cited 23 August
2005. Available from World Wide Web:
<www.who.int/violence_prevention/violence/world_report/factsheets/en/ipvfacts.pdf>.
2. Health Canada, Unintentional and Intentional Injury Profile for Aboriginal People in Canada:
1990-1999 (Ottawa, Ont.: Health Canada, 1999).
3. P. McFarlane, Winter 1997, Accidents Waiting to be Prevented, In Touch, 7,3 (issue devoted
to injury prevention).
4. Institute of Health Promotion Research, University of British Columbia, Injury Prevention
Programs in First Nations Populations (Vancouver, B.C.: University of British Columbia,
March 1995).
5. T. Kue Young, “Injuries and Social Pathologies,” The Health of Native Americans: Towards a
Biocultural Epidemiology (New York, N.Y.: Oxford University Press, 1994).
6. World Health Organization, Facts About Injuries: Preventing Global Injuries [online]. 2001,
WHO, Injuries and Violence Prevention section. Cited 23 August 2005. Available from World
Wide Web:
<www.who.int/violence_injury_prevention/publications/factsheets/en/index.html>.
7. Ibid.
1990-1999.
9. Kathryn Wilkins and Evelyn Park, “Injuries,” Health Reports 15, 3 (May 2004), pp. 43-48.
10. World Health Organization, Facts About Injuries: Preventing Global Injuries [online]. 2001,
WHO, Injuries and Violence Prevention section. Cited 23 August 2005. Available from World
Wide Web:
<www.who.int/violence_injury_prevention/publications/factsheets/en/index.html>.
1990-1999.
12. First Nations and Inuit Health Branch, Health Canada Unpublished data.
1990-1999.
14. Ibid.
15. First Nations and Inuit Health Branch, Health Canada. Unpublished data.
16. Statistics Canada, Canadian Community Health Survey 2.1 Indicator Profiles, by sex, Canada,
provinces, territories, health regions and peer groups [online]. Cited September 2005.
CANSIM table 105-0200. CCHS Profiles, catalogue 82-576-XIE. Available from World Wide
Web: <www.statcan.ca>.
17. Michael Tjepkema, “Non-fatal injuries among Aboriginal Canadians,” Health Reports 16, 2
(March 2005), pp. 9-22.
18. World Health Organization, Facts About Injuries: Preventing Global Injuries [online].
19. Wilkins and Park, “Injuries,” Health Reports, pp. 43-48.
20. Ibid.
21. Tjepkema, “Non-fatal injuries among Aboriginal Canadians,” Health Reports.
22. Wilkins and Park, “Injuries,” Health Reports, pp. 43-48.
23. Ryan Smith, “Injuries to children show definite patterns, study shows,” ExpressNews [online].
1 April 2004, University of Alberta. Available from World Wide Web:
<www.expressnews.ualberta.ca/print.cfm?id=5703>.
24. M. J. Chandler and C. Lalonde, 1998, Cultural continuity as a hedge against suicide in
Canada’s First Nations, Transcultural Psychiatry, 35: 191-219.
25. Tjepkema, “Non-fatal injuries among Aboriginal Canadians,” Health Reports.
26. World Health Organization, Facts About Injuries: Preventing Global Injuries [online].
27. Statistics Canada, “Impaired Driving,” The Daily [online]. 7 November 2003. Available from
World Wide Web: <www.statcan.ca/Daily/English/031107/d031107b.htm>.
28. First Nations and Inuit Health Branch, Health Canada. Unpublished data.
Programs in First Nations Populations
30. C. J. Cardinal et al., First Nations in Alberta: A Focus on Health Service Use (Edmonton,
Alta.: Alberta Health and Wellness, 2004).
31. Young, “Injuries and Social Pathologies,” The Health of Native Americans: Towards a
Biocultural Epidemiology.
Programs in First Nations Populations
82
Chapter 7
Access to Dental Care and Treatment Needs
Abstract
This chapter describes the level of access to dental care and the treatment needs of First Nations adults
in Canada aged 18 and over —estimated from the 2002/03 First Nations Regional Longitudinal
Health Survey (RHS). An interviewer-administered questionnaire collected data on health and dental
care access and health conditions. In addition, the survey also collected information on behavioural
and sociological determinants of health for 10,962 adults. Fifty-nine percent of respondents indicated
they received dental treatment in the past year, with rates lowest among males and older adults. Only
34.4% of First Nations elders (65+) received dental care in the past year compared to 46% of non-
Aboriginal Canadians aged 65+. Differences for receiving dental care within the past year varied by
education level. Principal barriers in accessing dental care included long waiting times, lack of dental
coverage under Health Canada’s Non-Insured Health Benefits Program (NIHB), cost and
unavailability of service. Receipt of dental care was associated with the respondent’s level of
education, employment status, self-reported health status, activity limitations, and the community’s
degree of isolation. Dental treatment needs have increased since 1997 for all treatment types. The
highest relative increases occurred for urgent dental care, periodontal treatment and maintenance.
Being overweight or obese and having diabetes were found to be associated with the need for
prosthetics and periodontal treatment. A collaborative approach to prevent oral disease for First
Nations people will be more effective than a disease-specific approach.
83
RHS 2002/03 Adult Survey – Chapter 7: Access to Dental Care and Treatments Needs
Note: The tables are located at the end of this chapter. that time, most dental services were available only for
children. These findings are consistent with other surveys of
adult Inuit populations in Canada. Among Canadian Inuit
Introduction elders aged 60 years and over living in three communities in
Health services for Aboriginal people in Canada are currently the Keewatin region of the NWT, total edentulism was
undergoing an important transition. Authority over the observed in 35 percent of the population, although only 47
delivery of services has shifted from the federal, provincial percent wore dentures.6, 7 Periodontal assessments revealed
and territorial governments to First Nations, Inuit and Métis, that the vast majority of the Inuit elders examined required
the three federally recognized Aboriginal groups in Canada. scaling and/or complex periodontal treatment.
Since 1989, Health Services Transfer Agreements between The levels of caries and periodontal disease in the Inuit in the
Health Canada and First Nations and Inuit (and to a lesser 90s are much higher than those reported for Inuit residing in
extent, the Métis) have provided the opportunity for Foxe Basin aged 16 years and over in 1969 and 1973,8 and in
Aboriginal communities to manage their own health First Nations adults living in communities in British
programs and services, thereby overcoming some of the Columbia and the Yukon Territories in the early 70s.9
administrative and jurisdictional barriers that previously Although no epidemiologic study of the oral health status of
impeded the delivery of health care services to these groups.1 Canadian Aboriginal adults has been conducted since the
Although this political development has been important with early nineties, there appears to be a trend toward a higher
regard to the health status of Aboriginal Canadians, its prevalence of oral diseases in today’s Aboriginal people than
impact on the health of Aboriginal people in general, and t on there was a decade or two ago. The increased incidence of
their oral health in particular, has yet to be fully determined. dental problems might explain the high levels of dental
Analyses of the First Nations and Inuit Regional treatment need found in the 1997 FNIRLHS.10 Also, the
Longitudinal Health Survey (FNIRLHS) of almost 10,000 2003-04 annual report of the Non-Insured Health Benefits
adults residing on reserves in 1997 revealed that the effects (NIHB) Program of Health Canada documents a 22 percent
of changes in Aboriginal lifestyle in recent decades were increase in expenditures on dental benefits provided to
clearly evident in the case of dental health, an area where registered First Nations and Inuit people since 1993-94.11
problems have rapidly escalated due to changes in diet.2 Findings from the 1991 Indian Health Service (IHS) Patient
Overall, just over half of the respondents in the FNIRLHS Oral Health Status and Treatment Needs Survey present
indicated that they received dental care within the previous similar trends in caries experience, tooth loss, periodontal
year, but approximately 50 percent needed dental treatment disease and treatment needs among American Indian and
at the time of the survey. For those who needed dental Alaska Native adult populations since 1984.12-16 It has been
treatment, the most common treatment required was suggested that Type II diabetes accounts for the significant
restorative work such as fillings. This was followed by increase in periodontal diseases and tooth loss in Native
maintenance (dental check-ups and teeth cleaning), dentures American populations.17-20 Similarly, Canada’s Aboriginal
and tooth extractions. Relatively few respondents mentioned people suffer disproportionately from chronic diseases
periodontal work, while 22 percent had experienced dental (obesity, Type II diabetes, cardiovascular diseases, and
problems or pain in the past month.3 arthritis) in comparison with the rest of the country.21, 22
Historical overview Diet is also an important determinant of oral health that can
be modified through improvements to nutritional education
The 1997 FNIRLHS did not include a clinical examination and greater availability of healthy foods in remote
component to assess the oral health status and the extent of communities. However, when oral diseases occur, treatment
the dental treatment needs of the survey participants. remains the only option to restore health and this will require
However, regional oral health surveys of adults conducted greater access to care. Therefore, the availability of health
over a decade ago indicate that Aboriginal Peoples have care services will continue to be one of the most important
poorer oral health status than Canadians as a whole. In 1990, determinants of general and oral health among Aboriginal
22 percent of Inuit in the Keewatin region of the Northwest peoples.
Territories (NWT) were completely edentulous as compared
with 13 percent of non-Inuit persons living in the region.4, 5 This chapter focuses on the level of access to dental care
The median number of decayed, missing and filled teeth currently available to Canadian Aboriginal adults aged 18
(DMFT index) observed was 23.1 for Inuit adults and 19.7 and older and the factors influencing accessibility to dental
for non-Inuit. Seventy-three percent of the dentate services as recorded in the 2002-03 First Nations Regional
individuals had bleeding gums, but only two percent had an Longitudinal Health Survey (RHS). The chapter also
average pocket depth greater than 3 mm, as pocket depth is addresses the perceived levels of dental treatment need and
associated with age and there were very few Inuit and non- the prevalence of self-reported dental injuries among First
Inuit adults older than 55 years. Two-thirds of the sample Nations adults.
required preventative and/or dental treatment services. At
84
Finally , this chapter includes comparisons with comparable respondents received dental care recently, nearly 79% of the
estimates for the general Canadian adult population. Sources adolescent participants in the RHS, and 69% of the children,
for comparative Canadian results include the 2003 Canadian received dental care in the previous year.
Community Health Survey (CCHS)23 and the 1996-97
RHS results presented in Figure 1 and Table 1 show variation
National Population Health Survey (NPHS)24, 25 from
in dental care by sex, i.e., females had a higher rate of dental
Statistics Canada.
care in the previous year (64.8%) than males (53.6%). Figure
The RHS Cultural Framework (as outlined in the 1 also illustrates that rates of dental care have increased for
introduction) was used to analyze the data and interpret the both sexes since the previous RHS conducted in 1997 (59.2%
results. The Cultural Framework considers total health to be in the 2002-03 RHS, up from an estimated 52% in 1997).
inclusive of the total person in the total environment.26 Total More non-First Nations males aged 20 and over (63%) have
health is understood, in its broadest sense, as all aspects of consulted with a dental professional (dentists, orthodontists
health and well-being, interconnected and interdependent. or dental hygienists) in the previous 12 months than
The total person encompasses the mind, body, heart and Aboriginal males (Figure 1).
spirit, and includes all the factors that affect the person’s Figure 1. Proportion of adults who received dental care in the
physical, mental, emotional and spiritual health. To have past year
total health is to be in harmony with oneself and with the 80%
living environment – Mother Nature.27

66.0% 65.0%
64.0%
This framework was also used to select the items from the 60.0% 61.0%
62.0% 63.0%
59.0%
60%
questionnaire that were used as explanatory variables in the 54.0%
57.0%
52.0%
analysis. For the analyses in this chapter, six outcomes were 47.0%
selected and based on the following questions:
40%
1. Whether the respondent had any difficulty accessing
dental care provided through the NIHB program for
status First Nations and Inuit persons through Health
Canada; 20%
NPHS 96/97
CCHS 2003
2. When was the last time the respondent had any dental RHS 1997
RHS 02/03
care;
0%
3. Whether the respondent had ever faced any problems Male Female Total
accessing dental care; NPHS - 1996-97 National Population Health Survey (n=21,599),20, 21
RHS 1997 - National Health Survey of First Nations and Labrador Inuit (n=9,870),2
4. What type of dental treatment he/she currently needed; RHS 2002-03 - First Nations and Inuit Regional Longitudinal Health Survey, n=10,455)
CCHS 2003 - Canadian Community Health Survey (CCHS)* (n=?).19 participants aged 20 years and
5. How they would rate the level of access to health older.
services available to them compared to Canadians

Analyses by age groups that are consistent with the NPHS
generally; and,
and CCHS reveal that only 34.4% of Aboriginal adults aged
6. Whether they had experienced any injuries that required 65 and older received dental care in the past year as
the attention of a health care professional in the previous compared to 46% of older non-Aboriginal Canadians (Figure
12 months(dental injury was then selected for analysis 2). Generally speaking, the likelihood of a recent dental visit
among those injuries that had). has increased for Canadians of all ages since the NPHS in
1996-97.
Results
Table 2 presents the age-specific results for the 2002-03
RHS. 60.2% of seniors aged 60 and over did not report
Dental care utilization
receiving dental care in the previous year, compared with
Table 1 shows the percentage distribution of the interval 36.6% of those aged 18 to 29 years. Although a similar trend
since First Nations adults’ most recent instance of obtaining by age was reported in the 1997 RHS,28 the situation appears
dental care, by selected demographic and socioeconomic to have improved for those aged 18-29 years, with a slightly
categories. Less than 1% had never had dental care, 10.0% of lower prevalence of “no dental care” reported in 2002/03.
the population had not had dental care in the previous 5 years
Individuals who did not graduate from high school reported
or more, and a similar percentage (13.4%) received dental
the highest rate of lack of dental care in the preceding year
care between 2 and 5 years previously. Approximately
(45.5%) compared with those having a college diploma
seventeen percent (16.7%) had received care between 1 and 2
(34.2%) (Table 2). A larger proportion of unemployed
years before the survey and the majority (59.2%) received
individuals had not had dental care in the previous year
some type of dental care within the year preceding the
compared with those who were employed full-time (45.9%
survey. Although 59.2% of the First Nations adult
vs. 34.7%, respectively) (Table 2).
85
Figure 2. Proportion of adults who received dental care in the too long and that services are not covered by the NIHB. As
past year by age group
80%
expected, those in the higher household income brackets
were less likely to cite ‘can’t afford it’ and are generally less
69.0%
68.0% likely to cite transportation costs as a barrier. Perhaps the
63.0% 62.0%
60.0% 60.0% 61.0% most important findings (presented in Table 3) were that, for
60%
52.0%
54.0% many of the barriers cited by the surveyed population,
**
46.0% residents in communities with a multi-community health
*
42.0%
services transfer agreement were more likely to report these
40%
34.0% barriers than both residents in communities who had control
over the delivery of health services (and managed their own
health programs) and those living in communities that were
20%
NPHS 96/97
not part of the health transfer agreement.
RHS 02/03
CCHS 2003
Dental treatment needs
0%
20-34 35-54 55-64 65+
The proportion of adults who reported having a need for
Age group (years)
NPHS - 1996-97 National Population Health Survey (n=21,599),20, 21

dental care is presented in Table 4. It is shown by the kind of
RHS 1997 - National Health Survey of First Nations and Labrador Inuit (n=9,870),2 dental care the respondents required, and whether or not they
RHS 2002-03 - First Nations and Inuit Regional Longitudinal Health Survey, n=10,455)
CCHS 2003 - Canadian Community Health Survey (CCHS)* (n=?).19 participants aged 20 years and had any difficulty in accessing dental services provided
older.
RHS 2002-03 distribution significantly different from NPHS 1996-97 (Chi-squared test, *p<0.05) and
through the NIHB program (last column). Table 4 also
CCHS 2003 (Chi-squared test, **p<0.01). includes on-reserve comparisons from other periods, namely
the 1997 RHS,29 and a global rating of access to health
Lack of dental care was also associated with self-reported services that asked respondents whether their level of access
health status, as shown in Table 2. Those who reported was ‘better’ or the ‘same / less’ than that available to
‘poor’ health (48.9%) or ‘fair’ health (51.0%) had not had Canadians in general.
any dental care within the past year, compared with 35.0% of
those reporting ‘very good’ and 33.6% reporting ‘excellent’ There was a dramatic increase in the reported need for dental
health. Disability and activity limitations were also found to care (all types of treatment) specified by the respondents over
be related to dental care utilization in the Aboriginal time. The need for dental fillings, crowns or bridges
population. Among those who reported physical limitations increased by 2 1/2 times, (from 15.4% in 1997 to 36.9% in
in activities to occur ‘often’, 50.6% had not received dental 2002/03). The increase was much higher for urgent dental
care in the year before the RHS 2002-03, compared with problems and for periodontal care and maintenance (see
39.7% of those with no limitations or who were able to carry Table 4).
out their usual activities. Slightly less than half of those reporting the need for urgent
Accessibility of dental care services was associated with the dental treatment (45.5%) said that they had difficulty
degree of isolation and remoteness of the community in accessing NIHB services. This was followed by 42.1% of
which the individual resides. Although the relationship was those who needed periodontal work and by 36.1% who
not linear, 55.6% of those residing in isolated communities required orthodontic work (Table 4). Nearly 60% (55.7%) of
had not had dental care within the previous year as compared the respondents who needed urgent dental treatment due to
to 37.7% of those living in non-isolated communities (Table pain or other problems perceived they had less access to
2). health services (including dental services) compared to the
rest of the Canadian population. This finding is strikingly
Barriers to dental care access similar to the 1997 FNIRLHS results, where almost 60% of
the Aboriginal population believed that health services
Principal barriers faced by participants in accessing dental offered to First Nations/Inuit people were not equal to those
care are given in Table 3. One in five (20.8%) reported that offered to other Canadians.30
long waiting times (‘waiting list too long’) was the primary
barrier. This was followed by ‘service not covered by NIHB’ Interestingly, the need for dentures or other prosthetic work
(17.6%) ‘can’t afford it’ (16.9%) and service ‘not available’ was positively associated with an individual’s percent of
in the area (15.1%). Denial of approval for dental services body fat, as measured by the Body Mass Index (BMI)
under NIHB was the next most frequently reported barrier to (Figure. 3). Specifically, those who were overweight or obese
care, but only 14.3% reported to have faced this problem. were more likely to need denture placement or repairs than
those with ‘healthy’ BMI. There is ample evidence in the
Adults between 30 and 59 years old were more likely to feel literature to support an association between edentulousness
that services were inadequate compared to younger adults or poor dentition status and a lower BMI, as well as with
(Table 3). Similarly, adults between 30 –and 49 are more overweight and obese adults.31, 32
likely than older adults (60+) to report that waiting lists are
86
Figure 3. Proportion of adults needing prosthetic work by body associated with having physical disabilities as a result of
mass index group
diabetes (12.7%) - much higher than the rate for diabetics not
20%
17.7%
having physical disabilities or activity limitations (4.1%).
16.2%
15.5%
Dental injuries
15% 14.2%
Injuries are a major cause of hospitalization, and accidents

remain one of the leading causes of potential healthy years of
10% 9.6% *
*
life lost.38 Motor vehicle accidents are one of the major
contributors to this toll, and alcohol played a role in a
majority of these accidents.39 When such accidents occur,
5% injuries to the head and neck are common, especially trauma
to the face, the mouth and the anterior teeth. An
epidemiological investigation of injuries in the Northwest
0% Territories found that First Nations and Inuit mortality rates
Underweight Acceptable Overweight Obese Morbidly obese were twice that of non-Natives in the NWT.40
* chi-square p<0.001 Overall, only 3.9% of the respondents reported that they
This link is significant. Obesity has become a major health experienced a traumatic dental injury in the past 12 months
problem facing American Indians and Aboriginal Canadians that required a medical visit. Although there were no
and is believed to be associated with the adoption of a diet significant differences between the genders, the prevalence
high in fats and sugars and the rapid transition to a sedentary of dental injuries varied within age groups (Figure 5).
lifestyle.33-35 In the RHS 2002-03, 31.2% of respondents had Figure 5. Proportion of adults reporting a dental injury in the
a BMI ranging from 30 to 39.9 and 4.8% had a BMI in past year by gender and age
7%
excess of 40. Being underweight was uncommon in the
Aboriginal adult population, with only 1.1% having a BMI 6% 5.8% 5.9%
less than 18.5. 5.4% Male
5.0% Female
5% 4.7% Total
Because Aboriginal Canadians are especially vulnerable to
Type II diabetes - due in part to genetic susceptibility and to 4%
3.6%
the same risk factors for obesity - the association between 3.5%
prosthetic needs and diabetes was investigated. The results 3%

2.9%
are presented in Fig. 4. Higher proportions of adults in need 2.2%

of prosthetic work were found among those who have been 2%
diagnosed with diabetes (30.9%).

1%
Figure 4. Proportion of adults needing prosthetic work by
diabetes status, treatment, and limitations in activity 0%
40% 18-29 30-39 40-49
37.9%
35.2% * Age group (years)
** Note: statistics for 50-59, and 60+ age groups have been suppressed due to small sample size
30.9%
*
30%
**
28.5%
Table 5 shows the causes of dental injury in First Nations
Yes
No adults and their potential relationship with alcohol and drug
22.1%
use. Bicycle and motor vehicle accidents were the primary
20%
causes of tooth injuries, which were unrelated to alcohol or
drug use. Of adults who indicated that they had received an
11.1% injury from a physical assault, 20.5% experienced a dental
10%
injury compared to 3.3% who did not receive an injury from
an assault. Moreover, 12.2% of adults who cite receiving an
injury related to sport also indicate experiencing a dental
0%
Diagnosed with diabetes Undergoing treatment for diabetes Limitations in activity due to injury, whereas 3.4% of those not involved in a sport injury
diabetes
Diabetes diagnosis, treatment, and limitations
also report dental injury. Similarly, adults who report
Chi-square test: * p < 0.05, ** p < 0.001
receiving an injury from a fall or trip are more likely to
report a dental injury than those who have not fallen.
Type II diabetes is a putative risk factor in periodontal
disease and tooth loss in Native American populations.36, 37 A
need for periodontal treatment was reported by only 5.6% of
the RHS population (Table 4), but was significantly
87
Conclusion emergencies, such as broken brackets or lost appliances,

41 usually influenced the treatment outcome.49
Since the 1997 FNIRLHS, it is evident that dental care
access for Aboriginal Canadians aged 18 years and over has In light of associations between oral infections and chronic
only slightly improved. The 2002-03 RHS revealed that diseases in adults noted in recent studies, the findings that
59.2% of adult First Nations people had received dental care dental treatment needs were associated with diabetes and
in the previous year, up from an estimated 52% in 1997. unacceptable BMI scores have far reaching public health
However, in spite of the limitations of self-reported data, implications. Along with obesity, diabetes is more prevalent
results also indicate that untreated caries, periodontal and among Canadian Aboriginal adults than non-Aboriginals.50, 51
prosthetic treatment needs have more than doubled since the In some provinces, greater rates of smoking and alcohol
previous survey. In addition, the rate of dental care for older consumption have also been reported among First Nations
adults has declined from about 42% in 1997 to 34.4% in the people when compared with non-First Nations.52 Such data
2002-03 RHS. A reason for the decline in dental care contribute to a more comprehensive assessment of the burden
utilization by First Nations seniors may be because they now of oral diseases and tooth injury among the First Nations
wear dentures. Among people aged 15 and older who had not Peoples of Canada, and reveal the need for further research
visited a dentist in the past three years, 27% reported that into these risk factors, with the goal of designing appropriate
wearing dentures was the main reason for not seeking care, intervention programs for First Nations populations. These
according to the 2003 Canadian Community Health Survey.42 programs must be developed with the full partnership of First
Nations Peoples so that they may be developed with more
Edentate elderly are also at increased risk for nutritional
traditional approaches to health. Through such programs it is
deficiencies, poorer health status and more activity
likely that the oral health, as well as the total health, of First
limitations than younger adults. Self-reported health status
Nations populations will improve.
and functional limitations were both associated with lack of
dental care in the previous year. A review of the oral health
Notes to Chapter 7
status and service use among institutionalized older adults in
the United States and Canada revealed that, while frail older
1. Health Canada, Ten Years of Health Transfer First Nation and Inuit Control [online]. [Ottawa,
adults are afflicted with a host of dental diseases, many do Canada] : FNIHB, 2001. Available from World Wide Web: <http://www.hc-
not seek care from dental services.43 Despite rising concerns 2.
sc.gc.ca/fnihb/bpm/hfa/ten_years_health_transfer/>.
Fred Wien and Lynn McIntrye, “Health and Dental services for Aboriginal People,” First
over the aging of the population, very few comprehensive Nations and Inuit Regional Health Survey [online]. [Ottawa, Canada] : First Nations and Inuit
Regional Health Survey National Steering Committee, 1999, pp. 219-245. Available from
studies exist that describe the oral health status and treatment World Wide Web: <http://www.naho.ca/firstnations/english/pdf/key_docs_1.pdf>.
3. Ibid.
needs of elderly First Nations people in Canada. 4. Elizabeth Rea et al., February 1993, Adult dental health in the Keewatin, Journal of the
Canadian Dental Association, 59, 2: 117-118, 122-125.
Dental services use is largely determined by the ability to pay 5. --------- et al., 1993, Dental health in Keewatin Region Adults, Arctic Medical Research, 53, 2:
754-756.
for services. Use of dental services by Canadians as a whole 6. Douglas Galan, Olva Odlum and Michel Brecx, February 1993, Oral health status of a group of
correlates with dental insurance, income status and education elderly Canadian Inuit (Eskimo), Community Dentistry & Oral Epidemiology, 21, 1: 53-56.
7. ---------- et al., July 1993, Medical and dental status of a culture in transition, the case of the
level.44-46 In the RHS, dental care increased with education Inuit elderly of Canada, Gerodontology, 10, 1: 44-50.
8. John T. Mayhall, October 1997, The oral health of a Canadian Inuit community: an
and employment status. According to the NIHB program anthropological approach, Journal of Dental Research, 56, Special Issue: C55-61.
policy, dental coverage is not comprehensive, which may 9. Gordon S. Myers and Melvin Lee, March-April 1974, Comparison of oral health in four
Canadian Indian communities, Journal of Dental Research, 53, 2: 385-92.
explain why more complex types of dental treatment among 10. Wien and McIntrye, “Health and Dental services for Aboriginal People,” First Nations and
Inuit Regional Health Survey [online].
older First Nations adults are sometimes neglected. Overall, 11. Health Canada, Non-insured Health Benefits Directorate Program Analysis Division, Non-
14.3% of the adults interviewed said they were denied prior insured health benefits program annual report 2003-2004 [online]. Available from World
Wide Web: <http://www.hc-sc.gc.ca/fnihb/nihb/annualreport/annualreport2003_2004.pdf>.
approval for dental services under NIHB. Of greater concern 12. William J. Niendorff and Candace M. Jones, 2000, Prevalence and severity of dental caries
among American Indians and Alaska Natives, Journal of Public Health Dentistry, 60, 1
is the fact that among the respondents who reported the need (Special Issue): 243-249.
for urgent dental treatment, 45.5% said they had difficulties 13. Scott M. Presson, William J. Niendorff and R. Frank Martin, 2000, Tooth loss and need for
extractions in American Indian and Alaska Native dental patients, Journal of Public Health
accessing NIHB for dental services. Dentistry, 60, 1 (Special Issue): 267-272.
14. David B. Jones, William J. Niendorff and Eric B. Broderick, 2000, A review of the oral health
of American Indian and Alaska Native elders, Journal of Public Health Dentistry, 60, 1
Historically, it has been difficult to attract general dentists (Special Issue): 256-260.
and specialists to more remote and isolated Aboriginal 15. Fred B. Skrepcinski and William J. Niendorff, 2000, Periodontal disease in American Indians
and Alaska Natives, Journal of Public Health Dentistry, 60, 1 (Special Issue): 261-266.
communities in Canada. There are also wide variations in 16. Eric B. Broderick and William J. Niendorff, 2000, Estimating dental treatment needs among
American Indians and Alaska Natives, Journal of Public Health Dentistry, 60, 1 (Special
relative dentist supply between provinces, and within regions Issue): 250-255.
in the provinces.47 A comparitive study of orthodontic 17. Presson, Niendorff and Martin, Tooth loss and need for extractions in American Indian and
Alaska Native dental patients, Journal of Public Health Dentistry.
treatment outcomes in First Nations and non-First Nations 18. Skrepcinski and Niendorff, Periodontal disease in American Indians and Alaska Natives,
Journal of Public Health Dentistry.
patients in Alberta showed that local patients had a greater 19. Robert G. Nelson et al., August 1990, Periodontal disease and NIDDM in Pima Indians,
improvement in the Peer Assessment Rating (PAR) index 20.
Diabetes Care, 13, 8: 836-840.
Aramesh Saremi et al., January 2005, Periodontal disease and mortality in type 2 diabetes,
scores than those who were non-local, adjusting for First Diabetes Care, 28, 1: 27-32.
Nations status and extractions.48 The authors of the study 21. T. Kue Young, John D. O’Neil and Brenda Elias, “Chronic Diseases,” First Nations and Inuit
Regional Health Survey [online]. [Ottawa, Canada ] : First Nations and Inuit Regional Health
suggested that timely access to orthodontic treatment in Survey National Steering Committee, 1999, pp. 55-86. Available from World Wide Web:
<http://www.naho.ca/firstnations/english/pdf/key_docs_4.pdf>.
88
22. Health Canada, A Statistical Profile of the Health of First Nations in Canada [online].
[Ottawa, Canada] : FNIHB, 2003. Available from World Wide Web: <http://www.hc-
sc.gc.ca/fnihb/sppa/hia/publications/statistical_profile.htm>.
23. Wayne J. Millar, “Dental consultations,” Health Reports 16, 1 (Oct 2004): pp. 41-44. (See also
the detailed tables for the CCHS from the CANSIM database available from World Wide Web:
<http://cansim2.statcan.ca/cgi-
win/cnsmcgi.exe?LANG=e&ResultTemplate=CII&CORCMD=GETEXT&CORTYP=1&CO
RRELTYP=4&CORID=3226>.)
24. Health Canada, Statistics Canada and the Canadian Institute for Health Information, “Dental
Visits,” Statistical Report on the Health of Canadians [online]. [Charlottetown, Canada] :
Health Canada, Statistics Canada and the Canadian Institutes for Health Information, 1999, pp.
97-99. Available from World Wide Web:
<http://www.statcan.ca:8096/bsolc/english/bsolc?catno=82-570-X&CHROPG=1>.
25. Wayne J. Millar and David Locker, “Dental insurance and use of dental services,” Health
Reports 11, 1 (Summer 1999) pp.: 55-65.
26. Jim Dumont, First Nations Regional Longitudinal Health Survey (RHS) 2002-03 Cultural
Framework (Ottawa, Ont.: First Nations Centre, National Aboriginal Health Organization,
First Nations Information Governance Committee, February 2005).
27. Ibid.
28. Wien and McIntrye, “Health and Dental services for Aboriginal People,” First Nations and
29. Ibid.
30. Ibid.
31. Christine S. Ritchie et al., October 1997, Nutritional status of urban homebound older adults,
American Journal of Clinical Nutrition, 66, 4: 815-818.
32. Nadine R. Sahyoun, Chien-Lung Lin and Elizabeth Krall, January 2003, Nutritional status of
the older adult is associated with dentition status, Journal of the American Dietetic
Association, 103, 1: 61-66.
33. Joel Gittelsohn et al., March 1998, Specific patterns of food consumption and preparation are
associated with diabetes and obesity in a Native Canadian community, Journal of Nutrition,
128, 3: 541-547.
34. Pamela H. Orr et al., 1998, Prevalence of diabetes mellitus and obesity in the Keewatin District
of the Canadian Arctic, International Journal of Circumpolar Health, 57, 1: 340-347.
35. Anthony J. G. Hanley et al., March 2000, Overweight among children and adolescents in a
Native Canadian community: prevalence and associated factors, American Journal of Clinical
Nutrition, 71, 3: 693-700.
36. Nelson et al., Periodontal disease and NIDDM in Pima Indians, Diabetes Care.
37. Saremi et al., Periodontal disease and mortality in type 2 diabetes, Diabetes Care.
38. Health Canada, Statistics Canada and the Canadian Institute for Health Information, “Injuries,”
Statistical Report on the Health of Canadians [online]. [Charlottetown, Canada] : Health
Canada, Statistics Canada and the Canadian Institutes for Health Information, 1999, pp. 241-
<http://www.statcan.ca:8096/bsolc/english/bsolc?catno=82-570-X&CHROPG=1>.
39. Ibid.
40. T. Kue Young, Michael E Moffatt and John D. O’Neil, 1992, An epidemiological perspective
of injuries in the Northwest Territories, Arctic Medical Research, 51, 7: 27-36.
41. Wien and McIntrye, “Health and Dental services for Aboriginal People,” First Nations and
42. Millar, “Dental consultations,” Health Reports.
43. Douglas B. Berkey et al., July-August 1991, Research review of oral health status and service
use among institutionalized older adults in the United States and Canada, Special Care in
Dentistry, 11, 4: 131-136.
44. Millar, “Dental consultations,” Health Reports.
45. Health Canada, Statistics Canada and the Canadian Institute for Health Information, “Dental
Visits,” Statistical Report on the Health of Canadians [online].
46. Millar and Locker, “Dental insurance and use of dental services,” Health Reports.
47. Canadian Institute for Health Information, Health Personnel Trends in Canada, 1993 to 2002
[online]. [Ottawa, Canada] : Canadian Institute for Health Information, 2004. Available from
World Wide Web: <http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=AR_21_E>.
48. Kirby C. Cadman et al., April 2002, Orthodontic treatment outcome in a First Nations
population in Alberta, Canada: a comparative study, American Journal of Orthodontics &
Dentofacial Orthopedics, 121, 4: pp. 396-402.
49. Ibid.
50. Young, O’Neil and Elias, “Chronic Diseases,” First Nations and Inuit Regional Health Survey
[online].
51. Health Canada, A Statistical Profile of the Health of First Nations in Canada [online].
52. Harriet L. MacMillan et al. with The Technical Advisory Committee of the Chiefs of Ontario,
May-June 2003, The health of Ontario First Nations people: results from the Ontario First
Nations Regional Health Survey, Canadian Journal of Public Health, 94, 3: 168-172.
Further References
C. K. Harris et al., December 1996, Oral health in alcohol misusers, Community Dental Health, 13, 4:
199-203.
U. Perheentupa et al., February 2001, Increased lifetime prevalence of dental trauma is associated with
previous non-dental injuries, mental distress and high alcohol consumption, Dental Traumatology, 17,
1: 10-16.
Douglas B. Berkey et al., July-August 1991, Research review of oral health status and service use
among institutionalized older adults in the United States and Canada, Special Care in Dentistry, 11, 4:
131-136.
Carlos R. Quinonez, 2004, A political economy of oral health services in Nunavut, International
Journal of Circumpolar Health, 63, 2: 324-329.
89
RHS 2002/03 Adult Survey – Chapter 7: Access to Dental Care and Treatment Needs - Tables
Table 1: Percentage Distribution of First Nations and Inuit Adults by Last Instance of Obtaining Dental Care and Selected
Demographic and Socioeconomic Characteristics
Last Instance of Obtaining Dental Care

Less than Between 6 Between 1 Between 2 More than Never
6 months months and and 2 years and 5 years 5 years ago
ago 1 year ago ago ago
Total weighted % (n=10,455) 31.9 27.2 16.7 13.4 10.0 0.7
Age group
18 to 29 yrs (n=3,231) 33.1 30.3 19.1 12.0 4.8 -
30 to 39 yrs (n=2,764) 32.6 (NS) 30.4 (NS) 18.4 (NS) 13.6 (NS) 4.6 (NS) -
40 to 49 yrs (n=2,187) 34.7 (NS) 26.2 (NS) 16.6 (NS) 13.1 (NS) 8.7 -
50 to 59 yrs (n=1,189) 31.6 (NS) 24.2 (NS) 12.5 (NS) 16.0 (NS) 15.2 -
60 yrs and older (n=1,050) 22.6 (NS) 17.2 11.1 14.2 (NS) 33.0 1.8
Sex
Male (n=4,736) 28.6 25.1 17.9 16.7 10.7 1.1
Female (n=5,719) 35.4 29.4 15.5 (NS) 10.1 9.3 (NS) 0.4
Educational attainment
Did not graduate from high school (n=5,552) 27.6 26.9 16.4 14.6 13.3 1.2
High school diploma (n=1,942) 33.5 (NS) 28.0 (NS) 19.4 (NS) 12.6 (NS) 5.9 -
Community college/CEGEP in Québec/trade/
technical/vocational school diploma (n=2,332) 38.7 27.2 (NS) 15.5 (NS) 11.8 (NS) 6.8 -
Bachelor’s degree (n=463) 36.0 (NS) 29.0 (NS) 16.1 (NS) 12.1 (NS) - -
Graduate degree (n=52) - - - - - -
Income level*
Under $10,000** (n=2,622) 15.3
29.8 27.3 17.9 8.8 1.0
$10,000 to $14,999 (n=1,297) 9.5 (NS)
26.7 (NS) 24.5 (NS) 20.5 (NS) 17.7 (NS) -
$15,000 to $19,999 (n=895) 17.1 (NS)
27.6 (NS) 26.5 (NS) 17.4 (NS) 10.7 (NS) -
$20,000 to $29,999 (n=1,496) 13.7 (NS)
34.4 (NS) 28.7 (NS) 15.8 (NS) 7.3 (NS) -
$30,000 to $49,999 (n=1,185) 12.9 (NS)
37.7 (NS) 29.9 (NS) 12.8 (NS) 5.7 (NS) -
$50,000 to $79,999 (n=313) 9.1 (4.3-
46.9 (NS) 26.9 (NS) 12.3 (NS) - -
$80,000 and over (n=40) 18.2) (NS)
- - - - -
-
Continued on the next page
90
Continued from the previous page.

Last Instance of Obtaining Dental Care
Less than Between 6 Between 1 Between 2 More than Never
6 months months and and 2 years and 5 years 5 years ago
ago 1 year ago ago ago
Household income***
Under $10,000**(n=667) 27.0 21.7 18.5 21.1 10.8 -
$10,000 to $14,999 (n=546) 28.0 24.1 28.2 7.6 10.9 -
$15,000 to $19,999 (n=493) 26.2 28.1 13.9 16.7 14.6 -
$20,000 to $29,999 (n=989) 34.1 26.7 15.1 13.9 9.2 -
$30,000 to $49,999 (n=1,281) 36.7 25.7 15.0 15.9 6.5 -
$50,000 to $79,999 (n=902) 35.6 32.2 16.3 10.2 4.6 -
$80,000 and over (n=326) 37.9 33.1 10.5 13.1 - -
Community size****
Small (<300), n=1,300 28.2 25.8 23.9 12.7 8.9 -
Medium (300-1,499), n=5,821 32.2 (NS) 28.1 (NS) 15.2 13.8 (NS) 9.7 (NS) 0.9 (NS)
Large (1,500+), n=3,334 32.5 (NS) 26.2 (NS) 17.1 (NS) 13.0 (NS) 10.7 (NS) -
Remoteness factor*****
Non-isolated (n=7,743) 33.6 28.7 15.5 12.1 9.3 0.8
Remote (n=339) 27.1 (NS) 31.0 (NS) 20.5 (NS) 15.8 (NS) - -
Isolated (n=1,187) 25.4 (NS) 19.0 21.6 (NS) 20.0 13.3 (NS) -
Semi-isolated (n=779) 31.6 (NS) 25.9 (NS) 18.6 (NS) 12.4 (NS) 10.8 (NS) -
Health Transfer Status******

Not transferred (n=6,123) 33.4 26.1 16.3 13.5 10.2 0.5
Community transferred (n=3,014) 30.5 (NS) 29.3 (NS) 17.1 (NS) 12.2 (NS) 9.6 (NS) -
Part of multi-community transfer (n=1,279) 28.1 (NS) 28.3 (NS) 18.2 (NS) 15.3 (NS) 9.5 (NS) -
*Includes the respondent’s personal income from all sources, before deductions, for the year ending December 31, 2001.
**Includes no income and income loss.
***Total household income from all sources, for all household members, including the respondent, before deductions, for the year ending December 31, 2001.
****The size of the on-reserve population in the respondent’s community of residence based on adjusted 2002 Indian Register counts for the population living on-reserve or on crown land associated with the band. Counts were adjusted for under-reporting and late
reporting of births and deaths.
*****The remoteness factor (isolation status) of the respondent’s community of residence according to 2002 data provided by First Nations and Inuit Health Branch (FNIHB, Health Canada). Remote isolated = no scheduled flights; isolated = flights, good telephone, no
road access; semi-isolated = road access greater than 90 km to physician services; non-isolated = road access, less than 90 km from physician services.
******Health Transfer Status of the community in which the respondent resides. Data are based on August 2002 data from FNIHB, Health Canada. Primary, secondary and tertiary level services were combined. Not transferred = respondent’s community of residence
is not part of a health transfer agreement; community transfer = respondent’s community of residence has responsibility, through “Health Transfer” for primary and/or secondary and/or tertiary services; multi-community = respondent’s community of residence is part of
a multi-community health services transfer agreement for primary and/or secondary and/or tertiary services.
Data source: First Nations Regional Longitudinal Health Survey 2002-03; First Nations Information Governance Committee – Assembly of First Nations, First Nations Centre at the National Aboriginal Health Organization.
91
Table 2: Factors Associated* with the Lack of Receipt of Dental Care in the Preceding Year among First
Nations and Inuit Adults Aged 18 Years.
Lack of Receipt of Dental Care in
Risk Factor or Indicator the Previous Year
Total n Weighted %
Age group (yrs)
18-29 3,231 36.6%
30-39 2,764 37.0% (NS)
40-49 2,187 39.1% (NS)
50-59 1,189 44.2% (NS)
60+ 1,050 60.2%
Sex
Male 4,736 46.4%
Female 5,719 35.2%
Education Attainment
Did not graduate from high school 5,552 45.5%
High school diploma 1,942 38.5% (NS)
College/CEGEP (in Québec)
/trade/technical/vocational school 2,332 34.2%
Bachelor’s degree 463 35.0% (NS)
Graduate degree 52 -
Employment status
Not working 5,514 45.9%
Part time worker 718 37.6% (NS)
Full time worker 4,078 34.7% Note:
Grouped self-determination indicator** *Significant at p≤0.001 using the
Chi-squared test.
Very low 2,646 43.1% **Summation of self-
determination scores from seven
Low 12 - questions with five response
options on a Likert scale,
Moderately low 77 37.6% (NS) ranging from ‘strongly agree’ =
Neutral 828 45.4% (NS) 2 to ‘strongly disagree’ = -2.
***Limitations in activity due to
Moderately high 2,633 45.2% (NS) the presence of a physical or
mental condition or health
High 2,852 38.1% (NS) problem. Results pertain to
limitations in activity at home.
Very high 1,407 32.1% (NS) However, findings were also
statistically significant for
Reported health status limitations in activity at work or
school or during leisure or
Excellent 1,391 33.6% traveling.
Very good 2,843 35.0% (NS) ****The remoteness factor (isolati
status) of the respondent’s commu
Good 4,010 41.9% (NS) of residence according to 2002 dat
provided by First Nations and Inui
Fair 1,686 51.0% Health Branch (FNIHB, Health
Canada). Remote isolated = no
Poor 430 48.9% scheduled flights; isolated = flights
good telephone, no road access; se
Disability and activity limitation at home*** isolated = road access greater than
km to physician services; non-isola
Yes, often 632 50.6% road access, less than 90 km from
Yes, sometimes 1,250 43.6% (NS) physician services.
Data source: First Nations
No 8,412 39.7% Regional Longitudinal Health
Survey 2002-03; First Nations
Remoteness factor of the community of Information Governance
Committee – Assembly of First
residence**** Nations, First Nations Centre at
the National Aboriginal Health
Non-isolated 7,743 37.7% Organization.
Remote 339 41.9% (NS)

Isolated 1,187 55.6%
Semi-isolated 779 42.5% (NS)
92
Table 3: Barriers to Dental Care Access by Selected Respondent’s and Community’s Characteristics.
Prior
DENTAL SERVICES: approval Felt
Long Not for Direct services
waiting covered Can’t Not services cost of were Travel Child Other
list by NIHB afford it available under care inadequat costs care costs cost
NIHB e
denied
Total number 10,441 10,112 10,307 10,549 10,018 10,177 10,095 10,324 10,251 10,060
Weighted % reporting barrier 20.8 17.6 16.9 15.1 14.3 12.5 12.1 11.1 6.2 4.9
Age group
18 to 29 yrs 21.4 13.2 13.5 16.9 9.0 9.0 7.8 10.6 7.4 4.0
30 to 39 yrs 22.5 (NS) 20.0 18.1 (NS) 15.7 (NS) 16.2 14.1 (NS) 14.7 11.7 (NS) 8.1 (NS) 5.4 (NS)
40 to 49 yrs 21.7 (NS) 23.0 20.2 14.2 (NS) 19.0 15.5 15.7 11.5 (NS) 6.1 (NS) 5.0 (NS)
50 to 59 yrs 20.8 (NS) 20.2 (NS) 21.3 (NS) 13.2 (NS) 19.3 14.9 (NS) 14.3 13.1 (NS) 3.7 (NS) 6.7 (NS)
60 yrs and older 12.8 (NS) 12.0 (NS) 13.1 (NS) 12.8 (NS) 10.5 (NS) 9.9 (NS) 9.3 (NS) 8.3 (NS) 1.2 (NS) -
Sex
Male 19.2 15.5 15.4 13.6 12.6 12.0 11.0 9.8 4.4 4.4
Female 22.3 (NS) 19.8 18.5 (NS) 16.7 (NS) 16.2 (NS) 13.0 (NS) 13.2 (NS) 12.5 (NS) 8.1 5.4 (NS)
Did not graduate from high
school 22.2 14.6 16.2 17.6 12.7 11.9 12.4 12.5 6.5 5.8
High school diploma 19.0 (NS) 16.3 (NS) 14.5 (NS) 12.1 (NS) 12.6 (NS) 11.1 (NS) 9.6 (NS) 10.4 (NS) 7.2 (NS) 3.5 (NS)
Community college/CEGEP/
trade/technical/vocational
school diploma 20.0 (NS) 23.9 20.8 (NS) 13.9 (NS) 18.9 14.8 (NS) 14.3 (NS) 9.9 (NS) 5.5 (NS) 4.2 (NS)
Bachelor’s degree 18.2 (NS) 24.4 16.1 (NS) 9.7 (NS) 15.2 (NS) 13.0 (NS) 9.3 (NS) 7.4 (CI: - -
Graduate degree - - - - - - - 3.8- - -
14.1%)
(NS)
-
Income level*
Under $10,000** 21.9 16.4 18.9 16.5 13.6 14.3 12.0 15.2 7.7 6.5
$10,000 to $14,999 19.7 (NS) 16.3 (NS) 20.1 (NS) 14.8 (NS) 13.8 (NS) 13.8 (NS) 13.9 (NS) 14.1 (NS) 8.4 (NS) 5.9 (NS)
$20,000 to $29,999 24.5 (NS) 18.8 (NS) 16.9 (NS) 14.2 (NS) 16.0 (NS) 13.5 (NS) 11.5 (NS) 9.1 (NS) 4.4 (NS) 2.9
$30,000 to $49,000 19.6 (NS) 23.1 (NS) 14.4 (NS) 15.6 (NS) 16.5 (NS) 11.6 (NS) 13.1 (NS) 6.6 5.7 (NS) 4.6 (NS)
$50,000 to $79,999 21.4 (NS) 26.3 (NS) 12.7 (NS) 11.1 (NS) 18.9 (NS) 9.6 (NS) 19.8 (NS) - - -
$80,000 and over - - - - - - - - - -
Continued on the next page.
93

Prior
DENTAL SERVICES: approval
Long Not for Direct Felt
waiting covered Can’t Not cost of services Travel Child Other
afford it available services were costs care costs cost
list by NIHB under care
NIHB inadequate
denied
Household income***
Under $10,000** 20.8 20.2 23.0 20.1 (NS) 20.0 17.1 18.8 20.1 12.3 8.9
$15,000 to $19,999 20.9 (NS) 19.6 (NS) 20.6 (NS) 14.4 (NS) 19.3 (NS) 16.4 (NS) 16.4 (NS) 14.2 (NS) 6.8 (NS) -
$30,000 to $49,999 21.2 (NS) 16.1 (NS) 11.3 12.6 (NS) 10.8 (NS) 9.2 (NS) 12.0 (NS) 7.0 4.8 1.9
$50,000 to $79,999 18.1 (NS) 21.6 (NS) 14.2 (NS) 13.3 (NS) 19.2 (NS) 13.3 (NS) 14.1 (NS) 6.2 5.4 (NS) -
$80,000 and over 21.7 (NS) 17.9 (NS) 6.5 10.6 (NS) 11.6 (NS) - 11.2 (NS) 8.1 (NS) - -9o
Community size****
Small (<300) 27.5 27.7 32.2 22.7 19.4 24.0 19.8 20.8 9.6 7.5
Medium (300-1,499) 18.5 16.7 16.3 14.9 (NS) 13.6 (NS) 12.5 12.9 11.9 6.3 (NS) 5.0 (NS)
Large (1,500+) 22.5 (NS) 16.4 13.7 13.5 (NS) 14.3 (NS) 9.3 8.7 7.2 5.2 (NS) 3.9 (NS)
Remote 44.3 13.8 30.6 45.4 10.2 22.3 26.5 31.6 10.6 -
Isolated 40.1 (NS) 12.1 (NS) 12.4 (NS) 21.2 10.1 (NS) 8.9 (CI: 10.6 (NS) 11.2 (CI: 8.0 (NS) 5.3 (CI:
Semi-isolated 35.6 (NS) 23.5 (NS) 24.8 (NS) 35.0 (NS) 20.1 (NS) 4.1- 20.1 (NS) 5.3- 12.4 (NS) 2.5-
Non-isolated 14.4 18.3 (NS) 16.4 (NS) 10.8 14.6 (NS) 18.3%) 10.6 21.9%) 4.8 (NS) 11.2%)
(NS) (NS) (NS)
16.9 (NS) 19.0 (NS) 10.9 (NS)
12.2 (NS) 9.3 3.5
Not transferred 19.8 19.3 18.1 14.7 15.5 12.3 12.0 10.1 5.3 4.3
Community transferred 18.1 (NS) 13.8 (NS) 10.9 11.7 (NS) 11.0 (NS) 10.2 (NS) 8.6 (NS) 8.4 (NS) 5.8 (NS) 3.7 (NS)
Part of multi-community 30.9 17.6 (NS) 23.4 (NS) 24.5 15.9 (NS) 18.0 (NS) 19.6 (NS) 21.6 11.4 10.0
transfer
Note: Respondents may have given more than one barrier in accessing dental care.
*Includes the respondent’s personal income from all sources, before deductions, for the year ending December 31, 2001.
**Includes no income and income loss.
***Total household income from all sources, for all household members, including the respondent, before deductions, for the year ending December 31, 2001.
**** The size of the on-reserve population in the respondent’s community of residence based on adjusted 2002 Indian Register counts for the population living on-reserve or on crown land associated with the band. Counts were adjusted for under-reporting and late reporting of
births and deaths.
*****The remoteness factor (isolation status) of the respondent’s community of residence according to 2002 data provided by First Nations and Inuit Health Branch (FNIHB, Health Canada). Remote isolated = no scheduled flights; isolated = flights, good telephone, no road
access; semi-isolated = road access greater than 90 km to physician services; non-isolated = road access, less than 90 km from physician services.
******Health Transfer Status of the community in which the respondent resides. Data are based on August 2002 data from FNIHB, Health Canada. Primary, secondary and tertiary level services were combined. Not transferred = respondent’s community of residence is not
part of a health transfer agreement; community transfer = respondent’s community of residence has responsibility, through “Health Transfer” for primary and/or secondary and/or tertiary services; multi-community = respondent’s community of residence is part of a multi-
community health services transfer agreement for primary and/or secondary and/or tertiary services.
94
Table 4: Reported Dental Treatment Needed* among Adults in the RHS 2002-03 in comparison to the
1997 First Nations and Inuit Regional Health Survey (RHS).2
RHS 2002-03 RHS 2002-03

2 Perceived less access Difficulties in
RHS 1997 RHS 2002-03
Type of dental treatment Increase to health services accessing NIHB
n=9,870 n=10,262
needed compared to services for
Weighted % Weighted %
Canadians** dental care
Weighted % Weighted %
Cavities filled or other
restorative work (e.g. 15.4 36.9 2.4× 44.2 27.4
crowns or bridges)
Maintenance (e.g. check-
ups or teeth cleaning) 8.5 48.4 5.7× 35.9 21.1
Dental extractions
5.2 12.4 2.4× 41.5 31.8
Fluoride treatment
---*** 13.8 --- 42.4 30.9
Periodontal work
0.4 5.6 14.0× 45.3 42.1
Prosthetic work (e.g.

dentures, including repair 5.4 14.0 2.6× 40.2 30.8
and maintenance)
Orthodontic work (braces)
---*** 3.6 --- 38.6 36.1
Urgent (dental pain or

other problems requiring 0.2 5.5 27.5× 55.7 45.5
immediate attention)
*Multiple treatments accepted. Includes respondents’ rating of access to health care services compared to Canadians and difficulty accessing dental services provided through the Non-Insured Health Benefits
Program (NIHB) of Health Canada to status First Nations and Inuit persons.
**Rating of access to health care with respect to Canadian population (less access vs. better or same level of access).
***Information not available in the 1997 RHS.2
Data source: First Nations Regional Longitudinal Health Survey 2002-03; First Nations Information Governance Committee – Assembly of First Nations, First Nations Centre at the National Aboriginal Health
Organization.
95
Chapter 8
Physical Activity, Body Mass Index, and Nutrition
Abstract
Physical activity reduces the risk of chronic diseases and conditions. In conjunction with appropriate
diet, it also helps to maintain a healthy body weight. This chapter examines physical activity and diet
in relationship to body mass amongst the First Nations adult population.
One fifth of First Nations adults participate in at least 30 minutes of physical activity most days of the
week, with walking, fishing and berry-picking being the most frequently reported types of activities.
One-third reported always or almost always eating a nutritious, balanced diet, and over half reported
that they often consume traditional protein based foods. Physical activity and diet are associated with
other lifestyle factors. Relationships were observed between physical activity and social support, and
between diet and suicide ideation, community progress and balance in the physical, emotional, mental
and spiritual aspects of life. One quarter of adults reported a healthy weight, while over one-third are
overweight. Roughly another third are obese. Obesity is associated with lower general health status
and a higher prevalence of chronic conditions.
Strategies addressing physical activity and nutrition are required to influence a variety of other sectors
in holistic health systems, and to target different population groups in culturally appropriate ways.
Periodic repetition of the RHS is required to assess the effectiveness of such strategies over time.
96
RHS 2002/03 Adult Survey – Chapter 8: Physical Activity, Body Mass Index, and Nutrition
other illnesses such as cardiovascular disease and type II

Introduction
diabetes.14,15
Regular physical activity is recognized for its role in
Certain chronic diseases are associated with obesity and
preventing several chronic and physical conditions, including
being overweight. Non-communicable or chronic diseases
coronary heart disease, hypertension, obesity, type II
are the major cause of death, representing 59% of deaths
diabetes, osteoporosis, certain site-specific cancers (such as
worldwide.16 Three preventive factors—diet, physical
colon cancer), and age-related functional limitations.1
activity and avoidance of tobacco use—play a significant
Physical activity also plays an important role in maintaining
impact in reducing chronic disease.17 These factors are
mental health. For instance, increasing physical activity is a
modifiable, meaning that a person has control over them.
factor in reducing anxiety, depression and tension, and in
Thus, modification of these preventive factors translates into
positively affecting the emotional state of both young and old
reducing the chance of developing chronic disease. This is
people.2 Data on physical activity rates in Canada over the
significant because research shows that 8 out of 10
last 20 years reveal that the general adult population has
Canadians have at least one of the following modifiable risk
become more active in their leisure time.3 Despite this trend,
factors and/or conditions: smoking, physical inactivity, being
physical inactivity still remains a public health issue,
overweight, or having high blood pressure or diabetes.18
particularly among women, older adults and lower income
groups.4 Given parallel increases in body mass index during Data reveals that Canadians of Aboriginal descent have
this same 20-year period,5,6 Canadians appear to have a net consistently higher rates of obesity compared to the overall
positive energy balance (which occurs when an individual Canadian population.19,20,21 This is especially true for First
consumes more calories from food energy than they expend Nations women, who are more likely than other Canadian
from activity), contributing to trends toward being women to report chronic diseases associated with being
overweight and obese. This balance is affected by metabolic overweight, such as heart disease and stroke.22
or genetic factors,7,8 environment, and modifiable behaviors
This chapter examines physical activity and aspects of
such as diet and physical activity.
nutrition in relation to body mass among the adult First
Unfortunately, this imbalance has caused escalating rates of Nations population. It also makes recommendations to help
overweight and obese adults in Canada.9 This trend may be a guide First Nations peoples themselves, as well as decision
result of reduced energy expenditure due to improved makers in First Nations communities and policy developers,
technology and suburban environments favouring motorized in shaping personal and national strategies for healthy living.
vehicles;10 however, it may also be due to excess
consumption or unbalanced caloric intake of foods that have General Approach
replaced nutritional choices that were more common in the
It is important for First Nations to examine health issues
past.11 In some First Nations communities in Canada,
traditional Aboriginal subsistence activities (e.g., hunting, from a multi-faceted, holistic approach, which takes the
trapping, fishing, gathering) remained primary activities into following into account: individual aspects (awareness,
the 1960s. After that time, a combination of decreased attitudes, and behaviours); social factors (social support from
reliance on traditional food and increased reliance on family, friends, and peers); environmental factors (physical
environment, geography, and accessibility); societal factors
governmental subsidies resulted in decreased participation in
traditional physical activities. Furthermore, store-bought (culture and community); and policy related factors (at a
foods became the norm as a source of food supply.12 band government level). All these factors work together, or
are harmonized, to affect a given behaviour. This multi-
Although nutrition data is limited for Aboriginal peoples,
existing data for the general population indicate that fruit and faceted approach, which has been presented in scholarly
vegetable consumption is negatively associated with being literature over the last five to ten years, is similar to the
cultural framework presented in this technical report. As
overweight and that total energy consumption for Canadians
has increased via carbohydrate intake (particularly soft drink outlined in detail in the introductory chapter at the beginning
consumption.)13 of this report, the First Nations’ cultural framework embodies
the “total person” and the “total environment.” This
Although there is a paucity of data on energy intake and framework includes: an individuals’ spiritual, emotional,
expenditure among First Nations peoples, there is reason to mental, and physical well-being; their culture’s values,
believe that the above analysis of these factors as they apply beliefs, identity, and practices; their community and
to the broader Canadian population would also hold for relationship to the physical environment; and their
Aboriginal peoples. Studies have found that traditional diets connectedness to their family. Put another way, this chapter
and physical activity patterns were associated with reduced describes physical activity, nutrition and body mass index
prevalence of obesity compared to non-traditional lifestyles. patterns amongst First Nations. Then it goes on to link these
This suggests that a way of life that reflects traditional aspects to qualities that are relative to a broader First Nations
lifestyle practices might help to reduce obesity, as well as specific cultural framework.
97
Results Regardless of age, walking is the most frequently reported

physical activity. Although rates of walking, fishing, hunting
Physical Activity
and trapping, aerobics or fitness classes, snowshoeing,
Walking is cited as the most frequently reported physical skateboarding and berry picking or food gathering activities
activity in which First Nations adults participated over the do not differ by age, participation in physical activities is
year prior to the survey (89.8%)i, followed by fishing generally lower in older age groups. Table 2 summarizes the
(42.8%), berry picking or other food gathering (38.1%), age-related differences in participation in physical activities.
swimming (37.7%), bicycling (35.0%), and hunting or Table 2. Prevalence of physical activities by age* (n=10,678)
trapping (31.9%). Roughly one in four adults reported Age group (years)
running or jogging (28.3%), using weights or exercise Activity 18-29 30-39 40-49 50-59 60+
equipment (27.9%), forms of dancing (27.1%), competitive, Walking 90.8% 89.9% 89.5% 91.1% 85.4%
group or team sports (26.4%) and hiking (24.2%).
Fishing 45.3 44.6 (NS) 45.5 (NS) 38.7 (NS) 30.4
Gender differences appear for certain physical activities. Berry picking or
31.6 39.0 44.8 39.4(NS) 40.8 (NS)
Women are more likely than men to report participating in food gathering
walking, berry picking or other food gathering activities, Swimming 51.5 43.2 31.8 23.9 10.8
dancing and aerobics or fitness classes.ii Men are more likely Bicycle riding 52.9 38.7 25.5 14.5 14.3
than women to cite participation in most other activities, Hunting, trapping 33.0 32.6 (NS) 34.1 (NS) 30.5 (NS) 24.9
including: fishing, hunting, cycling, weight training, running, Running 45.5 27.2 22.4 12.3 7.9
competitive or team sports (such as baseball, hockey, or Weights, exercise
41.6 27.1 22.3 15.7 12.2
lacrosse), hiking, rollerblading, golfing, skating, canoeing, equipment
snowshoeing, skiing, martial arts, and skateboarding. Table 1 Dancing 35.0 27.0 26.3 21.7 10.8
summarizes the gender differences in reported physical Competitive or
45.9 28.5 16.2 6.1 –
activities. group sports
Table 1. Prevalence of physical activities, overall and by gender Hiking 26.9 24.6 (NS) 28.9 (NS) 17.7 13.9
(n=10,712) Golfing 24.3 17.7 (NS) 15.6 (NS) 11.0 –
Rank Activity Total Men Women Skating 25.5 18.8 (NS) 11.6 4.6 –
1 Walking 89.8% 88.0% 91.7% Canoeing 17.4 12.5 16.4 (NS) 12.4 (NS) 9.3
2 Fishing 42.8 56.2 28.7 Bowling 19.5 12.6 11.7 8.1 6.1
Berry picking or other food Aerobics, fitness
3 38.1 31.9 44.6 11.5 7.8 (NS) 8.2 (NS) 7.5 (NS) - (NS)
gathering class
4 Swimming (NS) 37.7 35.8 39.8 Rollerblading, in-
12.5 4.3 – – –
line skating
5 Bicycling 35.0 41.5 28.3
Snowshoeing 4.9 4.5 (NS) 7.8 (NS) 6.2 (NS) 3.5 (NS)
6 Hunting or trapping 31.9 49.2 13.8
Skiing 7.7 4.3 4.1 (NS) – –
7 Running 28.3 37.0 19.1
Martial arts 3.8 2.7 (NS) 2.3 (NS) - (NS) - (NS)
8 Weight or exercise equipment 27.9 37.8 17.6
Skateboarding 3.9 – – – –
9 Dancing 27.1 21.2 33.3 – Data suppressed due to insufficient sample size.
* Significantly different from 18-29 year olds
10 Competitive sports 26.4 35.0 17.3
11 Hiking 24.2 31.7 16.3
Guidelines for recommended frequency and intensity of
12 Golf 17.3 24.2 10.0
physical activity and exercise have evolved over time.
13 Skating 16.2 23.3 8.7 Commonly accepted guidelines23,24 require the inclusion of
14 Canoeing 14.5 19.0 9.7 frequency, intensity and duration in the calculation, and they
15 Bowling (NS) 13.4 13.2 13.6 generally recommend a minimum of 30 minutes of moderate
16 Aerobics or fitness classes 8.9 5.5 12.4 or vigorous intensity on most days of a week. In the RHS, a
17 Rollerblading 5.6 7.9 3.2 criterion for sufficient activity was defined as reporting at
18 Snowshoeing 5.4 8.4 2.2 least 30 minutes of moderate to vigorous activity (defined in
19 Skiing 4.6 6.0 3.1 the survey as physical activity “…that results in an increase
20 Martial arts 2.6 3.4 1.8 in your heart rate and breathing”) for 4 or more days of the
21 Skateboarding 1.7 2.9 0.5 week. Using this criterion, 21.3% of First Nations adults
perform sufficient physical activity to meet these guidelines
(See Figure 1). Men are more likely than women to report
sufficient activity to meet these guidelines (26.7% for men
i
versus 15.2% for women). These gender differences are most
variation is greater than 33.3%.
ii
apparent among younger adults and those 60 and older.
98
Figure 1. Proportion of adults reporting sufficient activity by times a day, 5.6% once a day, 38.3% a few times a week and
gender (n=7,470)
30.9% once a week. Roughly one-third of adults report that
90% they add salt (35.3%) or sugar (37.1%) to their food several
84.8%
times a day.
80%
73.3%
Men are more likely than women to consume fast food,
70%
sweets (such as cakes, pies, cookies, candy or chocolate),
60% French fries, potato chips, or pretzels once a day. Generally
50% Sufficiently active
speaking, younger adults are more likely than older adults to
Not active enough consume soft drinks, French fries, potato chips, and pretzels.
40%
In terms of the consumption of traditional food items, 59.3%
of adults report that they often consume protein-based foods,
30% 26.7%
20%
15.2% such as game and fish, whereas 21.8% state that they often
10%
consume berries and other types of vegetation. In addition,
two out of five adults (42.2%) often eat other First Nations
0%
Men Women
foods, such as fry bread, bannock or corn soup. There are no
gender, age, income, or education related differences found
Nutrition in the consumption patterns for traditional or cultural foods.
Roughly one-third of First Nations adults report that they Adults in small communities (<300 residents) are more likely
always or almost always eat a nutritious and balanced diet than residents in larger communities (≥300 residents) to
(35.4%), whereas 52.7% only sometimes do. The remaining consume protein-based traditional foods (71.4% for small
11.9% either rarely (9.1%) or never (2.8%) eat a balanced communities versus 53.4%-60.9% for larger communities);
and nutritious diet. The proportion of adults always or almost the same is true for berries and other vegetation (31.9% for
always eating a nutritious and balanced diet increases small communities versus 18.9%-21.9% for large
generally with age (see Figure 2). communities – see Figure 3).
Figure 3. Proportion of adults often consuming traditional foods*
Figure 2. Proportion of adults reporting a healthy diet by age
by community size (n=10,962)
(n=10,714)
80%
60% 56.6%
54.4% 71.4%
53.9%
52.3% Protein-based meats
50.7%
Berries and other wild vegetation
50% 60.9%
60%
41.2% 42.0% 53.4%
40.5%
40%
33.2%
Always or almost always 40%
30% Sometimes
25.0% 31.9%
Rarely
Never
20% 22.0%
18.9%
13.6% 20%
9.8%
10% 7.3%
4.8% 4.7%
2.6% 2.7%
1.5%
1.8%
1.5% 0%
0%
<300 300-1499 1500+
18-29 30-39 40-49 50-59 60+
Community size (persons)
Age group (years)
* Based on those who often eat traditional meat or fish products
In terms of dietary intake, 50.0% of adults consumed coffee Body Mass Index
or tea several times a day, 19.2% once a day, with a further
14.3% citing a few times a week. Moreover, 17.8% cited For the purposes of these analyses, body mass index (BMI)
consumption of soft drinks several times a day, 14.7% once a was classified according to Canadian guidelines.25 These
day, and 33.0% stated that they consume this type of BMI guidelines are an update of the 1988 Canadian
beverage a few times a week. Of higher calorie foods, 3.6% classifications, which were recently revised by the Public
of adults state that they consume fast foods several times a Health Agency of Canada (formerly Health Canada) and a
day, 4.3% once a day, 31.5% a few times a week and 34.9% team of research experts, as a result of the World Health
once a week. Moreover, 2.8% of adults report consuming Organization’s recommendations for international standards
cakes, pies, cookies, candy, or chocolate several times a day, for adults. According to Canadian guidelines, 25.9% of First
5.8% state once a day, 29.6% a few times a week and 28.5% Nations adults are considered to be of normal weight, having
once a week. In addition, 4.2% of individuals say they eat the least risk of developing health problems (Figure 4).
snack foods such as French fries and potato chips several However, 37.0% of First Nations adults are considered
99
RHS 2002/03 Adult Survey – Chapter 8: Physical Activity, BMI, and Nutrition
overweight. An additional 31.2% are deemed obese, and a report always or almost always eating a balanced and
further 4.8% are considered morbidly obese, which entails an nutritional diet.
extremely high risk level for developing health problems. In Figure 5. Proportion eating a nutritious diet by sufficient
comparison, 49% of Canadians in general (age 20–64) are physical activity (n=7,402)
considered to be normal weight, 33% are considered 60%
overweight and 15% are considered obese.26 51.8%
50% 47.8%
Figure 4. Distribution body mass index among adults, overall
and by gender (n=8,998) Body mass index (BMI) categories
42.3%
Sufficiently active
50% Underweight: <18.5 40% 37.9%
Not active enough
Acceptable: 18.5 – 25.0
Overweight: >25.0 – 30.0
41.8% Obese: >30.0 – 40.0 30%
40% Men Morbidly obese: >40.0
Women
34.3%
20%
31.1%
30% 28.6%
26.7%
25.3% 10% 8.3% 8.2%
1.6% 2.1%
20%
0%
Always or almost Sometimes Rarely Never
always
Consumption of a nutritious diet
10%
6.8%
3.2%
1.1% 1.2%
0%
Physical activity, nutrition and body weight: a cultural
Underweight Acceptable Overweight Obese Morbidly obese framework perspective
Overall, First Nations men are more likely than women to be This section examines significant relationships of physical
overweight (41.8% for men compared to 31.1% for women). activity, nutrition and body weight to elements of the cultural
framework outlined in the introductory chapter. Table 3
This is particularly true for adults aged 18–29 (40.6% for
men compared to 24.4% for women) and those 40–49 years provides an overview of these relationships.
of age (48.5% for men compared to 32.2% for women). Table 3. Relationship of key indicators with physical activity, diet
However, as shown in Figure 4, women are more likely than and body mass index (BMI)
Physical activity Diet BMI
men to be obese (28.6% for men compared to 34.3% for Individual factors
women) and morbidly obese (3.2% for men compared to Age a a a
6.8% for women). Gender a a a
Community size x a x
Generally speaking, younger adults (18 to 29 years of age)
are less likely than adults older than 30 to be obese or Health factors
morbidly obese. General Health Status a a a
Number of specific x x a
chronic conditions
Relationships between physical activity, nutrition and body Physical activity n/a a x
weight Diet a n/a x
BMI x x n/a
Adults who are sufficiently active (47.8%) are more likely
Smoking x a a
than others (37.9%) to always or almost always eat a Alcohol a x x
nutritious and balanced diet. In addition, adults who are
sufficiently active are more likely than others to report that Mental health factors
they often consume berries and wild vegetation. Balance with 4 aspects a a x
Suicide ideation x a x
Adults who are obese are more likely than those who are of
Societal factors
acceptable weight to consume coffee or tea several times a Progress in community x a x
day, yet are more likely to never or hardly ever consume
snack foods such as French fries, potato chips, pretzels, or fry Social factors
bread. Obese individuals are more likely to report that they Social support a a x
a Significant association at the p=.05 level
never or hardly ever add sugar to their food compared to
x no observed association
individuals of normal weight.
n/a not applicable
There is an apparent interrelationship between diet, body
mass and physical activity. Among individuals who are Adults who meet the criteria for being sufficiently active are
obese, those who are sufficiently active are more likely more likely (21.9%) than those who do not (12.4%) to
(58.2%) than those who are insufficiently active (33.8%) to consider themselves to be in excellent health, and are less
100
likely to be in poor health (1.4% of those “sufficiently Figure 7. Proportion eating a healthy diet by suicide attempt and
ideation* (n=10,146)
active” reported poor health, versus 4.4% of those who did
not). In addition, adults who are sufficiently active are more 50%
likely than others to report that they always have social Thought of suicide 43.1%
support, as shown in Figure 6. 40%

Attempted suicide
35.4%
Figure 6. Type of social support* received by sufficient physical 32.2%
activity (n=7,339) 30%
25.6%
80%
70.5% 20.4%
70% 20%
17.0%
62.8% 15.8%
61.1% 60.5% 14.3%
60% 57.9% 57.0%
50.4% 51.4% 10%

50% 47.4% 47.7%
40%
0%
Always or almost Sometimes Rarely Never
30% always
Consumption of a healthy diet
20%
Sufficiently active * The relationship between eating a healthy diet and suicide ideation is non-
Not active enough
10% significant
0%
Person to listen Person to help Person provides Person to have Person to enjoy With regard to spirituality, people who always or almost
and talk love good time with
Source of social support
things with
always eat a nutritious diet (20.2%) are more likely than
those who never do (7.0%) to report that their community is
* % reporting available all of the time
making good progress in traditional ceremonial activities.
The “sufficiently active” adults are also more likely to report Adults who are obese are less likely than those with an
that they have 5 or more drinks on one occasion, more than acceptable weight to state that they are in excellent health
once a week. Individuals who are sufficiently active (40.1%) (9.2% of those who are obese compared to 16.7% of those
are more likely than those who are not (32.7%) to report a with an acceptable weight), as well as being less likely to
high level of balance of the mind, spirit, heart and body. report very good health (24.1% versus 31.4% respectively).
Adults who always or almost always eat a balanced diet are However, obese adults are more likely to say they are in fair
more likely than those who sometimes or rarely do to cite health (19.5% of obese adults versus 11.3% of those of
excellent health (19.4% those who always do versus 10.4% normal weight). With the exception of the pattern appearing
of those who sometimes do, and 5.8% of those who rarely for excellent health, the same pattern appears for adults who
do). The same pattern appears for those reporting very good are morbidly obese as for those who are obese, in relation to
health. Almost two out of five adults (38.5%) who always or adults of normal weight. Morbidly obese adults are also more
almost always eat a nutritious diet also smoke on a daily likely to say they are in poor health than those of an
basis, compared to 48.0% of those who sometimes eat acceptable weight (10.4% of morbidly obese adults versus
nutritiously, 57.1% of those who rarely do, and 58.3% of 2.6% of those of normal weight).
those who never eat a balanced or nutritious diet. Adults who are obese or morbidly obese are more likely than
Adults who always or almost always eat a nutritious diet are those of normal weight to report one or more chronic health
more likely to state that they have social support than those conditions (71.1% of morbidly obese adults and 65.7% of
who rarely eat a nutritious diet. Moreover, individuals who obese adults, compared to 43.1% of those of acceptable
always or almost always eat a nutritious diet (42.6%) are weight). This pattern is most apparent for musculoskeletal,
more likely to score highly on physical, emotional, mental respiratory and cardiovascular conditions, as illustrated in
and spiritual balance than those who never do (21.5%), and Figure 8.
are less likely to have thought of suicide (25.6% of those
always having a good diet compared to 43.1% of those who
rarely do). Although not significant, a similar pattern was
observed among those who attempted suicide: 14.3% of
those always having good diet had made suicide attempts,
compared to 20.4% of those rarely having a healthy diet.
101
Figure 8. Prevalence of chronic conditions by body mass index and type of condition (n=8,998)
50%
44.6%
Musculoskeletal
Respiratory
40%
Vision/hearing
Cardiovascular 34.5%
33.4%
30.6%
30%
26.8% 26.5%
21.2%
20% 18.2%
15.4% 15.7% 15.3%
11.3% 11.8%
10% 9.1%
8.1% 8.3%
0%
Acceptable Overweight Obese Morbidly Obese
Obese and morbidly obese First Nations adults are less likely energy expenditure. These strategies need to be culturally
than those of acceptable weight to be daily smokers (39.5% appropriate. For example, diet-related strategies need to take
of the obese and 34.0% of the morbidly obese, compared to access to or lack of traditional foods into account . Strategies
53.0% of those of acceptable weight). No differences appear for staying active should consider physical activity in all
between adults of different body weight with respect to social aspects of daily life (from berry picking to sports and fitness
support, which is defined as having someone to talk to or classes).
confide in, someone to count on when they need help,
Although pervasive in the population as a whole, physical
someone who shows love and affection, someone to have a
inactivity and poor quality diet are more prevalent in certain
good time with, or someone to take them to the doctor.
population segments than in others. Indeed, certain physical
Similarly, no relationships exist associating adult body
activities are more popular among certain population groups
weight with community perception of progress in First
than others, and these differences need to be reflected in the
Nations control over community health services, availability
development of strategies. For example, participation in team
of recreation or leisure facilities, or traditional ceremonial
sports and activities of greater intensity are more prevalent
activity for adults.
among men and younger adults, whereas individual activities
of moderate intensity are more popular with women.
Discussion and Recommendations
Walking remains prevalent among both men and women and
Research has shown that off-reserve First Nations adults are among all age groups. These patterns are consistent with
equally as likely to be overweight as the rest of the Canadian other national data30,31 and need to be considered in
population, yet 1.8 times as likely to be considered obese.27 developing policies and strategies targeting certain groups.
The finding that First Nations women are more obese and The relationship noted between physical activity and social
morbidly obese than the general population is in accordance interaction (having someone to have a good time with and
with other research.28 The high rates of overweight and obese having someone to do something enjoyable with all of the
people reflected in the RHS data are of great concern because time) suggests that activities involving social interaction, like
they mean a greater risk of health problems among First walking groups, should be promoted. Social networks
Nations adults compared to other Canadians. For adults, it is focused on certain physical activities that appeal to First
recognized that waist circumference is better able to predict Nations adults may result more often in the pursuit of healthy
health risk than that predicted by body mass index alone. It is lifestyles.
recommended that for adults, a combination of body mass
The nutrition data gathered by the RHS is consistent with
index and waist circumference be used to classify obesity-
another Canadian study examining food intake and food
related health risk.29 Strategies for diet and physical activity
habits of adults and adolescents. The RHS and “Canada’s
are part of the solution to balancing energy intake with
102
Food Guide to Healthy Eating” both found large approaches to increasing the physical activity of adults in the
contributions to carbohydrate and fat intake from “other” more general population is available.35,36,37 These approaches
foods, including sweetened drinks, desserts, candies, oils, could be vetted with community Elders, school officials and
and potatoes.32 In the Canada’s Food Guide study, these recreational service providers, to see what is culturally
types of “other” foods were the prevailing source of energy appropriate for certain First Nations communities, depending
for youth and adults. An adapted version of the “Food on their size, location, and accessibility to opportunities.
Guide” could be promoted, and might include examples of
Reliable baseline data involving food intake and diet
traditional foods and suggested amounts of “other” foods.
quality—and their determinants, including food insecurity—
The finding that adults who are obese and sufficiently active should be established and monitored on a regular basis. This
are more likely to report a nutritious and balanced diet than would ideally include the collection of objective measures of
insufficiently active obese adults is intriguing. It is energy intake. These data are lacking in First Nations
recognized that these data are self-reported and as such communities. Monitoring of physical activity levels should
represent perceptions of activity and diet. However, the continue, and self-reported data should be expanded to
finding suggests that increasing activity may be a means of include total physical activity across domains, to provide
encouraging improvements in diet and creating a more more objective measurements of energy expenditure. Dietary
healthy lifestyle overall within this at-risk group. and physical activity data are essential in designing
Alternatively, it could also suggest that a healthier diet makes appropriately targeted strategies, and regular monitoring on
one more inclined to physical activity. As a lifestyle choice, these and body mass indices would provide valuable
these types of factors influence and reinforce each other. information in the possible development of strategies
Much more work is required to determine absolute amounts addressing certain key public health concerns among First
of physical activity and dietary nutrients before Nations adults.
understanding issues related to achieving energy balance in
First Nations adults. Notes to Chapter 8
Social and environmental policies required to increase 1. U.S. Department of Health and Human Services, Physical Activity and Health: A Report of the
physical activity and improve diet are dependent upon other Surgeon General (Atlanta, Ga.: U.S. Department of Health and Human Services, Centers for
Disease Control and Prevention, National Center for Chronic Disease Prevention and Health
segments of society (e.g., agriculture, transportation and Promotion, 1996).
2. Ibid.
recreation). Therefore, strategies for physical activity and 3. C. L. Craig et al., 2004, Twenty-year trends of physical activity among Canadian adults,
nutrition are required to influence actions in different sectors. Canadian Journal of Public Health, 95, 1: 59-63.
4. Ibid.
Although independent strategies for individuals are useful, a 5. K. D. Raine, Overweight and Obesity in Canada: A population health perspective (Ottawa,
Ont.: Canadian Institute for Health Information, 2004).
common framework should be considered which harmonizes 6. P. T. Katzmarzyk, 2002, The Canadian obesity epidemic: 1985-1998, Canadian Medical
factors such as physical activity, nutrition, and tobacco Association Journal, 166, 8: 1039-1040.
7. R. F. Dyck, H. Klump and L. Tan, 2001, From "thrifty genotype" to “hefty fetal phenotype”:
reduction strategies. Such a framework would aim to the relationship between high birthweight and diabetes in Saskatchewan Registered Indians,
Canadian Journal of Public Health, 92, 5: 340-344.
improve interventions for population segments common to 8. S. R. Smith and E. Ravussin, January 2005, Genetic and physiological factors in obesity,
all strategies.33 Furthermore, the observed association Journal of the Louisiana State Medical Society, 157, 1: S12-8.
9. Katzmarzyk, The Canadian obesity epidemic: 1985-1998, Canadian Medical Association
between physical activity and nutrition suggests that changes Journal, 1039-1040.
10. Craig et al., Twenty-year trends of physical activity among Canadian adults, Canadian Journal
adopted to improve health in one lifestyle factor may of Public Health, 59-63.
contribute to a healthier lifestyle overall. In this regard, the 11. U.S. Department of Health and Human Services, Physical Activity and Health: A Report of the
Surgeon General.
association between higher rates of smoking among those of 12. T. K. Young et al., 2000, Childhood obesity in a population at high risk for type 2 diabetes,
Journal of Pediatrics, 136: 365-369.
‘normal’ weight versus those of obese people is troubling. Is 13. K. D. Raine, Overweight and Obesity in Canada: A population health perspective.
smoking being used for weight control? If so, how can 14. E. Ravussin et al., 1994, Effects of a traditional lifestyle on obesity in Pima Indians, Diabetes
Care, 17, 9: 1067-1074.
weight concerns be addressed among smokers as part of a 15. D. E. William et al., May 2001, The effect of Indian or Anglo dietary preference on the
incidence of diabetes in Pima Indians, Diabetes Care, 24, 5: 811-816.
tobacco cessation strategy? Finally, consideration of potential 16. World Health Organization, The Global Strategy on diet, physical activity and health [online].
protective factors in a healthy living strategy must include Cited March 2005. Available from World Wide Web:
<http://www.who.int/dietphysicalactivity/media/en/gsfs_general.pdf>.
more than physical activity, nutrition, and tobacco cessation 17. Ibid.
18. Heart and Stroke Foundation of Canada, The Growing Burden of Heart Disease and Stroke in
strategies; other factors to be considered include education Canada 2003 (Ottawa, Ont.: Heart and Stroke Foundation of Canada, 2003).
and income levels, community opportunities, physical 19. M. Tjepkema, "The health of off-reserve aboriginal population," Health Reports 13,
supplement (2002). Statistics Canada, Catalogue 82-003.
environment and social support. 20. P. T. Katzmarzyk and R. M. Malina, November 1998, Obesity and relative subcutaneous fat
distribution among Canadians of First Nation and European ancestry, International Journal of
Basically, First Nations are moving towards a model that 21.
Obesity and Related Metabolic Disorders, 22, 11: 1127-1131.
NAHO preliminary results.
ensures that the 4-dimensional aspects of the “total person” 22. M. Dion Stout, 2005, Healthy living and aboriginal women: the tension between hard evidence
and soft logic, Centres of Excellence for Women’s Health Research Bulletin, 4, 2: 16-20.
and “total environment” are considered when developing 23. U.S. Department of Health and Human Services, Physical Activity and Health: A Report of the
strategies for First Nations adults. A cultural perspective is 24.
Surgeon General.
Health Canada and Canadian Society for Exercise Physiology, Canada’s Physical Activity
essential in promotion strategies, to understand barriers Guide to Healthy Active Living [online]. 1998. Cat. No. H39-429/1998-1. ISBN 0-662-86627-
7. Available from World Wide Web: <http://www.hc-sc.gc.ca/hppb/paguide/main.html>.
relevant to the population and for the interpretation of 25. Health Canada, Canadian Guidelines for Body Weight Classification in Adults [online]. 2003.
definitions and meanings.34 A list of recommended Available from World Wide Web: <http://www.hc-sc.gc.ca/hpfb-dgpsa/onpp-
bppn/cg_bwc_introduction_e.html>.
103
26. C. L. Craig and C. Cameron, Increasing physical activity: Assessing trends from 1998-2003
(Ottawa, Ont.: Canadian Fitness and Lifestyle Research Institute, 2004).
27. Tjepkema, "The health of off-reserve aboriginal population," Health Reports.
28. Ibid.
29. I. Janssen, P. T. Katzmarzyk and R. Ross, March 2004, Waist circumference and not body
mass index explains obesity-related health risk, American Journal of Clinical Nutrition, 79, 3:
379-384.
30. Statistics Canada, 2003, Canadian Community Health Survey (CCHS).
31. C. Cameron et al., Increasing physical activity: Supporting an active workforce (Ottawa, Ont.:
Canadian Fitness and Lifestyle Research Institute, 2002).
32. L. J. Starkey, L. Johnson-Down and K. Gray-Donald, 2001, Food habits of Canadians:
comparison of intakes in adults and adolescents to Canada’s Food Guide to Healthy Eating,
Canadian Journal of Dietetic Practice and Research, 62, 2: 61-69.
33. World Health Organization. Press release: WHO World Health Assembly adopts global
strategy on diet, physical activity and health, May 22, 2004 [online]. Available from World
Wide Web: <http://www.who.int/mediacentre/releases/2004/wha3/en/>.
34. C. Tudor-Locke et al., "In their own voices: Definitions and interpretations of physical
activity," Women’s Health Issues 13 (2003), pp. 194-199.
35. S. E. Cragg, C. L. Craig and S. J. Russell, Increasing Physical Activity: Enhancing municipal
opportunities (Ottawa, Ont.: Canadian Fitness and Lifestyle Research Institute, 2001).
36. Craig and Cameron, Increasing Physical Activity: Assessing Trends from 1998-2003.
37. Cameron et al., Increasing physical activity: Supporting an active workforce.
104
Chapter 9
Non-Traditional Use of Tobacco (Smoking)
Abstract
The use and misuse of non-traditional (commercial) tobacco by First Nations people negatively
affects their well-being, directly and indirectly. To provide successful tobacco-cessation programs, we
must understand the physical effects of first and second-hand smoking, and the profiles of smokers
and non-smokers.
This chapter presents information about First Nations smokers, smoking behaviour and tobacco’s
impact on First Nations health. Using data from nationwide and regional studies in Canada, smoking
behaviour and the effects of smoking are compared between First Nations the nation as a whole, and
between different First Nation groups.
Two questions from the First Nations Regional Longitudinal Health Survey (RHS) are looked at
simultaneously. For example, gender and smoking status will describe the frequency of men and
women (gender) and their smoking status (current smoker, former smoker, or non-smoker). We also
used input from a major provincial strategy that is leading tobacco-wise awareness with First Nations
communities as a part of cancer prevention. The reported relationships between tobacco and lifestyle
present findings that may possibly be particular to First Nations communities.
In general, the prevalence rate of smoking by First Nations in Canada is 58.8%; 17.6% never smoked.
Younger First Nations adults (less than 50 years old) report the highest rates of daily smoking.
Pregnant First Nations women match the general First Nations population in terms of smoking
prevalence (58.8%), but they have a higher representation in the former smoker category (33.8%) than
women who are not pregnant (22.8%). Pregnant women are also more likely to be occasional smokers
(25.5%) than average female smokers (12.5%).
On average, the former First Nations smoker quit at 32 years old. Both men and women reported the
same reasons for stopping. The desire for a healthier lifestyle was overwhelmingly the main reason
(63.5%), followed by greater awareness (30.4%), a health condition (29.3%), and respect for loved
ones (28.1%). Abrupt withdrawal (cold turkey) was the cessation method that applied to most often to
former First Nations smokers (88.5%).
Community planners and health promoters could plan and implement more successful First Nations
non-smoking programs if they had more knowledge, such as further analyses on methods and
motivation for smoking cessation, and on the reasons non-smokers abstain. A detailed analysis on the
length of time First Nations people consume commercial tobacco may also be useful. Smoking and
the links to health conditions, nutrition and physical activity is a comprehensive undertaking that is
beyond the scope of this chapter but is recommended as a detailed analysis on First Nations health
status.
105
RHS 2002/03 Adult Survey – Chapter 9: Non-Traditional Use of Tobacco (Smoking)
pregnancy.6 No other details were found about this sample or

Introduction
data collection methodology.
Contemporary First Nations stem from a unique, historical
Some tobacco use information is available from the 1991
and ongoing Indigenous way of life that includes a
Aboriginal Peoples’ Survey. For 1991, based on the sample
relationship with tobacco. To study the differences of First
alone 45.8% of Aboriginal adults 15 years and older in
Nations traditional tobacco use and commercial tobacco is an
Canada were smokers. Examining the selected characteristics
undertaking that could utilize many approaches in order to
for North American Indians (NAI) a rate of 41.4% was
appreciate the historical relationship and current practices.1
calculated based on population figure of 288,365 NAI 15
This chapter, however, is written with the use of statistics to years and older.7 A preliminary custom table on ‘North
describe the behaviours of First Nations with respect to American Indians’ from the APS 2001 shows no change in
commercial tobacco. The statistics used most often are the 57% smoking rate on-reserve.8 A national-based survey
frequency distributions (in this case two questions from the with improved sampling of on-reserve populations was the
survey are looked at simultaneously). For example, gender (FNIRLHS) survey which reported a 62% prevalence of First
and smoking status will describe the frequency of men and Nations smokers in 1997.9
women (gender) and their smoking status (currently smoke,
In 1996/97 the National Population Health Survey (NPHS),
former smoker or non-smoker). In general, this chapter
reported that 29% of adults aged 15 and over were smoking,
discusses the descriptions of how First Nations smokers and
slightly lower than the 31% smoking prevalence observed
non-smokers are living in their communities in relation to
among adults aged 15 and over in the in 1994/95 (Cycle 1).
non-traditional tobacco use .
The Canadian data collection in 2003, reports a 19%
On should be aware of the specialized vocabulary used in the smoking rate from the Canadian Community Health
chapter to describe commercial tobacco use. This vocabulary Survey.10
is used because we are taking about groups of people and sets
of behaviours. For example instead of the common term Interpretive Methods
‘quit’ the term, ‘cessation method’ is used because it captures
This chapter presents information about the tendencies, and
multiple methods. ‘Non-traditional use’, ‘recreational use’,
characteristics of First Nations smokers as well as the non-
‘tobacco abuse’ and the ‘misuse of tobacco’ are all used in
smokers to profile differences in lifestyle. Our efforts to
describing commercial tobacco use in the First Nations
provide helpful information to community workers and
context. The ways smokers are identified includes: quitters,
planners led us to seek input from a major provincial strategy
former smokers, former daily smokers, former occasional
that is leading tobacco-wise 11 awareness with Aboriginal
smokers, daily smoker, occasional smokers and/or never,
communities as a part of cancer prevention. The reported
ever smokers. The term ‘initiation’ refers to the age smoking
relationships are not caused by the use tobacco, but the
began.
information relating to tobacco and lifestyle present possible
associations particular to First Nations communities.
Literature Review
Sparse data collection on the rates of smoking by First Results and Discussion
Nations people in Canada began roughly in 1970-722 and
subsequent studies took place in 19883, 1991, 1997 and 2001 General smoking trends
by various federal departments as well as the First Nations
Regional Longitudinal Health Survey (RHS). Other studies, In general, the prevalence rate of smoking by First Nations in
although not national in scale contribute to the body of data Canada is 58.8%. Most of these smokers smoke on a daily
basis.
on smoking rates in First Nations.
A Nutrition Canada study (1970-1972) found a 59.5% Younger First Nations adults (i.e. less than 50 years old)
smoking rate for First Nations men and 56.4% for First report the highest rates of daily smoking. The data
demonstrates that First Nation non-smoking status is highest
Nations women.4 Pregnant Indian women from the 1970-
1972 nutrition survey reported a smoking rate of 63.5%.5 among seniors 60 years and older, however, 23.5% of this
Some population data are available on First Nations group report daily smoking.
population from the 1981 and 1986 census; however no
national information is available on tobacco use.
An unpublished Medical Services Branch survey collected in
1988 on breast-feeding found various rates of maternal
smoking; 54.1% of Indian women smoked before pregnancy,
49.1% smoked during pregnancy and 49.3% smoked after
106
Figure 1. Smoking status of First Nations (n=10 827) Figure 2. Pregnant and not pregnant First Nations by smoking
status (n=5 777)
100%
Occasional smokers,
12.8%
33.3%
80% 45.5%
Non-smokers,
41.2%
60%
25.5%
12.5%
40%
Daily smokers, 42.0% 41.2%

46.0%
20%
Daily
Occasional
Not at present
0%
Not pregnant Pregnant
Table 1. Smoking status of First Nations adults (%) by age group
(n=10 790) Table 2. Distribution of non smoking status for First Nations
(n=4 325)
Smoking Age group (years)
status Non-smoking status Percent
18-29 30-39 40-49 50-59 60 + Total
Former smokers
Non
smoker 30.3 36.3 39.2 55.2* 71.9* 41.2
Daily 13.7%
Daily
smoker 53.9 49.1 49.6 33.6* 23.5* 46.0 Occasional 9.1%
Occas. Never smoked 17.6%*
smoker 15.9 14.6 11.2 11.2 4.6* 12.8
* significantly different than younger age groups. Total 40.4%
Pregnant women Initiation

Pregnant First Nations women match the general population The majority of the former smokers began smoking
of First Nations in terms of smoking prevalence (58.8%). cigarettes between the ages of 12 and 16. The initiation rate
Pregnant women did however, respond significantly at 13 years of age is over three times greater than the rate
(p<0.003) different than non-pregnant women about their seen at 11 years: 11.4% versus 3.4%) On average the former
smoking status. Pregnant women have a higher First Nation smoker began smoking at 16 years old (mean=
representation in the former smoker category (33.8%) than 15.83: female mean=16.25; male mean=15.42).
women who are not pregnant (22.8%). Pregnant women also
differed with respect to daily or occasional smoking status: Figure 3. Reported age of initiation of former smokers (n=2,154)
50%
twice as many pregnant women fell into the occasional
smoking category (25.5%) than the average rate of 42.6%
occasional female smokers (12.5%). Although 45.5% of non- 40% 38.0%

pregnant women are current daily smokers and 33.3% of
pregnant women are daily smokers, these differences are not
30%
statistically significant. Nonetheless the information may
support the positive impacts of maternal smoking health
promotion/awareness programs for First Nations.12 20%
Former Smokers 10%

10.2%
5.6%
This section of the chapter relates to respondents who are 3.8%
former smokers that, which is First Nations who at the time 0%

<10 10-14 15-19 20-24 25+
of survey were not smokers but who responded that they
Age of initiation
previously smoked. Here we discuss age of initiation and
when (and how) cessation occurred.
The rate of non-smokers is 41.2%, see Figure 1. Most former
smokers were daily smokers (13.7%) or occasional smokers
(9.1%).
107
Cessation British Columbia and reports an extremely low use of

pharmacotherapy as a cessation method. Researchers suggest
About one-third of former smokers quit smoking by 24 years
a further investigation in the cultural appropriateness,
old, just over one-third quit between 25 and 39 years old and
barriers to use and effectiveness of cessation
slightly less than one-third quit after their fortieth birthday.
pharmacotherapy related to First Nations.13
On average the former First Nation smoker quit smoking at
32 years old (male mean=32.99; female mean=31.24). Table 5. Former smoker’s methods for quitting smoking (n=2296)
Method of Quitting %
Table 3. Reported age of smoking cessation by gender (n=2055)
Age quit smoking All* Male Female Diff. “Cold turkey” (will-power alone) 88.5
<9 – – – – With help from spirituality 8.0
10 – 14 1.8% – – –
With assistance from family 5.2
15 – 19 16.1% 13.9% 18.4% -4.5%
Nicotine replacement – patch 3.7
20 – 24 17.0% 16.1% 18.0% -1.9%
25 – 29 14.0% 13.5% 14.6% -1.1% Support or self-help program 1.8
30 – 34 11.0% 11.1% 10.8% 0.3% Zyban (bupropion) 1.1

35 – 39 11.6% 13.9% 9.2% 4.7% Nicotine replacement – gum 1.0
40 – 44 10.4% 9.0% 11.8% -2.8%
45 – 49 4.8% 4.9% 4.8% 0.1%
Current smokers
50 + 13.2% 15.7% 10.6% 5.1%
– Data suppressed due to insufficient cell size. Almost 60% of First Nations people are current smokers.
This section on current smokers will describe the age
In the question about reasons for quitting smoking, distribution, consumption patterns by age group and gender,
respondents were read a list of reasons from which they ages of initiation for current smokers and the number of
could select all the reasons that applied. Based on the quitting attempts.
responses, the desire for a healthier lifestyle was
overwhelmingly the main reason (63.5%). The next was a Figure 4. Proportion of current smokers by age group and
close tie between the respondent having greater awareness smoking status (n=6386)
(30.4%) and a health condition (29.3%). This was followed 100%
Daily
by respect for loved ones (28.1%). The reasons for quitting Occasional
83.7%
81.6%
smoking generally did not vary by gender. 80% 77.3% 77.0%
75.0%
Table 4. Former smokers reasons for quitting smoking (n=2127)

Reason for Quitting % 60%
Chose a healthier lifestyle 63.5

Greater awareness/education on ill effects of tobacco on my 40%
30.4
health
25.0%
22.7% 23.0%
Health condition 29.3 20%
18.4%
16.3%
Out of respect for loved ones 28.1

0%
Pregnancy 11.9 18-29 30-39 40-49 50-59 60+
Age group (years)

Respect for the cultural and traditional significance of tobacco 8.1
Doctor’s orders 7.4

Consumption
Peer pressure from friends/co-workers 3.5 The average number of cigarettes consumed by current
smokers is 10 (mean=10.48) This rate of consumption is
From the list of cessation methods, respondents selected the lower than Canadians who average about 15 cigarettes a day.
method(s) that they used.. Based on the responses, ‘cold Young men (age 18-29) smoke more cigarettes daily than
turkey’ was the cessation method that applied to most often women of the same age, but older men and women are about
to former First Nation smokers (88.5%). Other frequently equal in the number of cigarettes consumed daily.
reported methods for smoking cessation included: help from
spirituality (8.0%), assistance from family (5.2%), and a
medication patch (3.7%). A recent study investigated non-
insured health benefit claims by First Nations living in
108
Table 6. Average number of cigarettes consumed by age and Socio-economic and health trends
gender (n=6,376
Gender Language and education
Age group Diff. (m-f)
Male Female Statistical differences appear when examining the
18-29 10.19 7.67 2.52 relationship between education and smoking status as
collected in this survey. Table 8 contains the rates of
30-39 11.42 9.98 1.44 (NS) smoking and non-smoking across education levels.
40-49 12.2 11.5 0.64 (NS) Table 8. Distribution of smoking status (%) across education
(n=10,595)
50-59 12.8 11.7 1.1 (NS)
Smoking status
60+ 12.5 10.7 1.75 (NS) Education
Former Former Never, Current
daily occasional ever smoker
Figure 5. Consumption of cigarettes by 18–29 year-old men and Not completed
women (n=2134) 47.0 42.8* 47.4 56.4*
high school
40%
36.5% High school graduate 17.6 20.8 21.8 19.1
33.4%
30.6% Post-sec. diploma 29.0* 31.2* 21.4 21.0*

30% 28.6% Men
26.9%
26.7%
25.0%
Women Bachelor’s degree 5.7 4.7 7.6%* 3.3*
Total
21.2% Graduate degree – – – –
20%
* significant relationships between cells.
16.3%
– Data suppressed due to insufficient cell size.
12.0% 12.4%
9.7%
General health
10% 8.8%
7.0%
4.8% Generally speaking, there were little differences in self-
reported health status between smokers, former smokers and
0% never, ever smokers. In this survey, adults who responded
<5 5-9 10-14 15-19 20+
that their health was either excellent or very good were
Number of cigarettes
further asked to disclose those things that made them so
Quitting attempts healthy. In the examination of smoking status and the range
of responses to healthy-being, one of the seven categories of
More than half of today’s First Nation current smokers have responses was statistically significant. Former daily smokers
made at least one attempt to quit smoking (54.1%). The are more likely than current smokers and never, ever smokers
majority of those who have made attempts have only done so to report a good diet as a reason for their excellent or very
one or two times. About twenty percent (19.3%) of the good health ranking.
smoking population is currently making their third, forth,
fifth or more attempts to quit smoking. About 46% of the Housing
smoking population has yet to make their first quitting
attempt. Those who attempted to quit were not asked about About half of all respondents have a smoke-free home
their choices of methods, nor their reasons or motivations to (52.4%), conversely half of the homes where First Nation
quit smoking. live are not smoke-free (47.6%). Current smokers have a
slightly higher number of children living in one household
Table 7. Current smoker’s reported attempts for quitting than do former occasional and never, ever smokers. In
(n=6056)
general, there are no differences between current smokers,
Number of attempts Percent
former smokers, and non-smokers in terms of living in an
None 45.9 overcrowded housing situation.
1 to 2 attempts 34.9 Personal wellness
3 to 4 attempts 12.1 In the section on personal wellness, respondents provided
5 or more attempts 7.2 attitude responses on the importance of traditional cultural
events, traditional spirituality and religion, in their lives.
Very important and somewhat important categories were
collapsed and compared against the not very important and
not important categories, creating high and low importance
categories. First Nations smoking and non-smoking
109
populations only marginally differed in their attitude about Table 11. Self-reported health conditions (%) by smoking status
traditional spirituality. Current smokers responded more Smoking status
favourably to traditional spirituality than did the non- Health condition Former Former Never,
smoking population by about 5% and this finding was is also Current
daily occasional ever
statistically significant.
Asthma (n=10,184) 15.4* 8.1* 10.1 8.7*
Table 9. Reported attitudes in personal wellness (%) by smoking
status Allergies (n=10,129) 26.3+ 22.2 18.8 16.0+
Smoking status
Heart disease
Attitudes on: Current 9.8+ 5.5 6.4 3.4+
Non-Smoking (n=10,142)
Smokers
High blood pressure
Cultural Event (n=10,244) 23.9+ 21.5+ 18.8+ 10.6+
(n=10,099)
High Importance 78.3 82.1 (NS)
Stomach and intestinal
Low Importance 21.7 17.9 (NS) 12.1+ 9.5 6.4 6.9+
problems (n=10,158)
Traditional Spirituality (n=10,080) Diabetes (n=10,091) 22.1+ 17.4+ 19.3+ 10.1+
High Importance 73.3 78.6
Arthritis (n=10,185) 24.9+ 21.0 20.5 15.9+
Low Importance 26.7 21.4
Religion (n=10,813) Hearing Impairment (n=
13.3+ 12.0+ 8.0 5.7+
10,179)
High Importance 70.5 69.8 (NS)
* significantly different from former daily smoker category
Low Importance 29.5 30.2 (NS) + significantly different from current smoker category
Never, ever smokers are more likely (by a full 10%) than Body Mass Index
current smokers to report a high level whereas current The number of First Nations calculated to have an acceptable
smokers are more likely than never, ever smokers to report a Body Mass Index (BMI) is roughly 26%. Associations
moderate level of balance. Current smokers are more likely between smoking status and BMI were statistically
than former daily smokers to report a low level of balance. significant. Table 16 details BMI levels and smoking status.
Further analysis is required to explore the associations and
Table 12. Body Mass Index (BMI) by smoking status (n=8861)
types of balances.
Smoking status
Table 10. Levels of balance by smoking status (n=10,728)
BMI
Smoking status Former Former Never,
Current
Level of daily occasional ever
balance Former Former Never,
Current
daily occasional ever Underweight – – – 1.4%
High level 36.1% 35.6% 39.0%* 28.8%* Acceptable 18.5%+ 16.1%+ 24.4% 30.0%+
Moderate
60.8% 59.3% 54.9%* 64.2%* Overweight 34.0% 37.6% 36.8% 37.8%
level
Low level 3.1%* 5.1% 6.1% 6.9%* Obese 40.4%+ 36.5% 32.6% 27.1%+
* significant relationships between cells.
Morbidly obese 6.7%+ 9.0%+ 5.4% 3.6%+
Health conditions + significantly different from current smoker category
The self-reported health conditions with a low prevalence Nutrition

(less than 5%) were: ADD or ADHD; blindness or serious
vision problem; bronchitis; cancer; cataracts; cognitive or Smokers have a lower proportion than ‘former’ or ‘never’
mental disability; effects of stroke; emphysema; epilepsy; smokers who reported nearly always have a nutritious,
glaucoma; HIV-AIDS; learning disability; liver disease balanced diet. At the combined level of rarely or never
(excluding Hepatitis); osteoporosis; psychological or nervous having a balanced diet, smokers reported the highest
disorder; rheumatism; thyroid problems; and tuberculosis. proportion at 14.3%, while the former smokers and never
The conditions with noticeable responses (5-25%) were: smokers report less than 10%.
asthma; arthritis; allergies; diabetes; hearing impairment;
heart disease; high blood pressure; and stomach and
intestinal problems.
110
Table 13. Frequency of a nutritious balanced diet by smoking to report having used cocaine, crack or freebase and codeine,
status (n=10,543)
morphine, or opiates at some time.
Smoking status
Nutritious balanced
diet Former Former Never,
Residential school
Current
daily occasional ever About half of the respondents, across all smoking statuses
Always or nearly believed that their health was negatively affected by their
45.3%+ 38.5% 39.4%+ 30.9%+
always attendance at residential school. There are no significant
differences between smoking status and those that report
Sometimes 46.5%+ 52.5% 51.5% 54.8%+
being negatively affected by residential school.
Rarely and Never 8.3%+ 8.9%+ 9.1%+ 14.3%+ Multigenerational residential school information was
+ significantly different from current smoker category collected in the survey. Based on the complex variables
which calculated one or more parents attending residential
Physical Activity school, the non-smoking population reports a lower
The only variable that was explored for physical activity was proportion (42.3%) than the smoking population (54.5%).
the hours per week participating in increased heart rate and Similarly, the non-smoking population reports a lower
breathing activities. There were no apparent differences proportion (34.9%) of one or more grandparents attending
between smoking status and hours per week participating in residential school than in the smoking population at 44.6%.
physical activity. Physical activities would require more
investigation before drawing conclusions on associations Employment and income
related to tobacco use. An equal proportion of smokers and non-smokers are
working part-time or full-time.
Alcohol and non-prescription drugs
A higher percentage of current smokers (83.1%) than non-
The proportions of alcoholic beverage consumption by smokers (74.7%) report personal income of less than
smokers and non-smokers is relatively similar, except for two $30,000. Upon closer examination, both smokers and non-
out of the five frequency categories. Non-smokers (32.3%) smokers report the $10,000 or less (including income loss)
are more likely to consume alcoholic beverages infrequently category as the highest proportion for their smoking status,
(2 to 3 times a year) than smokers (24.4%). but smokers have a 9% higher proportion of responses at
Chewing tobacco is rarely used by all respondents: only 37.4% whereas non-smokers are calculated at 28.3%.
5.8% (n=10,577) of the entire population of respondents Household income is fairly evenly distributed across the
report using it. Non-smokers are more likely than current smoking and non-smoking First Nations population
smokers to report using chewing tobacco at 7.8% and 4.5% (n=5225). Only for low- income levels are differences visible
respectively. according to smoking status. A smaller proportion of non-
Former daily smokers (15.6%), former occasional smokers smokers (8.9%) report an income of $10,000 or less
(15.2%) and current smokers (19.6%) are considered equally (including income loss) compared to smokers (13.9%).
likely to report having been treated for alcohol abuse. Current smokers are more likely than non-smokers to report a
‘Never-ever’ smokers (7.3%) report the lowest proportion household income exceeding $50,000. Both personal income
having had alcohol abuse treatment. Similarly, both former and household income had distinctly varied responses
and current smokers are just as likely to report having been according to smoking status.
treated for substance abuse. Those who have never, ever
smoked report the lowest proportion (2.0%) of receiving Conclusions
treatment for substance abuse whereas current smokers are The smoking prevalence for First Nations in 2001 was
more than four times as likely to have received treatment 58.8%, a reduction of about 3% from 1997. Pregnant women
(9.2%). follow a different trend on smoking than the general
The majority of both smokers and non-smokers report never population of women in this survey and a decline in smoking
using marijuana or hashish. Current smokers are more than rates is apparent for pregnant First Nations women. For
twice as likely as never, ever smokers and former smokers to former smokers the average age of initiation was 16 years.
report using marijuana or hash. The average age of cessation for former First Nation smokers
was at 32 years. Most quit for a healthier lifestyle: awareness
In the First Nations population at least 85% of respondents and health conditions are among the other frequently
reported never using any of the following non-prescription reported reasons. Cessation was succeeded mainly by the
drugs: PCP or angle dust; acid, LSD amphetamines; ecstasy; ‘cold turkey’ method.
inhalants; sedatives or downers; heroin, cocaine, crack or
freebase. Current smokers are more likely than non-smokers
111
Younger First Nations people have the highest rate of Further References
smoking among all First Nations. One-quarter of the senior
Statistics Canada, Canada’s Native People (Ottawa, Ont.: Statistics Canada, 1984).
population are smokers. More than half of the population of Gilles Y. Larocque and R. Pierre Gauvin, 1986 Census Highlights on Registered Indians: Annotated
First Nations surveyed have attempted to quit smoking.14 Tables (Gatineau, Que.: Indian and Northern Affairs Canada, 1989).
Margo Shields, "Healthy Today, Healthy Tomorrow? Findings from the National Population Health
Survey," A Step Forward, A Step Back: Smoking Cessation and Relapse (Ottawa, Ont.: Statistics
Canada, n.d.).
Recommendations Indian and Northern Affairs Canada, Aboriginal Women: A Profile from the 1996 Census (Gatineau,
Que.: Indian and Northern Affairs Canada, 2001).
With respect to former smoking status, some further analysis Four Directions Consulting Group, Implication of First Nations Demography (Final Report)
(Gatineau, Que.: Indian and Northern Affairs Canada, 2004).
on what has helped some First Nations people maintain their Indian and Northern Affairs Canada, Registered Indian Population Projections for Canada and
Regions 2000-2021 (Gatineau, Que.: Indian and Northern Affairs Canada, n.d.).
tobacco-wise lifestyle would be useful in future data Health Canada, On the Road to Quitting [online]. [Ottawa, Ont.]: Health Canada, n.d. Available from
collection as well as information on First Nations relapse World Wide Web: <http://www.hc-sc.gc.ca/hecs-sesc/tobacco/quitting/road/benefits.html>.
Health Canada, Canadian Tobacco Use Monitoring Survey (CTUMS) Annual Results 2001 (Ottawa,
could also provide insight. A detailed analysis on the length Ont.: Health Canada, n.d.).
of time First Nations people consume commercial tobacco,
either through recall on future data collection, or via high
level statistics, may greatly inform First Nations public
health workers. Such information could be comparable to the
“pack-years” measurements reported in the 1997 RHS. In
relation to the quit attempts current smokers are
experiencing, more information on the methods tried and
motivation for their attempts could assist community
planners and health promoters to target and support the
contemplative population (more than 3000 First Nations
respondents made at least one attempt in 2001.) Smoking and
the links to health conditions, nutrition and physical activity
is a comprehensive undertaking that is beyond the scope of
this chapter but is highly recommended as a detailed analysis
on First Nations health status. Housing and environmental
tobacco smoke (ETS) can be further reviewed as another
topic area with the use of high level statistics and applied
knowledge about tobacco exposure. Further analysis on the
‘balance’ variable, most unique to the Regional Health
Survey may provide more insight.
Notes to Chapter 9
1. Jeff Reading, Eating Smoke: A Review of Non-Traditional Use of Tobacco Among Aboriginal
People (Ottawa, Ont.: Health Canada, 1996).
2. Minister of National Health and Welfare, Health Status of Canadian Indians and Inuit, Update
1987 (Ottawa, Ont.: Department of Health and Welfare, 1988).
3. Minister of National Health and Welfare, Health Status of Canadian Indians and Inuit, 1990
(Ottawa, Ont.: Department of Health and Welfare, 1991).
4. Minister of National Health and Welfare, Health Status of Canadian Indians and Inuit, Update
1987.
5. D. T. Wigle and H. Johansen, June 1982, Parental smoking and infant morbidity, Canadian
Medical Association Journal, 126: 1277-1278.
6. Minister of National Health and Welfare, Health Status of Canadian Indians and Inuit, 1990.
7. Statistics Canada, Language, Tradition, Health, Lifestyle and Social Issues (Ottawa, Ont.:
Statistics Canada, 1993).
8. Statistics Canada, Aboriginal Peoples Survey 2001 (Ottawa, Ont.: Statistics Canada, 2004).
9. Jeff Reading, "The Tobacco Report," First Nations and Inuit Regional Health Survey, National
Report, 1999 (Ottawa, Ont.: First Nations and Inuit Regional Health Survey National Steering
Committee, Health Canada, 1999).
10. Statistics Canada, Health Reports 14, 3 (Ottawa, Ont.: Statistics Canada, May 2003, cat. no.
82-00.3).
11. Aboriginal Cancer Care Unit, Aboriginal Tobacco Strategy, newsletter (2005), Vol. 2, No.1.
12. Reading, "The Tobacco Report," First Nations and Inuit Regional Health Survey, National
Report, 1999
13. A. E. Dennis Wardman and Nadia Khan, August 2004, Tobacco cessation pharmacotherapy
use among First Nations persons residing within British Columbia, Nicotine & Tobacco
Research, 6, 4: 689-692.
14. Health Canada, Canadian Tobacco Use Monitoring Survey (CTUMS) Annual Results 2004
(Ottawa, Ont.: Health Canada, n.d.).
112
Chapter 10
Alcohol and Drug Use
Abstract
This chapter presents the results from the 2002/03 First Nations Regional Longitudinal Health Survey
(RHS) on the use of alcohol and other select substances by adults. Consistent with previous surveys,
rates for both abstinence from alcohol and the frequency of alcohol use were lower among First
Nations respondents than those of the general population. However, there were a higher proportion of
heavy drinkers (defined as those who have five or more drinks on one occasion) and drug users in the
First Nations population. The highest risk group for both drinking and drug use included young males
aged 18–29. Recommendations include increased surveillance regarding the health impact of
substance abuse and the integration of cultural components into prevention and treatment approaches.
113
RHS 2002/03 Adult Survey – Chapter 10: Alcohol and Drug Use
and social order of a community.7 As a result, substance

Introduction
abuse was likely used as a coping mechanism for the
growing loss of identity and culture.8 This hypothesis is
Chapter Overview reinforced by a number of studies which found that a higher
This chapter presents selected outcomes from the 2002/03 degree of cultural orientation at both an individual and
First Nations Regional Longitudinal Health Survey (RHS). community level has been found to reduce the risk for a
These results focus on the use of alcohol and other selected number of social problems such as substance abuse and
substances by adults (aged 18 and older). Although issues suicide.9 Many of the current factors associated with
around alcohol and drug use continue to be identified as a substance dependence focus around ongoing inequities in the
concern by many First Nations communities, there remains a determinants of health. Despite improvements, there continue
lack of comprehensive information on the abuse and impact to remain clear differences between the Aboriginal and non-
of these substances. This report offers a unique opportunity Aboriginal population in educational attainment, income and
to examine this topic through the analysis of nationally employment opportunities.10
collected survey data. To facilitate an understanding of the
nature and context of these results, a synthesis of the relevant Measurement Issues and Risk Factors
literature is provided, including historical and cultural
The impact of alcohol and drugs on Aboriginal communities
information, surveillance and measurement issues and risk
is substantial; alcohol-related deaths amongst First Nations
factors. Where appropriate, the results are compared with
people were six times higher, and drug induced deaths were
data available from previously undertaken surveys in both
more than three times higher, than those of the general
the Aboriginal and non-Aboriginal population. The chapter
population.11 However, the capacity to ascertain clear data on
concludes with a series of recommendations for future
the prevalence of substance use, abuse and dependence in
surveillance efforts, as well as prevention and treatment
First Nations and Inuit populations is limited by the
approaches.
reliability and validity of existing population surveys.
Previous surveys have been criticized due to a low level of
Historical and Cultural Context participation, as well as a lack of cultural sensitivity in the
Prior to colonization, alcohol and other psychoactive agents survey tools and interpretation of results.12 Furthermore,
played a role in the lives of Indigenous peoples both inside there may be cultural sensitivity concerns related to current
and outside of North America. Their use, however, was diagnostic instruments. For example, F. Frances (Ethnic and
strictly controlled and closely tied to the social customs and Cultural Considerations, Diagnostic and Statistical Manual
rituals of various tribes.1 Upon the arrival of Europeans, a on Mental Disorders) has noted the challenges of applying
number of factors contributed to changes in the traditional DSM-IVi criteria to evaluate individuals from different
perception and use of these substances. Foremost among cultural or ethnic groups, noting that psychopathology may
these factors was an increase in the availability of alcohol, be attributed to behaviours or beliefs that are norms within
which was often used during trade and diplomatic contacts.2 specific ethno-cultural groups.13 As such, increasing attention
In fact, the frequent use of alcohol by European authorities has been paid to the cultural relevance diagnostic tools. A
has been viewed as representing a type of chemical warfare number of smaller studies have found addiction-related
aimed at creating a European advantage as colonization was diagnostic tools, the CAGEii and SAQ,iii to be valid within
initiated.3 Another potential influence was the heavy drinking the Aboriginal population.14 Care must still be taken in
‘frontier lifestyle’ modelled by early traders, a pattern that applying or generalizing assessment tools and results to the
may have been replicated by Aboriginal peoples.4 As the use diverse Aboriginal population.
of alcohol became illegal for Aboriginal peoples, these Previous research work among Indigenous peoples has
abusive patterns of use were likely further enforced by the attempted to identify the factors that are associated with
need to engage in the rapid ingestion, or ‘gulp drinking’, of
alcohol and substance abuse. For example, a number of
alcohol in order to avoid authorities.5 The incorporation of studies have found associations between genetic markers and
these drinking patterns may still influence heavy alcohol dependence that have the potential to be either risk or
consumption patterns, such as binge drinking.
protective influences.15 In other words, there is inconclusive
Over the past hundred years, ongoing assimilation policies, evidence that the population is genetically prone to alcohol
such as the residential school system, further contributed to problems.16 Differences in physiological responses to alcohol
the disintegration of traditional cultural and family structures.
According to L. A. French (Addictions and Native
i
Americans), a state of harmony ethos existed prior to this Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV), published by
the American Psychiatric Association, Washington D.C., 1994, the main diagnostic reference of
cultural alienation, a concept that describes a balanced Mental Health professionals in the United States of America.
system of interpersonal and community interactions.6 The ii
C Have you ever felt that you ought to Cut down on your drinking? A Have people Annoyed you by
criticizing your drinking? G Have you ever felt bad or Guilty about your drinking? E Have you ever
disruption of this state led to what E. Durkheim (Suicide) had a drink first thing in the morning (Eye opener) to steady your nerves or get rid of a hangover?
referred to as ‘anomie’—a breakdown in the religious, family iii
Self Administered Questionnaire
114
demonstrated a reduced sensitivity to alcohol effects by some report alcohol use (69.3%) than females (61.7%), and the
Aboriginal groups. Along with challenging the “firewater” highest rates were found among younger males aged 18 to
myth, this suggests that exceptional problem drinking among 29. Canadian data from the general population reflects
First Nations people relates more to environmental rather comparable usage rates among younger males and also
than genetic factors.17, 18 Most research has focused on social indicates that this group is more likely to have consumed
and individual elements associated with substance alcohol over the past year.29
dependence. First Nations persons who have experienced a Figure 1. Alcohol consumption over the past year: RHS 2002/03
history of sexual and physical abuse, for example, have (n=10,655) vs. general Canadian population
consistently higher levels of alcohol or drug abuse.19 A 100%
history of familial alcoholism is also frequently identified as
a predictor of future alcohol and substance dependence, and 82.0%
79.3%
has been associated with the risk of childhood abuse.20 Other 80% 76.8%
risk factors include: exposure to alcohol and drugs; 69.3%

65.6%
61.7%
childhood neglect; depression; attendance at 60%
residential/boarding schools; and, being a victim of
violence.21 Although there is a lack of research indicating a
direct causal relationship between these individual factors 40%
and drinking behaviours, the presence of these factors is

often associated with harmful patterns of use, such as
20%
chronic/heavy drinking, in later life.22 First Nations
General population
Although generally perceived as a secondary issue to

0%
alcoholism, drug use has been of growing concern among Male Female Total
some First Nations communities.23 Alcohol dependence has
been found to be coupled to higher rates of abuse of other Rates of alcohol use were also available for a number of
substances, particularly cocaine and marijuana.24 The co- community indicators but did not vary significantly by
morbid use of these substances has also been associated with community size. However, residents of remote isolated
negative health and behavioural outcomes such as violence, communities (defined as having no scheduled flights) are
injury and psychiatric conditions.25 more likely than residents of non-isolated communities
(defined as having road access and being less than 90
Results kilometres from a physician) to report consuming alcohol
(75.7% versus 64.6%, respectively). Although lower rates of
The results presented here are derived answers from six use (62.3%) were found in communities in which the transfer
survey questions and include information on alcohol and process had occurred, these results were not statistically
substance use, alcohol and substance use patterns, the significant.
seeking of treatment, and community perceptions on
substance abuse. Frequency of Drinking
Alcohol Use As seen in Table 1, the frequency of alcohol use was
predominately moderate and did vary somewhat by a number
The data available from previous studies actually indicate of demographic characteristics. The data for frequency were
that Aboriginal people have a higher abstinence rate than that also consistent with abstinence rates, with a lower frequency
of the general population.26 The current RHS results for First of use being reported by First Nations than in the general
Nations people in particular are consistent with this population. Only 17.8% of respondents stated that they used
occurrence. As seen in Figure 1, over the past twelve months, alcohol on a weekly/daily basis, compared to 44% in the
two-thirds of survey respondents (65.6%)iv reported the use general population.30 Males were about twice as likely
of alcohol, compared to 79.3% of the general Canadian (22.8%) than females (11.9%) to be weekly drinkers. Only
population.27 Table 1 compares the proportion of alcohol 14.2% of First Nations persons who were 60 and older
users by various demographic variables and community size. reported weekly drinking, substantially less than their
Of note is a consistent decrease in drinking with age. In fact, counterparts in the general population.31
only 36.3% v of RHS survey respondents over 60 reported
the use of alcohol, less than half that of the rates found
among Canadians aged 55–74.28 Males were more likely to
iv
v
115
Table 1. Proportion having had a drink in the past year, frequency of alcohol consumption, and frequency of having had 5 or more
drinks on one occasion, by gender, age group, and educational attainment
Alcohol of consumption frequency (%) Frequency of having 5+ drinks on one occasion (%)
1+ drinks
2-3 x 2-3x 2-3x < 1x 2-3x > 1x
in past year (%) 1x per 1x per 1x per 1x per 1x per
per per per Never per per per
month day month week day
year month week month month week
Overall
Total 65.6 26.8 21.7 33.7 15.7 2.1 17.1 24.3 7.6 1.0 17.3 25.2 7.5
Male 69.3 19.7 21.8 35.8 19.7 3.1 11.5 24.1 9.5 1.4 15.8 27.8 10.0
Female 61.7 35.3 21.6 31.2 10.9 1.0 23.7 24.7 5.2 - 19.1 22.2 4.5
Age group (years)

18-29 82.9 22.6 22.3 35.1 18.4 1.5 12.0 24.0 8.7 - 16.9 30.3 7.6
30-39 71.0 28.6 20.9 35.9 13.3 1.3 13.6 26.4 7.7 - 18.6 25.7 7.5
40-49 58.1 29.1 19.7 33.8 14.1 3.3 21.9 23.0 6.8 - 16.1 23.0 7.0
50-59 49.8 29.4 21.9 29.1 16.7 - 26.9 22.8 7.1 - 14.8 17.9 8.4
60+ 36.3 36.5 26.5 22.8 9.3 - 35.1 22.7 - - 21.6 9.8 -
Did not
graduate high 64.5 25.5 22.0 34.6 15.7 2.1 12.7 25.3 7.2 1.2 16.0 28.5 9.1
school
High school
73.4 26.7 23.1 31.6 17.3 1.4 18.3 25.9 6.8 - 18.2 23.0 7.4
graduate
Post-secondary
62.6 29.1 23.7 31.9 14.9 4.4 21.1 22.6 9.2 - 18.6 21.8 5.3
diploma
Bachelor's
59.0 25.2 19.6 35.1 13.5 - 31.4 18.8 - - 20.9 21.2 -
degree
Graduate
85.8 - - - - - - - - - - - -
degree
-data suppressed due to small sample size
Heavy Drinking Twenty-nine percent of males in this age range reported the
The impact of alcohol is generally associated with problem use of marijuana on a daily basis. In general, prescription
drinking, rather than overall usage. Previous work has found drugs—including codeine, morphine and opiates—had the
higher rates of alcohol dependence and substance abuse next highest frequency of use, with 12.2% reporting the use
issues among heavy/binge drinkers.32 Although lower of these drugs over the past year. The use of sedatives was
abstinence and drinking frequency rates are a positive sign reported by 3.1% of respondents.
for Aboriginal communities, the proportion of heavy drinkers There is a relatively low frequency of illicit substance use.
(those who have 5 or more drinks on one occasion) remains The usage rate of any of 5 illicit substancesvi was found to be
higher for Aboriginal people than that found in the general 7.3% over the past year, and is more frequently reported by
population. As seen in Table 1, more than double the men (9.3%) than women (5.3%). However, this is more than
proportion of First Nations adults (16.0%) reported heavy double the rate found among the general population, in which
drinking on a weekly basis than in the general population past-year-use was reported to be only 3%, excluding
(6.2%) appear to be at highest risk, with 20.9% of males inhalants.36 No apparent relationship between drug use and
reporting heavy drinking on a weekly basis, compared to cultural affiliation (i.e., likelihood of consulting a traditional
only 10.2% of females reporting weekly heavy drinking.33 healer, importance of cultural events) was identified, perhaps
due to small sample sizes. Higher proportions of non-users
Drug Use reported a lower number of mental health or professional
There is limited information from previous studies on drug social support agents, whereas users of five or more drugs
use in the First Nations population. The results of these were more likely than non-users to report a higher number
smaller studies, however, do provide some indication of a (3) of support agents of this type. The impact of the use of
higher proportion of usage of selected illicit substances in the illicit substances is of concern to communities. The use of
Aboriginal population.34 Current RHS data found that 26.7% these substances is associated with alcohol dependence, as
of respondents had used marijuana over the past year, well as co-morbid dependence on other substances, with
compared to only 14.1% in the general population.35 By far, cocaine and marijuana acting as a ‘base drug.’37 Although
the highest frequency users were males aged 18 to 29. highly publicized in the media as a problem for Aboriginal
vi
PCP/Angel Dust, Acid/LSD/Amphetamines, Ecstasy, Inhalants, Cocaine/Crack/Freebase, Heroin
116
highly publicized in the media as a problem for Aboriginal information on alcohol and drug related mortality within the
communities, the reported use of inhalants was very low First Nations population of that province.39
(0.2%). No exploration between tobacco and alcohol/drug
use was undertaken in our analysis. Prevention and Treatment
The results of this study highlight a number of important
Treatment and Community Response
differences between the substance use patterns of First
The impact of substance abuse can also be seen through the Nations and Inuit peoples and the general Canadian
proportion of respondents who sought treatment for their population. In particular, there are both higher rates of
addiction. Treatment was most often sought for alcohol abuse abstinence and a lower frequency of alcohol use in
(16.3%). Approximately 7% of all respondents reported that Aboriginal populations. These differences may be indicative
they had sought treatment for drug abuse while another 1.2% of a rediscovery of traditional cultural attitudes and values
sought treatment for solvent abuse. These rates do not towards alcohol and other substances. For example, those not
necessarily reflect the extent of those requiring treatment, nor consuming alcohol were more likely to have seen a
do they necessarily represent a lack of treatment resources. traditional healer over the past year than those consuming
Generally speaking, young males are less likely to seek alcohol (who were more likely not to have seen a traditional
treatment for alcohol abuse compared to their older male healer for 2 or more years). There is a need to explore the
counterparts. Although the data indicate that there may be role of culture as a preventative tool, an approach already
lower rates of alcohol use among First Nations compared to undertaken by a number of communities.40 This may also
the general population, significant concern still remain over address maladaptive attitudes towards drinking patterns, such
the capacity of the community to respond to this issue. as gulp and heavy drinking, which were modelled by early
Consistent with previous surveys undertaken in First Nations frontiersman. These historical factors may still contribute in
communities, the majority of respondents expressed concern part to the pattern of binge drinking seen today. Historical
over the lack of progress against alcohol and drug abuse.38 and cultural awareness campaigns could be used to further
The current data found that 63.6% of respondents felt that no articulate these types of phenomena.
progress was being made in reducing alcohol and drug abuse.
Existing data seem to suggest that transfer polices are a
Only 6.6% felt that good progress was being made.
marker of community stability, which in turn can impact
Those seeking treatment were more likely to report one or substance use and misuse. For this reason, governments need
more medical conditions than those not seeking treatment. to support First Nations in their efforts for self-governance.
Approximately one third of individuals (31.9%) reporting As part of self-governance, First Nations communities need
treatment for alcohol use had attended a residential school. to examine comprehensive, community-wide policies
Those accessing treatment also indicated closer cultural ties addressing the prevention of alcohol and drug abuse and
than those not accessing treatment. For example, a higher dependence. The more publicized prevention efforts in First
proportion of individuals in treatment were more likely to Nations communities have utilized prohibition, but
report that traditional cultural events were of importance to unfortunately have had limited effectiveness and are
them. dependent on enforcement policies and infrastructure.41
Prohibition efforts need to be incorporated into broader
Discussion and Recommendations community prevention strategies.42 Health Canada has
recommended the collaboration of First Nations community
Surveillance and Impact leaders, health professionals, government and law
enforcement agencies in the development of prevention
For the first time, the RHS provides comprehensive and frameworks.43
national baseline information on substance use in the First
Nations population. However, there is still a need for Prevention programming must also be developed from a
surveillance initiatives that would provide data on health and perspective that considers the determinants of health.
social impacts related to alcohol and substance use. Two Although the general trends indicate lower overall usage in
opportunities are available to capture this information. The Aboriginal communities, there continues to be a significantly
first is the inclusion of further questions, such as those found higher proportion of heavy drinkers and drug users than in
in the Canadian Addictions Survey and previously the general population. There is a need to address the broad
administered First Nations and Inuit Regional Longitudinal determinants of health, such as poverty, in order to have an
Health Survey. These surveys explored the harmful effects impact on substance misuse.
and perceived impact from alcohol and substance use As mentioned, the RHS results highlight the importance of
through a number of inquiries. The second opportunity is the First Nations cultures in reducing alcohol and drug use.
linkage of data through partnerships with government Unfortunately, the body of literature describing best practices
ministries. For example, British Columbia has linked Indian in substance abuse programs for Aboriginal populations is
Status with coroner data that are providing critical limited; however, existing research supports the
117
Government Printing Office, 1976).

incorporation of cultural and spiritual healing practices into • French, Addictions and Native Americans.
addictions treatment approaches.44 French argues that this 6. French, Addictions and Native Americans.
7. E. Durkheim, Suicide (New York, NY: The Free Press, 1951).
approach necessitates the need for First Nations people to 8. • Health Canada, Literature Review Evaluation Strategies in Aboriginal Substance Abuse
both manage and provide treatment.45 Treatment Programs: A Discussion (Ottawa, Ont.: Health Canada, First Nations and Inuit Health Branch,
2000).
philosophies must also attempt to address the psychological • Schultz & Schultz, 1998.
9. • M. Herman-Stahl, D. L. Spencer and J. E. Duncan, 2003, The implications of cultural
impacts of historical trauma and abuse issues.46, 47 The results orientation for substance use among American Indians, American Indian and Alaska Native
Mental Health Research, 11, 1: 46-66.
of this survey indicate the importance of this approach based • J. J. Chandler and C. Lalonde, 1998, Cultural continuity as a hedge against suicide in
on the fact that many of those who accessed treatment Canada's First Nations, Transcultural Psychiatry, 35, 2: 191-219.
10. • N. Adelson, Aboriginal Canada (Ottawa, Ont.: Canadian Institutes of Health Research,
attended residential school. 2003).
• C. P. Shah, Public Health and Preventative Medicine in Canada (Toronto, Ont.: University
The RHS data indicate that a higher proportion of those of Ontario Press, 1998).
11. British Columbia Provincial Health Officer, Report on the health of British Columbians,
seeking treatment had a medical condition, which suggests Provincial Health Officer’s Annual Report 2001: The health and well-being of Aboriginal
people in British Columbia (Victoria, B.C.: Ministry of Health Planning, 2002).
that a continuum of services is needed, including a linkage 12. Health Canada, Literature Review Evaluation Strategies in Aboriginal Substance Abuse
with primary care within the treatment setting.48 13.
Programs: A Discussion.
F. Frances, Ethnic and Cultural Considerations, Diagnostic and Statistical Manual on Mental
Additionally, the data indicate that younger males are less Disorders, Fourth Edition (DSM-IV) (Washington, D.C.: American Psychiatric Association
Press, 1994).
likely to access treatment, suggesting that practical 14. • A. Saremi et al., 2001, Validity of the CAGE questionnaire in an American Indian
alternatives may be appropriate. Examples of alternatives population, Journal of Studies on Alcohol, 62, 3: 294-300.
• L. B. Bull et al., 1999, Validation of a self-administered questionnaire to screen for prenatal
include outreach services such as community mobile alcohol use in Northern Plains Indian women, American Journal of Preventive Medicine, 16, 3:
240-243.
treatment, telephone support and harm reduction services.49, 15. • T. L. Wall, L. G. Carr and C. L. Ehlers, 2003, Protective association of genetic variation in
50 alcohol dehydrogenase with alcohol dependence in Native American Mission Indians,
The cultural appropriateness of harm reduction has not American Journal of Psychiatry, 160, 1: 41-6.
been validated amongst the First Nations population, but • T. L. Wall et al., 1997, Alcohol dehydrogenase polymorphisms in Native Americans:
identification of the ADH2*3 allele, Alcohol & Alcoholism, 32, 2: 129-132.
strategies such as controlled drinking (i.e., appropriate for 16. W. T. Thatcher, Fighting firewater fictions: Moving beyond the disease model of alcoholism in
high risk groups such as younger males) have been shown to First Nations (Toronto, Ont.: University of Toronto Press, 2004).
17. C. L. Ehlers et al., 1999, Electroencephalographic responses to alcohol challenge in Native
be effective in non-Aboriginal populations, and are thus American Mission Indians, Biological Psychiatry, 45, 6: 776-787.
18. Thatcher, Fighting firewater fictions: Moving beyond the disease model of alcoholism in First
deserving of consideration.51 Finally, the diversity of First Nations.
Nations communities indicates the need for caution in 19. • Koss et al., 2003, Adverse childhood exposures and alcohol dependence among seven Native
American tribes, American Journal of Preventive Medicine, 25, 3: 238-44.
generalizing treatment approaches, as well as research and • M. L. De Wit, B. G. Embree and D. De Wit, 1999, Determinants of the risk and timing of
alcohol and illicit drug use onset among natives and non-natives: similarities and differences in
evaluation for determining best practices.52 family attachment processes, Social Biology, 46, 1-2: 100-121.
• S. C. Wilsnack et al., 1997, Childhood sexual abuse and women's substance abuse: national
survey findings, Journal of Studies in Alcohol, May, 58, 3: 264-271.
Conclusion 20. K. Gil, M. E. Elk and R. A. Deitrich, 1997, A description of alcohol/drug use and family
history of alcoholism among urban American Indians, American Indian and Alaska Native
Mental Health Research, 8,1: 41-52.
This chapter has presented the results from the 2002/03 First 21. • J. Shore, S. M. Manson and D. Buchwald, 2002, Screening for alcohol abuse among urban
Nations Regional Longitudinal Health Survey on the use of Native Americans in a primary care setting, Psychiatric Services, 53, 6: 757-760.
• Koss et al., Adverse childhood exposures and alcohol dependence among seven Native
alcohol and other select substances by adults. Consistent with American tribes, American Journal of Preventive Medicine.
• S. Peterson et al., 2002, Native American women in alcohol and substance abuse treatment,
previous surveys, abstinence rates for both abstinence from Journal of Health Care for the Poor & Underserved, 13, 3: 360-378.
alcohol and the frequency of alcohol use were lower among 22. • D. Hasin, A. Paykin and J. Endicott, 2001, Course of DSM-IV alcohol dependence in a
community sample: effects of parental history and binge drinking, Alcohol Clinical Experience
First Nations respondents than those of the general Research, 25, 3: 411-414.
• J. L. Jasinkski, L. M. Williams and J. Siegel, 2000, Childhood physical and sexual abuse as
population. However, there was also a higher proportion of risk factors for heavy drinking among African American women: a prospective study, Child
heavy drinkers (those having five or more drinks on one 23.
Abuse Neglect, 24, 8: 1061-1071.
Health Canada, Literature Review Evaluation Strategies in Aboriginal Substance Abuse
occasion) and drug users in the First Nations population. The Programs: A Discussion.
24. • C. A. Parks et al., 2001, Gender and reported health problems in treated alcohol dependent
highest risk group for both drinking and drug use included Alaska Natives, Journal of Studies on Alcohol, 62, 3: 286-293.
young males aged 18 to 29. Recommendations include • R. W. Robin et al., 1998, Relationship of binge drinking to alcohol dependence, other
psychiatric disorders, and behavioural problems in an American Indian Tribe, Alcohol Clinical
increased surveillance regarding the health impact of Experience Research, 22, 2: 518-523.
• S. J. Curry et al., 2000, At-risk drinking among patients making routine primary care visits,
substance abuse and the integration of cultural components Preventative Medicine, 31, 5: 595-602.
into prevention and treatment approaches. 25. Health Canada, Literature Review Evaluation Strategies in Aboriginal Substance Abuse
26. • Statistics Canada, Language, Tradition, Health, Lifestyle and Social Issues: 1991 Aboriginal
Peoples Survey (Ottawa, Ont.: Minister of Supply and Services Canada, 1993).
Notes to Chapter 10 • Health Canada, Literature Review Evaluation Strategies in Aboriginal Substance Abuse
1. • L. A. French, Addictions and Native Americans (Westport, Conn.: Praeger, 2000). 27. Adlaf, Begin and Sawka, eds., Canadian Addiction Survey (CAS): A national survey of
• R. G. Smart and A. C. Ogbourne, Northern Spirits: Drinking in Canada Then and Now Canadians' use of alcohol and other drugs, Prevalence of use and related harms, Detailed
(Toronto, Ont.: Addiction Research Foundation, 1986.) report.
2. • Beauvais, 1998. 28. Ibid.
• P. L. LeMaster and C. M. Connell, 1993, Boozing, sniffing and toking: an overview of the 29. Ibid.
past, present and future of substance use by American Indians, American Indian and Alaska 30. Ibid.
Native Mental Health Research, 5, 2: 1-33. 31. CAS, 2003.
3. LeMaster and Connell, Boozing, sniffing and toking: an overview of the past, present and 32. • Robin et al,, Relationship of binge drinking to alcohol dependence, other psychiatric
future of substance use by American Indians, American Indian and Alaska Native Mental disorders, and behavioural problems in an American Indian Tribe, Alcohol Clinical Experience
Health Research. Research.
4. J. W. Frank, R. S. Moore and G. M. Ames, 2000, Historical and cultural roots of drinking • Curry et al., At-risk drinking among patients making routine primary care visits, Preventative
problems among American Indians, American Journal of Public Health, 90, 3: 344-51. Medicine.
5. • R. Snake, Report on Alcohol and Drug Abuse (Task Force Eleven: Alcohol and Drug Abuse), 33. Adlaf, Begin and Sawka, eds., Canadian Addiction Survey (CAS): A national survey of
First Report to the American Indian Policy Review Commission (Washington, D.C.: Canadians' use of alcohol and other drugs, Prevalence of use and related harms, Detailed
report.
118
34. Health Canada, Literature Review Evaluation Strategies in Aboriginal Substance Abuse
35. Adlaf, Begin and Sawka, eds., Canadian Addiction Survey (CAS): A national survey of
Canadians' use of alcohol and other drugs, Prevalence of use and related harms, Detailed
report.
36. Ibid.
37. • Parks et al., Gender and reported health problems in treated alcohol dependent Alaska
Natives, Journal of Studies on Alcohol.
• Gil, Elk and Deitrich, R.A., A description of alcohol/drug use and family history of
alcoholism among urban American Indians, American Indian and Alaska Native Mental Health
Research.
38. Statistics Canada, Language, Tradition, Health, Lifestyle and Social Issues: 1991 Aboriginal
Peoples Survey.
39. British Columbia Provincial Health Officer, Report on the health of British Columbians,
Provincial Health Officer’s Annual Report 2001: The health and well-being of Aboriginal
people in British Columbia.
40. • P. Spicer, 2001, Culture and the restoration of self among former American Indian drinkers,
Social Science and Medicine, 53, 2: 227-240.
• B. Segal, 1998, Responding to victimized Alaska Native women in treatment for substance
abuse, Substance Use & Misuse, 36, 6-7: 845-865.
42. M. G. Landen, 1997, Alcohol-related mortality and tribal alcohol legislation, Journal of Rural
Health, 13, 1: 38-44.
44. • M. Brady, Culture in treatment, culture as treatment: a critical appraisal of developments in
addictions programs for indigenous North Americans and Australians, Social Science and
Medicine, 41, 11: 1487-1498.
• P. J. Abbot, 1998, Traditional and western healing practices for alcoholism in American
Indians and Alaska Natives, Substance Use and Misuse, 33, 13: 2605-2646.
• K. L. Walters, J. M. Simoni and T. Evans-Campbell, 2002, Substance use among American
Indians and Alaska natives: incorporating culture in an "indigenist" stress-coping paradigm,
Public Health Reports, 117, 1: S104-117.
45. French, Addictions and Native Americans.
46. M. Y. Brave Heart, 2003, The historical trauma response among natives and its relationship
with substance abuse: a Lakota illustration, Journal of Psychoactive Drugs, 35, 1: 7-13.
47. Robin et al., Relationship of binge drinking to alcohol dependence, other psychiatric disorders,
and behavioral problems in an American Indian Tribe, Alcohol Clinical Experience Research.
48. Parks et al., Gender and reported health problems in treated alcohol dependent Alaska Natives,
Journal of Studies on Alcohol.
49. J. Weibe and K. M. Huebert, 1996, Community mobile treatment: what it is and how it works,
Journal of Substance Abuse Treatment, 13, 1: 23-31.
50. M. Herman-Stahl and J. Chong, 2002, Substance abuse prevalence and treatment utilization
among American Indians residing on-reservation, American Indian & Alaska Native Mental
Health Research, 10, 3: 1-23.
51. D. Wardman and D. Quantz, Harm reduction services for British Columbia's First Nations
population: a qualitative inquiry into opportunities and barriers for injection drug users
(Vancouver, B.C.: First Nations and Inuit Health Branch, 2005).
52. J. Westermeyer, 2001, Alcoholism and co-morbid psychiatric disorders among American
Indians, American Indian and Alaska Native Mental Health Research, 10, 2: 27-51.
Further References
Health Canada, A Statistical Profile on the Health of First Nations in Canada (Ottawa, Ont.: Health
Canada, First Nations and Inuit Health Branch, 2002).
C. Stewart-Sabin and M. Chaffin, “Culturally competent substance abuse treatment for American
Indian and Alaska native youths,” Adolescent substance abuse treatment in the United States:
Exemplary Models from a national evaluation study, edited by S. J. Stevens & A. R. Morral (New
York, NY: Haworth Press, 2003), pp. 155-182.
K. A. Svenson and C. Lafontaine, First Nations and Inuit Regional Health Survey, National Report,
1999 (Ottawa, Ont.: First Nations and Inuit Regional Health Survey National Steering Committee,
1999).
E. L. Szabo, A Study of mortality related to alcohol use among the status Indian population of
Saskatchewan, paper presented at the 8th International Congress on Circumpolar Health, Whitehorse,
Yukon, 1990.
P. J. Thurman et al., 2003, Community readiness: the journey to community healing, Journal of
Psychoactive Drugs, 35, 1: 27-31.
119
Chapter 11
Abstract
The 2002/03 First Nations Regional Longitudinal Health Survey (RHS) contains data that allows for
an interpretation of adult sexual health and practices. Life is created through sexual expressions that
are viewed as both sacred and natural to First Nations. Colonization and the legacy of the residential
school system have resulted in many changes to the lives of First Nations people, including how
sexuality is expressed. In some cases sexual violence affects families and communities. To complicate
matters, viruses and bacteria have emerged that infect and afflict some First Nations with Sexually
Transmitted Infections (STIs) and HIV. Complacency about contracting STIs/HIV may be leading to
unsafe sex practices.
The data gathered here indicates that adult respondents are sexually active at all ages, while sexual
activity declines with age. First Nations males reported being more sexually active than females. First
Nations people over 60 years of age reported the highest prevalence rate (95.4%) of having one or two
sexual partners, while the youngest age group (18–29) reported the lowest rates (80.1%). Respondents
in this survey stated that they do not always use condoms. The reasons for not using condoms are
numerous. Younger people aged 18–39 reported that they were most likely to get tested for HIV.
Testing declines with age. Males were less likely to get tested for HIV than females. This data
suggests that having more sexual partners may not necessarily lead to more HIV testing and that more
education is needed among males and females of all ages regardless of marital status.
120
RHS 2002/03 Adult Survey – Chapter 11: Sexual Health Practices
warfare, famine, disease, and assimilation policies, our

Introduction
sacred life cycle was changed. Today, many First Nations are
Traditionally, First Nations peoples view life as being sacred. in a period of recovery, and searching for ways to heal from
Sexuality is viewed as an expression of the life-creating force this process of colonization. This includes honouring,
between men and women. Historically, First Nations have protecting, and respecting the sacredness of the life cycle.
experienced changes to their way of life that have affected
There has also been a movement toward healing from the
traditional understandings of sexuality and its relationship to
intergenerational impact of abuse, specifically sexual abuse.
the sacredness of life. This chapter offers a cultural and
It is widely known that residential schools are a construct of
historical perspective of First Nations’ sexuality and sexual
the federal government’s colonial policies coupled with
practices. Data is examined from the 2002/03 First Nations
church practices aimed at the assimilation of Aboriginal
Regional Longitudinal Survey (RHS) in relation to sexual
people into the dominant society.1 As First Nations leaders
activity, number of sexual partners, condom use, and HIV
have broken the silence, the dark legacy of the residential
testing (by age, gender, and/or marital status).
school system has come to light. In 1990, Phil Fontaine, a
former Chief of the Assembly of Manitoba Chiefs and
Interpretation Methods current National Chief of the Assembly of First Nations,
This chapter utilized the RHS Cultural Framework as informed the Roman Catholic Church representatives and the
outlined in the introduction to support a community-based press of the abuse that he and many other people experienced
approach toward improving and strengthening the health and over the years. “I think what happened to me is what
wellness of First Nations. Within a four-directions model, the happened to a lot of people. It wasn’t just sexual abuse; it
Eastern door emphasizes the need for visioning the optimum was physical and psychological abuse. It was a violation.”
health of the individual, family, and community through a If individuals, families, and communities are not healed from
cultural lens, and calls attention to the need for First Nations sexual abuse, it will continue to negatively affect First
people to return to their traditional teachings and values. The Nations. In 2003 the First National Indigenous Sexual Abuse
Southern door emphasizes the realization that individuals, Conference was held, and Phil Lane, Jr. addressed this topic
families, and communities have experienced disruptions, in his keynote address.2 Lane told a story about the most
distress, and a breakdown of their cultural perspective on sacred of all ceremonies—the birth of a child. This ceremony
sexuality as the sacred life force. The Western door has been neglected as a result of the interwoven complexities
emphasizes the understanding of data and interpreting the of widespread sexual abuse. He explained that widespread
current state of health and well-being among First Nations. sexual abuse, sexual abuse of children, incest, pornography,
The Northern door offers direction towards building the rape, child and adult prostitution, HIV/AIDS, and gang rape
healthy First Nations person, family, and community using exist in our communities because “the creative power and
cultural teachings and values. The framework suggests the sacred expression of life” has been abused.3 The disruption
need for culturally appropriate sexual health education of the most sacred aspect of life through sexual abuse has
among all age groups and genders, regardless of marital caused distress to First Nations people. The experience of
status. sexual abuse has caused a breakdown in their health and
well-being. These interwoven complexities also affect
The Eastern Door families and communities.
Many First Nations peoples tell Creation stories that depict Sex is a subject that people talk about in many different
how life was created on Mother Earth. Our Elders teach us ways. Traditionally, the act of sex is an expression of the
that the Creator gave us life, that life is sacred and that each most sacred ceremony—the birth of a child. Yet in this
one of us is a sacred and spiritual being. Through their kind contemporary life journey—which includes awareness,
and caring ways our parents, grandparents, and other family prevention, and the healing of one’s sacred being—there are
and community members protect, guide, and teach us to many reasons to be concerned about life and the process of
become healthy adults. Through this process of life we are creating life through sexuality. So what is sexuality? The
taught the beliefs and values of our community and culture in following definition of sexuality is offered:
order to become healthy people who are able to contribute to
our families and the First Nations community. It is a sacred Sexuality is a central aspect of being human throughout
cycle of life. life, and encompasses sex, gender identities and roles,
sexual orientation, eroticism, pleasure, intimacy and
The Southern Door reproduction. Sexuality is experienced and expressed in
Over time and through contact with other cultures, the life we thoughts, fantasies, desires, beliefs, attitudes, values,
knew began to change. Some people might refer to this behaviors, practices, roles and relationships. While
change as a period of colonization and subsequent adaptation sexuality can include all of these dimensions, not all of
to a foreign way. The changes affected our sacred life cycle, them are always experienced or expressed. Sexuality is
originally designed to create spiritual beings. Through influenced by the interaction of biological,
121
psychological, social, economic, political, cultural, Centers for Disease Control and Prevention (1998) have
ethical, legal, historical and religious and spiritual reported that AIDS “is affecting population groups with the
factors.4 highest rates of curable STDs”.16 In 2004, Alberta Health and
Wellness reported that:
In light of this, it is logical for First Nations to address the
experience of the residential school and the intergenerational All age groups are affected by STIs, but the majority of
trauma resulting from it. The majority of respondents those infected are in the 15–29 year age group. Although
(79.7%)i did not attend a residential school, but the majority most of those infected with STIs identify themselves as
of respondents (73.4%) felt that their grandparents’ Caucasian, Aboriginals are disproportionately affected
attendance at residential school negatively affected the by all STIs except syphilis.17
parenting their parents received. In 1997, the results for First
Nations and Inuit Regional Health Survey conducted in Results
Ontario (of 870 First Nations adults) reported that 59% of
men experienced physical abuse.5 The abusers were more This part of the chapter examines sexual activity, number of
often mothers than fathers.6 In addition, 34% of the sexual partners, condom use, and HIV testing by age, gender,
respondents reported experiencing sexual abuse during their or marital status, during a twelve-month period.
childhood, and often identified relatives or other The data from the First Nations Regional Longitudinal
acquaintances as the perpetrators.7 Traumatic childhood Health Survey (RHS) 2002/2003 shows that most (73.7%)
experiences affect the adult life, and are an area that requires adult respondents are sexually active regardless of age,
further investigation in order to heal. In 1997, the Regional although sexual activity declines with age. The majority of
Health Surveys conducted in Nova Scotia and Manitoba the respondentsii between the ages of 18–29, 30–39 and 40–
asked respondents questions about safe sex practices.8 The 49 are sexually active (83.5%, 84.6% and 77.9%; differences
results showed that 31% of respondents in Nova Scotia did not significant). Respondents between the ages of 50–59 are
not practice safe sex and that 61% of respondents in somewhat less sexually active (58.6%). Sexual activity
Manitoba reported not practicing safe sex.9 Preventing the declines further among respondents over the age of 60
spread of STIs/HIV through the adoption of healthy sexual (26.7%). Regardless of age, First Nations adults are sexually
practices is important because bacteria and viruses affect not active. This suggests that attaining optimal sexual health
only the body, but the mind and spirit of the people. within communities requires education for people of all ages
and backgrounds.18
The Western Door
Data from the RHS 2002/03 showed that First Nations males
A person’s thoughts and behaviours may either enhance or reported being more sexually active than females. The
disrupt the sacredness of life. We believe that the mind, majority of male respondents (80.3%) were sexually active,
body, and spirit are interconnected; this means that while 66.8% of female respondents reported sexual activity.
unprotected sex leading to STIs and HIV/AIDS can have a
negative effect on the minds, bodies, and spirits of people. Respondents were asked questions about their marital status
According to Health Canada (1997), STIs are spread during and sexual activity. A majority of the respondents (90.4%) in
sexual activity when bacteria or viruses travel in semen, common law relationships were sexually active. Sexual
activity declines among those who reported being married
vaginal fluids, and blood.10 If a person has a tiny cut around
the mouth, saliva can also spread STIs.11 Those who share (79.1%), single (70.6%), separated or divorced (58.1% and
needles or syringes can spread STIs through the contact of 51.6% respectively; difference not significant), and widowed
(17.0%).
bodily fluids. Pregnant mothers who are infected with STIs
can pass on the infection to their babies during pregnancy Marital status affected the number of partners reported over a
and through childbirth.12 Although vaccines are available for twelve-month period. The results suggest that the majority of
hepatitis B, there are no cures or vaccines for genital warts, married people (97.8%) had one or two partners, as did the
genital herpes or HIV.13 STIs include chlamydia, gonorrhea, widowed group (97.2%), common law group (95.8%), and
vaginitis/vaginal discharge, yeast infection, trichomoniasis, divorced group (88.4%). Fewer of those who were separated
bacterial vaginosis, pubic lice, scabies, genital herpes, genital (83.2%) or single (71.5%) had only one or two partners
warts (HPV), hepatitis B, syphilis, and HIV/AIDS.14 compared to those in the married, common law or widowed
In 2004, Alberta Health and Wellness reported that people group, although the majority still reported one or two
are becoming complacent about HIV and that 50% of all partners. Single and separated adults (16.3% and 12.3%
reportable communicable diseases in Alberta are attributed to respectively) were more likely to report having three to four
sexually transmitted infections.15 Further, complacent partners in the past twelve months than those who were
attitudes are shown to lead to unsafe sex practices. The common law, widowed, and married.
ii
i
To simplify the text, confidence intervals are not reported for estimates unless the coefficient of significant— is noted. Differences, in this chapter, are considered significant when confidence
variation is greater than 33.3%. intervals do not overlap at the 95% confidence level (after Bonferroni adjustment).
122
Within all age groups, the majority of adults reported having tested for HIV. More than half of the respondents (51.2%)
one or two sexual partners in the past twelve months. The who reported having five to six sexual partners had been
prevalence rate for having one or two partners was highest tested for HIV, and less than half of the respondents (36.6%)
among adults 60 years and older (95.4%) and was lowest reporting seven to ten partners had been tested for HIV.
among the youngest age group, 18–29 years of age (80.1%). Those who had 11 or more partners (44.1%) were less likely
In general, the data suggest that respondents of the youngest to get tested for HIV. This data suggests that having more
group had more sexual partners than older age groups. Some sexual partners does not necessarily lead to more HIV
respondents between the ages of 18–29 (11.8%) reported testing.
having three to four sexual partners. Some respondents Figure 1. Proportion having undergone a test for HIV in their
between the ages of 18–29 (8.0%) reported having five or lifetime by age group
more sexual partners. 50%
45.1%
Females are more likely to report having one or two sexual 41.9%
partners (93.1%), compared to males (81.6%). Conversely, 40%
males are roughly twice as likely as females to report having 34.1%
three or four partners (9.9% for men versus 4.7% for

30% 27.4%
women), five to six partners (4.5% for men versus 1.2% for
women), or even more.
19.7%
20%
Condom use has been strongly advocated as a means of 13.9%
STIs/HIV prevention, and yet across all age groups the
10%
respondents stated that they do not always use condoms,
citing the main reason as being with a steady partner. This
was also cited as the main reason among all marital groups, 0%
including those who were married, divorced, common law, 18-29 30-39 40-49 50-59 60+ Total
Age group (years)
widowed, separated, or single. Many respondents between
the ages of 18–29 (9.9%) stated that they did not always use Figure 2. Proportion having undergone a test for HIV in their
lifetime by gender
condoms because they were under the influence of alcohol or
50%
drugs. However, among older age groups, people were less
likely to cite alcohol or drug use as the reason for not using
condoms. Across all age groups, 6.6% stated that they didn’t 40% 39.0%
want to use a condom, 4.0% stated that their partner did not 34.1%
want to use one, 3.6% of people thought they were safe and 29.5%
30%
did not need to use a condom, and 3.4% stated that their
partner wanted to get pregnant.
20%
Figures 1 through 3 present the rate of HIV testing by age,
gender, and marital status respectively. Overall, 34.2% of all
adults have been tested for HIV at some point in their lives. 10%
Despite the reasons cited for not using condoms, younger

adults (45.1% of those aged 18-29 and 41.9% of those aged
0%
30-39) were the most likely to receive HIV testing. In Male Female Total
general, HIV testing declines with age. Males (29.5%) were
less likely to get tested for HIV than females (39.0%). Many The Northern Door
single respondents (40.8%), common law respondents
(40.6%), divorced respondents (38.9%) and separated The 2002/03 First Nations Regional Longitudinal Health
respondents (35.6%) were more likely to be tested for HIV Survey (RHS) data indicates that First Nations adults are
compared to married respondents (23.8%) and widowed sexually active at all ages and that sexual activity begins to
respondents (13.4%). decline with age. First Nations males reported being more
sexually active than their female counterparts. First Nations
Nevertheless, not all people are being tested for HIV, even if people over the age of 60 reported the highest prevalence rate
they report having more than one sexual partner in the past for having one or two sexual partners, while the youngest age
twelve months. Moreover, there were no significant group, those between 18–29, reported the lowest prevalence
differences in rates of HIV testing by the number of sexual rates of having one or two partners. Respondents in this
partners. Less than half of the respondents (40.3%,) having survey stated that they do not always use condoms. The
one to two partners in the past 12 months had been tested for reasons cited for not using condoms varied. Younger people
HIV, compared to half of the respondents (51.0%) having were reported as the most likely to receive HIV testing, with
three to four partners in the past 12 months having been
123
the tendency to obtain testing declining with age. Males were Notes to Chapter 11
less likely to be tested for HIV than females. The need for 1. J. R. Miller, Shingwauk’s vision: A history of Native residential schools (Toronto, Ont.:
University of Toronto Press, 1996).
testing among females is strongly suggested prior to 2. P. Lane. Keynote address, First National Indigenous Sexual Abuse Conference, Edmonton,
pregnancy. The data also suggest that having more sexual Alberta, Healing the intergenerational impact of sexual abuse, February 13, 2003 [online].
Cited 6 April 2005. Available from World Wide Web:
partners does not lead to the increased likelihood of HIV <http://www.turtleisland.org/discussion/viewtopic.php?t=623>.
3. Ibid.
testing, and that there is a need for culturally appropriate 4. Adriane Martin Hilber and Manuela Colombini, “Promoting sexual health means promoting
education among males and females of all adult ages. healthy approaches to sexuality,” Sexual Health Exchange [online]. 2002/4. Available from
World Wide Web: <http://www.kit.nl/ils/exchange_content/assets/images/Exchange_2002-
4_eng.pdf>.
Figure 3. Proportion having undergone a test for HIV in their 5. First Nations Information Governance Committee, First Nations and Inuit Regional Health
lifetime by marital status Surveys, 1997 [online]. [Ottawa, Canada] : First Nations Centre at the National Aboriginal
Health Organization, 2004. Cited 27 April 2005. Available from World Wide Web:
50% <http://www.naho.ca/firstnations/english/pdf/RHS_synthesis.report.pdf>
6. Ibid.
7. Ibid.
40.6% 40.8% 8. Ibid.
40% 38.9%
9. Ibid.
35.6% 10. Health Canada, What you need to know about sexually transmitted diseases, brochure (Ottawa,
34.0%
Ont.: Minister of Public Works, 1997).
11. Ibid.
30% 12. Ibid.
13. Ibid.
23.8%
14. Ibid.
15. Alberta Health and Wellness, Sexually Transmitted Infections (STI) Surveillance Report
20% Alberta—1998 to 2002 [online]. [Edmonton, Canada] : Alberta Health and Wellness, 2004.
Cited 4 February 2003. Available from World Wide Web: <http://www.health.gov.ab.ca>.
13.4% 16. Centers for Disease Control and Prevention, HIV prevention through early detection and
treatment of other sexually transmitted diseases—United States recommendations of the
10% advisory committee for HIV and STD prevention, July 31, 1998 [online]. Cited 4 February
<http://11wonder.cdc.gov.wonder/prevguid/m0054174/m0054174.asp>.
17. Alberta Health and Wellness, Sexually Transmitted Infections (STI) Surveillance Report
0% Alberta—1998 to 2002 [online].
Married Divorced Common law Widowed Separated Single Total 18. U.S. Department of Health and Human Services, The Surgeon General’s call to action to
Marital status promote sexual health and responsible behavior, 2001 [online]. Available from World Wide
Web: <http://www.surgeongeneral.gov/library/sexualhealth/call.htm>.
By educating all age groups, grandparents, parents, and other
adult community members can become proactive and help
the next generation of young people cope with and perhaps
defeat STIs/HIV. Our traditional teachings prompt us to take
an inclusive and holistic approach towards education,
because STIs and HIV bring shame, hurt and grief to those
who are afflicted. As family and community members, we
have a social responsibility to help prevent and treat STIs and
HIV. STIs and HIV affect the sacredness of life. Together,
Western Medicine and Traditional Indigenous Knowledge
can lead to more effective prevention and treatment for STIs
and HIV, thus restoring sexual balance to First Nations
communities.
124
Chapter 12
Healthcare Access
Abstract
This chapter reports on selected indicators of access to “Western” preventive primary health care
measures. Overall, 40.8% of respondents rate their access to health services as being the same as that
of Canadians. An additional 23.6 % rate their access as being better, whereas 35.6% rate their access
as being less than that of Canadians.
Similarly to other Canadians, First Nations feel that waiting lists pose a barrier. At the same time,
First Nations-specific barriers also exist. Language, high costs, transportation, and unavailable
services available locally and inadequate services are some of these barriers. According to Health
Canada, Non-Insured Health Benefits (NIHB) are provided in order to assist First Nations in reaching
an overall health status on par with other Canadians. Thus, NIHB should at least in part, help alleviate
geographic and economic barriers to access care. The evidence documented in this survey shows that
current access rules to NIHB may be creating barriers in these areas rather than alleviating them.
The results of this study also suggest that preventive and screening activities available at the
community level could be expanded to target the prevention of certain health conditions. In First
Nations communities, improvements should be pursued in screening for heart disease (cholesterol),
diabetes mellitus (blood sugar) and vision. Screening for breast, cervical, prostate and colorectal
cancer (DRE) could also be improved. National First Nations-specific screening and preventive
standards could help guide community-based primary prevention and screening activities.
125
RHS 2002/03 Adult Survey – Chapter 12: Healthcare Access
Results and Discussion

Introduction
Overall access to health services
This chapter focuses on First Nations’ access to “Western”
primary health care measures with regards of prevention and A number of factors, such as health status, gender, age,
early intervention. Numerous reports have shown that First community and transfer status, impacts how First Nation
Nations people experience a higher burden of illness when respondents rate their access to health services. Overall,
compared to their Canadian counterparts.1-3 Access to 40.8%i of First Nations respondents generally rate their
“Western” health care is only one determinant of health.4 access to health services as being the same as that of
First Nations people may also utilise “western” health Canadians. This is an increase from the 1997 RHS,ii where
services to complement traditional healing and wellness 34.0% of First Nations respondents rate their access to health
practices or vice versa Primary health care is thus only a as being the same as Canadians.8 An additional 23.6 % rate
portion of care and healing activities that First Nations their access as being better, whereas 35.6% rated their access
depend on for health and wellness. . as being less than that of Canadians.
Documenting First Nations’ access to primary health care is
Self-rating of health status
important because recent studies have shown that countries
with better access to primary health care are less likely to As shown in Table 1, First Nations respondents who rate
report health inequities,5 mainly because primary health care their health as being very good or excellent estimate their
focuses on prevention, health promotion, early intervention access to health services as being better (24.6%)iii or the
and rehabilitation. Primary health care also promotes same (45.5%) as Canadians. Moreover, respondents who
community, family and individual-centred approaches to rated their health as very good are likely to report better
care.6-7 This is shown in Figure 1. access to health services as compared to Canadians and other
survey respondents that rated their health as good, fair or
The next section reports on selected indicators of access to
poor. Those reporting fair or poor health were less likely to
primary health care measures, including respondents’ rating
report having the same level of access than those in good,
of their access to health care in comparison to Canadians,
very good, or excellent health. There were no significant
access to screening and preventive measures, barriers to
differences seen in having better accessibility as a function of
accessing health care, and access to Non-Insured Health
self-rated health status.
Benefits (NIHB). The results will be discussed in the context
of other studies, including the 1997 RHS and of the 2002-03 Table 1. Proportion of adults rating their access to health
Canadian Community Health Survey (CCHS). The last services in relation to self-rated health status (n=8,731)
section provides conclusions and recommendations. Excellent or
Good Poor
very good
Figure 1. Model of primary healthcare
Better access (NS) 24.6% 22.3% 24.7%
Same level of access 45.5% 39.6% 34.0%
Less access 29.9% 38.1% 41.3%
Gender and Age

About the same proportion of women and men consider that
they have less access to services than Canadians in general
(37.6% vs. 33.7%—NS). The differences by age, shown in
Figure 2 are also not statistically significant.
i
To simplify the text, confidence limits are only reported for overall adult estimates with a co-efficient
of variation greater than 33.3%. A statistical appendix including confidence intervals for all reported
figures is available at www.naho.ca/fnc/rhs.
ii
In the 1997 RHS, respondents were asked to rate their access to health as being either equal or not
equal. In the 2002-03 RHS, respondents were asked to rate their access as either the same, better or
lesser when compared to other Canadians. The results must therefore be compared with caution.
iii
Comparisons between groups reported in this chapter that are all significant unless “NS” —not
significant— is specified in brackets. In this chapter, estimates are considered significantly different if
their confidence intervals do not overlap (95% confidence level).
126
Figure 2. Proportion believing that they have less access to Figure 4. Proportion who believe that they have less access to
health care than Canadians by age (n=8,767) health care than Canadians by community remoteness (n=8,453)
70%
60+ 37.6%
60% 58.1%
53.7%
50-59 32.9% 50%

Age group (years)
40%
34.7%
40-49 38.3%
30.8%
30%
30-39 39.0% 20%
10%
18-29 30.8%
0%
20% 30% 40% 50% Remote isolated Isolated Semi-isolated Non-isolated
Proportion rating their access as less than Canadians Isolation status
Education Transfer status

Figure 3 shows the proportion of First Nations respondents Finally, and as shown in Figure 5, First Nations from
reporting having less access to health services in relation to communities where services are delivered through a health
education. Respondents who achieved a higher level of transferv are more likely to rate their access to health services
formal education are more likely to rate their access to as being generally better than that of Canadians (28.5%)
services as generally less than that of Canadians (NS). compared to First Nations living in a non-transferred
Figure 3. Belief that they have less access to health care is
community (22.0%, NS) –or in a community that transferred
generally less than Canadians by education (n=8,689) as part of a multi-community transfer (20.8% NS). In fact,
respondents from communities that transferred as part of a
Graduate degree 66.5% multi-community transfer are more likely to rate their access
to health services as generally less than Canadians (43.4%).
This result is puzzling. Further analysis was conducted to
Bachelor's degree 43.5%
ensure that other factors such as remoteness and community
Education attained
size were not influencing the results. The importance of this

Diploma or certificate* 33.7%
finding is explored in the final section of this chapter.
Based on the above findings, it appears that remoteness is an
High school graduate 33.4%
important factor when it comes to access to health care. This
finding above is not surprising. The results on multi-
community transfers are puzzling. It is beyond the scope of
Did not graduate
highschool
36.1% this report to conduct multivariate analysis to ensure that
other factors such as remoteness and community size were
0% 20% 40% 60% 80% not influencing the results. More comparisons would be
*Diploma or certificate from university, college, technical or vocational school required to understand the meaning of these findings.
Community characteristics
As shown in Figure 4, respondents from remote or isolated
communities are more likely to rate their access to health
services as generally poorer than that of other Canadians.iv
v
The Health Transfer Policy was adopted by Health Canada in 1989. This policy provides First
Nations the opportunity to exercise some autonomy in allocating financial resources over a number of
selected programs, thereby ensuring some measure of local autonomy in decision-making. See Lavoie
iv
Results for community size were not statistically significant and are not reported here. et al. for a more comprehensive review.9
127
Figure 5. Rating of access to health care in by health transfer 18 to 29 reporting having had a complete physical examined
status of community (n=8,788)
the past 12 months. This proportion increases with age;
50%
40.3% for respondents between 30 and 39 and rising to
42.8% 43.4% 61.2% for those 60 and above.
40% 38.0%
35.8%
Figure 7. Screening tests accessed in the past 12 months by age
35.2%
33.4%
61.2%
60+
30% 28.5% 50.7%
Complete physical 50-59
44.5% 40-49
examination (n=10,649)
22.0% 40.3% 30-39
20.9%
34.3% 18-29
20%
72.7%
Type of test
66.1%
10% Less access Vision or eye exam
58.5%
Same level of access (n=10,705)
Better access 54.1%
51.2%
0%
Not transferred Community transferred Part of multi-community transfer 79.7%
Health transfer status 71.5%
Blood sugar test
58.6%
(n=10,684)
49.7%
Access to Screening and preventative measures 37.6%
0% 20% 40% 60% 80% 100%

Screening and Prevention
Regular vision or eye exams
Respondents were asked to identify whether they had
received screening tests in the past 12 months. Figure 6 Regular vision or eye exams not only ensure optimal vision,
shows the results in relation to gender. First Nation men were but can also help detect the development of conditions such
consistently less likely to have undergone testing in the past as high blood pressure or diabetes. More than half of all
12 months, when compared to First Nation women. The only respondents (57.6%) reported having undergone a vision or
exception was for rectal examination, which is used to detect eye exam in the past 12 months. Since optometric and
rectal cancer in both men and women, but is also used to ophthalmologic exams are usually not available on-reserve,
detect prostate cancer in men. this result suggests perhaps an expected, albeit low,
coverage.
Figure 6. Proportion of respondents having received selected
health screening tests in the past 12 months, in relation to
gender Blood sugar test
Complete physical exam 49.9% This is a key test in screening for diabetes mellitus. The 1994
(n=10,685) 36.0% National Population Health Survey documented that the age-
61.5%
standardised rate of diabetes mellitus in the First Nation
Vision or eye exam
(n=10,743) 53.8% population was 10% compared to 3% in the overall Canadian
population.10 Recent studies have document an upward trend
60.9%
Blood sugar test
among First Nations.11,12 It is also generally recognised that
Type of test
(n=10,719) 46.6%
First Nations develop diabetes at a younger age. One study
Blood pressure test
(n=10,776) 61.1%
70.1%
suggested that the age of onset is actually dropping.13 The
findings reported here show that only 37.6% of respondents
Cholesterol (n=10,607)
38.5% between the age of 18 and 29, and 49.7% between the age of
31.8%
Female
30 and 39 had been screened in the past 12 months. The
Rectal exam* (n=10,532)
10.3% Male current level of coverage is less than ideal given current
13.8%
trends.
0% 20% 40% 60% 80%
Blood pressure exams and cholesterol tests

Complete physical exam
Blood pressure exams and cholesterol tests are key
Figure 7 shows the proportion of respondents who received a components in screening for heart disease. Cholesterol
complete physical exam, vision or eye exam, and who were screening is recommended for individuals at higher risks.
screened for diabetes mellitus in the past 12 months, in Current data suggests that First Nations living on reserve are
relation to age. at higher risk of mortality by acute myocardial infarction
(heart attack) with a documented age standardised rate of
The findings suggest that the current level of coverage is a
72.7 per 100,000 (on-reserve, 2001) compared to 52.1 per
concern with only 34.3% of respondents between the age of
100,000 for all Canadians (2000), suggesting an earlier age
128
of onset.14 Figure 8 suggests that routine cholesterol testing is Breast self-examination (BSE)
generally low. It may be advisable to improve cholesterol
BSE has been recommended as an inexpensive and non-
screening given current trends. In contrast, blood pressure
intrusive method for early detection of abnormalities. First
examinations are being obtained at a higher rate among all
Nations mortality from breast cancer remains less than half
age groups.
of that reported for the Canadian population (11.2 per
Figure 8. Screening tests for heart disease accessed in the past 100,000 versus 25.0 per 100,000).17 Repeated studies have
12 months, in relation to age
shown that this method is not effective in reducing mortality
86.8%
from breast cancer,18 unless women are trained to detect
79.5%
abnormalities. Figure 10 reports on First Nations women
Blood pressure exam
habits with regards to BSE. In comparison, the 2002-03
69.0%
(n=10,740) CCHS reports that 47.0% of Canadian women perform a
63.5%
BSE about once a month, 25.9% do so about every 2 to 3
months, and 27.0% do so less often than every 2 to 3 months.
Type of test
52.1% 60+
50-59
40-49 Figure 10. Breast self-examination (BSE)
61.6% 30-39
18-29
56.8%
Never 36.0%
Cholesterol (n=10,571) 42.8%
29.9%
Frequency of examination
16.7%
Less often than every 2
16.1%
to 3 months
0% 20% 40% 60% 80% 100%
Digital rectal exam (DRE) About every 2 to 3

12.8%
months
The mortality rate associated with prostate cancer for First

Nations males is slightly higher than that of the Canadian
population (29.7 per 100,000 compared to 26.9 per 100,000). About once per month 35.1%
The mortality associated with colorectal cancer is, in

comparison, slightly lower, at a documented 16.1 per 0% 10% 20% 30% 40%
100,000 for First Nations compared to 18.4 per 100,000 per
100,000 for the Canadian population (males and females).15 Pap Smear Test
General guidelines suggest that an annual DRE may assist in
The Pap Smear Test is a recognized measure for the
early detection for the over 50 population.16 As shown in
prevention and early treatment of cervical cancer. This is in
Figure 9, of all tests investigated in this survey, DRE has the
fact one of the most effective and successful methods of
lowest rate of uptake. The reasons for this are not entirely
cancer prevention and early intervention.19 Early detection is
clear, and may be due to the intrusive nature of the test or
a key issue for First Nations women. In 1992, Band et al.20
other reasons.
reported that First Nations women living in British Columbia
Figure 9. Digital rectal exam (DRE) screening tests accessed in had a cervical cancer mortality rate four to six times that of
the past 12 months by age and gender
other British Columbian women. Table 2 compares the
frequency of Pap smear testing amongst First Nations and
29.9%
Canadian women. The level of coverage between the two
60+
16.9%
populations is remarkably similar. This is encouraging, and
shows improvement from the screening rates reported by
Clarke et al.21 However, given the disproportionate mortality
Age group (years)
35.7% rate First Nations women experience as a result of cervical

50-59 cancer, it would be advisable to strive for more systematic
15.3%
First Nations-specific screening strategies.
Male
14.6%
Female
40-49
13.1%
0% 10% 20% 30% 40%
129
Table 2. When was the last time you had a PAP smear than men. Systemic barriers were reported more often than
any other categories. This is also the category with the widest
Canada, all FN PAP Smear difference between men and women.
Last instance women, (N=5,260)
All ages22 All ages Table 3. Barriers to access health services according to gender
(n= 9991-10539)
Less than 6 months ago 26.0%
52.7%vi Overall Male Female Diff.
6 months to less than 1 year ago 22.2% Barriers related to First Nations-specific needs
1 year to less than 3 years ago 23.6% 27.4% Chose not to see health professional 10.9% 11.7% 10.1% (NS)
3 years ago to less than 5 years ago 6.4% Felt service was not culturally appropriate 13.5% 13.1% 16.2% (NS)
12.3%
5 or more years ago 7.4% Felt health care provided was inadequate 16.9% 15.5% 18.4% (NS)
Difficulty getting traditional care 13.4% 12.1% 14.7% (NS)
Never had one 10.2% 10.6%
Barriers related to geography and availability of services
It is worth noting that access to screening generally did not
improve or worsen in transferred communities. This is not Health facility not available 10.8% 9.6% 12.1% (NS)
surprising. Most transferred communities are in non-isolated Service was not available in my area 14.7% 12.4% 14.6% (NS)
communities (402 out of 603, 67%, 2003 figures)23 and offer
Doctor or nurse not available in my area 18.5% 15.1% 22.0% 6.9%
public health, prevention and health promotion services. A
majority of the screening tests listed above are not performed Economic barriers
at these facilities, but rather be accessed from general
Could not afford childcare costs 7.1% 5.2% 9.2% 4.0%
practitioners or other providers located off-reserve.
Could not afford direct cost of care,
13.2% 11.7% 14.8% (NS)
Since a basis for a Canadian comparison is lacking, it service
remains impossible to ascertain whether access to preventive Could not afford transportation costs 13.7% 11.6% 15.9% 4.3%
screening is reasonably accessible to First Nations Systemic barriers
respondents compared to other Canadians. Further, screening
Unable to arrange transportation 14.5% 11.6% 17.6% 6.0%
was not documented in the 1997 RHS, so it is not possible to
Approval for services under NIHB was
document a trend. However, the burden of illness denied
16.1% 13.0% 19.4% 6.4%
experienced by First Nations, (e.g., the generally lower age Not covered by NIHB 20.0% 18.6% 21.3% (NS)
of onset for heart disease, cancer and diabetes mellitus)
Waiting list too long 33.2 29.3% 37.3% 8.0%
justify the development of First Nations-specific standards
and strategies. Improving screening and prevention in the
As shown in Table 4, respondents who did not complete high
First Nations population will require the commitment of
school reported significantly more difficulties in accessing
provincial health authorities and health providers, as well as
care compared to those who have attained higher levels of
on-reserve services.
education.
Barriers to accessing care Table 5 compares the results of the RHS to the results of the
CCHS. Overall, First Nations men generally reported less
Respondents were asked to identify the barriers they barriers to care. First Nations respondents similarly reported
experienced in accessing health care in the past 12 months. waiting lists as a barrier when compared to their Canadian
The barriers included in the survey loosely fall into four counterpart. Barriers associated with geography (lack of local
broad categories: services), economics (lack of transportation and cost of
• barriers related to First Nations-specific needs; services) however affects First Nations disproportionately.
• barriers related to geography and availability of services; First Nations are also much more likely to report difficulties
with language, and perhaps as a consequence, to consider the
• economic barriers; and services they receive as being inadequate or to decide not to
• systemic barriers seek care. Given the disproportionate burden of illness
experienced by First Nations, this is a concern.
As shown in Table 3, a higher proportion of First Nations
women reported having experienced certain barriers to care
vi
This study was conducted by Statistics Canada, and did not use the same breakdown as the RHS.
130
Table 4. Barriers to accessing health care by education (n=9912- Access to Non-Insured Health Benefits (NIHB)
10409)
Did not
High school University
Respondents were asked to report on their difficulties in
graduate Diploma accessing NIHB. The question asked was broad, and did not
graduate degree
high school
specify a time period (a year for example). Figure 11 shows
Barriers related to First Nations-specific needs the results. Women reported more problems for medication,
transportation and vision care. The 1997 First Nations and
Felt service was not Inuit Regional Longitudinal Health Survey (FNIRLHS) did
49.7% 15.5% 28.2% 6.7%
culturally appropriate
not document access to NIHB, so it is not possible to explore
Felt health care trends.
provided was 51.4% 15.3% 27.8% 5.4%
inadequate Figure 11. Problems accessing NIHB by gender (n=9,745)
20.1%
Medication
15.6%
Barriers related to geography and availability of services
19.1%
Dental care
15.4%
Health facility not
63.1% 13.9% 19.9% 3.1%
Type of access problem

available Vision care
19.4%
15.1%
Difficulty getting
48.9% 14.4% 30.4% 6.2% Transportation services 11.3%
traditional care or costs 6.9%
9.1%
Economic barriers Escort travel
6.7%
Female
6.6%
Could not afford Other medical supplies Male
6.4%
50.5% 16.6% 28.1% 4.8%
direct cost of care
2.5%
Hearing aid
4.4%
Could not afford
59.4% 15.4% 22.5% 2.7%
transportation costs 0% 5% 10% 15% 20% 25%
Systemic barriers The relationship between access to NIHB and factors such as
income, education or community size was not statistically
Unable to arrange significant.
60.0% 16.4% 19.0% 4.6%
transportation
Conclusions and Recommendations
Not covered by NIHB 41.1% 17.4% 34.1% 7.4%
Equitable access to primary health care is paramount in
NIHB approval
45.0% 15.1% 32.0% 7.9% ensuring that the health inequalities documented in First
denied
Nations are addressed. Recent studies show that health care
systems that promote primary health care are much more cost
Table 5.Barriers to access care, comparison between the
CCHS24 and the RHS (n=9507-9847) effective.25-26 More importantly, a strong primary health care
system will help reduce the human cost associated with
CCHS 2003 (n=13,416
RHS 2002-03
throughout)
illnesses.
Barrier
Male Female Male Female
Although First Nations’ rating of their access to health care
appears to have improved in comparison to the 1997 RHS,
Language problems - - 0.4% 0.7% the results of the 2002-03 RHS study suggest inequities in
Not culturally appropriate 12.4% 14.6% - - First Nations’ access to primary health care. Improvements
Felt to be inadequate 15.5% 18.4% 8.7% 10.8%
should be pursued in screening for heart disease
(cholesterol), diabetes mellitus (blood sugar) and vision.
Decided not to seek care 11.7% 10.1% 9.7% 6.6% Screening for breast, cervical, prostate and colorectal cancer
Transportation problems 11.6% 15.9% 1.2% 1.9% (DRE) could also be improved. The level of DRE is
Cost 11.7% 14.8% 11.2% 11.7%
remarkably low considering the First Nations mortality rate
associated with prostate cancer. It is noteworthy that First
Not avail. in area 13.1% 16.2% 9.9% 12.0% Nations-specific screening and preventive standards have yet
Wait too long 29.3% 37.3% 35.0% 36.0% to be developed. This area requires attention, and would help
guide community-based and primary prevention and
screening activities.
Although First Nations and Canadians in general report long
waiting lists, First Nations-specific barriers were also
131
documented, including barriers related to cultural Notes to Chapter 12

appropriateness, costs, transportation, services not available
1. First Nations and Inuit Regional Health Survey National Steering Committee, First Nations
locally and inadequate services. Access to NIHB is and Inuit Regional Health Survey (Ottawa, Ont.: Health Canada and the Assembly of First
Nations, 2001.)
increasingly contentious for First Nations. These health 2. Health Canada, A second diagnostic on the health of First Nations and Inuit people in Canada
provisions are seen by most as a Treaty right that cannot be (Ottawa, Ont.: Health Canada, 1999).
3. P. Martens et al., The health and health care use of registered First Nations people living in
eroded as a result of shift in federal priorities, policies or for Manitoba: a population-based study (Winnipeg, Man.: Centre for Health Policy, Department
of Community Health Sciences, Faculty of Medicine, University of Manitoba, 2002).
cost containment. The federal government has instead taken 4. M. Marmot and R. G.Wilkinson, Social determinants of health (U.K.: Oxford, 1999).
the position that NIHB are provided to First Nations as a 5. J. Macinko, B. Starfield and L. Shi, 2003, The contribution of primary care systems to health
outcomes within Organization for Economic Cooperation and Development (OECD) countries,
matter of policy, on humanitarian ground.27 Transportation 1970-1998, HSR: Health Services Research, 38: 831-865.
6. World Health Organization, Ottawa Charter for Health Promotion, 6 (Ottawa, Ont.: Canadian
was also identified as a barrier. If the purpose of NIHB is to Public Health Organization, Health and Welfare Canada, World Health Organization, 1986).
insure that First Nations have a more equitable access to 7. Primary health care: International Conference on Primary Health Care, proceedings of the
World Health Organization's International Conference on Primary Health Care, Alma-Ata,
services, then the results reported here suggests that current Kazakhstan, 1978, Geneva: World Health Organization, 1978.
8. F. Wien and L. McIntyre, "Health and dental services for Aboriginal people," First Nations
practices are not meeting their stated goals. and Inuit Regional Health Survey, pp. 219-245.
9. J. G. Lavoie et al., The National Evaluation of the health transfer policy, summary report
It is important to note that the results of this survey do not (Winnipeg, Man.: Centre for Aboriginal Health Research, 2004).
10. Statistics Canada, National Population Health Survey (Ottawa, Ont.: Statistics Canada, 1994).
provide strong evidence on the effectiveness of health 11. S. Johnson, D. Martin and C. Sarin, 2002, Diabetes mellitus in the First Nations population of
transfer. As of March 2003, FNIHB reports that, British Columbia, Canada, Part 3. Prevalence of diagnosed cases, International Journal of
Circumpolar Health, 61: 260-264.
12. E. Bobet, Diabetes among First Nations People (Ottawa, Ont.: Health Canada, 1998), cat. no.
• 1.9% of communities have entered into a self- H34-88/1998E, 1-34.
13. T. K. Young et al., The burden and impact of diabetes mellitus in the Canadian population,
government agreement; draft report (1997), NHRDP 6607-1782-NPH.
14. Health Canada, First Nations comparable health indicators (Ottawa, Ont.: Health Canada,
• 47.9% have signed a transfer agreement; 2005).
15. Ibid.
• 28.6% signed an integrated agreement; and 16. T. L. Lipskie, 2000, Resource file: a summary of cancer screening guidelines, Chronic
Diseases in Canada, 19: 1-21.
• 21.6% are under a different type of agreement.28 17. Health Canada, First Nations comparable health indicators.
18. M. Vahabi, 2003, Breast cancer screening methods: a review of the evidence, Health Care for
• The current RHS categories do not capture the Women International, 24: 773-793.
19. Health Canada, Cervical cancer screening in Canada: 1998 surveillance report (Ottawa, Ont.:
complexity of First Nations self-government activities Health Canada, 2002), cat. no. H39-616/1998E.
and introduce ambiguity in the results, since 20. P. R. Band et al., 1992, Rate of death from cervical cancer among Native Indian women in
British Columbia, Journal of the Canadian Medical Association, 147: 1802-1804.
communities under an integrated or self-government 21. H. F. Clarke, 1998, Reducing cervical cancer among First Nations women, Canadian Nurse,
94: 36-41.
agreement fall under the non-transferred communities, as 22. Statistics Canada, Table 3.2.3.1 Pap smear, by age group, women aged 18 to 69, Canada and
would communities that are still under direct service provinces, 1994/95-1998/99 (Ottawa, Ont.: Statistics Canada, 2001), cat. no. 82-221-XIE.
23. Health Canada, Annual Report First Nations and Inuit Control 2002-2003: Program Policy
delivery from FNIHB. Transfer Secretariat and Planning Directorate, Health Funding Arrangements (Ottawa, Ont.:
Minister of Public Works and Government Services Canada, 2003).
Second, most on-reserve health facilities are funded to offer 24. Statistics Canada, Canadian Community Health Survey, Cycle 2.1, Public Use Microdata file
(Ottawa, Ont.: Statistics Canada, 2003).
only a limited number of health promotion and prevention 25. B. Starfield and L. Shi, 2003, Policy relevant determinants of health: an international
perspective, Health Policy, 60: 201-218.
services. Only Nursing Stations offer a more comprehensive 26. C. B. Forrest and B. Starfield, 1996, The effect of first-contact care with primary care
complement of primary health care services. There are 27.
clinicians on ambulatory health care expenditures, the Journal of Family Practice, 43: 40-49.
J. B. Waldram, D. A. Herring and T. K. Young, Aboriginal health in Canada: historical,
currently only 75 Nursing Stations across Canada.29 While, cultural and epidemiological perspectives (Toronto, Ont.: University of Toronto Press, 1995),
p. 334.
as an example, all on-reserve facilities may have the capacity 28. Health Canada, Annual Report First Nations and Inuit Control 2002-2003: Program Policy
to increase First Nations women’s awareness of BSE, only 29.
Transfer Secretariat and Planning Directorate, Health Funding Arrangements
Lavoie et al., The National Evaluation of the health transfer policy, summary report.
Nursing Stations could have a more direct impact on 30. Ibid.
cholesterol testing.
The result of this survey instead speaks more readily to
services delivered by provincial health care systems off-
reserve, which provide screening and preventive services.
Residents from communities that transferred alone, as
opposed to as a part of a multi-community transfer, report
better access. Prudence should be exercised in interpreting
these findings. For one, multi-community transfers occur
mainly in British Columbia and Saskatchewan. Second,
access to services on-reserve may be constrained by the
current financing formula, which was designed with single
transfer communities in mind.30 Third, it is unclear whether
respondents were speaking to access to on or off-reserve
services. The next RHS may perhaps assist in making this
distinction.
132
Chapter 13
The Impacts of Residential Schools
Abstract
This chapter presents findings on the impacts of residential schools on the health and well-being of
First Nations. Of the adults interviewed, 1 in 5 attended residential school and stayed there an average
of five years. Almost half of the residential school survivors reported that their overall health and
well-being was negatively affected due to their attendance at residential school. The top four negative
impacts effecting the overall health and well-being of survivors were isolation from family, verbal or
emotional abuse, harsh discipline, and loss of cultural identity. Survivors were also victims of more
subtle institutionalized forms of abuse, such as the loss of language, lack of proper clothing and food,
and bullying from other children. Few survivors have acquired anything beyond the most basic
academic skills. Furthermore, almost half of the adults interviewed believe that their parents’
attendance at residential school negatively affected the parenting they received as children. The
majority of adults also believe that their grandparents’ attendance at residential school had a negative
effect on the parenting that their own parents had received as children. This chapter is not intended to
provide answers, but is meant to raise questions and promote dialogue about how the residential
school experience has had enduring psychological, social, cultural and health effects on survivors.
This chapter also issues a call for more in-depth studies to more precisely identify the effects of
residential school and the factors contributing to recovery from these effects.
133
RHS 2002/03 Adult Survey – Chapter 13: The Impacts of Residential Schools
of their lives; and cultural expressions through language,

Introduction
dress, food, or beliefs were vigorously suppressed
Over 150 Indian Residential Schools1 operated in Canada concurrently. Almost half of the survivors interviewed
from the mid-19th Century to the late 20th Century.2 (47.3%) reported that their overall health and well-being has
Residential schools were the primary tools used by the been negatively affected due to their attendance at residential
government in pursuance of their policy of assimilating First schools (see Table 2).
Nations peoples—Indian and Inuit3 - into the dominant Euro- Table 1. Proportion of First Nations adults who attended
Canadian culture.4 Between 1840 and 1980, an estimated residential school
125,000 First Nations children, or about 20 to 30 percent of
Age group Percent
the First Nations population in Canada, attended residential
schools5. This chapter consists of a discussion of the impact 60+ 43.3%
of these schools on First Nations adults. Specifically, the
following areas are highlighted: 50-59 47.2%
• The proportion of First Nations and Inuit adults who 40-49 26.5%
attended residential schools;
30-39 10.3%
• The impacts of residential schools on the health and
well-being of survivors;6 18-29 5.7%
• Types of abuse experienced by survivors, including

Table 2. Negative impacts on the health and well-being of
more subtle institutionalized forms of abuse (i.e., loss of survivors due to attendance at residential schools*
language, loss of spirituality and traditions, and so on);
Negative outcome/impact on survivor due to: Percent
• Lack of education;
• The proportion of adults who had parents and Isolation from family 81.3%
grandparents who attended residential schools;
Verbal or emotional abuse 79.3%
• The relationship to parent and grandparent residential
school attendance and poor parenting; and Harsh discipline 78.0%
• The possible susceptibility of survivors to specific types Loss of cultural identity 76.8%
of mental and health effects as a result of their
Separation from First Nation or Inuit community 74.3%
residential school attendance.
Witnessing abuse 71.5%
Loss of language 71.1%
Of the adults interviewed, 20.3%1, or 1 in 5, attended
residential schools, and spent an average of almost 5 years Physical abuse 69.2%
(4.8 years) there. Adults who attended residential schools
Loss of traditional religion or spirituality 67.4%
usually started their attendance at about 10 years old and left
the schools when they were 15. A 1991 survey7 of on-reserve Bullying from other children 61.5%
Aboriginal people across Canada found that 39% of First
Poor education 45.4%
Nations people (45+) had attended a residential school and
had stayed there an average of six years. In general, the Harsh living conditions** 43.7%
greatest proportion of adults who attended residential schools
are 40 years of age and over.2 The proportion of First Nations Lack of food 43.2%
adults who attended residential schools generally increases Lack of proper clothing 40.5%
with age—a reflection of the gradual disappearance of
residential schools between the 1950’s and 1990’s (see Table Sexual abuse 32.6%
1, no significant difference between 60+ and 50-59 groups).
Researchers8 report that: the schools were often located in The findings reported in Table 2 suggest that the residential
isolated areas; the children were allowed little or no contact school experience has had enduring psychological and health
with their families and communities; there was a regime of effects on survivors. Although direct causal links are difficult
strict discipline and constant surveillance over every aspect to demonstrate with quantitative methods, researchers
strongly indicate that there is clear and compelling evidence
1
To simplify the text, confidence limits are only reported for overall adult estimates with a co-
suggesting that the long history of cultural oppression caused
efficient of variation greater than 33.3%. A statistical appendix including confidence intervals for all by residential schools has contributed to high levels of
reported figures is available at www.naho.ca/fnc/rhs
2
Comparisons between groups reported in this chapter are all significant unless “NS” —not mental health problems and other negative health effects
found in many First Nations communities.
134
Survivors reported that isolation from their family (81.3%), cultures, and that the disciplinary regime of the schools
verbal or emotional abuse (79.3%), harsh discipline (78.0%) worked to denigrate all aspects of First Nations life and
and loss of cultural identity (76.8%) were among the top four customs. Nonetheless, we do find that 69.7% of those who
negative impacts affecting their overall health and well- did attend residential school can speak one or more First
being. Mangham et al. (1995) found that separation from Nations languages, versus 37.4% who did not attend
parents, exposure to violence and life stress are three of the residential schools. A similar pattern exists for those
most important family-level risks leading to an increased understanding one or more First Nations languages: 74.8% of
likelihood of negative outcomes later in life. those who attended residential school can understand one or
more First Nations languages, compared to 43.7% of those
Stout and Kipling (2003) believe that the most telling legacy
who did not attend residential school. This might indicate
of the residential school system is the frequency with which
patterns of resilient behaviour among children who attended
survivors died an early death, demonstrated not only in the
residential school. There have been studies indicating that the
high incidence of suicide, but also in the large numbers of
resiliency of children in residential school proved to be a
deaths due to violence or alcohol-related causes.10 In this
factor in their overall survival in that environment.
study, 19.4% of survivors have attempted suicide in their
Resiliency among children to secretly speak to one another in
lifetime; however, reports of attempted suicide by these
the language of their First Nation as an act of rebellion in
individuals did not differ from adults who did not attend
residential school may have contributed to the preservation
residential school.
of language(s). At the same time, common sense would seem
In another study,11 survivors contended that the treatment and to dictate that the passing of time could also be a factor in
abuse they suffered in residential schools caused them language retention rates among residential school attendees
extreme emotional anguish that lingered on for years, often vs. non- attendees. For a variety of reasons, fluency and
resulting in confused personal identities, alcoholism and the understanding of First Nations languages has been receding
inability to engage in productive activities. This is the as the generations pass, and the older generations were more
“Legacy12 of the Indian Residential Schools.” We found that likely to attend residential school. Retention rates may be
26.7% of survivors have used one or more non-prescription higher among survivors, since at least they were more likely
drugs in the past year, compared to 35.8% of adults who did to be exposed to the language in their formative years, before
not attend residential school.13 being taken away from the community.
Agnes Grant (1996) identifies four general categories of In 1945, out of approximately nine thousand First Nations
abuse perpetrated in the schools: physical, sexual, spiritual children enrolled in residential schools, none went beyond
and psychological. The majority of survivors (71.5%) grade nine. Researchers have reported that few survivors
reported that they had witnessed the abuse of others and had acquired anything beyond the most basic academic skills.16
experienced either one or more of the following types of This is reflected in the findings of this study; for adults who
abuse as a student in the schools: sexual abuse (32.6%), attended residential schools, the majority (55.5%) did not
physical abuse (69.2%) and verbal or emotional abuse graduate from high school. However, this is not significantly
(79.3%). In another study, Chrisjohn et al. (1997) found that different from adults who did not attend residential schools.
79% of residential school attendees were abused in some In terms of attaining and completing higher formal education
manner, and that 48% were sexually abused. such as a bachelor or graduate degree, only 6.0% of survivors
have a bachelor’s degree; however, this is not significantly
Survivors were also victims of more subtle institutionalized
different from adults who did not attend residential school
forms of abuse.14 For example, survivors indicated that their (see Table 3).
overall health and well-being was negatively impacted by
harsh living conditions (43.7%), lack of proper clothing Table 3. Proportion of First Nations survivors who have
completed formal education
(40.5%), bullying from other children (61.5%), loss of
language (71.1%) and loss of traditional religion or Level of formal education completed %
spirituality (67.4%). Other researchers have reported similar
Did not graduate high school 55.5%
findings, noting how survivors were confronted with a
difficult environment. This environment included heavy High school Graduate 11.1%
chores, bullying from other children, and a lack of sufficient Diploma from college, university, trade, technical
food.15 or vocational school
27.3%
In terms of loss of language, one-third (30.3%) of survivors Bachelor’s Degree 6.0%

can not speak one or more First Nations or Inuit languages
Master’s Degree (Graduate Degree) –
fluently, and 25.2% have no understanding of any First
– Data suppressed due to insufficient sample size.
Nations or Inuit language. Claes and Clifton (1998) strongly
believe that the prohibition of Aboriginal languages was a
priority of the first order in the suppression of First Nations
135
It should be noted that the completion of formal education17 susceptibility to specific types of mental and physical health
for survivors most likely did not take place immediately after effects resulting from their attendance at residential schools.
they left a residential school. Stout and Kipling (2003)
Survivors are more likely to suffer from a variety of health
indicate that the majority of survivors who hold diplomas or
effects such as tuberculosis, diabetes, arthritis, and allergies,
degrees from trade schools, vocational schools, colleges and
to name a few. It can be noted that attendance at residential
universities enrolled as mature students, after years spent
schools is not the only causal factor related to being
raising a family or employed in the labour force. The
diagnosed with health problems listed in Table 5. Some
completion of formal education studies by these survivors
diseases may be associated with age, gender, likelihood of
should be highlighted as an incredible accomplishment,
high-risk lifestyles and other factors. However, there are
given the adversity they faced as children in residential
some noteworthy health differences between those adults
schools.
who did not attend residential schools and those who did.
In the 1990’s, several Canadian provincial inquiries Table 5. Residential school attendance and diagnosis of
discussed the relationship between the residential school illnesses*
system, family violence and sexual abuse. The First Nations Non-
Justice Inquiry of Manitoba (1991) stressed that many of Diagnosis Survivor
survivor
today’s First Nations parents and grandparents who went
through the residential school system were denied role Arthritis 30.0% 15.6%
models from which they could learn proper parenting skills. Diabetes 28.7% 10.8%
In other residential school studies, many formal students High blood pressure 23.0% 13.0%
have indicated that their confinement in the residential school Chronic back pain 20.3% 12.6%
system left them ill-prepared to become parents in their own Hearing impairment 15.8% 6.4%
right.18 Table 4 summarizes intergenerational attendance at Stomach or intest. problems 11.0% 6.8%
residential schools. Cataracts 9.8% 2.9%
Table 4. Proportion of First Nations adults who had parents, Tuberculosis 8.8% 1.5%
grandparents or both parents and grandparents attend Heart disease 8.3% 4.0%
residential schools Thyroid problems 5.7% 3.5%
Intergenerational residential school attendance Percent Rheumatism 5.4% 2.7%
Osteoporosis 5.4% 2.3%
Adults who had one or more parent attend residential
49.3%
Chronic bronchitis 5.2% 2.5%
school Glaucoma 4.2% 1.1%
Adults who had one or more grandparent attend
39.7%
Effects of stroke 3.2% 1.0%
residential school Liver disease** 2.4% 1.1%
*Only significant result are reported p<.05
Adults who had one or more parent and grandparent **Excludes Hepatitis
15.3%
attend residential school
In a study of residential school sexual and physical abuse
victims,20 survivors indicated a reliance on First Nations and
Almost half (43.0%) of the adults interviewed believe that other sources of help rather than on Euro-Canadian
their parents’ attendance at residential schools negatively mainstream sources of support. The two most frequently used
affected the parenting that they received as children. The sources of support and aid included First Nations Elders and
majority of adults (73.4%) also believe that their the sweat lodge. Over half of the survivors (58.6%) indicated
grandparents’ attendance at residential schools negatively that traditional cultural events and traditional spirituality
affected the parenting that their own parents had received (54.2%) are very important in their lives. Additionally,
when they were children. The failure of survivors to be 42.5% of survivors say that religion is very important in their
taught positive strategies for dealing with interpersonal lives. For survivors who have gone on to lead well-adjusted
conflict may have led to high rates of family breakdown and lives, religious beliefs and spirituality are frequently cited as
problems that youth carried with them into their adult lives. reasons for their current well-being.21 Aboriginal spiritual
The notion of the historic trauma response (HTR) refers to traditions have proven particularly attractive to former
the cumulative wounds inflicted on First Nations people over pupils, who see them as a way of claiming their own identity
their lifetime and over the lifetimes of their ancestors, and finding meaning in their lives.22
resulting in potentially chronic symptoms that range from
depression and psychic numbing to hyperglycaemia (high
blood sugar) and substance abuse.19 In addition to suffering
from mental health effects and other negative social effects,
survivors interviewed in this study showed an increased
136
Conclusion
status Indian, Métis and Inuit Survivors have all had to contend with the Legacy of their
In summary, residential schools have adversely affected the residential school experiences.
4. • Jennifer J. Llewellyn, “Dealing with the Legacy of Native Residential School Abuse in
overall mental and physical well-being of survivors. The Canada: Litigation, ADR, and Restorative Justice,” University of Toronto Law Journal 52
shame, pain and hopelessness resulting from abuses23 arising (2002), pp. 253-300.
• V. Coleman and B. Thorpe, “Researcher defends residential schools,” The National Post
from residential schools have lead to internalized oppression, [online] March 17, 2001 [cited 30 April, 2005]. Available from World Wide Web:
<http://www.uccan. org/airs/010323.htm>.
lateral violence and post-traumatic stress disorder, among 5. Murray R. Thomas, 2003, Can money undo the past? A Canadian example, Comparative
other things.24 Many survivors in other studies have reported 6.
Education, 39, 3: 331-343.
Stout and Kipling, Aboriginal People, Resilience and the Residential School Legacy. Note: A
symptoms reminiscent of post-traumatic stress disorder, Survivor is an Aboriginal person who attended and survived the residential school system.
7. Statistics Canada, “Aboriginal Peoples of Canada: A demographic profile,” 1991 Aboriginal
including nightmares, sleep problems, apathy, and Peoples Survey, Catalogue 89-533 (Ottawa, Ont.: Statistics Canada, 1991).
depression.25 It could be argued that every residential school 8. Laurence Kirmayer, Cori Simpson and Margaret Cargo, 2003, Healing traditions: culture,
community and mental health promotion with Canadian Aboriginal peoples, Australasian
student was subject to abuse of one kind or another, Psychiatry, 11: 15-23.
10. Rhonda Claes and Deborah Clifton, Needs and Expectations for Redress of Victims of Abuse at
including subtle forms of abuse that had drastic effects on Native Residential Schools (Ottawa, Ont.: Law Commission of Canada, 1998).
their overall well-being, such as removal from families, 11. Ibid., p. 5.
12. Stout and Kipling, Aboriginal People, Resilience and the Residential School Legacy. Note:
isolation from communities, and the destruction of their The Legacy refers to on-going direct and indirect effects of physical and sexual abuse at
residential schools. The Legacy includes the effects on Survivors and their families,
culture, language and identity. Chronic under-funding of the descendents and communities (including communities of interest). These effects may include,
residential schools also left children hungry, malnourished, but are not limited to, family violence, drug, alcohol and substance abuse, physical and sexual
abuse, loss of parenting skills and self-destructive behavior.
inadequately clothed, and forced into labour to support the 13. Note: Non-prescription drug use excludes chewing tobacco.
14. Llewellyn, “Dealing with the Legacy of Native Residential School Abuse in Canada:
daily costs of running the schools.26 Litigation, ADR, and Restorative Justice," University of Toronto Law Journal.
15. • Celia Haig-Brown, Resistance and Renewal: Surviving the Indian Residential School, 7th ed.
While the figures in this study give one an idea of the many (Vancouver, B.C.: Arsenal Pulp Press, 1988).
• Stout and Kipling, Aboriginal People, Resilience and the Residential School Legacy.
lives that have been touched indirectly and directly by the 16. • Stout and Kipling, Aboriginal People, Resilience and the Residential School Legacy.
• Isabelle Knockwood, Out of the depths: The experiences of Mi’kmaw children at the Indian
residential school legacy, they cannot begin to capture the residential school at Shubenacadie, Nova Scotia (Lockeport, N.S.: Roseway, 1992).
physical, psychological, spiritual and cultural harm the 17. Note: Formal education is defined as within the public or private schooling system of
mainstream Canadian society.
schools inflicted on survivors, their families and 18. Stout and Kipling, Aboriginal People, Resilience and the Residential School Legacy.
communities.27 Several researchers28 remind us that there has 19.
20.
Ibid., p. 17.
Roland Chrisjohn, Sherri Young and Michael Maraun, The circle game: shadows and
yet to be an in-depth study conducted on First Nations substance in the Indian residential school experience in Canada (Penticton, B.C.: Theytus
Books, 1997).
peoples that captures both the effects of , and the recovery 21. Ibid., p. 17.
22. Ibid., p. 17.
from, residential schooling. With the exception of a 23. Ruth Morin and Alfred Riediger, Healing Together, Our Sacred Journey (Edmonton, Alta.:
reasonably comprehensive study by Chrisjohn et al. (1997), 24.
Nechi Training Research and Health Promotions Institute, 2000).
• Eduardo Duran and Bonnie Duran, Native American Post Colonial Psychology (New York,
most studies29 on residential school survivors and the legacy N.Y.: SUNY Press, 1995).
• Roderick McCormick, Report on the research project exploring the facilitation of healing for
of intergenerational effects (direct and indirect) left by the survivors of sexual and physical abuse in residential schools, including the intergenerational
schools tend to focus on single communities of localized impacts and the cycle of abuse that began in residential schools (Vernon, B.C.: Association of
BC First Nations Treatment Programs, August 2002).
populations with relatively small numbers of informants. 25. Knockwood, Out of the depths: The experiences of Mi’kmaw children at the Indian residential
school at Shubenacadie, Nova Scotia.
26. Ibid., p. 14.
This chapter is not intended to provide the answers, but is 27. Ibid., p. 14.
meant to raise questions and dialogue about the overall 28. • Knockwood, Out of the depths: The experiences of Mi’kmaw children at the Indian
residential school at Shubenacadie, Nova Scotia.
impacts of residential schools on the health and well-being of • Elizabeth Furniss, Victims of Benevolence: The Dark Legacy of the Williams Lake
Residential School (Vancouver, B.C.: Arsenal Pulp Press, 1995).
survivors (eg. connection to other illnesses, intergenerational • Agnes Grant, No end of grief: Indian residential schools in Canada (Winnipeg, Man.:
effects, etc.). It is hoped that individuals who read this Pemmican Publishers, 1996).
• James Roger Miller, Shingwauk’s Vision: A History of Native Residential Schools (Toronto,
chapter question the findings, in order to discern the Ont.: University of Toronto Press, 1996).
• Stout and Kipling, Aboriginal People, Resilience and the Residential School Legacy.
numerous individual and collective outcomes experienced by • Chrisjohn, Young and Maraun, The circle game: shadows and substance in the Indian
First Nations peoples as a result of the residential school residential school experience in Canada.
29. • Harvey D. Plouffe, The Indigenous Healing Process and Cultural Rebirth of First Nations,
experience in Canada. unpublished dissertation, Fielding University, California, 2000.
• N. Rosalyn Ing, Dealing with Shame and Unresolved Trauma: Residential School and its
Impact on the 2nd and 3rd Generation Adults, unpublished dissertation, Department of
Educational Studies, University of B.C., 2001.
• Assembly of First Nations, Breaking the silence: An interpretive study of residential school
Notes to Chapter 13 impact and healing as illustrated by the stories of Aboriginal individuals (Ottawa, Ont.:
Aboriginal Health Commission, 1994).
• R. Linda Bull, 1991, Indian residential schooling: the native perspective, Canadian Journal of
Native Education, 18: 161-167.
1. Madeline Dion Stout and Gregory Kipling, Aboriginal People, Resilience and the Residential • N. Rosalyn Ing, 1991, The effects of residential school on Aboriginal child-rearing practices,
School Legacy: The Aboriginal Healing Foundation Research Series (Ottawa, Ont.: The Canadian Journal of Native Education, 18, Supplement: 65-116.
Aboriginal Healing Foundation, 2003). Note: The residential school system in Canada attended • Haig-Brown, Resistance and Renewal: Surviving the Indian Residential School.
by status Indians, Inuit and Métis children included industrial schools, boarding schools and
homes for students, hostels, billets, residential schools, and residential schools with a majority
of day students, or a combination of any of the above.
2. Aboriginal Healing Foundation, Where are the Children? Healing the Legacy of the
Residential Schools (Ottawa, Ont.: Legacy of Hope Foundation, 2003). Further References
3. Stout and Kipling, Aboriginal People, Resilience and the Residential School Legacy. Note:
Status Indians formed the majority of attendees at any given time; however, the residential
schools later accepted many Métis children in order to boost school enrollment figures. In Aboriginal Justice Inquiry of Manitoba, Report of the Aboriginal Justice Inquiry of Manitoba
addition, the number of Inuit children grew quickly in the 1950s when a network of schools (Winnipeg, Man.: Queen’s Printer, 1991).
was built across the North. Regardless of the manner in which they found themselves enrolled, C. Mangham et al., Resiliency: Relevance to Health Promotion: Discussion Paper (Ottawa, Ont.:
Alcohol and Drugs Unit, Health Canada, 1995).
137
Chapter 14
Mental Health, Wellness, and Personal Support
Abstract
First Nations people continue to struggle with issues affecting their mental health and personal
wellness. They are challenged in the process of accessing support and services, and consistently
encounter more obstacles to access than the broader Canadian population. The data presented in this
chapter examines aspects of mental health and personal wellness, and respective supports. This
analysis enables us to monitor the conditions relating to mental health and personal wellness, to
prepare for helpful prevention, and to increase outreach activities. Although the majority of First
Nations people surveyed claim to feel in balance physically, emotionally, spiritually and mentally, the
population is still challenged with issues regarding suicide. Many First Nations adults feel sad, blue or
depressed, and have suicidal ideations. Continued experiences of racism also impact mental health
and well-being. People who are in balance seek personal and emotional supports from immediate
family members or traditional healers, while those who are feeling sad, blue or depressed are more
likely to report using mainstream mental health and emotional supports almost exclusively. Overall,
access to appropriate mental health support must be improved to benefit the mental health and well-
being of First Nations peoples. An overall goal of supporting balanced lifestyles for First Nations
people also needs to be considered.
138
RHS 2002/03 Adult Survey – Chapter 14: Mental Health, Wellness and Personal Support
episodes, while others show a tendency towards depression.4

Introduction
The report asserts that these depressed people are at risk of
Historical factors affecting the mental health of Aboriginal suicide. These risk factors are increased for those who
communities have gained attention through various grapple with various addictions or traumatic life experiences.
initiatives, such as the Aboriginal Healing Foundation1 and
Further to this, it can be asserted that various types of trauma
the Aboriginal Healing and Wellness Strategy.2 However,
are contributing factors to First Nations peoples’ general
data documenting the state of mental health for First Nations
experience of poor mental health, personal wellness and
people are extremely limited, in comparison to the mass of
access to supports. This prevalence of trauma may be
data available regarding the general Canadian population.
attributed to the intergenerational effects of colonialism. For
Most national or regional studies do not focus on First example, the Aboriginal Healing Foundation Mental Health
Nations people. While many First Nations communities are Profile Report states that: 100% of the case files reported
beginning to undertake research studies for their own use and sexual abuse at residential school; 90% reported physical
planning strategies, they generally do not release this abuse; 75% reported alcohol abuse; and 21.1 % reported
information to external agencies as a means of ensuring self- major depression.5
determination and concerns over the proper utilization of
In addition, the 1997 First Nations and Inuit Regional
such information. Far too often, First Nations communities
Longitudinal Health Survey (FNIRLHS) reported that about
have found themselves the focus of academic research that
18% of the general Aboriginal adult population surveyed met
has little if any commitment to community development.
the criteria for major depression; 27% reported problems
This historical fact has made information very difficult to
with alcohol; 34% reported sexual abuse during childhood;
access. The Royal Commission on Aboriginal Peoples (1996)
and 15% attempted suicide at some time in their lives.6
detailed conclusively the problems First Nations
communities have with mental health and well-being.3 This Causes of poor mental health have been related to
chapter shows how a sample of the First Nations population colonization and assimilation policies. In their article “The
views mental health, personal wellness and supports at this Mental Health of Aboriginal Peoples: Transformation,
particular time. Identity and Community,” Kirmayer, Bass and Tait
acknowledge the consequences to First Nations mental health
Interpretation methods
of policies arising from contact, reserve creation, residential
The cultural framework set out by the First Nations Regional schools, disruption of traditional subsistence patterns and
Longitudinal Health Survey (RHS) was employed to ensure connection to the land.7
the use of a community-based approach in researching the
One testament to the poor overall state of mental health
health and well-being of our people. Using a four directions
among First Nations people is the suicide rate across all age
model, the following data are related to the first direction, the
groups, which is approximately three times higher than the
East. The East represents vision, and the need for cultural
national average. The Royal Commission on Aboriginal
respect and understanding of the current state of our people’s
People (RCAP 1996) further asserts that up to 25% of
health.
accidental deaths among Aboriginal Canadians are
The RHS cultural framework embodies a “total person” and unreported suicides.8
“total environment” model, which includes:
Results
• The individual’s spiritual, emotional, mental and Mental health, personal wellness and support
physical well-being;
• Their culture’s values, beliefs, identity, and Respondents felt in balance in the four aspects of their lives
practices; most of the time. 70.9%i felt in balance physically, 71.0%
emotionally, approximately 75% felt in balance mentally,
• Their community and their relationship to the and about 69.0% felt in balance spiritually.
physical environment; and,
Despite these high levels of perceived balance among the
• Their connectedness to family.
respondents, 37.9% have experienced instances of racism in
The following chapter examines the mental health and the past 12 months, and 30.1% have experienced a time when
personal wellness of the First Nations population, and they felt sad, blue or depressed for two weeks or more in a
supports available for them, with guidance from the RHS row.
cultural framework. Suicide and racism are highlighted in
Further to this, data on suicidal thoughts and attempts were
several sections of this study.
alarming, and contradict the notion that First Nations people
A glance at the literature
The Statistical Report on the Health of Canadians (1999) i
“To simplify the text, confidence limits are only reported for overall adult estimates with a co-
reports that some First Nations people have major depressive all reported figures is available at www.naho.ca/fnc/rhs”
139
are in balance. Overall, 30.9% reported having suicidal Roughly 60% of respondents seek emotional or mental
thoughts over their lifetime. There were no significant gender support from immediate family and friends (Figure 2). This
differences in lifetime ideation of suicide. Moreover, 15.8% is followed by 44.7% of individuals who seek this type of
reported having attempted suicide at least once in their support from other family members. Approximately 24%
lifetime. Females were more likely than males (18.5% vs. received emotional or mental health support from their
13.1% respectively)ii to have attempted suicide at least once family doctor, followed by 15% who reported the use of
in their life. traditional healers. About 5% sought support from a
psychiatrist and/or psychologist, while roughly 2% received
Adults between the ages of 18 and 59 were more likely than
support from a crisis line worker.
those 60 and over to have thought about suicide in their
lifetime. The lowest rate of suicide ideation occurs among Figure 2. Individuals First Nations adults sought for support
the 60+ group, with 11.7% (versus 27.3 - 36.5% for all other Immediate family member 60.6%
age groups). A similar pattern exists with respect to Friend 60.0%

attempted suicides in the lifetime of respondents. Only 6.4% Other family member 44.7%
of adults over 60 reported having attempted suicide in their Family doctor 23.5%
lifetime, versus 15.4 - 18.6% among the other age groups.
Individual sought
Traditional healer 15.0%
This section looks at the constellation of factors that may Nurse 13.1%
impact mental health and personal wellness, especially in Counselor 13.1%
light of personal support. In relation to the availability of CHR 8.9%
personal support, over 61% of respondents felt they always Social worker 7.8%
have someone to show them love and affection. Over half of Psychologist 5.1%
the respondents felt they always have someone who will take Psychiatrist 4.6%
them to a doctor (51.8%), or someone to do something Crisis line worker 2.0%
enjoyable with (50.2%). Unfortunately, the availability of
0% 20% 40% 60% 80%
someone who can always give them a break from their daily
routines was quite low, at 28.3% (Figure 1). An important factor that may impact mental health and well-
Figure 1. Availability of personal support (n=10,507)
being is one’s experience of racism. Roughly two out of five
(37.9%) respondents experienced instances of racism, and
To do something
they were asked to elaborate on such experiences by
50.2% 30.1%
enjoyable with answering further questions concerning racism. These
respondents were asked to state how strongly they agree or
To confide in or talk disagree with a series of statements (Table 2).
about yourself or 45.2% 29.9%
your problems
Education
To have a good time

Individuals who did not graduate high school are less likely
48.9% 30.0%
with than those who have attained higher levels of education to
report that they have personally experienced an instance of
Type of personal support
Who can give you a racism during the previous year.

break from your daily 28.3% 29.9%
routines
Employment
Who shows you love The percentage of respondents who thought about suicide
61.4% 22.9%
and affection
during their lifetime was similar for both those working for
pay and those who were not, with only a 2.7% difference.
To take you to a
doctor if you needed
However, 42.3% of those who work are more likely to have
51.8% 27.8%
it experienced racism than those who do not currently work for
pay (33.5%). Those who work 15 hours a week or more
You can count on
46.3% 31.3%
reported higher proportions of racism than those who are
when you need help
working less than 15 hours a week.
You can count onto In relation to government sources of income, the rate of
listen to you talk
when you need to
46.3% 31.7% suicidal ideation increases from 27.5% for those who do not
talk
receive any government sources of income to one third
All of the time
Most of the time
0% 20% 40% 60% 80% 100% (31.3% to 33.9%) for those who receive sources of
government income (Table 3). Dependence on government
ii
may be a factor in a person’s locus of control and sense of
Comparisons between groups reported in this chapter are all significant unless “NS” —not
significant— is specified in brackets. In this chapter, estimates are considered significantly different if self.
140
Table 2. Reported instances of racism by levels of agreement to self-esteem related statements (n=8,228) (a=racism reported,
b=racism not reported)
Neither agree nor
Agreement/disagreement Strongly agree Agree Disagree Strongly disagree
disagree
statements
a b a b a b a b a b
I can solve the problems that I have 38.6% 35.5% 46.9% 50.1% 10.4% 10.1% 3.2% 3.3% – –
No one pushes me around in life 39.5% 38.9% 39.2% 45.8%* 14.4% 10.3%* 6.0% 4.3% 0.9% 0.6%
I have control over the things that

29.1% 31.4% 45.6% 50.9% 17.5% 11.9%* 6.3% 5.1% 1.6% 0.6%
happen to me
I can do anything I really set my

44.0% 38.9% 43.6% 50.8%* 9.7% 7.2% 2.4% 3.0% – –
mind to
I often feel helpless in dealing with

4.5% 5.6% 17.4% 19.9% 18.5% 16.9% 45.4% 47.5% 14.2% 10.2%
problems of life
What happens to me in the future

43.7% 33.3%* 45.8% 53.4%* 7.2% 9.3% 2.8% 3.2% – 0.8%
mostly depends on me
There is little I can do to change
many of the important things in my 6.1% 8.1% 17.1% 22.5%* 13.2% 13.2% 45.1% 44.9% 18.5% 11.2%
life
* Significantly different from those who report experiencing an instance of racism
– Data suppressed due to insufficient cell sizes.
strong effect on their self-esteem, compared to those who are
Table 3: Number of government income sources and rates of
suicidal thoughts not limited in activity at home.
# of government income sources Rates of suicidal thoughts Figure 3. Relationship between reported depression and suicide
thought and attempt
60%
0 27.5%
1 31.3% 50.5%
50% Depressed
2+ 33.9% No depression
40%
Perceived Health Status
The rate of those reporting suicidal thoughts during their 30%
26.0%
lifetime decreased with improved self-reported health status, 23.1%
from 38.4% among those with fair and poor rated health to 20%
28.9% among those with excellent self-reported health. There
were no significant differences, however, between suicide 11.6%
10%
attempters and non-attempters with respect to why they felt
healthy.
0%
Depression Thought about suicide Attempted suicide
Individuals who report a time when they felt sad or depressed

for two weeks in a row or more are more than twice as likely Self-Esteem
to report a suicide ideation and attempt. Thus, the
Self-esteem is the confidence and satisfaction one has
antecedents to attempted suicide deserve further exploration.
regarding one’s self. Of First Nations adults reporting that
Disability their self-esteem was affected by instances of racism, 13%
stated that it had a strong or very strong effect, and a further
People with disabilities experience limitations in home,
22.7% reported that it had some effect (see Table 4). In
school, work and leisure activities, which may in turn impact
addition, 27.6% stated that it had little effect and 36.8% cited
on their mental health and overall well-being. Also, during
no effect. A slightly but significantly higher percentage of
school/work and leisure activities people with disabilities
those who had suicide ideation felt that racism experienced
report a higher proportion of racism experiences, which may
by them had a very strong effect (5.8%) on their self esteem,
have mental health impacts as well. People who report
compared to those who did not report ever thinking about
limitations within their home are more likely to report
suicide (2.9%).
personal experiences of racism, and that this has had a very
141
In addition, it is apparent from the personal statements on and spiritual balance almost none of the time, compared to
control in one’s life - or locus of control - that feelings of those who did not indicate depression.
sadness, experiencing the blues or depression are related to Table 5. Report barriers to health care access by perceived
an individual’s perceptions of control and self-worth. experiences of racism
Table 4. Self-determination indicators by feelings of depression Experienced racism
Healthcare access barrier
or sadness. Yes No
Depressed Doctor/Nurse not available in area 23.2% 15.6%
% strongly agreeing that…
Yes No 9.7%
Health facility not available 12.0%
(NS)
I can solve the problems I have 32.4% 38.5% Waiting list too long 42.5% 27.7%
No one pushes me around in life 33.8% 41.0% Unable to arrange transportation 20.1% 11.4%
31.1% Difficulty getting traditional care 19.2% 9.7%

I have control over things that happen to me 28.0%
(NS)
Not covered by Non-insured Health Benefits 28.9% 14.8%
I can do just about anything I set my mind to 35.2% 43.2%
Approval for services under NIHB was denied 24.4% 11.2%
I often feel helpless in dealing with the problems
7.4% 4.1% Could not afford direct cost of care, service 19.8% 9.2%
of life
What happens to me in the future mostly depends 37.6% Could not afford transportation costs 19.4% 10.1%
37.0%
on me (NS)
Could not afford childcare costs 10.5% 5.0%
There’s little I can do to change many of the
10.6% 5.9%
important things in my life Felt health care provided was inadequate 24.2% 12.9%
Felt service was not culturally appropriate 20.2% 9.7%

Access to Health Care
Chose not to see health professional 14.9% 8.5%
According to the data, those with suicidal ideation and/or
those who have experienced an instance of racism perceive Service was not available in my area 19.6% 11.7%
their access to health care as poor in comparison to other
Canadians. A majority (64.4%) of First Nations people Nutrition
perceive their access to health care to be the same as or better
Those who feel sad, blue or depressed are less likely to
than that of other Canadians. Adults reporting that they had
always or almost always eat a nutritious, balanced diet
personally experienced an instance of racism compared to
compared to those who did not indicate depressive states..
those who did not have such an experience are more likely to
However, those reporting depressive states are more likely to
report that they have less access - and are less likely to report
sometimes consume a nutritious, balanced diet than those not
they have the same access - to health care, compared to other
indicating depressive states.
Canadians. Similarly, significant differences appeared among
those who reported an incident of racism and those who did Residential school
not, in terms of reporting barriers to health care access.
Adults who indicated that they had experienced racism were The number of First Nations who reported feeling sad, blue
more likely than those who did not to report virtually all or depressed and also reported attending residential school is
barriers to health care access (see Table 5). 23.5%, which is not significantly different than those who
did not report feeling sad, blue or depressed, at 19.2%. When
In addition, attitudes reported by First Nations people on the asked about the negative effects of residential school on their
importance of traditional cultural and spiritual beliefs have health, residential school survivors who reported depression
statistically significant linkages with personal experiences of were statistically similar in relation to these negative effects
racism. Interestingly, those who had experienced an incident (51.6%) to those who were not depressed (45.0%). 48.4% of
of racism are more likely to deem traditional cultural events survivors who did not believe their health suffered negative
and traditional spirituality as very important. results from residential school reported depression.
Adults who reported that they had felt depressed or sad for Personal support
two or more consecutive weeks are less likely to report that
they feel in balance physically, emotionally and mentally all First Nations use of mental health and emotional supports
of the time, compared to those who did not report depression. varies for those reporting feeling sad, blue or depressed (see
However, adults who report feelings of depression or sadness Table 6).
are more likely to report that they feel in physical, emotional
142
Table 6. Depressive states and the use of family and community Table 7. Proportion reporting community progress by level of
supports perceived balance (a=no progress, b=some or good progress)
Not feeling sad, blue or Level of balance
Feeling sad, blue or depressed Community progress indicator
depressed for 2 or more weeks Low Moderate* High*
for 2 or more weeks in a row
in a row
Traditional approaches to a 59.9 40.8 37.8
71.7% Friend 57.8% Immediate family member healing b 40.1 59.2 62,2
68.5% Immediate family member 55.7% Friend Renewal of First a 65.7 43.1 40.5
Nations/Inuit spirituality b 34.3 56.9 59.5
52.0% Other family member 42.2% Other family member
Traditional ceremonial a 61.8 36.4 33.2
31.8% Family doctor 20.4% Family doctor activity b 38.2 63.6 66.8
a 63.0 44.8 44.3
19.7% Counsellor 14.0% Traditional healer (NS) Renewal relationship with
land b 37.0 55.2 55.7
18.6% Nurse 10.8% Nurse
Use of First Nation/Inuit a 49.3 38.8 (NS) 36.3
17.6% Traditional healer 10.3% Counsellor language b 50.7 61.2 (NS) 63.7
13.5% Community health 7.2% Community health 62.9
a 68.3 63.6 (NS)
representative representative (NS)
Reduction in alcohol and drug
abuse 37.1
12.7% Social worker 5.7% Social worker b 31.7 36.4 (NS)
(NS)
9.1% Psychiatrist 3.8% Psychologist Availability of First a 57.8 40.0 37.8
Nation/Inuit health
8.4% Psychologist 2.7% Psychiatrist b 42.2 60.0 62.2
professionals
3.6% Crisis line worker 1.0% Crisis line worker a 34.2 22.9 19.6
Cultural awareness in schools
b 65.8 77.1 80.4
Those who reported feeling sad, blue or depressed ranked a 30.2 21.9 (NS) 19.5
Education and training
friends and family as their top choices for support. Those opportunities b 69.8 78.1 (NS) 80.5
who reported no feelings of sadness, being blue or depression
ranked their use of support similarly. However, those a 56.3 40.6 37.1
Housing quality
reporting depression cited higher use of supports available b 43.7 59.4 62.9
for their emotional and mental health needs. a 40.9 30.0
30.4
(NS)
Adults who reported a high or moderate level of balance are Water and sewage facilities
69.6
more likely than those with a low level of balance to cite the b 59.1 70.0
(NS)
use of immediate family members and a traditional healer as a 47.1 36.0 31.7
First Nations/Inuit control
sources of emotional and mental health support. However, over health services b 52.9 64.0 68.3
those citing a high level of balance are less likely to indicate
the use of a psychiatrist than those with moderate or low Recreation and leisure a 54.2 47.7 (NS) 40.1
levels of balance. activities b 45.8 52.3 (NS) 59.9
* Significantly different from low level of balance unless indicated by (NS)
Community progress
First Nations adults who reported a low level of balance are Discussion and Recommendations
more likely to indicate that their community was not
The data presented in this chapter reveals several areas of
progressing in relation to most indicators, including those
concern for First Nations mental health and well-being, one
relating to culture as depicted in Table 7.
of the primary concerns being the presence of racism in a
variety of contexts. Attention should be devoted to racism
awareness in the workplace, as a large number of First
Nations people working for pay and working multiple jobs
experienced far more instances of racism than those who are
not working for pay. It can be asserted that racism is an
important factor that impacts on our mental health and well-
being, and should be further explored.
Further discussion on family composition and dynamics may
explain the availability of personal supports for people who
are depressed or have need to seek emotional and personal
supports. In addition, information specific to nation or
143
community could help address wellness-enhancing resources.

This chapter provided an overview of the preferential choices
of First Nations people when seeking supports. In addition to
friends and family members, family doctors rank highly as
important and readily relied upon resources for First Nations
people seeking support. For this reason, family doctors
should be suitably prepared to engage as integral components
in supporting the mental and emotional health of First
Nations people.
Future research, interventions and policy related to First
Nations mental health should incorporate resiliency
promotion for individuals and their families and friends, to
cope with challenges arising at the personal, family, and
community levels. The building of mental health capacity
within First Nations communities and affiliated health care
facilities should be encouraged. The consideration of the idea
of feeling holistic balance in the survey design provides
insight into an Indigenous approach that future surveys can
embrace.
This chapter examined First Nations mental health and well-
being. It gives us an indication of how we (First Nations) are
doing right now. This data will be compared to the next data
collection stage of the RHS, with proactive measures and
further development to benefit mental health, personal
wellness and supports among First Nations adults.
Notes to Chapter 15
1. Aboriginal Healing Foundation [online]. 2004. Available from World Wide Web:
<www.ahf.ca/newsite>.
2. Aboriginal Healing and Wellness Strategy [online]. 2003. Available from World Wide Web:
<www.ahwsontario.ca>.
Peoples (Ottawa, Ont.: Minister of Supply and Services Canada, 1996).
4. Canadian Institute for Health Information, Statistical Report on the Health of Canadians
(Ottawa, Ont.: Health Canada and Statistics Canada, 1999)
5. Raymond R. Corrado and Irwin M. Cohen, Mental Health Profiles for a Sample of British
Columbia’s Aboriginal Survivors of the Canadian Residential School System (Ottawa, Ont.:
Aboriginal Healing Foundation, 2003).
6. First Nations Information Governance Committee, First Nations and Inuit Regional Health
Surveys, 1997: A Synthesis of the National and Regional Reports (Ottawa, Ont.: First Nations
Centre, 2004).
7. Laurence Kirmayer, Gregory Brass and Caroline Tait, September 2000, The mental health of
Aboriginal peoples: transformations of identity and community, The Canadian Journal of
Psychiatry, 45, 7: 607-616.
Peoples.
144
Chapter 15
Community Wellness
Abstract
Community wellness from an Indigenous knowledge framework requires a close examination of the
unique assumptions contained within the worldview of First Nations peoples. For First Nations
peoples, the path to community wellness is to be found within a holistic paradigm that includes the
mental, physical, cultural and spiritual well being of both the individual and the community. The
Western biomedical model, premised on European cultural constructs, does examine some
determinants of health and wellness - for example, housing, employment and education - but is unable
to absorb the negative health impact of colonialism and is culturally limited in its definition of
wellness.
145
RHS 2002/03 Adult Survey – Chapter 15: Community Wellness
the development scale.3 Health is then understood based on a

Defining Community Wellness from an Indigenous
European premise that increased use of technology and
Knowledge Framework
industry can be correlated with an increase in a society’s
Community wellness from an Indigenous knowledge wellness. However, First Nations literature suggests a
framework requires a close examination of the unique different measurement of health and wellness, one that
assumptions contained within the worldview of First Nations surpasses materialism and technology as a measure of
peoples. For First Nations peoples, community wellness is community wellness. The holistic framework of Indigenous
related to the mental, physical, cultural and spiritual well- knowledge encourages a broader scope of inquiry for
being of both the individual and the community. The measuring community wellness. Cultural, emotional,
Western biomedical model does not embrace Indigenous spiritual and physical wellness are critical components in the
cultural constructs such as values relating to culture and the social, political and economic life of a community.
land. Also, the literature reveals the impact of colonialism on
There are three common sources within Indigenous
First Nations health and community wellness. This chapter
knowledge inquiry. Marlene Brant Castellano (2000), a
will discuss Indigenous knowledge and its relevance as an
Mohawk scholar, suggests that Indigenous knowledge is
appropriate framework to discuss First Nations peoples and
grounded in the traditional, spiritual, and empirical spheres.4
their community wellness.
Indigenous knowledge engages a holistic worldview that
There is little, if any, acknowledgment of Indigenous acknowledges the emotional, spiritual, physical and mental
knowledge perspectives being “empirical.” This lack of well-being of a people. The cultural diversity of Indigenous
acknowledgement seems somewhat inherent to the Peoples is addressed through the recognition that Indigenous
biomedical model, “which focuses on the physical processes, knowledge is intimately bound to the language(s), landscapes
such as the pathology, the biochemistry and the physiology and cultures from which it emerges.
of a disease. It does not take into account the role of a
…under the colonial influence the biological and
person's mind or society in the cause and treatment”1 - or any
intellectual heritage of non-western societies was
other legitimate, scientific approach to health and illness.
devalued. The priorities of scientific development
Any other “wellness” (as opposed to “illness”) system, no
...transformed the plurality of knowledge systems into a
matter how ancient, is seen as secondary and at most
hierarchy of knowledge systems. When knowledge
complementary/ alternative, but unscientific. However, for
plurality mutated into knowledge hierarchy, the
many First Nations peoples their worldview includes an
horizontal ordering of diverse but equally valid systems
empirical and scientific based health paradigm grounded in
was converted into vertical ordering of unequal systems,
language and other cultural practices. Most Indigenous health
and the epistemological foundations of western
paradigms have been shaped outside of mainstream
knowledge were imposed on non-western knowledge
institutions and the academy and are connected to their
systems with the result that the latter were invalidated5.
distinct view of the world. The global community has begun
to analyze and appropriate Indigenous knowledge in many The dominance of Western cultural constructs as the only
spheres, including health, and found it to be scientifically valid form of empirical research serves to marginalize
valid in its practices and processes. Indigenous knowledge is Indigenous ways of knowing.6 The linear and reductionist
a complete knowledge system with its own epistemology, Western view of the world stands in direct contrast to the
philosophy, and scientific and logical validity, which can holistic, accumulative view of the world historically
only be understood by means of pedagogy traditionally developed by Indigenous people. The cyclical,
employed by the people themselves.2 comprehensive and multi-dimensional Indigenous beliefs are
premised on the dynamics of co-existence and inter-
Indigenous pedagogy acknowledges diverse ways of
relationship. In this circular model, progress and
knowing and respects the plurality of knowledge. Geographic
development are not necessarily the singular path to
and cultural diversity is an integral principle of Indigenous
achieving well-being.
knowledge. Traditional teachings contribute to the
knowledge base of First Nations peoples, and subsequently to The past, present, and future inform everyday actions,
how they frame their beliefs regarding health and wellness. including political, social, economic, and spiritual spheres,
which are related to the whole.7 To assume human behaviors
The Western biomedical model is highly individualized and
and health and wellness are solely molded by the economic
disease based. The individual is solely responsible for their
or political spheres is a foreign, if not absurd, concept to
‘lifestyle’, and thus people are individually “blamed” for
many Indigenous peoples. The belief that all spheres of life
their ill health due to their “lifestyle.” Social science also has
must be maintained and balanced is the only path to ‘true’
notions of superiority and inferiority in the linear measuring
community wellness.
of peoples. This manner of measuring places the
primitive/Native at the ‘low’ end of the Western scale of Scholars are giving new attention to Indigenous peoples’
development and the civilized Westerner at the ‘high’ end of knowledge systems and how they might be utilized and
146
applied to alleviate the ‘burden of ill health’ carried by both Indicators of community wellness: language
Native and non-Native communities.8 The basic threads of
One of the best indicators of community wellness is fluency
Indigenous knowledge are woven into the themes of
levels of Aboriginal languages, as well as the prevalence of
interconnectedness, inter-relationships and holism. In
other cultural practices. Data compiled by the First Nations
addition, the historical processes of colonialism that currently
Regional Longitudinal Health Survey (RHS) demonstrates
impact negatively on the wellness of many First Nations
that First Nations people view the recent cultural
communities are viewed as critical within an Indigenous
revitalization (including language use) as having a minimal
knowledge view. Therefore, community wellness is
impact. This view is held across generations, with little
significantly influenced by many factors, grounded in both
variation, as improving minimally. Three-quarters (74.7%)i
the past and the present. The factors of the past are woven
of the respondents listed English as their primary language.
into the current data and related to the ideas Indigenous
people hold about what constitutes legitimate measures of The data suggests there is a critical link between First
wellness. Community wellness should be discussed within Nations people’s sense of identity and their ties to the
the context of its appropriate cultural framework. land/locale where their roots originate. The closer a people
are to their Nation’s ‘roots’ and their spiritual beliefs and
Identifying the determinants of First Nations community
practices, the higher the levels of health and self-esteem
wellness must be accomplished within the broadest of terms,
found within that community. The “web of relationships” is
and virtually all statistical data could essentially be relevant
viewed as a “key” to achieving balance among individuals
in assessing levels of community wellness. Voyle and
and their environment. This point is elaborated on by
Simmons (1999) believe that, “…alienation and
Gregory Cajete, who coined the term “ethnoscience” in his
marginalization within their own countries have had
book, Look to the Mountain (1998). He articulates that
deleterious consequences for [Aboriginal] cultural traditions
Indigenous knowledge is tied to the land, the spiritual laws
and identity, social cohesion and self-esteem.9 There is no
that govern the land, and the co-existence of relationships
doubt colonialism has had both direct and indirect negative
between animal, plant and human life combined into a
consequences for Indigenous peoples’ health.”10
collective balance or web. He explores how ethnoscience
We need to utilize a process of logic to prioritize which reflects the uniqueness of place and is thus inherently tied to
indicators and measures will most accurately represent land/locality and expressed through language and cultural
Aboriginal wellness, and these measures must be grounded practice.13
within an Indigenous knowledge framework. We must draw
Studies show that Aboriginal peoples who have strong ties to
from literature in the area of community or collective
the land are also working/ harvesting the land First Nations
wellness that will be illustrated in this report and
and Inuit Regional Longitudinal Health Survey (FNIRLHS
complemented by relevant empirical statistical data.
1997). Table 1 demonstrates that many First Nations people
Anthropologist Wayne Warry (2000) states, “The feeling of
feel there has little progress in renewing the relationship of
powerlessness and low self worth leads people with these
First Nations peoples to the land.
vulnerabilities to negative behaviors. There is a clear
relationship between welfare dependency and ill health.”11 Table 1. Relationship to the land
Degree of progress % of respondents
From an Aboriginal perspective, individual and
Good progress 11.1%
community problems do not stem simply from poor
No progress 45.5%
socio-economic conditions, but are also directly
attributable to low cultural esteem, or to a lack of The lack of progress in relationship to “land renewal” is very
cultural identity, which is critical to feelings of low self- similar to the respondents’ view of “renewal of spirituality.”
worth.12 Table 2 demonstrates there is a great need for improvement
The colonial policies and practices that stripped First Nations in renewal of spirituality; the two tables indicate the need to
people of their language and identity and encouraged restore the relationship people have to their land and their
assimilation must be viewed as not only oppressive and own spirituality.
traumatizing, but also directly linked to decreases in levels of Table 2. Renewal of spirituality
Community Wellness. The loss of self-esteem experienced in Degree of progress % of respondents
many First Nations communities occurred during an era of
Good progress 11.2%
governmental policies of assimilation and cultural
oppression, and poverty and its accompanying ill-health were No progress 43.3%
both a direct and indirect consequence.
i
of variation of greater than 33.3%. A statistical appendix including confidence intervals for all
147
In relation to the variable of language (which is a cultural traditional integration and low acculturation stress experience
measure), there was only a slight difference between fluent much lower levels of alcohol related problems. The
First Nations language speakers and non-speakers in whether weakening of informal control mechanisms due to loss of
they chose to ‘hunt’ and live off the land (Table 3).ii This control has not been adequately investigated.18
demonstrates that First Nations people can remain connected
Thus, substance abuse is a coping mechanism for the social
to the land and animals even when they possess no
disintegration experienced by many First Nations
understanding of their language.
communities. Health analyses must begin by more
Table 3. Relationship between land and First Nations language adequately measuring levels of social disintegration, as well
fluency
as community strengths. Indigenous literature on the topic of
Fluency in FN language % involved in hunting wellness emphasizes ties to land, language, and culture.
Svenson and Lafontaine (1999) report in their study that over
One or more fluently or
relatively well
33.8% 80% of respondents answered ‘yes’ to the question, “Do you
think a return to traditional ways is a good idea for promoting
No understanding at any community wellness?”19 Traditional ways are viewed as a
32.3%
level
solution to community wellness. Elders are considered the
people that possess knowledge of traditional ways. The
Community wellness: A cultural framework for evaluating literature reviewed suggests Elders and healers were
psychological wellness frequently framing Western “medical” concepts as
One of the major health consequences of colonization is disconnected from culture, families and community.
cultural dispossession characterized by negative social
impact and assimilation. “The manifestation of colonialism is Traditional medicine
through the configurations of power. The political culture of Within the literature, the terms “Elder” and “healer” are used
colonial rulers operated within the frames of conquest, interchangeably since traditional teachings are considered
exploitation and repression to break existing social patterns “healing for the mind.” “Elder” is another term attached to
and reassemble them according to European standards.”14 traditional healing that is discussed in the Gathering Strength
Good mental health is considered an important health priority volume of the Report of the Royal Commission on Aboriginal
by many Aboriginal communities.15 Studies have shown that Peoples (1996), which states that Elders are “Keepers of
a Eurocentric bias is imbedded in “psychosomatic testing tradition, guardians of culture, the wise people, the teachers.
tools.” Thus, we need to utilize a culturally appropriate tool While most of those who are wise in traditional ways are old,
when evaluating the health of people with a unique not all old people are elders, and not all elders are old.”20
worldview and who suffer from the psychological impact of
colonialism.16 Community wellness is contingent on some The literature on health confirms the need for First Nations
form of a “sobriety movement.” It is important to examine people’s control over health and wellness, which must
the statistics gathered by the RHS regarding First Nations include access to traditional medicine as a critical aspect of
peoples’ view of substance abuse reduction within their well-being. Recognition of the validity and importance of
communities. Table 4 demonstrates that respondents view traditional medicine within the mainstream health care
substance abuse treatment as needing vast improvement to system is a key component to achieving Aboriginal health
support the achievement of community wellness. 29.8% do status. Table 5 demonstrates that respondents view progress
view some progress as having been made, but the majority of in the area of traditional healing practices as not having been
respondents feel no progress has been made. revitalized substantially; while a significant number feel that
some progress has been made, just as many feel no progress
Table 4. Has there been a reduction of substance abuse in First
Nations communities?
has been made.
Degree of progress % of respondents Table 5: Revitalization of traditional healing practices
Good progress 6.6%
Good progress 13.5%
Some progress 29.8%
Some progress 45.7%
No progress 63.6%
No progress 40.8%
The susceptibility of various Native American groups to
alcohol-related problems is significantly correlated with the There is a relationship between respondents’ level of
level of social disintegration in the culture.17 Tribes with high education and their beliefs regarding the revitalization of
traditional healing practices. An interesting finding is
ii
demonstrated by Table 6. Respondents who did not graduate
148
from high school are more likely than individuals with post being made in ‘cultural awareness in the schools”; over
secondary vocational education to state that there has been no 79.3%, said that “good to some” progress had been made.
progress to the revitalization of traditional healing practices. The women’s view of progress in these regards mirrored
Conversely, those with post-secondary vocational training their male counterparts’ views.
are more likely than those who did not graduate from high
school to state that some progress has been made. Role of sports and recreation in community wellness
Table 6. Level of education and perceived revitalization of Sport has always had an integral role in traditional
traditional healing practices
Indigenous cultural practice and social cohesion. However,
Degree of progress
Did not graduate Post-secondary according to Table 7, over half of adults report that some
high school diploma (41.4%) or good (13.1%) progress has been made in terms of
recreation, leisure, and sports activities in their community.
Good progress 13.9% 12.9%(NS)
The remaining 46% state that no progress has been made in
Some progress 42.1% 52.4% the past 12 months.
No progress 44.0% 34.7% Table 7. Revitalization of recreation, leisure and sports activities
Roughly two-thirds of the respondents viewed the “renewal
Good progress 13.1%
of First Nations ceremonial activity” to have made good
(16.6 %) to some (46.8 %) progress. The statistics Some progress 41.4%
demonstrate that First Nations are improving community
No progress 45.5%
wellness through acquiring traditional medicines, ceremonies
and spirituality, but that there remains a great deal of work to
Role of shelter in community wellness
be done in this area.
Present day government policies and practices continue to
Health of First Nations Women within the Community: The have a negative health impact for First Nations people,
Variable of Gender particularly those living on reserves. Studies have
consistently shown the critical role of safe shelter in
The impact of missionaries, residential schools, the Indian
achieving health status. The World Health Organization
Act, and internalized colonialism upon several generations of
(WHO) includes access to shelter as a critical variable and
women has had severe consequences on women’s health in
health determinant globally, yet three quarters of all existing
particular. Colonial policies and practices affected the social,
on-reserve housing fails to meet basic standards of living.24
political, economic and spiritual well-being of First Nations
More than one third of First Nations people live in
women. The authority and esteemed positions that
overcrowded conditions.25 According to Table 8, under half
Aboriginal women held in their societies have been severely
(40.3%) of respondents feel no progress has been made in the
eroded.21 Women were and are responsible for nutrition and
improvement of housing, while 46.2% feel some
emotional and spiritual well-being, including cultural esteem,
improvement has been made. Table 9 demonstrates that the
for both their family and the larger community. It is clear that
majority of respondents answered positively regarding
colonialism interfered with their ability to govern families
improvements in water and sewage facilities (23.0% good
and maintain cultural roles. The literature suggests women
and 46.3% some progress). Improvements in water and
need to play a critical role in nurturing their communities
sewage were identified as the most improved overall;
back to health.22
however, it should be noted that 31% reported that there had
The ill health of many Aboriginal women within the been no progress made during the past year.
communities is often a direct result of poverty and poor Table 8: Improvement in quality of housing
cultural identity.23 First Nations women have been both
formally and informally marginalized through legal, social Degree of progress % of respondents
and economic intrusion into the “web or relationships.” The Good progress 13.5 %
impact of colonialism on the role of Indigenous women in
wellness has not been addressed specifically by any of the Some progress 46.2 %
literature. However, the data demonstrates that women’s No progress 40.3 %
views of the revitalization of ceremonial activity are positive.
Over half (64.0%) of female respondents believed “good to
some” progress in ceremonial activity had been made, and
only 36.0% felt no progress had been made. Women were
less positive regarding the progress made in renewing
relationship to the land; almost half (46.5%) felt there was no
progress made in this area. Women did view progress as
149
Table 9. Improvement in quality of water and sewage facilities not having progressed enough. The work towards community
Degree of progress % of respondents wellness is directly tied to achieving cultural esteem; there is
much work to be done by health services in truly
Good progress 23.0 %
harmonizing First Nations medicine and western medicine.
Some progress 46.3 %
No progress 30.7 % Notes to Chapter 15
1. Wikipedia, Biomedical model [online]. Available from World Wide Web:

<http://en.wikipedia.org/wiki/Biomedical_model >. Cited 4 July 2005.
Conclusions and Recommendations 2. Marie Battiste and James S. Henderson, Protecting Indigenous Knowledge and Heritage:
Global Challenge (Saskatoon, Sask.: Purich Publishing Ltd., 2000), p. 41.
The wellness of a First Nations community can only be 3. Dawn Martin-Hill, As Snow before the Summer Sun (Brantford, Ont.: Woodland Cultural
Centre, 1992), pp. 39-40.
adequately measured from within an Indigenous knowledge 4. Marlene Brant Castellano, Indigenous knowledges in Global Contexts: Multiple Readings of
Our World, edited by George J. Sefa Dei, Budd L. Hall and Dorothy Goldin Rosenberg
framework. Indigenous knowledge, a holistic framework, (Toronto, Ont.: University of Toronto Press, 2000).
measures all levels of the “web of relationships” - including 5.
6.
Vandana Shiva, Indigenous knowledges in Global Contexts: Multiple Readings of Our World.
• Dei, Hall and Rosenburg, Indigenous knowledges in Global Contexts: Multiple Readings of
spiritual, emotional, physical and social balance - in order to Our World.
• Battiste and Henderson, Protecting Indigenous Knowledge and Heritage: Global
accurately represent health and community wellness. Data Challenge.
gathered by the RHS shows some progress in the areas of • Linda Tuhiwai Smith, Decolonizing Methodologies: Research and Indigenous Peoples
(London, England: Zed Books, 1999).
traditional activities, healing and cultural esteem. However, 7. Gregory Cajete, Look to the Mountain: An ecology of indigenous education (Skyland, N.C.:
Kivaki Press, 1999).
only an increase in traditional medicine practices and 8. Harriet MacMillan et al., “Children’s Health,” First Nations and Inuit Regional Health
culturally sensitive healing and knowledge paradigms will Survey (Ottawa, Ont.: First Nations and Inuit Regional Health Survey National Steering
Committee, 2004).
improve community wellness, including culture and self 9. David Simmons and Judith A. Voyle, 1999, Reaching hard-to-reach, high-risk populations:
piloting a health promotion and diabetes disease prevention programme on an urban marae in
esteem, among Indigenous peoples and their communities. New Zealand, Social Sciences & Medicine, 49: 1035-1050.
10. Ibid.
Recommendation 11. Wayne Warry, Unfinished Dreams: Community Healing and the Reality of Aboriginal Self-
government (Toronto, Ont.: University of Toronto Press, 1998), p 65.
The historical trauma experienced by most First Nations 12. Ibid.
13. Cajete: Look to the Mountain: An ecology of indigenous education, p. 95.
communities has led to a myriad of social, spiritual, 14. Cynthia C. Wesley-Esquimaux and Magdalena Smolewski, Historic Trauma and Aboriginal
Healing (Ottawa, Ont.: The Aboriginal Healing Foundation, 2004).
psychological and physical health problems. The Elders 15. • Warry, Unfinished Dreams: Community Healing and the Reality of Aboriginal Self-
continue to put forth their understanding of culture, as related government.
• Eduardo Duran and Bonnie Duran, Native American and Postcolonial Psychology (New
to wellness, as a key solution to the improvement of York, N.Y.: State University New York Press, 1995).
16. Duran and Duran, Native American and Postcolonial Psychology.
community wellness. Most First Nations cultures were 17. Ibid.
collectivities that functioned to achieve balance; this 18. Ibid.
19. Kenneth Svenson and Christopher Lafontaine, “The Search for Wellness,” First Nations and
collective process was shattered during the colonization Inuit Regional Health Survey (Ottawa, Ont.: First Nations and Inuit Regional Health Survey
National Steering Committee, 1999).
process. Part of the decolonization process must include the 20. Royal Commission on Aboriginal Peoples, Report of the Commission on Aboriginal Peoples:
rebuilding of relationships: relationships among the people, Gathering Strength, Vol. 3, (Ottawa, Ont.: Minister of Supply and Services Canada, 1996), p.
527.
relationships to their land, and relationships to their spiritual 21. • Alfred Taiake, Peace, Power, Righteousness—An Indigenous Manifesto (Canada: Oxford
University Press, 1999).
world. The balance of community wellness is best achieved • Kim Anderson, A Recognition of Being: Reconstructing Native Womanhood (Toronto, Ont.:
through a two-tier process that includes the self (the Second Story Press, 2000).
• Paul Gunn Allen, "Recovering the Feminine in American Indian Traditions," Sacred Hoop
individual) and the whole (the collective). (Boston, Mass.: Beacon Press, 1986).
22. • Anderson, A Recognition of Being: Reconstructing Native Womanhood.
The biomedical model is most useful when placed within an • Gunn Allen, "Recovering the Feminine in American Indian Traditions," Sacred Hoop.
• Dei, Hall and Rosenburg, Indigenous knowledges in Global Contexts: Multiple Readings of
Indigenous knowledge framework - when it is culturally Our World.
23. Cynthia Kasee, 1995, Identity, Recovery and Religious Imperialism: Native American
managed within a holistic model. The need of First Nations Women and the New Age, Women & Therapy, 2, 3: 83-93.
peoples to recover their languages, heritage, and identity is 24. Wayne Warry, Unfinished Dreams: Community Healing and the Reality of Aboriginal Self-
government (Toronto, Ont.: University of Toronto Press, 1998), p 65.
related to their cultural esteem. Elders, First Nations primary 25. James S. Frideres, Native Peoples in Canada: Contemporary Conflicts, 7th ed. (Scarborough,
Ont.: Prentice Hall Canada Inc., 1998), p. 194.
and secondary schools with urban principals, teachers and
administrators have a role in preventative care; they can
instill a healthy respect for Indigenous heritage and cultures
in educational settings. Education is viewed as a primary
source of transmitting First Nations values, which include
healthy choices and lifestyles and community wellness.
Data presented in the RHS indicates that it is apparent that
there is not enough progress in the areas of substance abuse
reduction and increasing traditional healing. Infrastructures
such as water and sewage are viewed as improved, but the
rebuilding of social structures and cultural work is viewed as
150
The Health of
First Nations Youth
Chapter 16
Household Structure, Income, and Parental Education
Abstract
Abundant connections to family, community and nation were reported by youth living in First Nations
communities. A significant proportion of these youth reported living in homes with their extended
families and expressed preferences for First Nations languages and, to some extent, traditional cultural
events. Cultural influences came from many sources in the family and community. At the same time,
the youth were less fluent in the language of their First Nation than in English or French. About half
of the youth did not value participating in traditional cultural events. Despite being richly surrounded
by extended family households, some youth lived in overcrowded conditions that could have negative
implications for mental and physical health and overall well-being.
153
RHS 2002/03 Youth Survey – Chapter 16: Household Structure, Income, and Parental Education
For the most part, only those differences that were both
Introduction
socially and statistically significanti were reported.
This chapter focuses on the relationship of First Nations
youth (ages 12 through 17) to their traditional culture and to Results and Discussion
the people from whom they have learned their First Nations
cultures and languages. Family and community Language and culture
characteristics provide not only the context in which
Speaking a First Nations was considered important by most
community-based First Nations youth live. They also act as
of the youth surveyed (82.1%)ii. Having traditional cultural
a vehicle for these youth to potentially develop healthy
connections to their families, communities and nations. events in one’s life was considered important by about half
of the youth (54.8%). Of note, however, is that nearly half
This chapter also focuses on how First Nations youth gain the youth (45.2%) considered it not very important or not
knowledge about and appreciate their traditional cultures. important to have cultural events in their lives. This may be
Youth are examined in the context of their families and the result of influences present in the mainstream of Western
households —which are considered to be primary influences society. Other factors that may elicit this type of response
for physical, emotional, mental and spiritual health. Of could be connected with intergenerational trauma (e.g.:
particular interest is the documentation of the types of people shame, low-self-esteem and sublimated anger stemming from
who have assisted youth in gaining an understanding of their residential school experiences of parents, grandparents or
traditional culture. With regard to traditional culture, the great grandparents).
information focused on: Table 1. Importance of traditional culture to youth
• The importance to First Nations youth in speaking the Importance of:
language of their First Nation and experiencing
Speaking a First Having traditional
traditional cultural events; Degree of importance
Nation language cultural events in
• First Nations languages understood and spoken (n = 4670)iii one’s life (n = 4698)
(especially those First Nations languages in daily use by
youth); and, Very important 45.0% 49.3%
• Family and community sources of support in developing
Somewhat important 37.1% 5.5%
the youth’s cultural understanding.
Attention is also given to the physical surroundings of the Not very important 12.3% 34.5%
youth (in particular, housing issues). It is no secret that,
overall, First Nations housing is sub-standard compared to Not important 5.5% 10.7%
the Canadian norm, (i.e., over-crowding inside the house and
structural insecurity). This “kind of physical” environment The actual daily use of First Nations languages by youth lags
has an impact on First Nations youth, and, at the same time, behind the sense of importance in speaking it (13/9% of the
has implications for how youth connect with family and other youth surveyed reported using a First Nations language daily.
household members. Community characteristics can also be The majority of those who reported speaking daily in a First
indicators of connectivity and also illustrate potential Nations language spoke only First Nations languages (12.6%
exposure to western influences. of the total, compared with the 13.9% who spoke daily).
Approximately three times as many youth understood a First
With regard to family situations, information was gathered Nations language fluently or relatively well (32.8%).
on the:
In contrast, 87.6% of respondents employ English (85.4%),
• number of people sharing their household with youth French (2.4%) or American Sign Language (ASL) as their
and their respective relationships to the youth; and, language of daily use. The use of First Nations languages can
• living and marital situations of the biological parents of
the youth. i
There were two criteria for whether differences were significant – social and statistical. Socially
significant differences, although they may be based on quantitative data, are usually focused on
With regard to community characteristics, information was whether the observable differences really matter in the real world. In this chapter, differences of about
gathered on the: 10% from one group to another were usually considered socially significant, although this was not a
rigid criterion. Readers may have different criteria than the authors. Statistically significant differences
• community size (with its potential effect on resources);

are mathematically derived and have to do with the accuracy of the estimates. Estimates of
percentages and means that are based on samples are not exactly transferable to the populations that
the samples represent. Each estimate comes with a range of values around it (a confidence interval)
and, that describes all the possible values that the percentage or mean can take in the population. Hence, in
• relative isolation of the communities in which the youth
this chapter, statistically significant differences are concluded when the 95% confidence intervals did
not overlap.
ii
lived (with its potential effect on limiting or increasing To simplify the text, confidence limits are only reported for overall adolescent estimates with a co-
exposure to western cultures). all reported figures is available at www.naho.ca/fnc/rhs
iii
154
be viewed in the context of the number of languages used by influential in a youth’s understanding of his or her culture
each youth daily. The majority (96%) indicated the use of were other relatives (25.2%), other community members
one language in daily life, while 3.0% used two languages (18.1%) and friends (14.2%). A small minority of youth said
and 0.2% used 3 languages. that there was no one helping with cultural understanding
Table 2. Daily use of First Nation languages by youth (n=4983)
(5.0%).
Estimate of % Figure 1. Relatives and community members involved in helping
youth understand their culture (n = 4857)
Using First Nation language 13.9%
First Nation language only 12.6% Parents 54.3%
Using English, French or sign 87.6% Grandparents 53.5%
English 85.4% Aunts/Uncles 32.5%
French 2.4% School Teachers 30.8%
Number of daily use languages Community Elders 29.5%
1 96.0% Other Relatives 25.2%
2 3.0% Other Community Members 18.1%
3 0.2% Friends 14.2%
No one 5.0%
The First Nations languages that were cited most often as
0% 10% 20% 30% 40% 50% 60%
being used on a daily basis were Cree (3.4%), Montagnais Proportion of youth assisted by individual indicated
(1.8%), Attikamekw (1.3%), and Mi’kmaq (0.7%).
In addition to being asked about languages of daily use, The 2001 Aboriginal Peoples Survey illustrated a
youth were queried about their understanding and speaking relationship between the number of sources of help and the
levels in relation to First Nations languages. ability to learn the language. “The more a child can rely on
Typically, understanding a language develops in most multiple sources for learning an Aboriginal language, the
individuals before speaking. Questions in the RHS survey more likely they are to speak and understand [fluently and
asked about the degree to which each language could be relatively well] an Aboriginal language”1.
understood. Response options to this question were: fluently, For Inuit, First Nations and Métis children in non-reserve
relatively well, a few words, or not at all. Of all youth aged areas, the rates of those who speak and understand an
12 through 17, 32.8% were able to understand and 27.0% Aboriginal language ranged from 15% for those with one
could speak their First Nation language fluently or relatively source of help to 80% for those with seven or more sources
well. There were no significant differences in the ages of the of help (in between, the rates were 38% for those with 3
youth in relation to their ability to understand a First Nations sources of help and 54% for those with 5 sources). The
language fluently or relatively well. number of sources of help for cultural understanding
30 of 32 First Nations or Inuitiv languages were reportedly available to children living in First Nations communities
spoken fluently or relatively well by Aboriginal Youth. The (RHS) ranged from 0 to 7. A pattern appeared in the RHS
most cited First Nations languages that were understood that is similar to the 2001 Aboriginal Peoples’ Survey, where
fluently or relatively well were Cree (9.3%), Ojibway the number of sources of help for cultural understanding
(3.3%), and Oji-Cree (3.2%). appeared to be related to rates of understanding or speaking a
First Nations language.
About 85.4% of First Nations youth spoke English fluently
and 2.4% spoke French fluently. Family and household structure
Role of family and community members in understanding Over half (57.4%) of the youth living in First Nations
culture communities lived in households with six or more people,
mostly family. About one-third (32.4%) lived with more than
An enquiry into the types of people who had helped a youth two adults, and half lived with four or more children and
understand his or her culture showed that grandparents and youth. The number of household members ranged from one
parents were mentioned the most (approximately 54% each). to 26, with a mean of 6.6. The number of adults (ages 18+)
Schoolteachers were mentioned as often as aunts/uncles and ranged from zero to twelve with a mean of 2.4. As for the
community Elders (approximately 30%), but less often than number of children and youth, the range was one to 20
the parents and grandparents. Other people who were cited as (including the youth in the survey), with a mean of 4.3.
iv
As only 10 youth spoke Inuktitut and nine of the ten spoke only a few words, further reference to
Aboriginal languages in this chapter will specify First Nations languages.
155
Table 4. Number of sources of help for youth to understand households without abuse patterns, it may not hold true for
culture (n = 4983)
those with abusing parents. In such instances, separation of
% Understanding a % Speaking a parents may be in the best interests of the children and youth.
Number of
Total First Nation First Nation
Sources
Language Language Figure 2. Parents or other relatives or caretakers in families of
youth (n=4983)
0 8.8 16.7 14.3
1 33.3 27.7 23.9 Spouse, gi r l f r i end,

boyf r i end
Si bl i ngs
0.8%
2 18.4 34.5 29.2 0.9%
One par ent

3 14.2 39.3 33.2
32.3%
4 11.4 36.1 27.3

Two par ents
5 8.3 38.5 25.6
55.4%
Gr andpar ents
6 3.7 51.5 30.3 7.5%
Aunts, uncl es, cousi ns
2.0%
7 1.8 54.0 74.7 Foster par ents
1.0%
Eighty-six percent of First Nations youth lived with one or

more parents (biological, adoptive and/or step). Of these:
Table 5: Relationships of birth parents of youth (n=4850)
• 54.4% lived with two parents Relationships Estimate of % of Youth
• 31.7% lived with one parent Living together, married 43.1%
Of the remaining 13.9% who did not live with their parents: Not living together, separated 34.2%
• 7.4% lived with grandparents Living together, not married 10.8%
• 2.0% lived with other extended family (aunts, uncles, One parent deceased 6.7%
cousins) Both parents deceased 0.1%
• 1.0% lived with foster parents Divorced 5.1%
• 0.9% lived with brothers and sisters Housing resources

35.9% of households with one or more parents present had
other adults (aged 18 and over) living in the household. Most The average (mean) household size was 6.6 (adults, youth
First Nations youth lived in households with other children and children). Households with youth had a median number
and youth (82.3%)v The breakdown of households by number of rooms of 6.3.
of youth under age 18 is as follows: The number of rooms usually ranged from one to thirteen or
• 17.7% of the youth were the only household members more. Western standards of crowding would consider
under age 18 households with more than one person per room as crowded.
Using this standard, 42.9% of First Nations’ households with
• 13.5% lived with one other household member under youth were crowded. In all households with five or fewer
age 18 members, crowding occurs less than 10.3% of the time. The
• 27.4% lived with two or three others under age 18 rate increases dramatically to 34.5% for households of six,
• 41.5% lived with 4 or more others under age 18. and climbs steeply to 94.2% for households of nine or more.
The pattern of crowding is similar in relation to the number
Although 20% of births were to mothers aged 15 through 192 of children versus youth in the household.
only 1.0% of youth aged 15 through 17 listed their own
children as household members. Community characteristics
The youth reported that about half (53.9%) had birth parents Community size and relative isolation appear to be related to
who were living together. About thirty-nine percent had family and housing situations, and to the degree of value
parents who were not living together (although 6.8% had at assigned to First Nations languages and cultures.
least one parent who was deceased). Research that is not
Aboriginal specific suggests that parental separation can have Youth in small communities (<300 residents) reported lower
an impact on children’s behavioural or emotional levels of crowding than those in large communities (>1,500
development.3 However, while this may hold true for residents). Large communities were least like the small
communities. While mid-size communities (300 to 1499
v
The data on whether the other adults in the household were extended family or whether children in residents) tended to be like larger ones, there were many
the household were siblings or otherwise related were not complete enough to analyze
156
ways in which they fell in the middle on measures taken in highest rates of understanding and speaking First Nation
the RHS survey. Youth in small communities are less likely languages compared to non-isolated communities (defined as
than those in mid-sized communities to attribute a high those with road access and being less than 90 km from a
degree of importance to learning to speak First Nations physician). Youth in non-isolated communities were less
languages. Youth in large communities are more likely to be likely to consider speaking a First Nations language as very
able to understand and speak a First Nations language than important than youth in remote or semi-isolated
youth in communities of less than 1,500 residents; however, communities. Youth in remote, isolated communities shared
in the smallest communities there was generally more a higher rate of fluency in English with non-isolated
involvement of other relatives with youth in the process of communities, compared to isolated and semi-isolated
acquiring cultural familiarity. communities. Youth from non-isolated communities are less
Table 6. Percentage of Youth living in homes with more than one
likely to report crowded conditions than youth in isolated and
person per room by household size and number of semi-isolated communities.
children/youth (n=4800)
Based on Number of Table 8. Youth language and housing variations (%) by degree of
Household Based on Number of isolation of community (n=~4600)
Children and Youth
composition HH Members
in HH Isolation status
All hh with youth 42.9 42.9 Non- Remote- Semi-

Isolated
isolated isolated isolated
1 youth n.a. 5.7
Very 39.7 62.6 55.5(NS) 58.1
2 persons/children +
– Somewhat
youth 6.8 40.2 26.3(NS) 31.9(NS) 26.6
3 – 17.6 Understanding 27.6 48.6 42.0 44.2
4 – 37.6 Speaking
5 10.3 60.0 21.6 39.4 37.2 39.0
6 34.5 85.5 Speaks English
89.0 87.3(NS) 70.5 72.4
7 52.7 93.1 fluently
8 76.2 95.0 Crowding 35.9 = 40.2 (NS) 60.5 61.3
9+ 94.2 98.6
– Data suppressed due to insufficient sample size.
Table 7. Youth language, culture and family variations (%) by Conclusions and Recommendations
community size (n =4600)
Community size Conclusions
Small Medium Large
First Nations youth were well surrounded by family. Youth
Speaking First Nations languages important
living in First Nations communities were living in families,
Very 31.6 47.6 43.8 (NS)
both nuclear and extended, in households with many
Somewhat 49.3 34.8 38.2 (NS) members. Most of these youth lived with their parents and
Knowledge of First Nations language most lived with siblings or other related children. Many lived
Understanding First
21.4 30.4 39.1 with other relatives as well. Parents and extended family
Nations languages were among the most mentioned sources of cultural
Speaking First Nations knowledge. Other community members were also involved
14.7 23.7 34.6
languages in helping with cultural socialization.
Who influences culture of child While the standards for crowding used in this report might be
Other relatives 33.8 25.7 22.4 labeled as based on a Western perspective, the problem of
Community Elders 33.9 31.9(NS) 24.7 (NS) crowding is still real. Housing in many First Nations
Community members 22.1 18.5(NS) 16.5 (NS) communities is inadequate by many standards. For many
Other First Nations families, the preference may be for living with
Only child in household 25.6 16.7(NS) 17.9 (NS) extended kin, and where there is a housing shortage this may
Crowding 30.9 40.9(NS) 48.8 be a necessity. In other instances, the typical houses are too
small and the resources for enlarging the houses do not exist.
Isolated communities were defined as those having scheduled Whatever the reasons, crowding can be severe, and this
flights and good telephone service, but no road access. Semi- undoubtedly has an effect on health.
isolated communities were defined as those having road
access, but being >90 km from a physician. Remote isolated Youth living in First Nations communities reported on
communities were defined as those having no scheduled aspects of their lives that indicate a potential for strong
flights available. Youth in isolated, semi-isolated, and remote relationships to their traditional culture. They also reported
isolated communities were the most alike in that they had the connections to their families and culture. For the most part
157
they valued the ability to speak a First Nations language, and

to a lesser extent they valued involvement in traditional Notes to Chapter 16
cultural events. It is important to note, however, that almost
half of the youth did not consider involvement in traditional
cultural events to be important or very important. 1. Statistics Canada, “Aboriginal children and Aboriginal languages,” A Portrait of Aboriginal
Children living in Non-reserve Areas: Results from the 2001 Aboriginal Peoples Survey
The ability to speak First Nations languages fluently or (Ottawa, Ont.: Statistics Canada, 2004).
2. Government of Canada, “Young First Nations Children in Canada,” The Well-Being of
relatively well lagged behind attitudes about language. Canada’s Young Children: Government of Canada Report 2003 (Ottawa, Ont.: Human
Resources Development Canada and Health Canada, 2003).
Speaking a First Nations language, valued as important by 3. Government of Canada, “The Family Environment and Its Impact on Child Well-Being,” The
over 80% of youth, is in stark contrast with findings that only Well-Being of Canada’s Young Children: Government of Canada Report 2003.
27% of youth have the ability to speak one or more of 30

First Nations languages. An even smaller percentage of youth
surveyed used a First Nation language on a daily basis
(13.9%), and almost all of these youth speak only that
language in their daily life.
At the same time, 87.6% of the youth surveyed speak English
or French in daily life. This could be taken to indicate the
strong influence mainstream culture has on most youth living
in First Nations communities. English was more fluently
spoken in both remote isolated and non-isolated
communities.
Recommendations
While indications are clear that First Nations youth have
potential for staying involved in their culture, it is likely that
they will continue to be involved in both western and
traditional cultures as long as they live in First Nations
communities This bi-cultural reality is demonstrated by the
finding that only a small minority of the youth do not speak
English or French. Given the pervasiveness of Western
influences and the diversity of First Nations, organized and
concerted efforts will be needed to ensure healthy
socialization into two (or even multiple) cultures. This effort
will be necessary to maintain spiritual ties to family,
community and nation for generations to come.
Housing is urgently needed to accommodate the preferences
of some residents in First Nations communities for living
with extended family. Where large, crowded households are
the result of an inadequate supply of houses, more housing
infrastructure is needed.
158
Chapter 17
School Education
Abstract
Fair/poor overall health was a good predictor of non-attendance at school, of learning problems, and
of not liking school. Although there were no significant relationships between learning problems and
the specific health conditions examined, when the health conditions were grouped, there were
significant increases in the reporting of learning problems.
The induced peer/societal precursors to reduced school performance, especially as related to non-
attendance and repeat grades, are related to increased alcohol consumption, smoking and sexual
activity among older youth. Diet was found to be an important indicator of school performance
among First Nations youth. Always eating a nutritious, balanced diet is associated with lower rates of
grade repetition, less learning problems, and higher rates of liking school very much (as compared to
never). Participating in sports and frequency of physical activity are also positively associated with
attending school. Relationships between residential schools, traditional language and culture, and
learning problems at school were also found to be present in the data.
159
RHS 2002/03 Youth Survey – Chapter 17: School Education
Figure 2. Proportion experiencing learning problems at school

Introduction by self rating of health
80%
School performance can be measured most accurately by
examining the attendance and non-attendance of students and
the percentages of students who report repeating grades.1-3 62.5%
60%
Other useful indicators of school performance include the
reported liking/disliking of school and self-reported learning 47.1%
problems.2,4 While these factors in and of themselves are not
40% 37.3%
definitive in regards to future schooling aspirations of First
Nations youth, they are significant in predicting school
performance.
20%
Lifestyle and health factors related to school attendance,
attitudes toward school, and behaviour while in school will
be examined in this chapter. Factors to be considered include 0%
diet, alcohol consumption, smoking, sexual activity, health Fair/poor Good Very good/excellent
Rating of health
conditions, activity limitations, and participation in physical
activity and sport, art and music, and cultural activities such
Figure 3. Proportion who like and dislike somewhat or very
as drumming and dancing. The detailed examination of these much school by self rating of health
factors will lead to recommendations regarding the health of
100%
First Nations youth in relation to factors that may be Dislikes school
85.8%
associated with school performance. Likes school
81.1%
80%
Results and Discussion 69.4%
i
Overall, the majority of the youth surveyed (57.2%) 60%
considered themselves to be in very good or excellent health.
32.9% rated their health as good and only 9.9% reported their
40%
health as fair or poor. Self-rated health (fair/poor vs. very
good/excellent) was a good predictor of non-attendance at 22.3%
school (15.6% vs. 5.6%—see Figure 1), of learning problems 20%
12.3%
at school (62.5% vs. 37.3%—see Figure 2), and of not liking 7.8%
school (22.3% vs. 7.8%—see Figure 3).ii 0%

Fair/poor Good Very good/excellent
Figure 1. Proportion not attending school by self rating of health
Rating of health
20%
Physical diseases were examined as potential predictors of
15.6%
poorer school performance. Asthma and allergies were
15%
examined in particular, because of their prevalence (13.6%
and 15.1% respectively). However, there were no significant
differences between those with and without asthma relating
10%
9.8% to school attendance, grade repetition, liking school, or
experiencing learning problems at school.
5.6% Although there were no significant elevations in learning
5% difficulties associated with the specific health conditions
such as asthma or allergies, First Nations youth reported
significantly more learning problems overall when health
0% conditions were grouped. Having one or more physical health
Rating of health
conditions was related to a marked increase in learning
problems at school (38.6% for those with none vs. 54.1% for
those with one or more—see Figure 4). However, of those
with one or more reported medical conditions, there were no
significant differences in learning problems at school
between those receiving treatment for illnesses and those
i
who were not. In cases where the medical condition induced
efficient of variation of greater than 33.3%. A statistical appendix including confidence intervals for some limitation in activity levels, the rate of learning
all reported figures is available at www.naho.ca/fnc/rhs
ii
Comparisons between groups reported in this chapter are all significant unless “NS” —not problems at school was higher: 59.2% for those with a
limitation vs. 42.3% with no limitation.
160
Figure 4. Proportion with and without learning problems at and balanced diet, while only 10.6% of youth who rated their
school, by one or more medical conditions, activity limitations
health as fair or poor claimed that they ate nutritiously (see
from a medical condition, and undergoing treatment for a
medical condition Figure 6). Moreover, among the respondents who considered
80%
their health to be fair or poor, 40.3% claimed to rarely or
never eat a nutritious, balanced diet, compared to only 10.7%
None
One or more of those in good or very good health. Diet is directly
59.2% associated with indicators of school performance among First
60%
54.1% Nations youth; always eating a nutritious, balanced diet is
49.4%
associated with lower rates of grade repetition, lower rates of
38.6%
42.3% 42.7%
reported learning problems and higher rates of liking school
40%
very much (see Figure 7). Moreover, diet is also associated
with school attendance. Always or almost always eating a
nutritious and balanced diet is associated with higher rates of
20%
attending school.
Figure 6. Proportion consuming a nutritious diet by self rating of
health
0%
50%
Health conditions Activity limitations Undergoing treatment
Rarely/never
40.3%
With regard to youth liking or attending school, no 40%
Almost always
differences were apparent when considering whether or not

their parents had attended residential school. Youth were,
30%
however, more likely to report having learning problems at 27.8%
24.7%
school if one or both of their parents had attended residential
school (48.7% of youth whose parents attended residential 20%
school versus 40.4% whose parents did not attend—see

Figure 5). Similarly, 47.3% of youth with a parent who 10.6% 10.2% 10.7%
10%
attended residential school reported having had to repeat a
grade, compared to 35.2% of youth with no parental
experience of residential school. In contrast, the attendance 0%
of one or more grandparents at a residential was unrelated to Rating of health
school attendance, learning problems at school, feelings
about school, or having had to repeat a grade. Thus, one may Figure 7. Proportion with a learning problem at school, liking
argue that there may be a generational decrease in the impact school somewhat or very much, and having had repeated a
grade by consumption of a nutritious diet
of attending residential schools.
100%
Learning problems at school
Figure 5. Proportion with learning problems at school and Likes school somewhat or very much
repeated a grade by past parental residential school attendance Repeated a grade
85.5% 85.9%
60% 80%
73.0%
Learning problems
Repeated grade
50% 48.7% 59.9%
47.3% 60% 56.1% 54.8%
48.7%
40.4% 44.7% 43.1%
40% 41.8%
35.2% 40%
33.0% 31.9%
30%
20%
20%
0%
Never Rarely Sometimes Almost always
10% Frequency of consuming a nutritious diet
0% Participation in passive indoor activities, such as television

No parents attended One or both parents attended
viewing, playing video games and using the computer, was
At least in part, diet may be an important indicator of school found to be unrelated to school attendance. There were,
performance among First Nations youth. Of the youth who however, relationships between school attendance and
considered their health to be very good or excellent, 24.7% participating in sports (Figure 8), art and music groups
reported that they always or almost always ate a nutritious (Figure 9), and other traditional events such as singing,
161
drumming, and dancing groups (Figure 10). In the case of Figure 10. Proportion attending school by participation in
traditional singing, drumming, or dancing
sports, those who participated more than once per week were
100%
more likely to attend school than those who never 96.3% 96.0%
participated. Youth who participate in physical activities 93.9%
90.5%
every day (87.4%) are more likely than those who never do 90%
(73.2%) to like school somewhat or very much. Those who

never participated in art or music groups were less likely to
80%
be attending school than those who participated occasionally
(less than once per week). Similarly, with traditional singing,
drumming, and dancing, the only significant difference 70%
observed was between those who never participated and

those who participated only occasionally (less than once per 60%
week). Lastly, holding down a job such as babysitting or
tutoring was not found to be related to school attendance.
50%
Differences between daily smokers and non-smokers also Never < 1x per week 1-3x per week > 4x per week
appear among those who participate in sports teams often (4+ Frequency of participation
times a week) and those who never do, in terms of non-

attendance at school. As seen in Figure 11, youth who felt that it was very
Figure 8. Proportion attending school by participation in sports important to speak a First Nations language were more likely
teams or lessons outside of school than those who did not to have problems learning at school
100% 97.5%
(47.5% versus 40.1%), and to have had repeated a grade
94.7% (46.1% versus 37.0%). There were, however, no significant
91.9%
differences in how the youth felt about going to school.
90%
84.8% Figure 11. Proportion reporting a learning problem and having
had repeated a grade at school by self-rated importance of
80% learning a First Nations language
50% 47.5%
46.1%
70%
40.1%
40%
37.0%
60%
30%
50%
Never < 1x per week 1-3x per week > 4x per week
20%
Frequency of participation
Figure 9. Proportion attending school by participation in art or 10% Learning problems

music activities outside of school Repeated grade
100%
97.0% 96.2%
0%
Very important Somewhat, not very, or not important
90.8%
90% Importance of learning a First Nations language
81.9% The importance of traditional cultural events (Figure 12) in

80%
the lives of First Nations youth is related to experiencing
problems at school and feelings about going to school. Those
70% who felt that traditional cultural events were very important
were more likely than those who did not to have problems at
school (49.4% versus 37.0%), but were slightly more likely
60%
to report liking school somewhat or very much (85.5%
versus 80.5%). No significant differences were seen with
50% respect to having to repeat grades.
Never < 1x per week 1-3x per week > 4x per week
Frequency of participation
The attachment of high importance to speaking First Nations
languages may be a reflection of isolation or remoteness,
where the language might be spoken in the home, in contrast
with English or French as a language of instruction in school
– which could explain the greater likelihood of problems in
162
school for those expressing a higher value on the language. Figure 14. Highest level of education youth aspire to by
previously having had to repeat a grade
This divergent result suggests that further study needs to be
undertaken to determine the relative importance of Doctorate
9.5%
maintaining First Nations languages and traditional culture in 2.6%
school when these are viewed as important by those who
Highest level of education aspired to

14.7%
Masters
report they like school. 14.8%
Figure 12. Proportion who like or dislike school and reporting a Bachelors
37.9%
learning problem at school by self-rated importance of 29.9%
traditional cultural events
4.0%
100% College
6.0% Never repeated
Previous repeat
85.5%
11.9%
80.5% Trade school
80% 13.4%
22.0%
High school
60% 33.3%
49.4%
0% 10% 20% 30% 40%
37.0%
40% There are few relationships between academic attendance,
performance or attitudes, and community factors including
20%
Like school very much
community size, the transfer of health administration, and
Learning problems living conditions such as crowding and remoteness.
Residents of small communities (< 300 residents) are less
0%
Very important Somewhat, not very, or not important likely than those in larger communities to report repeating a
Importance of traditional cultural events grade. 48.2% of youth who experience crowded conditions
The educational aspirations of youth were examined against are more likely than those who have not (35.8%) to report
learning problems (Figure 13) and repeat grades (Figure 14). having repeated a grade. Furthermore, youth who live in
Youth who experienced learning problems at school are more communities that are not part of a health transfer agreement
likely to not want to purse any education beyond high school are more likely to report that they do not currently attend
(35.3% versus 20.5%). Similarly, those who had previously school compared to those from communities with health
repeated a grade were also more likely to not want to go transfer status.
beyond high school (33.3% who repeated a grade versus Three key “user-choice” variables—alcohol consumption,
22.0% who did not), and were less likely to want to attain an smoking, and sexual activity—were examined. User-choice
undergraduate degree (29.9% versus 37.9% respectively) or a variables, which may be characterized as peer-influenced or
doctorate (2.6% versus 9.5% respectively). Having higher societal-influenced variables, showed strong correlations to
educational aspirations for those without learning problems school attendance and poor school performance (repeated
and those not having repeated a grade is apparent. grades). The variables were examined by looking at three age
Figure 13. Highest level of education youth aspire to by groups. Those aged 12 and 13 were mainly in grades 5–8;
presence of a learning problem at school those aged 14 and 15 were mainly in grades 7–10; and those
7.7%
aged 16 and 17 were mainly in grades 9–12.
Doctorate
5.4%
Smoking
Highest level of education aspired to
16.2%
Masters
12.4%
The graphs examining school attendance and having to
39.3% repeat a grade in relationship to smoking (by age groups) are
Bachelors
28.1% shown in Figure 15 and 16 respectively. As might be
4.7% expected, since the compulsory school age in all school
College
5.0% No learning problems jurisdictions includes 12 and 13 year olds, almost all youth
Presence of learning problem
11.6%
reported being in school. Moreover, the level of attendance
Trade school
13.7% was unrelated to their smoking status, alcohol consumption,
and whether they were sexually active or not. This is in stark
20.5%
High school
35.3%
contrast to the older age groups (14–15 and 16–17), where
school attendance was significantly lower among smokers
0% 10% 20% 30% 40% 50%
than both non-smokers and occasional smokers. A greater
discrepancy was found in the oldest age group (16–17) where
26.3% of smokers were not attending school, compared to
9.0% of non-smokers and 10.9% of occasional smokers.
163
Looking at non-smokers versus daily smokers, having to were less likely to be attending school than their counterparts
repeat a grade was found to be related to smoking amongst in the 12–13 age group (81.7% versus 97.7% attendance,
all age groups (Figure 16). There are also significant respectively). Similarly, 16–17 year olds who also drank
differences between non-smokers and both daily and were more likely to have repeated a grade (55.0%) than both
occasional smokers in the 16–17 age group. Once again, the 12–13 and 14-15 (year olds (40.0% and 39/8% respectively).
largest difference occurs in the 16–17 age group, where Figure 17. Proportion attending school by alcohol consumption
38.2% of non-smokers were required to repeat a grade (once in the past year) and age group
compared to 61.0% of daily smokers and 67.1% of 100% 98.8%
97.7%
96.7%
occasional smokers.
91.3%
Figure 15. Proportion attending school by current smoking 90%
87.2%
status and age group
100% 98.9% 98.2% 81.7%
97.0% 97.3% 96.4%
80%
91.0%
90% 89.1%
86.0%
70%
80%
73.7% 60%
12-13
14-15
70% 16-17
50%
Non-drinker Drinker
12-13 Drinking status
60%
14-15
16-17
Figure 18. Proportion having had to repeat a grade by alcohol
50% consumption (once in the past year) and age group
Non-smoker Occasional Daily
Smoking status 60%
12-13 55.0%
14-15
Figure 16. Proportion having had to repeat a grade by 16-17
50%
participation smoking status and age group
43.9%
80% 39.8% 40.0%
40% 37.0%
12-13 67.1%
14-15 29.9%
61.0% 30%
60% 16-17 57.6%
52.1%
45.9% 20%
41.7%
40% 38.2%
32.3% 10%
29.0%
0%
20%
Non-drinker Drinker
Drinking status
0%
Sexual Activity
Non-smoker Occasional Daily
Smoking status A significant relationship was observed between school
attendance and being sexually active among the 14–15 and
The increase in this variable (smoking), like diet, appears to 16–17 age groups (Figure 19). Sexually active 14–15 year
be a stand-alone factor that has a marked effect on decreasing olds were less likely to be attending school (89.2% were
school attendance and increasing poor school performance attending) than those who were not sexually active (97.0%)
(grade repetition). were attending). A similar difference is observed in the 16-17
age group: 79.9% attendance for those who were sexually
Alcohol Assumption active versus 89.4% for those who were not.
School attendance and school performance (measured by A similar relationship exists between being sexually active
grade repetition) were also examined in relationship to and repeating a grade among 14–15 and 16–17 year olds.
alcohol consumption. In both instances and amongst all age Sexually active 14–15 year olds are more likely to report
groups, there were no significant differences between non- repeating a grade (53.6%) than those who are not sexually
drinkers and those who have had at least one alcoholic drink active (31.5%). The same relationship exists for 16–17 year
in the past year. However, older alcohol consumers (16–17) olds, where 59.7% of those who are sexually active are more
164
likely to report repeating a grade compared to 41.1% of those school performance need to be designed and implemented at
who are not sexually active. an early age and grade. The deleterious effects of increased
Figure 19. Proportion attending school by sexual activity status
rates of smoking on attendance and performance at school
and age group (measured by grade repetition) should bring strength and
100% 99.0% 100.0% credence to smoking cessation programs. Encouragement of,
97.0%
and access to, active treatment for health conditions may
89.4% 89.2%
produce a positive result relating to school performance.
90%
Finally, promoting increased participation in certain types of
79.9% activities such as sports and traditional cultural programs8
80%
may have positive benefits resulting in increased attendance
at school and reduced repeated grades among First Nations
70% youth.
60%
12-13
Notes to Chapter 17
14-15
16-17
1. S. Barro and A. Kolstad, Who drops out of high school? Findings from high school and beyond
Report 87-397 (Washington, D.C.: U.S. Department of Education, National Center for
50% Education Statistics, 1987).
Not active Active
Sexual activity status
2. Janosz M. LeBlanc, B. Boulerice and R. E. Tremblay, 1997, Disentangling the weight of
school dropout predictors: A test on two longitudinal samples, Journal of Youth &
Adolescence, 26: 733-762.
Figure 20. Proportion having had to repeat a grade by sexual 3. S. R. Jimerson, G. E. Anderson and A. D. Whipple, 2002, Winning the battle and losing the
war: Examining the relation between grade retention and dropping out of high school,
activity status and age group Psychology in the Schools, 39: 441-457.
80% 4. P. Miller and M. Plant, 1999, Truancy and perceived school performance: An alcohol and drug
study of UK Teenagers, Alcohol and Alcoholism, 34: 886-893.
5. Indian and Northern Affairs Canada, Our Children—Keepers of the Sacred Knowledge, Final
Report of the Minister’s National Working Group on Education (Ottawa, Ont.: Indian and
12-13 60.2%
60% Northern Affairs Canada, December 2002).
14-15
52.5% 53.6% 6. D. A. Santor, D. Messervey and V. Kusumakar, 2000, Measuring peer pressure, popularity,
16-17
and conformity in adolescent boys and girls: Predicting school performance, sexual attitudes,
and substance abuse, Journal of Youth & Adolescence. 29: 163-182.
40.8%
40% 7. R. E. Kleinman et al., 2003, Diet, breakfast, and academic performance in children, Annals of
Nutrition & Metabolism. 46, 1: 24-30.
31.7% 31.5%
8. T. Delormier et al., Activity implementation as a reflection of living in balance: The
Kahnawake Schools Diabetes Prevention Project, Pimatisiwin: A Journal of Aboriginal and
Indigenous Community Health, 1: 145-163.
20%
0%
Not active Active
Sexual activity status
Conclusions and Recommendations

The health of First Nations youth in Canada is vital to our
continuity as Aboriginal peoples. Education is a key factor in
strengthening health and culture and building our future.5
This survey has delineated a number of barriers which stand
in the way of healthy First Nations youth and their attainment
of educational success.
Two of the peer-influenced user-choice variables, increased
alcohol consumption and increased sexual activity,6 are
related to lower school attendance and higher rates of grade
repetition. There is potentially much to program and develop
in the provision of educational programs and health services
and promotion. These findings on school board education
and health point to the need for an increased focus on
nutrition and diet7 in school-aged children in First Nations
communities.
Further, health education programs that relate to the effects
of increased alcohol consumption and sexual activity on
165
Chapter 18
Abstract
In addition to the health benefits derived from life-long participation in physical activity, immediate
benefits of physical activity for youth include increased self-esteem, perceived physical competences,
and ability to cope with mental stress. This chapter examines (for First Nations youth) factors of
physical activity and diet and how they relate to body mass.
Popular physical activities among First Nations youth are walking, running, cycling, competitive
sports and swimming. Just under half of the youth accumulate at least 30 minutes of moderate-to-
vigorous activity most days of the week. Although three in five First Nations youth sometimes eat a
nutritious and balanced diet, only about one in five always or almost always do — fewer than reported
among adults. Similarly, consumption of traditional protein-based meat is lower among youth than
adults. The majority of youth are normal/underweight, but 28% of First Nations adolescents are
considered overweight and 14% are classified as obese. Being active and having a healthy diet are two
factors associated with higher ratings of their life being in balance, lower rates of suicide ideation and
fewer difficulties learning at school.
The results suggest that physical activity and diet may contribute to the resilience of First Nations
youth. Creating supportive social norms and opportunities (e.g. positive community/sporting events
such as the North American Indigenous Games) are approaches that need to be developed and vetted
with community elders, school officials and recreational service providers, to determine which are
culturally appropriate and feasible.
166
RHS 2002/03 Youth Survey – Chapter 18: Physical Activity, Body Mass Index, and Nutrition
criterion for sufficient activity was defined as reporting at

Introduction
least 30 minutes of moderate/vigourous activity (defined in
A physically active lifestyle has been linked to several short- the survey as physical activity “…that results in an increase
term and long-term benefits. Short-term benefits for children in your heart rate and breathing”) for 5 or more days of the
and youth include: increased self-esteem and perceived week.
physical competence, ability to cope with mental stress1 and
The definition for body mass index (BMI) cut-points was
greater chances of pursuing a healthier lifestyle (not smoking
selected using a system of classification that is indirectly tied
or consuming alcohol or drugs).2 Long-term benefits of an
to health outcomes. These cut-points were established by
active lifestyle among adults include decreased risks of
single-year age group to predict the individual’s adult body
several chronic and physical conditions, including coronary
mass index for being overweight — known to be associated
heart disease, hypertension, obesity, type II diabetes,
with elevated health risks.21 In the model adopted, no cut-off
osteoporosis, certain site-specific cancers (such as colon
points were provided for an underweight classification;
cancer), and functional limitation with aging.3
therefore, normal and underweight classifications are
The proportion of Canadian youth that meet international combined for this analysis. Classifications of normal (or
guidelines for appropriate levels of physical activity is low.4 under) weight, overweight, and obese were determined by
The prevalence of overweight and obese young people in first calculating body mass index and then using age-
Canada has increased substantially over the last 20 years.5 appropriate cut-off points for the BMI measurements. These
This increase is not unique to Canada. The World Health were then compared to international standards for overweight
Organization (WHO) states that rates of childhood obesity and obese children and youth.22
are already considered an “epidemic” in some countries and
Next, the relationship of lifestyle and body mass index to the
the prevalence of overweight youth in the United States has
total person and their environment is examined using the
tripled in the last 20 or so years.6 This is of concern because
cultural framework model outlined at the beginning of this
being overweight or obese are factors associated with non-
technical report. Physical activity, diet and body mass will be
communicable or chronic diseases such as type II diabetes
examined in context with factors that make up a person’s
and hypertension (which are now being observed among
spiritual, emotional, mental, and physical well-being. In
obese youth and even pre-pubescent children).7
addition, cultural values, beliefs, identity, and practices - as
Obesity is related to either metabolic or genetic factors,8 well as community, relationship to the physical environment
environmental factors (including improved technology and and connectedness to family members - will be related to
suburban environments favoring motorized vehicles9), and body mass index, physical activity and nutrition.
behavioural factors (including high fat carbohydrate
intake).10 Canadian trends show that total energy intake has Results
increased via carbohydrate intake, particularly soft drink
consumption,11 during a period when the physical demands Physical and sedentary activity
of everyday life are generally decreasing. This may be
particularly true in Aboriginal communities, where Walking is the most frequently reported physical activity in
traditional physical activities have decreased.12 which First Nations adolescents participated over the year
prior the survey (87.9%)i. This is followed by running
Obesity and chronic conditions such as type II diabetes are (70.3%), bicycling (64.5%), competitive sports (63.1%),
more prevalent among Canadians of First Nations descent swimming (62.4%), ice skating (40.5%), weights and
than in the general Canadian population.13,14, 15 First Nations exercise equipment (39.1%), forms of dancing (33.5%),
children and youth are at particularly high risk of becoming fishing (33.2%), and berry picking or food gathering
obese.16,17,18 This chapter will examine physical activity (32.2%). Activities reported by roughly one-quarter of the
levels and aspects of diet among First Nations youth youth include hiking (25.7%), hunting or trapping (25.0%),
populations in relationship to body mass. and rollerblading (23.4%). Other activities are less prevalent:
bowling (19.7%), canoeing (17.2%), skiing (16.7%), golfing
General approach (16.7%), skateboarding (14%), aerobics or fitness classes
(11.4%), snowshoeing (7.9%), and martial arts (5.8%).
The chapter first describes the physical activity, diet and
Regardless of age, walking is the most frequently reported
body mass index among First Nations youth. Guidelines for
physical activity.
recommended frequency, intensity, and duration of physical
activity and exercise have evolved over time. Commonly Gender differences are apparent for certain physical
accepted guidelines19,20 require the inclusion of frequency, activities. Girls are more likely than boys to participate in
intensity and duration in the calculation and generally walking, dancing, and berry picking or other types of food
recommend a minimum of 30 minutes of moderate or
vigorous intensity on most days of the week. Similarly, in the i
To simplify the text, confidence limits are only reported for overall adolescent estimates with a co-
First Nations Regional Longitudinal Health Survey, a all reported figures is available at www.naho.ca/fnc/rhs
167
gathering.ii Boys, however, are more likely than girls to participate 2-3 times a week, 10.2% once a week, 6.7% less
participate in running, bicycling, skating, rollerblading, than once a week, and 3.7% never participate. Teenage boys
skateboarding, snowshoeing, golf, weight training, hiking, or are more likely than girls to participate everyday (36.8% for
traditional activities such as hunting, trapping, or fishing. boys compared to 27.9% for girls). Girls are more likely than
Table 1 summarizes the gender differences in reported boys to participate once a week or less. There are no
physical activities. differences in frequency of participation by age.
Table 1. Prevalence ratings of physical activities by gender Using a measurement criteria of 30 minutes of moderate-to-
(n=4,950)
vigorous activity most days of the week, 45.1% of First
Rank Activity Boys Girls Total Nations youth engage in sufficient physical activity. Boys are
more likely than girls to report activity rates that meet these
1 Walking 85.1% 90.8% 87.9%
guidelines (51.0% for boys versus 38.6% for girls), although
the gender differences appear only among 15-17 year old
2 Running 77.4 62.7 70.3
adolescents (52.7% for boys versus 33.0% for girls).
3 Bicycle riding 70.4 58.2 64.5 Nevertheless, the proportion of youth that are sufficiently
4 Competitive sports 65.6 60.4 63.1 (NS) active overall does not vary by the age of the adolescent.
5 Swimming 60.6 64.3 62.4 (NS) Figure 1. Proportion of youth reporting sufficient activity by
6 Exercise equipment 51.9 25.4 39.1 gender
60%
7 Skating 48.1 32.3 40.5
8 Fishing 44.1 21.4 33.2 51.0%
50%
9 Hunting, trapping 39.0 9.8 25.0 45.1%
10 Hiking 31.3 19.6 25.7 40% 38.6%
11 Berry picking, food 27.6 37.1 32.2

gathering 30%
12 Dancing 20.0 48.0 33.5
13 Rollerblading 27.1 19.5 23.4
20%
14 Bowling 19.3 20.2 19.7 (NS)
15 Canoeing 19.1 15.1 17.2 (NS) 10%
16 Skiing 17.4 16.0 16.7 (NS)

17 Golf 23.8 9.0 16.7 0%
Male Female Total
18 Skateboarding 20.4 7.1 14.0
19 Aerobics, fitness classes 10.7 12.1 11.4 (NS)
Just over half of First Nations adolescents watch 3 or more
hours of television daily (50.7%), an additional 41.2% watch
20 Snowshoeing 9.9 5.7 7.9
between 1 to 2 hours, and the remaining 8.0% watch less
21 Martial arts 5.9 5.7 5.8 than one hour or no television at all. Almost one in five
teenagers report playing video games or using a computer for
Adolescents were also asked how often they participated in more than 3 hours daily (18.8% for video games and 15.8%
lessons after school involving physical activity or sports for computer), roughly one-third of youth cite between 1 to 2
teams. Over one-quarter (29.4%) of youth indicate that they hours for the same activities (31.4% for video games and
never do, 17.0% indicated less than once a week, 34.0% 1 to 34.6% for computer use), and half play for less than an hour
3 times a week, and 19.6% 4 or more times a week. Girls are or not at all (49.8% for video games and 49.6% for computer
more likely than boys to never be on sport teams or use). Playing video games is two to three times more
participate in lessons (35.3% for girls versus 23.9% for prevalent among First Nations boys than girls (71.4% of
boys), whereas boys are more likely to do so 4 or more times teenage girls play video games for less than an hour or not at
a week (25.2% for boys versus 13.4% for girls). Older youth all, compared to 29.8% of teenage boys). Older youth (15-17
(aged 15-17) are more likely than their younger counterparts years) are more likely than 12-14 year olds to report playing
(aged 12-14) to state that they never partake in sports or video games for less than an hour a day: 44.4% for 12-14
lessons outside of school (24.5% for 12-14 year-olds, versus year olds versus 54.2% for 15-17 year olds.
33.2% for 15-17 year-olds).
Youth were also asked about time spent in potentially more
One-third of adolescents participate in physical activity every active pastimes, such as spending time outdoors and assisting
day (32.5%), 21.8% do so 4-6 times a week, 25.1% in household chores. Over half (60.2%) of teenagers spend 3
hours or more during the day outdoors, 30.7% spend 1 to 2
ii
hours, and a mere 9.2% spend less than one hour outside.
significant— is specified in brackets. In this chapter, estimates are considered significantly different if Moreover, 19.2% spend 3 hours or more a day assisting in
168
household chores, 54.2% spend 1 to 2 hours and 26.6% obese. Adolescent girls are more likely than boys to be
spend less than one hour. Boys spend a greater amount of categorized as normal or underweight (62.3%, for girls and
time (6 hours or more) outdoors, compared to girls (29.8% 54.5% for boys). However, when asked about the degree of
for boys compared to 19.2% for girls), whereas girls are satisfaction with their weight, girls are more likely than boys
more likely to spend a greater amount of time (3-5 hours) to be somewhat or very dissatisfied with their weight (14.7%
assisting in household chores compared to their male and 9.8% for girls respectively, versus 7.0% and 3.8% for
counterparts (19.7% for girls versus 10.2% for boys). boys). There are no age-related differences for classification
of body mass; however, younger adolescents (aged 12-14)
Nutrition are more likely than older youth (aged 15-17) to be very
satisfied with their weight (37.6% versus 30.3%
Roughly one in five First Nations youth indicate that they
respectively).
always or almost always eat a nutritious and balanced diet
(18.4%), whereas 62.0% only sometimes do. The remaining Figure 3. Body mass index and satisfaction with weight by
gender
20% either rarely (15.4%) or never (4.2%) eat a balanced and
70%
nutritious diet.
62.3%
Figure 2. Proportion of youth consuming a nutrition and 60% 57.8%
54.5% Male
balanced diet by gender
Female
70% 50% Total
62.3%
60% 57.8% 40%

35.8%
54.5% Male 33.5%
Female 29.7% 30.9%
50% Total 30% 28.1%
25.9%
40% 20%
35.8% 15.8%
33.5%
14.1%
11.8%
30.9%
29.7%
30% 28.1% 10%
25.9%
20% 0%
15.8%
14.1% Normal or underweight Overweight Obese Very Satistfied
11.8%
10% BMI Satisfaction with weight
0%
Normal or underweight Overweight Obese Overall Relationships between physical and sedentary activity,
Body mass index group nutrition and body mass index
Youth who are sufficiently active (23.1%) are more likely
There were no differences between boys and girls in terms of
than those who are not (14.8%) to report that they always or
eating a balanced and nutritious diet. However, boys
almost always eat a nutritious or balanced diet, and are more
consumed fast foods (49.2% a few times weekly) and soft
likely to state that they often consume berries/wild vegetation
drinks (90.3% at least once a week) more frequently than
(31.7% for those who are sufficiently active versus 22.1% for
girls (41.9% and 86.6% respectively), whereas girls were
those who are not), or cultural foods such as fried bread or
slightly more likely than boys to eat sweets (pies, cakes, etc.)
bannock (52.6% for those who are sufficiently active versus
several times a day (6.4% for girls versus 3.6% for boys).
42.5% for those who are not)iii.
Adolescent boys are more likely than adolescent girls to state
that traditional food was “never” shared by someone in the Those who are sufficiently active are more likely to be
household (17.6% for boys versus 10.4%, for girls), yet boys normal or underweight (62.3%) compared to youth that are
are more likely than girls to report that they have consumed not active enough (53.3%). Sufficiently active youth are
traditional protein-based meat such as game or fish (38.8% more likely than those who are not to report that they are
for boys versus 31.0% for girls). Younger adolescents (12-14 very satisfied with their weight (38.2% for those who are
years) are more likely than 15-17 year olds to report never or sufficiently active, compared to 29.9% for those who are
hardly ever consuming coffee or tea (64.1% versus 47.1% not). Sufficiently active youth are more likely to participate
respectively), and are less likely to state that they never or in sports and other activity lessons 4 or more times a week
hardly ever eat cake, pies, cookies and other sweets (13.7% outside of school hours compared to those who are not active
versus 19.5% respectively). enough (34.7% versus 8.3%), and they are more likely to
spend 6 or more hours outdoors a day (30.0% for those who
Body mass index are active compared to 20.2% for those who are not active
enough).
Over half (57.8%) of youth are considered to be normal or
under weight. However, 28.1% of First Nations adolescents iii
Sometimes it may be necessary to take be cautious of associating traditional food with proper diet.
are considered overweight. Moreover, 14.1% are deemed For example, while berries and wild vegetation may be nutritious, fried bread consumed in large
quantities may not be.
169
Figure 4. Frequency of consuming a healthy diet by physical Figure 6). Normal or underweight youth are more likely to be
activity
sufficiently active (54.6% of those who are normal or under
70%
weight compared to 45.0% of obese youth). Obese youth are
62.0% 61.8%
60%
more likely (34.4%) than those who are normal or
underweight (22.7%) to never participate in sport teams or
50% lessons outside of school hours. Normal or underweight
youth are more likely than obese youth to report spending at
40% Sufficiently active
Not active enough
least 3 hours a day outdoors (36.6% for 3-5 hours among
30%
normal or underweight youth compared to 26.6% among
23.1% obese youth). Normal or underweight youth are also more
20% 18.4% likely than obese youth to report spending 6 hours or more a
14.8%
11.8% day outdoors (26.5% among normal and 25.0% among obese
10%
5.0% youth). Overweight youth are more likely than normal or
3.1%
underweight youth to watch 6 or more hours of television per
0%
Always or almost Sometimes Rarely Never day (16.7% for overweight youth compared to 10.2% for
always
Consumption of a healthy diet normal or underweight youth).
Figure 6. Proportion of youth very satisfied with their weight by
body mass index
Figure 5. Physical activity of youth by body mass index
50%
70%
62.3% 42.5%
60% 40%
Sufficiently active
53.3% Not active enough
50%
30%
40%
23.4%
31.3% 19.8%
20%
30%
25.5%
20%
15.4% 10%
12.2%
10%
0%
0% Normal or underweight Overweight Obese
Normal or underwieght Overweight Obese Body mass index group
Physical activity, nutrition and body mass from a cultural

No differences were observed in the reported nutrition or perspective
dietary practices of youth who were overweight or obese
compared to those of normal weight or who were Table 2 summarizes the significant findings on physical
underweight. activity, nutrition and body mass index of youth according to
a First Nations holistic cultural framework, which takes into
Those who always or almost always eat a nutritious or account the whole person and total environment. In addition
balanced diet are more likely to be sufficiently active to relationships with individual factors described in the first
(56.8%) compared to those who rarely (35.0%) or never do three sections of 2.0 above, significant relationships with
(34.6%). Adolescents who consume soda pop several times a physical and mental health, societal, and social factors are
day (16.7%) are more likely than those who do so more now described (see Table 2).
infrequently (i.e. about once a week - 7.2%) to watch
television for more than 6 hours a day, whereas those who Youth who are sufficiently active (26.9%) are more likely
often consume traditional protein-based meat products are than those who are not (17.6%) to report excellent health. As
more likely to spend 6 or more hours outdoors (29.4% for well, adolescents who are sufficiently active (37.4%) are less
those who do compared to 22.3% for those who do not). likely than those who are not (47.5%) to report experiencing
Youth who always or almost always consume a balanced diet difficulties learning at school.
are considerably more likely to report that they are very Sufficiently active youth (68.1%) are more likely than
satisfied with their weight (50.2%) compared to those who inactive youth (58.5%) to not smoke cigarettes at all. Active
never consume a balanced diet (18.9%). youth are more likely to report that they feel that they are in
Large differences in being very satisfied with weight appear balance spiritually and almost twice as likely to report feeling
among youth who are obese (19.8%) or overweight (23.4%) in balance physically all of the time. They are also more
and those who are of normal or underweight (42.5% - see likely to have never thought about suicide (82.6% for those
170
active compared to 75.7% of those who are not active those who always do versus 12.4-18.9% for others).
enough). Adolescents who always or almost always eat a balanced and
Table 2. Relationship of key indicators with physical activity, diet
nutritious diet are roughly two times more apt to report that
and body mass index (BMI) they like school very much (52.3%) compared to those who
rarely eat a balanced diet (24.5%). Those who never eat a
Physical balanced and nutritious diet (59.9%) are more likely to report
Diet BMI
activity
that they experience learning problems at school compared to
Individual factors those who always or almost always consume a nutritious diet
(33.0%).
Age x a x
Gender a a a Youth who always or almost always eat a balanced and
Health factors nutritious diet are more likely to state that they never smoke
cigarettes (71.5%) compared to those who do not eat a
General Health Status a a a
balanced diet (56.4%). Youth who always or almost always
Cigarette smoking a a x
eat a balanced and nutritious diet are also less likely than
Alcohol consumption x a x
those who rarely do so to report alcohol consumption (34.1%
Sedentary activity x a a
for those always or almost always do, versus 55.2-55.9% for
Participation in physical
activity/sports a a a those who rarely or never do).
BMI a x n/a Youth who always or almost always consume a healthy diet
Nutritious diet a n/a x are more likely than those who rarely eat healthy to state that
Mental health factors they feel that they are in balance all of the time. Similarly,
Suicide ideation a a x they are more likely to have never thought about committing
Life in balance a a a
suicide (86.2% of those who always or almost always eat
healthfully versus 66.3% of those who rarely do).
Societal factors
Community size x (trad foods)a x Adolescents that are obese are less likely than those who are
Liking school x a a normal or underweight to indicate being in excellent health
Problems learning at (15.2% for obese adolescents compared to 25.0% for those
a a x
school who are normal or under weight), yet are more likely to say
Level of education
x x x
they are in good health (42.1%for those who are obese versus
aspire to complete 28.7% for those who are normal or under weight). Obese
Social factors adolescents are also less likely to consider themselves in
physical balance all of the time compared to normal or
Person to go to for help x a x underweight youth. Moreover, obese youth (45.6%) are more
a Significant association at the p=.05 level likely than normal or underweight youth (35.1%) to state that
x No observed association
n/a Not applicable they like school very much.
Table 3. Prevalence ratings of being in balance by consuming a
Figure 7. Relationship between sufficient activity and suicide
nutritious diet (n=3,902)
ideation
14%
Eating a nutritious diet
Being in balance
12.5%
all of the time Always or
12% Rarely
Sufficiently active almost always
Not active enough
9.6%
10% Physical balance 49.5% 23.1%
8% Emotional balance 31.9% 16.5%

6.1%
6% 5.7% Mental balance 39.3% 23.8%
4%
4.0% 3.9% Spiritual balance 34.9% 14.4%
2%
Youth who always or almost always consume a nutritious
0%
diet are more likely than those who rarely eat a healthy diet
Yes, when less than 12 old Yes, when 12 to 17 years old Yes, during past year to approach their parents if they have family problems
Suicide ideation (49.5% for those who always eat healthfully versus 31.2%
for those who rarely do). Conversely, having no one to turn
Adolescents who always or almost always eat a balanced diet to for help occurs less frequently when the youth has a
are more likely than others to cite excellent health (40.0% for
171
healthy diet (4.0% for those who always eat healthfully strategies, policy development and programs to combat this
versus 16.7% for those who rarely do). unprecedented crisis.
Figure 8. Proportion consuming a healthy diet by who to Although pervasive among all youth, physical inactivity is
approach with family problems
more prevalent in certain segments than in others.
60%
Furthermore, certain physical activities are more popular
49.5% Parent or guardian among certain population groups than others, and these
50% No one trends need to be reflected in the development of strategies.
42.1% For example, participation in traditional physical activities,
40%
34.5%
outdoor activities, team sports and activities of greater
31.2% intensity are more prevalent among First Nation boys,
30%
whereas individual activities of more moderate intensity are
more popular with girls. Research among the general
20% 16.7%
population shows that physical activity among children and
10.4% youth tends to decrease with age; 49% of grade-school
10%
4.0%
6.2% children (aged 5–12) are active compared to 36% of
teenagers (aged 13–17).25 This is consistent with the finding
0%
Always or almost Sometimes Rarely Never that participation on sports teams and in physical activity
always
Consumption of a healthy diet lessons was generally lower among older First Nations teens.
An interesting result from this study found that adolescents
Adolescents living in small communities (less than 300
who consume traditional foods were more likely to report
residents) are more likely to consume traditional protein-
spending time outdoors. Nonetheless, the profiles of youth
based meat products (42.8%), and to eat traditional berries
who never follow a traditional diet differ from those who
and wild vegetation (29.3%), compared to those in
rarely do. Could this be related to relative access to food
communities of 1,500 residents or more (where 28.7%
choices? Encouraging outdoor activities may be a strategy to
consume traditional protein-based meat products and 19.6%
increase physical activity among teenage girls and obese
consume traditional berries and vegetation).(See Table 3).
youth, who currently tend to spend less time outdoors. At the
same time, girls typically reported spending more time at
Discussion and Recommendations household chores than boys of the same age. Canada’s
Immediate consequences of childhood obesity may include Physical Activity Guides for Children and for Youth
diabetes, asthma, gallstone development, hepatitis, incorporate household chores into their suggested activities.
obstructive sleep apnea, orthopedic problems (bowing of the Chores may be an important way to increase the total amount
legs as an example), menstrual abnormalities and of activity by supplementing time spent in moderate and
neurological conditions.23 In addition, social and emotional vigorous activities — which are fundamental to the
problems result from obesity and being overweight; obese development of physical movement and decision-making
children may suffer from self-consciousness about their body skills that will enable youth to pursue a lifetime of enjoyable
image, poor academic achievement, and lower self-esteem. activity. Health promotion efforts should underscore the
However, differences in self-esteem also appear based on value of all physical activities, particularly sport and
age, culture and socioeconomic status. recreational physical activities, along with bicycling and
walking as a utilitarian means of travel. In determining
Suicide is a particular issue among Aboriginal youth; policies and strategies targeting certain groups, it may be
Aboriginal youth suicide rates are estimated to be five to six important to consider tailoring the types of physical activities
times higher than those of non-Aboriginal youth in Canada.24 preferred by certain age and gender groups to culturally
These rates vary by region, Aboriginal community, tribal appropriate activities (such as traditional physical activities
councils, language, facets of community control, and gender. used for procuring traditional foods)
Strategies to overcome the issue of youth suicide among
Aboriginal communities should be multi-faceted and should Poor quality diet is pervasive. The nutrition data gathered by
involve the individual, family, and community. The First the RHS is consistent with another study examining food
Nations Regional Health Survey found that youth who are intake and food habits of First Nations children. Both found
sufficiently active and who always consume balanced and that fat composition of diet is related to accumulation of
nutritious diets are less likely to have suicidal thoughts. This body fat.26 Several interesting findings indicated that children
suggests that following a healthy lifestyle may contribute to who always or almost always eat a balanced and nutritious
the resilience of youth. Therefore, physical activity and diet diet are roughly two times more likely to report that they like
may be key considerations when elders and health school very much and less likely to report that they
professionals in First Nations communities are considering experience learning problems at school. This suggests that
having a nutritious diet may confer greater benefits for youth
172
beyond physical health benefits. However, roughly four out • Socio-cultural factors such as the role of family and
of five adolescents only eat a balanced and nutritious diet one’s socio-economic status; and,
sometimes or even less often. Why are teenagers not eating a • Ecological factors such as geography, climate and
balanced diet? Is it related to food preferences, access issues, opportunities to be active and to obtain nutritious
or lack of knowledge on how to create such a diet? foods.31
Adolescent girls are more likely than boys to be categorized In relation to the last point, research indicates that physical
as normal or underweight; however, when asked about the activity levels of children tend to be associated with weather
degree of satisfaction with their weight, girls are more likely patterns and changes in climate.32 Activity levels are average
than boys to be somewhat or very dissatisfied with their in the spring, increase dramatically in the summer, and then
weight. Why is there such a discrepancy, and how does this decline in the fall and winter months.
relate to preferences for physical activity and dietary
choices? More research can be undertaken to determine the Thus, policies and strategies for increasing physical activity
reasons for such discrepancies (i.e., research into the absolute and improving diet need to take a broad perspective,
amount of physical activity undertaken, nutrients in the diet, including a consideration of the agriculture, transportation,
and access to opportunities for physical activity and recreation, and social sectors. A review of existing policies
nutritious choices) before understanding the issues related to and practices in these sectors should examine how they
diet, physical activity and perceptions of weight among First influence access to opportunities among boys and girls of
Nations youth. different ages as well as the families and communities in
which they live. Independent yet complementary strategies
Given the influence of television advertising, youth who need to be developed to ensure that children and youth
consume soda pop several times a day are more likely to internalize the importance of physical activity and nutrition
watch television for more than 6 hours a day than those who in their development, since these both contribute to optimal
never or hardly ever do. This is supported by content analysis development of the “total” person.
research indicating that during Saturday morning television
programming, an individual can be exposed to 1 food A cultural perspective is essential to promotion strategies,
commercial for each 5 minutes of television viewing,27 and and to understanding barriers relevant to the Aboriginal
that television food advertising has a negative influence on a population, such as weather, safety, homework, chores, and
child’s ability to identify a healthy food choice from paired lack of facilities.33 Therefore, the list of recommended
items.28,29 Aside from a parent’s role in reducing or approaches to increasing physical activity of youth34,35,36
restricting the amount of television viewing to which a youth needs to be vetted with community elders, school officials
is exposed, governmental policies regarding television and recreational service providers to determine which are
advertising content and other types of advertising are also both culturally appropriate and feasible.
important. Healthy living strategies need to consider potential protective
Regulating participation in sedentary activity is also a key factors other than physical activity and nutrition in improving
message contained in Canada’s Physical Activity Guides for health and reducing the number of overweight and obese
Youth. This guide states that reducing “non-active time” (i.e., children. Policies addressing factors such as socio-economic
watching television, videos, or working on the computer) disparities, community opportunities, physical environment
should start with 30-minute reductions a day. A study and social support are needed. Moreover, harmonized
examining the relationship between obesity, physical activity programs that involve school, community, and family are
and hours of sleep in school children found that excess important in developing healthy eating habits and activity
weight was directly correlated with daily sitting hours.30 behaviours among First Nations children and youth, by
Reducing sedentary time is particularly important for creating supportive social norms and opportunities (e.g.
overweight First Nations youth, as this study found that positive community/sporting events such as the North
overweight youth are more likely to spend 6 or more hours a American Indigenous Games).
day watching television. In many of these cases, this This study found that, when dealing with family problems,
sedentary time is in addition to those hours spent being those who eat healthfully tend to find support from parents,
sedentary at school. whereas those who do not eat healthfully have no one for
Understanding physical activity and dietary patterns of youth support. This suggests that using family role models to
from a First Nations holistic cultural framework means influence behaviours may be an important means of reaching
considering the following: certain segments of the youth population. Further
investigation of the interconnectedness of these factors is
• Physiological factors such as growth and development; necessary to understand how programs could positively
• Psychological factors such as motivation, confidence influence healthy lifestyle practices and reduce obesity
and self-efficacy; among First Nations youth. A better understanding of the
interconnectedness of the various factors could help to ensure
173
that the 4-dimensional aspects of “total person” and of “total

29. ——— and M. Lears, 1992, Television and children’s conception of nutrition: unhealthy
environment” are considered when developing strategies for messages, Health communication, 4: 245-257.
First Nations youth. 30. R. Giugliano and E. C. Carneiro, 2004, Factors associated with obesity in school children,
Journal of Pediatrics (Rio J), 80, 1: 17-22.
31. C. H. Lindquist, K. D. Reynolds and M. I. Goran, 1999, Sociocultural determinant of physical
The Regional Health Survey is one necessary component in activity among children, Preventive Medicine, 29: 305-312.
an ongoing system which develops First Nations peoples’ 32. C. A. Poest et al., 1989, Physical activity patterns of preschool children, Early Childhood
Research Quarterly, 4: 367-376.
health strategies. More detailed information on diet and 33. J. L. Thompson et al., 2001, Patterns of physical activity among American Indian children: an
assessment of barriers and support, Journal of Community Health, 26, 6: 423-445.
physical activity - including their determinants - is required 34. S. E. Cragg, C. L. Craig and S. J. Russell, Increasing Physical Activity: Enhancing municipal
for children and adults, and this information should be opportunities (Ottawa, Ont.: Canadian Fitness and Lifestyle Research Institute, 2001).
35. C. Cameron et al., Increasing Physical Activity: Encouraging physical activity through school
monitored regularly. The data monitoring process would (Ottawa, Ont.: Canadian Fitness and Lifestyle Research Institute, 2003).
36. Craig et al., Increasing physical activity: Supporting children’s participation.
ideally include collection of objective measures of energy
intake and physical activity. Objective anthropometric
measures (e.g. height, weight, waist girth) are also needed.
This surveillance data is a key component of the overall
knowledge system required to identify and assess the success
of policies, strategies and programs that will help shape the
future health of First Nations youth.
Notes to Chapter 18
1. T. DeMarco and K. Sidney, 1989, Enhancing children’s participation in physical activity,

Journal of School Health, 59,8: 337–340.
2. T. Stephens and C. L. Craig, The Well-being of Canadians: Highlights of the 1988 Campbell’s
Survey (Ottawa, Ont.: Canadian Fitness and Lifestyle Research Institute, 1990).
3. U.S. Department of Health and Human Services, Physical Activity and Health: A Report of the
Surgeon General (Atlanta, Ga.: U.S. Department of Health and Human Services, Centers for
Disease Control and Prevention, National Center for Chronic Disease Prevention and Health
Promotion, 1996).
4. C. L. Craig and C. Cameron, Increasing physical activity: Assessing trends from 1998-2003
5. M. S. Tremblay and J. D. Willms, 2000, Secular trends in the body mass index of Canadian
children, Canadian Medical Association Journal, 163, 11: 1429-1433.
6. World Health Organization, Obesity and overweight [online]. Cited 2005. Available from
World Wide Web: <http://www.who.int/dietphysicalactivity/media/en/gsfs_obesity.pdf>.
7. Ibid. Cited March 2005.
8. R. F. Dyck, H. Klump and L. Tan, 2001, From “thrifty genotype” to “hefty fetal phenotype”:
the relationship between high birthweight and diabetes in Saskatchewan Registered Indians,
9. C. L. Craig et al., 2004, Twenty-year trends of physical activity among Canadian adults,
10. A. J. G. Hanley et al., 2000, Overweight among children and adolescents in a Native Canadian
community: prevalence and associated factors, American Journal of Clinical Nutrition, 71:
693-700.
11. K. D. Raine, Overweight and Obesity in Canada: A population health perspective (Ottawa,
12. T. K. Young et al., 2000, Childhood obesity in a population at high risk for type 2 diabetes,
13. M. Tjepkema, “The health of off-reserve aboriginal population,” Health Reports 13,
14. NAHO preliminary results.
15. N. D. Willows, 2005, Overweight in First Nations children: prevalence, implications, and
solutions, Journal of Aboriginal Health, 2, 1: 76-86.
16. Hanley et al., Overweight among children and adolescents in a Native Canadian community:
prevalence and associated factors, American Journal of Clinical Nutrition, 693-700.
17. L. Bernard et al., 1995, Overweight in Cree school children and adolescents associated with
diet, low physical activity and high television viewing, Journal of American Dietician
Association, 95: 800-802.
18. Willows, Overweight in First Nations children: prevalence, implications, and solutions,
Journal of Aboriginal Health, 76-86.
Surgeon General.
20. Health Canada and Canadian Society for Exercise Physiology, Canada’s Physical Activity
Guide to Healthy Active Living [online]. 1998. Cat. No. H39-429/1998-1. ISBN 0-662-86627-
7. Available from World Wide Web: <http://www.hc-sc.gc.ca/hppb/paguide/main.html>.
21. T. J. Cole et al., May 2000, Establishing a standard definition for child overweight and obesity
worldwide: international survey, British Medical Journal, 320: 1240-1243.
22. Ibid.
23. A. Must and R. S. Strauss, 1999, Risks and consequences of childhood and adolescent obesity,
International Journal of Obesity, 23, 2: S2-S11.
24. Advisory Group on Suicide Prevention (Canada), Assembly of First Nations and Health
Canada, Acting on what we know: Preventing youth suicide in First Nations (Ottawa, Ont.:
25. C. L. Craig et al., Increasing physical activity: Supporting children’s participation (Ottawa,
Ont.: Canadian Fitness and Lifestyle Research Institute, 2001).
26. J. H. Himes et al., 2003, Impact of the Pathways intervention on dietary intakes of American
Indian schoolchildren, Preventive Medicine, 37: S55-S61.
27. R. Boyton-Jarret et al., 2003, Impact of television viewing patterns on fruit and vegetable
consumption among adolescents, Pediatrics, 113: 1321-1326.
28. N. Signorielli and J. Staples, 1997, Television and children’s conception of nutrition, Health
communication, 9: 281-301.
174
Chapter 19
Abstract
This chapter explores disability and long-term health conditions among First Nations youth aged 12–
17 years. Disability is more prevalent among youth 12–14 years than 15–17 years.
First Nations youth with disabilities are as likely to be attending school as those without disabilities.
Although they are more likely to have difficulties in school, they are about as likely as those First
Nations youth without disabilities to have repeated a grade, and their educational aspirations are much
the same.
Those with disabilities consider it as important as others to be able to speak their First Nations
language but are less likely to be able to speak a First Nations language fluently or relatively well.
Youth with disabilities are as likely to engage in physical activity, traditional cultural activities and
sports teams/lessons as those without disabilities, suggesting that they live in cultures that are
inclusive.
Allergies, asthma and chronic ear infections are the most common of the chronic conditions affecting
First Nations youth. Levels of treatment for allergies and ear problems are low—as they are for
learning disability, Attention Deficit Hyperactivity Disorder and chronic bronchitis.
Youth with disabilities tend to be affected by more than one long-term health condition and to be
limited in their activities by more than one of these. Their general health is poorer and they are more
likely to be overweight/obese. They are just as likely to have consumed alcohol and marijuana/hash
and to be sexually active. Between one-fifth and one-third did engage in each of these activities.
Youth with disabilities have lower self-esteem and tend to exhibit lower dexterity in certain areas of
personal control/mastery. They are more likely to experience loneliness, stress and depression, and to
have contemplated suicide. The chapter ends with recommendations.
175
RHS 2002/03 Youth Survey – Chapter 19: Disability and Chronic Conditions
Canadian results are based on the Canadian Community

Introduction
Health Survey (CCHS) and include a wider age range:
Chapter overview respondents 12 to 19 years.iii
This chapter explores disability and long-term health Results
conditions among First Nations youth 12 to 17 years. Long-
Basic demographics of disability among First Nations
term conditions are defined as those that have lasted or that
youth
are expected to last six months or more and that have been
diagnosed by a health professional. The chapter examines General prevalence
general demographics (e.g., prevalence of disability by age,
Using the RHS data on any activity limitations that stem
gender and various other dimensions; living arrangements,
from long-term health conditions, 7.7%iv of First Nations
schooling and activities in the community) as well as issues
youth can be classified as having disabilities. Applying a
of health, lifestyle and well-being. The chapter provides
similar definition of disability to children, which is narrower
selected comparisons of First Nations youth with and without
than the definition used in the chapter on children with
disabilities, as well as several comparisons of First Nations
disabilities, the comparable rate for children under 12 is
youth and their counterparts in the broader adolescent
8.1%. The more broadly defined disability estimate presented
population in Canada.
in that chapter (11.7%) is 1.44 times higher than the narrower
For comparative purposes, the chapter includes data from approach. Applying this “escalator” (factor) to the presently
Statistics Canada’s Canadian Community Health Survey conservative estimate for youth, the prevalence of disability
(CCHS) of 2003i and in a few places draws from published among First Nations youth rises to 11.1%.
tables and user-defined tabulations based on Statistics
Unpublished data, provided by the federal Office for
Canada’s Participation and Activity Limitation Survey
Disability Issues (ODI) and based on the disability questions
(PALS) of 2001, a survey that placed a focus on disability.ii
for the 2001 Census, indicate that disability is 1.5 times more
Working definition of disability in adolescence prevalent among First Nations children from birth to 14 years
than among non-Aboriginal children in Canada.v These
The First Nations Regional Longitudinal Health Survey
findings are similar to those reported by ODI for Aboriginal
(RHS) asks a battery of questions about what the survey
adults in Canada.1 It seems plausible that the prevalence of
classifies as long-term health conditions diagnosed by health
disability among First Nations youth is also higher than in
professionals and about whether any of these conditions limit
the general population.vi
the kinds or amount of activity survey respondents can do.
Based on the RHS, the research defines First Nations youth Prevalence and gender
12 to 17 years as having a disability if they indicated that
The research found that disability in adolescence is as
they are limited in their activities due to any of those long-
common among First Nations females as males. 8.3% of
term conditions.
adolescent females have disabilities compared with 7.2% of
Fewer activity limitation/disability questions were asked in males (NS)vii.
the RHS youth survey than in the adult and child
Of all First Nations youth with disabilities, 51.6% are
questionnaires, resulting in a narrower definition for this
females. Among youth without disabilities, 47.6% are
chapter. Nevertheless, since the youth disability questions are
females. Although not significant, the general direction of
in large measure a subset of those used for determining
this finding is similar to that based on the CCHS, which
disability rates among children and adults, some
shows that 51.8% of youth in the general population with
comparability is still possible.
disabilities are females. Among youth in the general
Differences in survey design indicate that the research uses a population without disabilities, 47.9% are females.
broader (and not directly comparable) definition of disability
Prevalence and age
for Canadian youth in general. For Canada overall, disability
among youth is defined as having the amount or kind of The research found that 9.8% of First Nations youth 12–14
activities that one can do at home, work or school or other years have disabilities compared with only 6.1% of youth
activities (such as leisure or travelling) reduced because of a
long-term health condition or problem, and/or having any iii
In the CCHS public use file, respondents are grouped into 5-year age categories. That file does not
difficulties seeing, communicating, walking, climbing stairs, facilitate disaggregating 15 – 17 year-olds from the 15 – 19 age group.
iv
bending, learning or doing any similar activities. The To simplify the text, confidence limits are only reported for overall youth estimates with a co-
v
The term “Aboriginal people” as used by ODI includes First Nations, Métis and Inuit people.
vi
There are some comparability issues between the RHS, CCHS and PALS that make it difficult to
i
The CCHS provides information on the health and health-related behaviours of Canadians. It did not show comparative prevalence rates for First Nations and other adolescents. Essentially, there are no
survey people in the northern territories, on military bases, in institutional collective dwellings or equivalent questions in the CCHS or PALS to the RHS disability indicators for adolescents.
vii
living on First Nations reserves. It did not include children younger than 12 years. Comparisons between groups reported in this chapter that are all significant unless “NS” —not
ii
PALS included children but did not include people in the northern territories, on military bases, in significant— is specified in brackets. In this chapter, estimates are considered significantly different if
institutional collective dwellings or living on First Nations reserves. their confidence intervals do not overlap (95% confidence level).
176
15–17 years. It is not immediately clear why there is an Table 1. Types of difficulties First Nations youth have learning at
school, by disability status
apparent dip in prevalence across these age groups. PALS
shows that in the general population the prevalence of With
Difficulty Others Total
disability tends to increase with age.2 However, in the disability
general population there is also what appears to be a dip in Reading 26.6% 38.2% * 27.8%
prevalence between 10–14 year olds (4.2%)3 and 15–19 year Writing 15.8% 36.5% * 18.0%
olds (3.5%).viii Again, the reasons for this are not Math 46.9% 62.9% * 48.6%
immediately clear.
Attention span 13.4% 22.9% E * 14.4%
Prevalence, isolation status and size of community of Too many distractions 35.6% 42.7% 36.3%
residence Understanding the teacher 26.8% 35.4% 27.7%
No differences were found according to community size. * Statistically significant difference at a 95% confidence interval.
Although not statistically significant, the research found
81.6% of First Nations youth with disabilities live in non- Language, culture and community activities
isolated communities (with road access and less than 90 km When asked how important it is for them to speak their First
from physician services) compared with 68.5% of their Nations language, youth with disabilities are about as likely
counterparts without disabilities. as their counterparts without disabilities to say it is “very
Living arrangements, schooling and activities in the important” (48.2% compared with 44.8%) or “somewhat
community important” (31.9% compared with 37.6%). Those with
disabilities are more likely to have the support of three or
Living arrangements more people to help them understand their culture (46.7%
Generally, First Nations youth with disabilities are in similar compared with 36.4%). Such people include nuclear and
living situations as youth without disabilities. For example, extended family members, friends, teachers, community
among those with and without disabilities, respectively, elders and other community members to a maximum of
78.8% and 79.0% live with their biological mothers and seven helpers.
47.9% and 49.9% live with their biological fathers (NS). Youth with disabilities are less likely to indicate that they are
Schooling able to speak one or more First Nations languages fluently or
relatively well (19.6% compared with 27.6%, a difference
The vast majority of First Nations youth with disabilities are that is statistically significant).
attending school (95.9%) and they are statistically equal to
their counterparts without disabilities to be doing so (91.3%). In general, youth with disabilities appear to be about as
While fewer than half of youth with and without disabilities active physically and involved in other activities as those
say they very much like going to school (43.2% compared without disabilities. Most First Nations youth with
with 35.6% respectively), relatively few (12.3% and 10.7% disabilities report being physically active at least twice per
respectively) say they dislike school somewhat or very much week (78.5%), which is equivalent to their counterparts
(NS). without disabilities (79.5%) (NS). More than half take part in
sports teams or lessons outside of school hours at least once
A higher proportion of First Nations youth with disabilities in a given week (53.4%), as do more than half of their
indicate that they have had problems learning in school counterparts without disabilities (53.7%) (NS). Those with
(59.2% compared with 42.3%). Those with disabilities have disabilities are about as likely as their counterparts without to
had greater difficulties with reading, writing, math and take part in a given week in traditional singing, drumming or
attention span (Table 1). Of some interest, First Nations dancing groups or lessons (10.8% compared with 9.7% in a
youth with disabilities are about as likely as their given week - NS) and to have a job such as baby-sitting,
counterparts without disabilities – not significantly more working at a store or tutoring (33% compared with 32.5% -
likely – to have repeated a grade (42.9% compared with NS). They are also as likely to be involved in art or music
41.6% respectively). However, despite the disparity in lessons or groups in a given week (10.6% compared with
various learning problems at school, there were no significant 15.2% - NS).
differences with the educational aspirations of First Nations
youth among those with or without disabilities.
viii
The latter figure is based on a cross-tabulation performed with the PALS public use file.
177
Health, lifestyle and well-being Chronic bronchitis would seem to be more prevalent among
First Nations youth than youth in the general population;
Long-term conditions and disability in adolescence
2.4% of First Nations youth have this condition compared
Table 2 shows the prevalence of what the RHS classifies as with 1.4% of youths more generally. Chronic bronchitis
long-term health conditions among First Nations youth. presents potentially serious long-term health risks. Only
These are conditions that have lasted or are expected to last 16.5% of First Nations youth with this condition are
at least six months and that have been diagnosed by a health receiving treatment for it.ix
care professional. The RHS enquired into 19 such conditions
At 3.5%, the reported prevalence of learning disability
and allowed for open-ended responses about conditions not
among First Nations youth is not as high as in the general
specifically presented on the youth questionnaire. Among the
population, where 6.3% of youths have this condition. Lesser
conditions for which structured questions were asked, some
access by First Nations youth to diagnosis of learning
are very low prevalence and involve high sampling
disability by educational psychologists and other
variability so are not shown on the table. These include
professionals may be a factor that accounts for some of the
hepatitis, HIV-AIDS, epilepsy, cognitive or mental disability,
reported difference. Only 12.6% of First Nations youth with
cerebral palsy, physical disability other than cerebral palsy,
learning disability are receiving interventions to address this
liver disease aside from hepatitis and kidney disease.
condition, which is of some concern as learning disability
Column D on Table 2 shows that allergies, asthma and can adversely affect academic and vocational prospects as
chronic ear infections/ear problems are the most common of well as relationships into and throughout adulthood. x
the conditions reported for First Nations youth. These are
Of the 2.4% who have ADD/ADHD, only 34.2% are
also the most common for First Nations children younger
receiving treatment for it. xi This is also of some concern
than 12 years. Chronic bronchitis is not so prevalent but
because, as with learning disability, ADD/ADHD can have
presents serious health risks. Learning disability and
adverse, long-range effects on academic and vocational
Attention Deficit Disorder / Attention Deficit Hyperactivity
prospects as well as relationships.
Disorder are fairly low in prevalence but can involve
multiple challenges to academic performance and social While low in prevalence and affecting only 0.7% of First
integration that can persist into and throughout adulthood. Nations youth, tuberculosis (TB) is an infectious
communicable disease caused by bacteria (Mycobacterium
The chapter in this publication on First Nations children and
tuberculosis) that most commonly affects the lungs. It is
disability provides brief descriptions of chronic bronchitis,
transmitted primarily from person to person during close
asthma, allergies, chronic ear infections, learning disability
contact by breathing infected air. When the inhaled TB
and Attention Deficit Hyperactivity Disorder. A separate
bacteria enter the lungs, they can multiply, causing a local
chapter is dedicated to diabetes. Blindness/serious vision
lung infection. TB also can involve almost any organ of the
problems and hearing impairments are self-explanatory.
body; the kidneys, bone, and lining of the brain and spinal
Allergies are the most common of the conditions shown in cord are the most common sites beyond the lungs. Without
Column D on Table 2. First Nations youth seem to be less effective treatment, patients can “waste away.” However, TB
susceptible to allergies than youth in general in Canada. usually can be treated successfully with antibiotics.4
Allergies affect 15.1% of First Nations youth but 31.2% of
The CCHS does not provide comparable data to the RHS on
youth more broadly. However, of First Nations youth with
the prevalence of TB, blindness/serious vision problems or
this condition, only 26.3% with are receiving treatment for it.
hearing impairments, so comparisons are difficult to draw
The next most common long-term condition among First with the broader adolescent population. Coefficients of
Nations youth is asthma, affecting 13.6%. First Nations variation are high for RHS data on the extent of
youth seem to be at least as susceptible as youth in the treatments/interventions for First Nations youth who have
general population, among whom 12.4% have asthma. Some these conditions. However, it is probably safe to say that
31.2% of First Nations youth with this condition had an those who receive treatments are minorities among the youth
asthma attack in the reference year, compared with 42.7% of who have the conditions.
youths in the general population. As confidence intervals
were not available for the CCHS data, and as the questions
on recent asthma attacks/symptoms are worded slightly
differently in the RHS and CCHS, the differences in the
reported occurrence of asthma attacks affecting First Nations
and other youth in the past 12 months may not be statistically
significant. Of some concern is that only 55.9% of First ix
Owing to high sampling variability, that figure should be used with caution. At a 95% confidence
Nations youth with this condition are being treated for it. interval the estimated proportion receiving treatment ranges between 10.2% and 25.8%.
x
interval the estimated proportion receiving treatment ranges between 8.3% and 18.7%.
xi
interval the estimated proportion receiving treatment ranges between 21.8% and 49.2%.
178
Table 2. Selected long-term health-related conditions among First Nations youth, by two disability statuses
A B C D E F
Total % (with Of those with Of those with
% with no % with any
and without the condition, the condition,
disability disability
disabilities) % with % with
Long-term conditions reporting the reporting the
reporting the disability disability
long-term long-term
long-term caused by any caused by that
condition condition
condition condition condition
Chronic bronchitis 1.5% E 12.1% 2.4% 39.5% 36.0%
Asthma 9.8% 57.9% 13.6% 34.0% 31.2%
Allergies 12.8% 41.5% 15.1% 21.7% 16.7%
Blindness or serious vision problems 1.2% 9.2% 1.9% 38.6% - E
Chronic ear infections or ear problems 3.5% 19.8% 4.8% 32.5% 23.1%
Hearing impairment 1.1% E – E 1.7% – E – E
Tuberculosis 0.6% E – E 0.7% E – E – E
Psychological or nervous condition – E – E 1.2% E – E – E
Learning disability 2.3% 17.1% 3.5% 38.9% 23.2%
ADD/ADHD (1) 1.8% 10.0% E 2.4% – E – E
Diabetes 0.7% E – E 0.8% E – E – E

1. Attention Deficit Disorder / Attention Deficit Hyperactivity Disorder
Column F on Table 2 again takes as the units of analysis the
Column C on Table 2 shows the percentage of First Nations “universes” of youth with a given long-term condition, but
youth with any disabilities who have the long-term shows the extent to which youth with a given condition incur
conditions reported in Column A. High percentages of youth disability (are limited in their activities) as a result of that
with disabilities have asthma (57.9%), allergies (41.5%), condition; the figures range from 16.7% to 36%. In all cases
chronic ear problems (19.8%), learning disabilities (17.1%) the prevalence of condition-specific disability is lower than
and chronic bronchitis (12.1%). the prevalence of disability shown in Column E because the
Column E takes as the units of analysis the “universes” of figures in column E represent disability stemming from any
First Nations youth who have a given condition, and then it condition. Some youth are limited in activities by more than
shows the percentage of these youth who have any disability, one condition. Accordingly, the figures in column E are
whether caused by that condition or by one or more inclusive of the figures shown in column F.
additional long-term conditions. Generally, about one-third Multiple disabilities and health conditions in adolescence
of youth with the long-term health conditions shown on the
table have some level of disability. These figures suggest that It is not uncommon for First Nations youth to report more
there is about a one in three chance that youth who have any than one long-term health condition and more than one type
of the conditions shown on Table 2 will have some level of of disability. The average number of long-term health
disability. conditions among youth without disabilities is 0.4. Among
youth with disabilities the average number is 2. Youth with
While the figures for low prevalence conditions cannot be any disability are limited in their activities on average by 1.4
shown owing to high sampling variability, youth reported as long-term conditions.
having a cognitive or mental disability, and physical
disabilities aside from cerebral palsy were found to have Among First Nations adolescent males with disabilities, the
activity limitations in the majority of cases. average number of long-term health conditions is 2.2, and the
average number of conditions identified as limiting activity is
1.7. Among female youth with disabilities, the average
number of long-term health conditions is 1.8, and the average
xv
number of these that limit activities is 1.2.
Some 70.7% of adolescents in the general population without disabilities are in excellent or very
good health and only 3.4% are in fair or poor health.
179
Disability and general health in adolescence less likely to agree or strongly agree with the statement “I
like the way I am” (78.2% compared with 85.6%). The
The general health of First Nations youth with disabilities is
difference is most pronounced among males, among whom
poorer overall than that of other youth. For instance, 36% of
79.6% with disabilities agree or strongly agree with the
youth with disabilities rate their health as very good or
statement compared with 90.4% of their counterparts without
excellent compared with 59% of their counterparts without
disabilities (Table 3).
disabilities. Some 18.1% of youth with disabilities indicate
they are in fair or poor health, compared with only 9.2% of The RHS also explored issues of personal control and
other First Nations youth. In the general youth population in mastery. Generally, the responses of First Nations youth with
Canada, 11.2% with disabilities are in fair or poor health, and disabilities imply a statistically similar sense of
52.1% are in excellent or very good health.xv mastery/control to their non-disabled counterparts. For
example, First Nations youth with disabilities, both male and
The general health of only 27.6% of First Nations female
female, are just as likely as their non-disabled counterparts to
youth with disabilities is excellent or very good, compared
feel that they do things well (78.1% compared with 83% non-
with 57.7% of their counterparts without disabilities. The
disabled) and that they can do just about anything they set
general health of 44.9% of male youth with disabilities is
their mind to (78.9% compared with 85.3%). However, youth
excellent or very good, compared with 60.3% of their
with disabilities are considerably less likely to indicate that
counterparts without disabilities.
no one pushes them around (63.3% compared with 76.2%).
First Nations youth with disabilities are more likely than their In other words, they are more likely to feel pushed around.
counterparts without disabilities to be overweight or obese
Adolescent males with disabilities are less likely than their
(58.0% compared with 40.8%). Adolescent males with
counterparts without disabilities to agree or strongly agree
disabilities are more likely than females to have this problem
that they no one pushes them around (60.5% compared with
(68.4% compared with 44.9%).
79.1%) and that they have control over the things that happen
Alcohol and drug use to them (62.8% compared with 78.9%).
Although not significant, 32.8% of First Nations youth with There are no significant differences between adolescent
disabilities have consumed alcohol in the year before the females with disabilities and those without.
survey compared to 43.7% of youth without disabilities.
The RHS asked youth about how lonely, stressed and loved
They are, however, just as likely to have used marijuana or
they feel. Those with disabilities are more likely to feel some
hashish in the year (27.6% vs. 33.1%) (NS). The proportion
level of loneliness than their counterparts without disabilities
reporting use of other non-prescription drugs (e.g. cocaine,
(62.8% compared with 50.7%). They are also more likely to
crack, inhalants, LSD) is below 2% for both those with and
experience some level of stress (78.8% compared with
without disabilities.
64.3%). Overall, First Nations youth with disabilities are just
Sexual Activity as likely to feel loved “a lot” (50% compared with 52.2%),
but there are some gender differences.
Some 20.4% of First Nations youth with disabilities consider
themselves to be sexually active, and 20.2% had sexual First Nations youth with disabilities seem more prone to
intercourse in the reference year. Among their counterparts depression, which is defined as feeling sad, blue or depressed
without disabilities, the same proportion consider themselves for more than two weeks in a row in the reference year
sexually active (29.1%) (NS), but are more likely to report (35.6% compared with 26.5%). Females with disabilities are
having sexual intercourse (31.9%) in the reference year. particularly likely to have experienced depression (51.2%
compared with 35.8% of adolescent females without
Among sexually active First Nations youth without
disabilities). Youth with disabilities are also more likely to
disabilities, 45.4% are females compared with 64.1% among
have contemplated committing suicide at some point in their
sexually active youth with disabilities.
lives (32.4% compared with 20.1%).
Self-esteem, personal control and mood/affect
Although a statistically similar percentage of youth with than
The RHS explored how First Nations youth feel about without disabilities received counselling, psychological
themselves by asking them how strongly they agree or testing or other mental health service in the 24 months before
disagree with the statements “I like the way I am,”, “I have a the RHS was conducted, females with disabilities are more
lot to be proud of” and “A lot of things about me are good.” than twice as likely to have received such services as males
Overall, the picture looks similar for youth with and without with disabilities (29.9% compared with 13.7% NS).
disabilities, except that youth with disabilities are somewhat
180
Table 3. Percentages agreeing or strongly agreeing with the following statements, by disability status and gender
Others With disability
Male Female Total Male Female Total
Self-esteem
In general, I like the way I am 90.4% 80.3% 85.6% 79.6% 76.8% (NS) 78.2%
Overall, I have a lot to be proud of 91.3% 86.0% 88.8% 91.7% 80.7% (NS) 86.0% (NS)
A lot of things about me are good 85.2% 82.5% (NS) 83.9% 90.7% 79.0% (NS) 84.7% (NS)
Personal control/mastery
When I do something, I do it well 86.1% 79.7% 83.0% 82.3% 74.1% (NS) 78.1% (NS)
I can solve the problems that I have 82.5% 71.9% 77.4% 75.5% 72.8% (NS) 74.1% (NS)
No one pushes me around in life 79.1% 73.1% 76.2% 60.5% 65.9% (NS) 63.3%
I have control over the things that happen to me 78.9% 74.2% (NS) 76.7% 62.8% 76.1% (NS) 69.9% (NS)
I can do just about anything I really set my mind to 87.9% 82.5% 85.3% 80.6% 77.2% (NS) 78.9% (NS)
I often feel helpless in dealing with the problems of life 34.3% 33.5% (NS) 33.9% 24.3% 39.2% (NS) 32.5% (NS)
What happens to me in the future mostly depends on me 87.0% 85.4% (NS) 86.2% 80.6% 85.3% (NS) 83.0% (NS)
There is little I can do to change many of the important things in my life 39.9% 42.1% (NS) 41.0% 37.5% 50.5% (NS) 44.7% (NS)
Summary of Key Findings The general health of First Nations youth with disabilities is
poorer than their counterparts’ without disabilities and they
This chapter explored disability and long-term health are more likely to be overweight or obese.
conditions among First Nations youth 12 –17 years. The
research found that disability is more prevalent among First Nations youth with disabilities are as likely to have had
younger youth 12 –14 years than youth 15 –17 years. an alcoholic drink, to use marijuana or hashish and to have
sexual intercourse, although those activities were still
First Nations youth with disabilities are in much the same reported by about one-fifth to one-third of the group.
family living arrangements as other First Nations youth, are
as likely to be attending school, but are more likely to have Youth with disabilities generally have a lower sense of self-
difficulties with various school subjects. They are about as esteem and a lower level of certain aspects of personal
likely as their counterparts without disabilities to have control and mastery than other youth. They are also more
repeated a grade and their educational aspirations are much likely to experience loneliness, stress and depression and to
the same. have contemplated suicide.
Like First Nations youth without disabilities, those with Recommendations

disabilities generally consider it important to be able to speak It would be helpful if there were greater symmetry between
their First Nations languages, but youth with disabilities are the disability indicators for youth in the RHS and on
less likely to be able to speak them fluently or relatively well Statistics Canada’s population surveys. This would better
(27.6% versus 19.6%). Those with disabilities are about as enable comparisons of prevalence of disability and of other
likely as those without to take part in sports teams/lessons issues concerning First Nations and other youth.
outside of school, to be physically active and to take part in
traditional cultural activities. Overall, it would seem that First Nations adolecents
valuation of and participation in physical activities,
Allergies, asthma and chronic ear infections are the most community/cultural activities and schooling is on par with
common of the chronic conditions affecting First Nations that of youth without disabilities. So are their educational
youth with and without disabilities. Levels of treatment for aspirations. This suggests that community cultures of
allergies and ear problems are low, as they are for lower inclusion are emerging or are already place for many of these
prevalence but problematic conditions such as learning young people. Community elders and other leaders, families
disability, Attention Deficit Hyperactivity Disorder and and educators should be acknowledged and supported to
chronic bronchitis. It is fairly common for youth with continue fostering inclusion and support for youth with
disabilities to be affected by more than one long-term disabilities.
condition and to be disabled by more than one condition.
Troubling are the low levels of treatment/intervention for
high prevalence conditions such as allergies and chronic ear
infections, for lower prevalence but challenging conditions
such as learning disability and ADHD, and for potentially
181
risky if low prevalence conditions such as chronic bronchitis. Such analysis is possible based on the RHS data but was
While levels of treatment for asthma are above 50%, no beyond the scope of the present chapter.
doubt more young people could benefit from treatment.
Family members, educators and other adults could bolster the
Parents/guardians need to be alerted to the risks of conditions
generally lower self-esteem of First Nations youth with
such as asthma and bronchitis, and about how to help young
disabilities through encouragement and positive messaging.
people manage the risks. They may need information on how
As well, these youth’ lower sense of personal mastery and
to help youth manage allergies and may need information
control could be addressed by ensuring that they have
about, or better access to, interventions to address conditions
opportunities and the supports needed to exercise their self-
such as learning disability and ADHD. Community audits
determination and to develop their personal sense of
may be useful to determine why the treatment/intervention
empowerment and self-agency.xvi 6 7 8
levels are quite low for various conditions and what can be
done to address those issues. Also needing attention is the more widespread loneliness,
stress, depression and proneness to contemplate suicide
The significantly poorer health of youth with disabilities,
among youth with disabilities. While these difficulties are not
particularly females, needs attention through research and
epidemic, they are fairly common and can be very
gender-specific health promotion efforts that target not only
challenging for young people and their families to contend
individual health behaviours but broader social and economic
with. Families may need information on how to help young
health determinants as well. The RHS youth survey was self-
people manage these difficulties and educators and
administered and household income information was not
social/health service providers may need to be sensitized.
collected. If that gap were addressed in a future iteration of
Youth may need information about, and better access to,
the survey, the RHS could perhaps shed some light on the
supportive counselling and other mental health services.
broader determinants of the relatively poor health of youth
Youth with disabilities no doubt have a role to play as self-
with disabilities. Also useful would be information about the
advocates in telling others how they are feeling and why.
difficulties young people might be encountering in their
Analysis of the availability of companionship, assistance,
efforts to secure the health and other services they need to
guidance and other kinds of support to First Nations youth
optimize their health.
with and without disabilities would also be useful and is
Youth with disabilities are more likely to experience feasible based on the RHS but was beyond the scope of the
difficulties with core subjects such as reading, writing and research for the present chapter.
math. Meanwhile, relatively few with learning disabilities or
ADD/ADHD are receiving treatment/interventions to address
the difficulties they face. This suggests that effective Notes to Chapter 19
educational strategies and support systems for pupils with
disabilities, their teachers and families need to be made more 1. Social Development Canada, Advancing the Inclusion of Persons with Disabilities, 2004
(Ottawa, Ont.: Social Development Canada, 2004), p. 9 and Endnote 14.
widely available. It would make sense if these strategies and 2. Statistics Canada, 2001 Participation and Activity Limitation Survey: A Profile of Disability in
systems were to reflect the culture of inclusiveness that 3.
Canada, 2001—Tables (Ottawa, Ont.: Minister of Industry, 2002), Tables 3.1 and 10.1.
Statistics Canada, 2001 Participation and Activity Limitation Survey A Profile of Disability in
seems to be evident in community life more generally. Canada, 2001—Tables, Table 10.1.
4. MedicineNet.com, Tuberculosis (TB) [online]. Cited 11 October 2005. Available from World
Wide Web: <http://www.medicinenet.com/tuberculosis/article.htm>.
Research into various combinations of long-term health 6. SDTAC, Self-Determination Technical Assistance Centers [online]. Cited 14 October 12005.
conditions and into combinations of those conditions that Available from World Wide Web: <http://www.sdtac.uncc.edu/project_description.asp>.
7. M. L. Wehmeyer, Research Highlights, Topic: Self-determination [online]. [Lawrence, Kan.]:
result in activity limitations would be useful in shedding light Beach Centre on Disability, University of Kansas, 2001. Cited 14 October 2005. Available
from World Wide Web:
on health complications and other difficulties First Nations <http://www.beachcenter.org/Research%5CQuickDownloads%5CQckSD14Turnbull2001.pdf
youth experience. Analysis of the causes of those conditions >.
8. J. W. Conroy et al., Outcomes of the Robert Wood Johnson Foundation’s National Initiative
(e.g., congenital, environmental factors, injury or accidents) on Self-Determination for Persons with Developmental Disabilities—Final Report on 3 Years
of Research and Analysis (Narberth, Pa.: Center for Outcome Analysis, 2002).
would also be helpful.
Parents, educators and others responsible for sexuality
programs and social service providers who have contact with
youth with disabilities should be cognizant of the fact that,
while these youth may not be as sexually active as their
counterparts without disabilities, a significant proportion is
sexually active. Particular attention may be needed to
safeguard the sexual health of young women with
disabilities, who are more sexually active than their male
counterparts. Further analysis is also needed of the numbers
of sexual partners, birth control and protection methods, and xvi
There is a large and growing literature on self-determination and disability. The Self-Determination
Technical Assistance Centers project at the University of North Carolina at Charlotte provides
measures to avoid contracting sexually transmitted diseases. research and other resources, as does the Beach Centre on Disability at the University of Kansas, the
Robert Wood Johnson Foundation, the Center for Outcomes Analysis in Narberth, Pennsylvania and a
range of other organizations and Internet portals.
182
Chapter 20
Injuries
Abstract
Injury rates are higher in youth than in any other age group, and the Regional Health Survey (RHS)
results show that First Nations youth are at much greater risk than others in Canada. The most
common causes of injury in First Nations youth were falls, sports, motor vehicle crashes, and bicycle
accidents that frequently resulted in cuts or scrapes, sprains or strains or fractures were frequent
results. The findings also indicate certain groups that should be the target of prevention efforts. Risk
was higher in males, and in youth who frequently participated in sports or other extracurricular
activities. Injury also appeared to be associated with a series of “personal problems” indicators
personal problems: depression, low self-esteem, problems learning at school, recently loss due to
suicide of someone close, and drinking.
183
RHS 2002/03 Youth Survey – Chapter 20: Injuries
when analysing the alcohol responses. Many people refused

Introduction
the alcohol questions (under-reporting is likely because of
Injury rates are higher during adolescence than at any other the stigma associated with alcohol use). In short, the numbers
time. Figures for both First Nations and other youth in on alcohol involvement should be treated as estimates only.
Canada show that injuries are more common in teenagers
than in other age groups, and are by far the leading cause of Results
death at this age.1, 2, 3 Injuries can be unintentional (falls,
sports or car crashes) or intentional (suicide, self-injury, Nature and causes of youth injuries
assault or homicide).
Injuries are extremely common in First Nations youth: half
Injuries typically involve a complex interaction of factors. (49.5%)i indicated that they had been injured in the previous
These factors may operate at the societal level (e.g., cultural year. This was a much higher proportion than in any other
norms that support violence); at the community-level (e.g., age group (Figure 1). It was also almost double the rate for
unsafe recreational areas, easy access to firearms, low rates other youth in Canada and for First Nations youth living off-
of seatbelt use); at family level (e.g., insufficient reserve. Figures from the Canadian Community Health
supervision); or at individual level (e.g. risk-taking Survey (CCHS) show that across Canada, 23.5% of
behaviour, alcohol abuse).4 adolescents (age 12-19) were injured in 2003.6 The figure for
First Nations youth living off-reserve was similar, at
Although injuries are a problem for youth throughout
26.3%.ii7 This comparison, though should be interpreted
Canada, evidence suggests that First Nations youth are at
cautiously as the survey questions differed: the RHS asked
higher risk than others. Figures from the mid-1990s show
about injuries serious enough to require medical attention,
that at that time, the injury death rate for First Nations
while the Canada-wide figures are for injuries “serious
teenagers (15-19) was triple that of other youth (176 versus
enough to limit normal activities.” A follow-up question on
48 per 100,000).5 Available data from the RHS suggests that
the Canada-wide survey did ask if the person had or had not
the picture has improved but not changed substantially since
seen a doctor about their activity-limiting injury. Most of the
that time.
available, published analyses do not present this breakdown.
Although injury death rates have long been collected for First In the one case in which it is available, the figures show that
Nations, there has been no information on the lesser day-to- only about half of Canadians who sustained an activity-
day injuries that do not result in death or hospitalisation. The limiting injury consulted a doctor about it. This suggests that
RHS fills this gap. The survey asked about any injury in the if the comparison to First Nations were based solely on
preceding year that was serious enough to require care from a people who had seen a doctor about their injury, the gap
health professional. This chapter presents the resulting between the First Nations and Canadian figures would be
information on the types of injuries youth that are even wider (Figure 2).
experiencing and what caused those injuries. It also presents Figure 1. Injury rates by age group: First Nations, 2002-03
information on which youth are at greatest risk, considered 60%
under three headings: characteristics of the teenager,
characteristics of the family, and characteristics of the 50%
49.5%
community.
40%
Interpretation methods 35.3%
The RHS asked three sets of questions on injury. The first set 30%
24.2%
focused on the nature of injury: youth were asked if, in the 22.1%
year prior to the survey, they had experienced any of a list of 20% 17.5%
injuries such as major cuts, sprains, broken bones, or

concussion. Each of these questions was answered with “yes” 10%
or “no,” so the resulting numbers reflect how many youth

experienced a given type of injury, rather than how many 0%
0-11 12-17 18-34 35-54 55+
injuries happened in total. The different types of injury are Age group (years)
not mutually exclusive and some respondents might have * All differences are statistically significant except between the two oldest groups.
been injured more than once during the year.
The second set of questions asked about the causes of injury,
such as falls or car crashes, etc. Again, these were yes/no
questions. For each “yes” answer, a follow-up question asked i
if the incident was alcohol-related. Because of the way the efficient of variation of greater than 33.3%. A statistical appendix including confidence intervals for
questions were structured, some assumptions had to be made ii
This figure is for Aboriginal youth living off-reserve in the provinces (only) in 2001 and 2003
combined.
184
Figure 2. Proportion of youth injured in the past year: First types of injury. Young men and women were about equally
Nations (2002-2003) compared to Canada as a whole (2003), by
likely to experience burns or scalds, hypothermia, dental
age group
injuries, or cuts, scrapes and bruises. However, young men
60%
51.5%
were significantly more likely to experience fractures,
49.5%
47.0% dislocations, sprains/strains, and concussions. This pattern
40%
may be at least partly attributable to males being more likely
to engage in sports. Much of the difference between the male
and female injury rates is due to just two causes: males’
20%
higher rates of sports injuries, and of bicycle injuries in
10.6% 9.5% 9.9%
males. The sexes do not differ significantly in their
14.0% 13.3% 13.6%
propensity to be injured by other causes such as falls, motor
0%
vehicle crashes, or burns/scalds.
FN All Canada FN All Canada FN All Canada
12-14 yrs 15-17 yrs (Canada 15-19) Total 12-17 yrs (Canada Figure 3. Proportion of youth who experienced various causes
12-19) of injury (n=4983)
Sought treatment (whether injury limited activity or not)
Fall 20.7%
Limited activity but did not seek treatment
Limited activity-sought treatment
* Note that the RHS figures are for injuries serious enough to require medical attention, while the Sports 20.1%
Canada-wide figures are for injuries that limit normal activities, with a further distinction according to
whether or not the person sought medical attention.
Source: Canada-wide figures from the Canadian Community Health Survey.8 Motor vehicles 11.9%
The most common injuries reported to the RHS were cuts,

scrapes or bruises, followed by sprains/strains, and then by Bicycle 10.8%
fractures. These injuries were typically caused by falls and/or

by sports. Motor vehicle and bicycle accidents were also Burns/scalds 7.6%
common.
Other assault 5.3%
Table 1. Proportion of youth reporting various types of injuries
(n=4983) Other assault 6.2%
Nature of injury % of youth
0% 5% 10% 15% 20% 25%
Cut, scrape or bruises 34.8
* “Motor vehicle” includes cars, trucks, ATVs, snowmobiles, and collisions between motor vehicles
and bicycles.
Sprain or strain 21.6
Broken bone, fracture 15.8 Age
Burn or scald 12.6 The RHS results suggest that older teenagers are at greater
risk of injury than younger ones—which is consistent with
Hypothermia, frostbite 6.6
patterns observed among Canadian youth in general.9 The
Dental injury 4.3 overall injury rate in 15-17 years olds is somewhat higher
Dislocation 4.0 than in children 12-14, although the difference is not large
enough to be statistically significant. For certain causes of
Concussion 3.7
injury, however, the difference is significant: older youth are
Accidental poisoning 0.8 at greater risk of motor vehicle crashes in which the youth is
Injury to internal organ 0.8
the driver, of assault, and of burns/scalds. The motor vehicle
crash rates no doubt reflect the early years of driving
Any type(s) of injury * 49.5 experience, and higher assault rates at this age may reflect
* Note: Respondents could report more than one type of injury, so the number shown for “any type of
injury” is not a total of the categories above.
factors like drinking behaviour.
Balance and mental health
Gender
Mental health can be expected to affect risk-taking
In adulthood, men are more likely than women to be injured.
behaviour, so it is interesting to examine whether various
The RHS results show the same pattern in youth: injury rates
indicators of good mental health are related to injury rates.
were significantly higher for young men than young women,
Some feelings that one would expect to be associated with
(53.1% vs. 45.5%.i), although this did not hold true for all
injury (a perception of being “in balance” in life, and the
belief that one’s life is under one’s control) were not
i
Comparisons between groups reported in this chapter are all
significant unless “NS” —not significant— is specified in significantly different if their confidence intervals do not
brackets. In this chapter, estimates are considered overlap (95% confidence level).
185
significantly related to injury rates. On the other hand, injury to report an injury (55.3% versus 44.7%). One possible
rates correlated strongly with depression (having felt explanation is that problems in the home environment are
depressed, sad or blue for two weeks or longer in the showing up both in difficulties at school and in other
previous year) and with the youth’s level of self-esteem. behaviours that affect a youth’s risk for injury.
Table 2. Proportion of youth injured, by occurrence of Use of alcohol and drugs

depression and by level of self-esteem (n=4983)
Alcohol clearly raises the risk for several different types of
% of youth
injured injury, including falls, car crashes, and violence. Over all,
Felt depressed, sad or blue for Depressed 62.3 alcohol was said to have played a role in 6.4% of all the
two weeks or longer in the injuries that youth reported, but it was involved in fully
past year Not depressed 45.0
27.1% of the assaults.
Poor 70.1 Half of all youth reported having had a drink of alcohol in
Self-esteem
Good 48.6 the past year, and those individuals were more likely than
others to report having been injured (56.0% vs. 44.6%) —
Activities although part of this may be because both alcohol use and
injuries tend to be more common in older youth.
The type and number of activities that a youth engages in Unexpectedly, injury rates did not differ significantly
could be expected to affect injury rates in several ways. First, between youth who “binged” frequently (had five or more
sports and injuries tend to be related.10 Second, involvement drinks at a sitting, once a month or more) and those who
in groups and activities, and a feeling of belonging, tend to never binged, or did so less than once a month. Drug use was
be associated with good mental health.11 This can have an less common than alcohol: a third (33.4%) of youth had used
affect on injuries related to mental health (for instance, in an illegal substance at least once in the past year. Injury rates
some areas, church attendance has been found to be inversely were considered the same in youth who used drugs as in
related to suicide attempts).12 The RHS results suggest that those who did not, because the difference did not quite reach
despite their desirable effects, sports and participation in statistical significance at the thresholds established for this
extracurricular activities both raise the risk of being injured. report. It seems likely that a larger sample may show a
Youth who frequently participate in sports are more likely to statistically significant difference.
be injured than those who are less sports-oriented, and youth
who engage in extracurricular activities (which can include Injury risk and family characteristics
sports) are more likely to be injured than those who do not.
Family characteristics and living situation seem likely to
Table 3. Proportion of youth injured, by frequency of physical affect a youth’s risk of injury. This analysis looked at three
activity and extracurricular activities (n=4766) aspects of the family situation:
% of youth
injured • whether or not the youth’s mother had attended a
Three times a week
44.4 residential school;
Physical activity
or less
• living situation (whether the youth was living with at
Four or more times a
53.3
least one biological parent; with other family; or in some
week other arrangement such as with step-parents, foster
parents, a boyfriend/girlfriend, or in a boarding home);
and
Low participation* 41.4
Extracurricular activities • emotional support (whether the youth who had someone
(sports, dance, music, jobs) to talk to, confide in, or count on in case of need “all the
High participation* 50.6
time” or not).
* “High participation” is defined as engaging at least once a week in one or more sports teams
or lessons; art or music groups or lessons; traditional singing, dancing, drumming groups or None of these factors was significantly related to injury rates.
lessons; jobs such as babysitting, working at a store, or tutoring. “Low participation” defined as
doing these things less than once a week.
Injury risk and community characteristics
School experience
None of the community characteristics appeared to be
Interestingly, injury rates were not associated with whether associated with youth injury rates. That is, neither
the youth was attending school, or whether he or she liked community size nor its degree of isolation nor transfer status
school.i However, youth who said they were having problems seemed to affect injuries.
learning at school were significantly more likely than others
Suicide can be an indication that a community is having
problems, and it is possible that high rates would go along
i
Note that in any case there was little variation on these dimensions: 90% of all youth said they were with other risky characteristics such as elevated levels of
attending school, and 82.3% liked school either “somewhat” or “very much.”
186
alcohol abuse or violence in the community. Alternatively, the influence of alcohol. The research has identified certain
having someone close commit suicide might increase a measures that do—and do not—work. Specifically, the
youth’s likelihood of indulging in unsafe behaviours, or results suggest that, as the Insurance Institute for Highway
might lead to depression and other risk factors. Whatever the Safety succinctly puts it, “Education alone almost never
reason, youth who report that a family member or close changes driver behaviour.”17 Media campaigns to encourage
friend committed suicide in the past 12 months are safe driving apparently have little or no impact,18 and
significantly more likely than others to report having been surprisingly providing driver education produces no
injured themselves. reduction in the likelihood of young drivers’ being involved
Table 4. Proportion of youth who were injured, by suicide of
in a crash or having traffic violations.19, 20 However,
friend/family education seems to be useful if it is part of a larger package
% of youth of mutually reinforcing strategies to change driving
injured behaviour,21 such as enforcing the laws on legal drinking age
In the past 12 months, has a close Yes 64.5 or taking action on speeding. Other interventions that are
friend or family member
No 45.4 known to work are graduated licensing and random
committed suicide?
checkpoints. Seven provinces and one territory currently
Discussion have graduated-licensing schemes that have appreciably
reduced the number of collisions in novice drivers.22 In
Two points stand out clearly in the RHS results. The first is Europe, checkpoints (random checks of drivers’ blood-
the extremely high injury rates in youth as compared to other alcohol levels) have been shown to decrease traffic fatalities
age group. The second is how much higher the rates are for by 16-29%.23
First Nations youth living on-reserve than for Canadian
youth in general, or for First Nations youth living off-reserve. There is less research on how best to prevent bicycling
The size of the gap highlights the magnitude of the impact injuries. Many of the existing studies focus on how to
that preventive measures could have. increase the use of bicycle helmets, which are estimated to be
85% effective in protecting cyclists against head injuries.24
The evidence suggests, once again, that multifaceted
Preventing the most common injuries
interventions—such as a combination of bicycle rodeos,
Until now, most of the existing information on injuries has media campaigns and helmet discounts—work better than
been drawn from records of hospitalization and death. The any one initiative taken alone.25 Changes to regulations, such
RHS results provide the first opportunity to look at the day- as requiring helmets for bicycle races, or on school grounds,
to-day injuries that happen to youth and they show quite a may also help.26 Much less attention has been devoted to
different picture. Mortality statistics point clearly at motor aspects other than helmet use. Some jurisdictions have
vehicle crashes and suicide as the main causes for youth. introduced bicycle paths, or widened the shoulders on
Nonetheless, the RHS results show that attention also needs roadways, but there is no information on whether this has
to be paid to causes such as falls, sports, and bicycle crashes. helped to reduce injuries.27 Other logical measures include
making sure that bicycles are well maintained and the
Some of these injuries might be prevented by modifications
appropriate size for the rider, and using reflectors, reflective
to the environment. For instance, injuries from falls can
clothing, and lights at night.28
happen when youth fall from bleachers or fences, trip over
objects, or step into holes.13 Some of these falls can be
Recognizing the connection between injury and the youth’s
prevented by attention to the surface of playing fields and
situation in their life
playgrounds,14 and by modifications such as installing
guardrails in arenas. Many sports injuries can be prevented, Besides identifying the most common causes of injury in
or made less serious by using protective equipment and youth, the RHS results also show that certain groups of youth
enforcing rules on fair play. Helmets are demonstrably are at greater risk than others. Although most of the family
effective in reducing the risk of head injury in a variety of and community characteristics examined in this analysis
sports, including rollerblading, skateboarding, cycling, were not clearly related to youth’s risk for injury, some of the
skiing, snowboarding, tobogganing, and riding ATVs or youth’s characteristics seemed to be strongly correlated with
snowmobiles.15 A comprehensive review of the evidence on injury risk. As is typical in injury statistics, males were at
injuries incurred in football, rugby, and hockey suggests that greater risk than females. Older youth were at greater risk
using mouth guards, and enforcing the rules on “fair play” than younger ones for particular types of injury, especially
and on illegal types of blocks and tackles can decrease injury motor vehicle crashes and assault. And despite their benefits,
rates considerably.16 frequent participation in sports and extracurricular activities
clearly raised a youth’s likelihood of being injured.
There has been considerable research on how to prevent
motor vehicle crashes in new drivers, with the common Beyond the predictable differences by sex, age, and activity
theme being the need to reduce speeding and driving under level, the RHS results point to a more troubling conclusion.
187
Youth who are struggling with personal problems are far

more likely than others to be injured—whether the injury is
an intentional one (such as an assault), or an unintentional
one (such as a bicycle accident or a fall). Injury rates were
significantly higher for youth who were depressed, had low
self-esteem, or had a close friend or family member commit
suicide in the past year. They were also higher in youth who
reported having problems learning at school. Finally, rates
were higher for those youth who reported drinking alcohol.
All of these things suggest that injury risk in youth is tied to a
broader constellation of personal and social problems.
Notes to Chapter 20
1. Kathryn Wilkins and Evelyn Park, “Injuries,” Health Reports 15, 3 (May 2004), pp. 43-48.
2. Health Canada, Unintentional and Intentional Injury Profile for Aboriginal People in
Canada: 1990-1999 (Ottawa, Ont.: Health Canada, 1999).
3. Michael Tjepkema, “Non-fatal Injuries among Aboriginal Canadians,” Health Reports 16, 2
(March 2005), pp. 9-22.
4. World Health Organization, Facts About Injuries: Preventing Global Injuries [online]. Injuries
and Violence Prevention section, WHO, 2001. Cited 23 August 2005. Available from World
Wide Web:
<http://www.who.int/violence_injury_prevention/publications/factsheets/en/index.html>.
5. Health Canada, Unintentional and Intentional Injury Profile for Aboriginal People in
Canada: 1990-1999.
6. Statistics Canada, Health Indicators [online]. 2003, cat. no. 82-221-XIE. Cited 19 August
<http://www.statcan.ca/english/freepub/82-221XIE/2005001/hlthstatus/conditions5.htm>.
7. Tjepkema, “Non-fatal Injuries among Aboriginal Canadians,” Health Reports.
8. Statistics Canada, Health Indicators [online].
9. Wilkins and Park, “Injuries,” Health Reports.
10. Ibid.
11. Laurence J. Kirmayer et all, Suicide Prevention and Mental Health Promotion in First Nations
and Inuit Communities, Culture and Mental Health Research Unit Report number 9 [online].
[Montreal, Que.]: McGill University, 1999, p. 14. Cited October 2005. Available from World
Wide Web: <http://upload.mcgill.ca/tcpsych/Report9_Eng.pdf>.
12. L. Boothroyd, Suicidal Behaviour among the Cree of James Bay: Information from the 1991
Santé Québec Health Survey and Prevention Strategies, unpublished draft, August 18, 1998.
13. Gordon Trueblood, Prevention of falls and fall-related injuries among First Nations and Inuit,
draft document (Ottawa, Ont.: First Nations and Inuit Health Branch, Health Canada, 2002).
14. Direction de la santé publique de Montréal-Centre et al, Prévenons les blessures chez nos
enfants: guide à l’intention des intervenants (Montreal, Que. : Régie régionale de la santé et
des services sociaux de Montréal-Centre, 2001).
15. Ibid.
16. Andria Scanlan et al., Sports and Recreation Injury Prevention Strategies: Systematic
Review and Best Practices [online]. B.C. Injury Research and Prevention Unit et al.,
2001. Cited October 2005. Available from World Wide Web:
<http://www.injuryresearch.bc.ca/Publications/ Reports/SportSystematicReport.pdf>.
17. Insurance Institute for Highway Safety, Status Report [online]. May 2001, vol. 36, no. 5,
special issue: "What Works and Doesn’t Work to Improve Highway Safety." Available
from World Wide Web: <http://www.hwysafety.org/sr/2001.html>.
18. Ibid.
19. Ibid.
20. Anna Auer, Preventing Motor Vehicle Related Injuries: Taking a Look at What Works,
unpublished document prepared for the First Nations and Inuit Injury Prevention Group
(Ottawa, Ont.: Health Canada, March 2002).
21. Ibid.
22. Factsheet: Transport Canada, Road Safety in Canada: An Overview [online]. 2004. Cited
October 2005. Available from World Wide Web:
<http://www.tc.gc.ca/roadsafety/stats/overview/2004/menu.htm>.
23. Auer, Preventing Motor Vehicle Related Injuries: Taking a Look at What Works.
enfants: guide à l’intention des intervenants.
25. Scanlan et al., Sports and Recreation Injury Prevention Strategies: Systematic
Review and Best Practices [online].
26. Ibid.
27. Factsheet: Transport Canada, Road Safety in Canada: An Overview [online].
enfants: guide à l’intention des intervenants.
188
Chapter 21
Dental Care and Treatment Needs
Abstract
This chapter reports results of the 2002-03 First Nations Regional Longitudinal Health Survey (RHS)
in the areas of dental care and treatment needs of the First Nations youth population in Canada (aged
12-17 years). Nearly 79 percent of the respondents received dental care within the past year – a rate
very similar to that of the Canadian population for this age cohort. The need for cavity fillings or other
restorative work was reported by 36.6% of the participants and the need for maintenance was reported
by 42%. Overall, 19.1% of Aboriginal youth experienced some dental pain in the past month. The
prevalence of dental injuries was 3.7% for among 12-14 year-olds and 4.8% among 15-17 year-olds.
Community isolation and health transfer status are factors in the reported high levels of restorative
dental treatment needs that were reported. However, significant associations were found between the
prevalence of dental pain in First Nations youth (12-14 years old) and a number of other factors
including: their parents’ attendance at residential schools, the participant’s self-ratings of general
health and emotional well being, performance at school, levels of self-worth and self-determination,
and depression. Taken together, these findings confirm the serious effects of societal stress on the
dental care needs of the current generation of First Nations youth.
189
RHS 2002/03 Youth Survey – Chapter 21: Dental Care and Treatment Needs
NOTE: Due to spacing issues, the tables associated with this While the NIHB program has removed some of the financial
chapter can be found at the end of the chapter. barriers to dental treatment, the reasons for the under-
utilization of dental benefits by Canadian First Nations and
Inuit are complex and are in part the result of social factors
Introduction that impede access to dental care. This chapter compares the
characteristics of First Nations youth who reported that they
Current data documenting the oral health of First Nations had received dental care in the preceding year to the
youth are very limited. The data that are available for
characteristics of and those who did not using data from the
Canadian Aboriginal youth and Native American youth First Nations Regional Longitudinal Health Survey (RHS)
generally present a picture of oral health that is poorer than conducted in 2002/03. While data on access to dental care is
that of non-Aboriginals in North America. Data on the oral
important, it is also essential to document the level of unmet
health of American Indians and Alaska Natives are available dental care needs. Therefore, this chapter also examines RHS
through periodic surveys conducted by the Indian Health results regarding types of dental treatments or procedures
Service (IHS). These surveys cover the population residing that First Nations youth perceive that they require and the
on reservations where services, including dental services, prevalence of dental pain and dental injuries in this cohort.
have been provided by the IHS or contracted to tribes or
Dental pain or toothache is consistently associated with
urban American Indian/Alaska Native organizations. The untreated cavities among lower socioeconomic groups owing
HIS findings revealed substantial unmet dental needs and primarily to reduced access to care among this sector of the
quality of life issues related to the experience of dental pain
population.28 However, the underlying reasons for the high
among schoolchildren and adults.1-8 For some groups of prevalence of physical injuries, including dental injuries, in
American Indians, diabetes and high rates of tobacco and First Nations and Inuit youth have been more difficult to
alcohol use are prevalent and continue to contribute to poor
determine.29
oral health.8-10
Oral diseases are also common in First Nations and Inuit and
Métis youth living in Canada. Large amounts of dental needs Data for 4,983 youth aged 12 to 17 years were used from the
go unmet each year. It is estimated that 95-100 percent of second Canadian National First Nations and Inuit Regional
Aboriginal youth will have had a cavity by the age of 17 Health Survey (RHS) collected in 2002/03. The previous
years, while the severity of oral diseases, as expressed by the First Nations and Inuit Regional Health Survey (FNIRHS)
mean number of decayed, extracted and filled permanent was conducted in 1996/97 and included questions on health
teeth (DMFT) index, ranges from 4.1 to 8.5 in 12 to 15-year- services and dental care. While some data pertaining to
old First Nations children,11-15 and was 7.8 in Northern children and youth were collected in the FNIRHS, the dental
Labrador Inuit aged 15–22 years. 16 It should also be noted care questions which are of particular interest in this chapter
that regional oral health surveys of Aboriginal children and were asked only of adults, (i.e., persons 18 years of age and
youth in Canada conducted before 1988 showed variable but older).30 This chapter compares RHS data with content
overall higher rates of dental caries than studies conducted related to age-specific dental consultations/visits and content
after 1988.17-26 The decline has by no means been striking, in the 2003 Canadian Community Health Survey (CCHS; n =
but at the same time, rates of oral diseases, especially dental 3,316,567)31 and the National Population Health Survey of
caries, remain disproportionately higher in Aboriginals than 1996/97 (NPHS; n = 2,284).32
in non-Aboriginals. These high rates remain despite the Non-
The dental care questions asked the youth about the last time
Insured Health Benefits (NIHB) program from the First
they obtained dental care, what type of treatment they
Nations and Inuit Health Branch (FNIHB) of Health Canada
currently perceived themselves to need and if they had
which provides payment for a comprehensive list of
experienced any dental pain or problems with their teeth in
preventive and dental treatment services, including
the previous month. A dental injury that had occurred in the
orthodontics. Dental benefits ranked third among NIHB
past 12 months and required the attention of a health care
expenditures in 2003/04, at $134.5 million, following NIHB
professional was also one of the dependent variables selected
expenditures on transportation and pharmacy benefits.27
for analysis. Other independent variables included some of
Statistics on the use of dental benefits show that only 35% of
the determinants of health, such as individual characteristics
the 750,000 registered First Nations and Inuit population
(e.g. gender and education), lifestyle factors (e.g. smoking
received at least one dental procedure paid through the NIHB
and drinking), and ecological determinants (e.g. geographic
program in 2003/04. Approximately one-quarter of all dental
isolation and health transfer status of the community where
claimants were between 10 and 19 years of age. Expenditures
the respondent resides). Other questions were selected as
on restorative services (fillings, crowns, etc.) were the
independent measures, including the respondent’s last
highest of all dental sub-benefit categories at $42.8 million in
instance of consulting a traditional healer, self-ratings on
2003/04.27
general health status, emotional and social well being,
190
instances of suicidal ideation and attempts and the attendance healer. Moreover, older youth who reported themselves to be
at residential schools by their parents and/or grandparents. in very good or excellent health are more likely than those
reporting good health to have received dental care in the
The analysis and process used to interpret the data were
previous year.
based on the RHS Cultural Framework, in which the
meaning of First Nations health and well-being is understood Figure. 1. Proportion of youth who received dental care in the
past year, by sex, age group, and health survey
in its broadest sense as “the total health of the total person
within the total environment.” 33 In view of this holistic 82.9%
definition of health, the dental care and treatment needs of Male 12-14 78.8%
First Nations youth are presented in relationship to a First 86.0%
Nations vision of their broader health. This vision aspires to
Gender and age group (years)

86.3%
keep individuals free of disease while considering the Female 12-14 82.7%
broader community context, including the provision of a 86.0%
variety of health services to all community members. In this

73.5%
view, oral health is included as an integral component of *Male 15-17 75.0%
CCHS 2003
overall health and well being. 78.8% RHS 2002-03
NPHS 1996-97
Results 78.7%
*Female 15-17 79.2%
82.7%
“Time since last dental visit” or “time elapsed from when an 65% 70% 75% 80% 85% 90%
individual last received any dental care” are standard (*12-19 years in the Canadian Community Health Survey, 2003)
measures used to document patterns of access to dental care.
In the 2002/03 RHS, the response options to this question Dental care also varied by the isolation status of the
were: community where the youth resided. Youth living in isolated
First Nations communities were significantly less likely to
• Less than 6 months ago
report the receipt of dental care in the year before the survey
• Between 6 months and 1 year ago than those living in non-isolated communities (Figure 2). The
• Between 1 and 2 years ago isolation status (remoteness factor) of the respondent’s
• Between 2 and 5 years ago community of residence was based on 2002 data provided by
• More than 5 years ago FNIHB (Health Canada), and on that agency’s classification
• Never of community isolation (remote isolated = no scheduled
The corresponding population-weighted responses were: flights; isolated = flights, good telephone service, no road
48.9%,i 29.7%, 12.4%, 5.8%, 1.3%, and 1.8%. These results access; semi-isolated = road access greater than 90 km to
indicate that nearly 79% of First Nations youth received physician services; non-isolated = road access and less than
some form of dental care within the past year. When results 90 km from physician services).
from the RHS 2002/03 are compared to findings from the Figure. 2. Proportion of First Nations youth aged 12 to 17 years
CCHS 2003, it is evident that the numbers of First Nations who received dental care in the past year by isolation status of
youth receiving dental care in the preceding year were on par community of residence
90%
with those for the general Canadian population aged 12–17
years (Figure 1). The NPHS 1996/97 reported a higher 82.3%
percentage of males aged 15–17 making a dental visit in the
preceding year than the RHS 2002/03ii and the CCHS 2003.
80%
76.9%
75.8%
The receipt of dental care by age group and selected

characteristics of the respondents is presented in Table 1. 15– 70%
66.6%
17 year-olds, youth with one or more parents that had
attended residential school were more likely to have received
dental care in the previous year compared to youth whose 60%
parents had not attended residential school. Youth aged 15–

17 who had consulted a traditional healer within the last 12
months were more likely to have received dental care in the 50%
previous year compared to those who never consulted a Remote Isolated Semi-isolated Non-isolated
Isolation status of community
i
To simplify the text, confidence limits are not reported for overall youth estimates unless the co-
efficient of variation is greater than 33.3%.
ii
Comparisons between groups reported in this chapter are statistically significant except where “NS”
—not significant— is noted. For this chapter, differences are judged to be significant if the
Bonferroni-adjusted 95% confidence intervals do not overlap.
191
Dental treatment needs FNIHB’s classification, a community designated as “not-

transferred” is a community that is not part of a health
“Time since dental care was last received” is a useful
transfer agreement; a ‘transferred’ community is one that has
indicator of inequity in access to care. Nevertheless, it is of
responsibility, through a “Health Transfer” for primary
limited value unless accompanied by information on the
and/or secondary and/or tertiary services; a ‘multi-
types of treatments or dental procedures people actually
community transfer’ is a community that is part of a multi-
receive when they see a dental care provider. First Nations
community health services transfer agreement for primary
youth who needed dental treatment were also asked to
and/or secondary and/or tertiary services.
specify the kind of dental care they required. The results
shown in Table 2 reveal that the most common treatments Figure 4. Need for dental fillings or other restorative work in
First Nations youth aged 12 to 17 years by health transfer status
required were maintenance work (check-ups or teeth
of the community of residence
cleaning) and dental fillings or other restorative work such as 50%
crowns and bridges. These were followed by fluoride
treatment and tooth extractions. Relatively few youth 41.3%
39.7%
40%
mentioned periodontal (gum) work.
Because oral diseases are prevalent among Aboriginal
30%
populations and are not necessarily resolved over time in the 25.2%
absence of intervention, the “need for fillings and other
restorative work” was used as an indicator of unmet dental 20%
treatment needs. As anticipated, those living in non-isolated

communities were also significantly more likely to have had 10%
their cavities treated by dental health professionals than those
living in isolated communities (Figure 3).
0%
Figure 3. Need for dental fillings or other restorative work in Not transferred Community transferred Part of multi-community transfer
First Nations youth aged 12 to 17 years by isolation status of Health transfer status of community
community of residence
70%
Dental pain
59.8%
60% Respondents were asked whether they experienced any
50.6% dental problems or pain in the past month. Dental pain or
50% 46.9%
toothache is largely a result of untreated deep cavities that
40%
progress to the dental pulp and can lead to acute pain
31.6%
symptoms. Acute dental pain can be disabling, affecting
30% eating, sleeping and other aspects of everyday life. Studies
have shown that dental pain is greatest in populations with
20%
reduced access to care, such as children in lower
socioeconomic groups or those living in poverty.28,35 In the
10%
RHS, a relatively sizeable percentage of the total sample of
0%
youth had a recent episode of dental pain (19.1%). Table 3
Remote isolated Isolated Semi-solated Non-isolated shows the characteristics of First Nations youth who
Isolation status of community
experienced dental problems or pain in the month previous to
the survey. The prevalence of dental pain was somewhat
A significant relationship was also found between the
higher in females. Among 12–14 year olds, parental
transfer status of the community and the rates of cavity
attendance at residential schools was associated with higher
fillings. Youth living in communities that have engaged in
rates of dental pain than for those whose parents did not
the health transfer process are less likely to have had their
attend residential school. Among 15–17 year-olds, youth
cavities filled than those in communities that have not been
reporting excellent (15.5%) or very good (19.4%) health
part of a transfer agreement or those who are part of a multi-
status are less likely than those in poor health (58.8%) to
community agreement (Figure 4). The “Health Transfer”
report dental pain or problems with their teeth. In addition,
process began in 1989 as part of Aboriginal self-
significant associations were found with smoking, poor
determination and social development34 when First Nations
performance at school, and the participant’s levels of self-
and Inuit health programs and services from Medical
worth, self-determination, their emotional well being and
Services of Health and Welfare Canada (now Health Canada)
depression.
were transferred to First Nations and Inuit control.
Information on the Health Transfer Status of the community
in which the respondent resides, was based on August 2002
data from FNIHB (Health Canada). According to the
192
Dental injuries restorations and/or maintenance with a minority reporting the

need for tooth extractions. Dental pain, an indicator of the
There are probable linkages between dental injuries body
need for urgent care and a good predictor of tooth loss, was
mass and diet. To explore these links and to find out the
reported by 19.1% of the respondents. These findings reflect
prevalence of dental injuries in the First Nations population,
other research suggesting that partial or complete tooth loss
the question on dental injuries from the RHS was analyzed
remains a substantial problem in adult Aboriginal dental
according to age group and cause of injury. The prevalence
patients in both Canada and the U.S.39-43 While periodontal
of dental injuries was 3.7% for 12–14 year-olds and 4.8% for
disease becomes the major indicator for tooth extraction
15–17 year-olds. These findings are comparable to the
among the older cohort, acting more quickly on symptoms
prevalence of the more severe types of traumatic dental
like dental pain in youth can result in less frequent
injuries reported in Grade 8 children in Ontario.36
complication as youth reach adulthood.
High rates of Type 2 diabetes and obesity in Aboriginal
The introduction of Health Canada’s NIHB program in the
children and youth have also increased as a result of a non-
late 1980s has led to changes in treatment patterns. There
traditional diets and lack of physical activity. It has been
was an immediate increase in fillings and denture treatments
suggested that schoolchildren who frequently play sports and
soon after the program was instituted.44, 45 Since that time,
lively games are less obese and also more agile and, for this
the rate of surgical procedures has remained high, with
reason, less prone to trauma if they fall while engaged in
preventive procedures making up a smaller proportion of the
these activities.37, 38 The relationship between obesity and
total care provided under the program. This may, in part, be
traumatic dental injuries was evaluated by comparing the
due to the program’s primary mandate which had focused on
mean Body Mass Index (BMI) scores of youth with dental
restorative treatment. In addition, manpower shortages in
injuries to those of youths without dental injuries (Figure 5).
Canada’s north have led dental therapists to perform
The results confirm the hypothesis that the mean BMI is
extractions, restorations and preventative procedures in
higher among youth also reporting recent dental trauma. This
remote and under-served areas serviced by the Medical
is only evident among youth between the ages of 12 and 14.
Services Branch of the Canadian Federal Government.46-48
Figure 5: Mean body mass index (BMI) scores for First Nations Recent data from the NIHB program database on fee-for-
youth by age group and dental injury experienced in the past 12 service dental expenditures by type of service indicate that
months
treatment patterns are beginning to move away from
35
extraction in favor of more restorative care, but that
30
preventive oral health care continues to constitute a smaller
26.3 fraction of the total care provided to the Aboriginal
25.2
25
22.8
24.0 population.27
Mean body mass index
20 It should be noted that the delivery of dental services to

isolated communities remains a difficult undertaking.49, 50
15 Many variables impact on the effectiveness of dental care
programs in Northern Aboriginal communities including: the
10
Injury ongoing problem of finding adequate numbers of dentists and
5
No injury dental hygienists to work in remote areas; the logistics of
organizing travel and accommodations for health care
0 workers and, problems associated with getting patients to the
12-14 15-17
Age group (years)
dentist when the workers are in the area. The RHS results
showed that ‘isolation’ is related to “lack of receipt of dental
Conclusions care in the preceding year,” and to the need for fillings in
youth. Even for non-First Nations children,
Survey data indicated that the receipt of dental care was high remoteness/isolation can be related to lack of access to care.
among First Nations youth and was comparable to the For example, the oral health and treatment needs of children
national rate for Canadian youth. Nonetheless, the findings in Thunder Bay, a northern community in Ontario, were
also point to a pattern of dental care that remains episodic significantly worse than those of communities located in the
and symptomatic, with care usually being undertaken for southern part of the province.51 These differences by
emergency rather than preventive reasons. Evidence in geographic location persisted after controlling for the age of
support of this statement comes from the RHS findings the children in the areas studied.
related to the dental treatment needs of youth. The questions
on the need for cavities filled, maintenance work and The degree of isolation of an Aboriginal community can also
extractions provide valuable insights into the differences in affect food consumption patterns, particularly among youth
the patterns of treatment received. Among respondents who who often make poor dietary choices. The cost of purchasing
needed dental treatment, the majority reported needing marketed food in northern communities remains high
193
3. Charles W. Grim et al., Fall 1994, A comparison of dental caries experience in Native
because of high transportation costs (food is often American and Caucasian children in Oklahoma, Journal of Public Health Dentistry, 54, 4: 220-
transported by air). This also means that the variety and 227.
4. Joanna Jenny et al., 1991, Differences in need for orthodontic treatment between Native
availability of nutritional foods can often be limited, leaving Americans and the general population based on DAI scores, Journal of Public Health
Dentistry, 51, 4: 234-238.
youth even more likely to eat an unhealthy amount of snack 5. C. M. Schlife and D. B. Jones, 1991, The oral health status of the Inuit people of the North
foods and soft drinks. In fact, soft drink consumption remains Slope of Alaska, Arctic Medical Research, Supplement: 664-665.
6. Anonymous, July 5, 1985, Dental caries in American Indian and Alaskan native children,
one of the major risk factors for tooth decay in children Morbidity & Mortality Weekly Report, 34, 26: 400-401.
7. Meei-shia Chen, 2002, Oral health status and its inequality among education groups:
residing in First Nations communities and their dietary comparing seven international study sites, International Journal of Health Services, 32, 1: 139-
choices as children are very likely to influence their choices 161.
8. Scott M. Presson, William J. Niendorff and R. Frank Martin, Special Issue 2000, Tooth loss
as youth52. and need for extractions in American Indian and Alaska Native dental patients, Journal of
Public Health Dentistry, 60, 1: 267-272.
The degree of isolation and remoteness, which affects 9. Fred B. Skrepcinski and William J. Niendorff, Special Issue 2000, Periodontal disease in
American Indians and Alaska Natives, Journal of Public Health Dentistry, 60, 1: 261-266.
accessibility to health care services, and the availability and 10. R. G. Nelson et al., August 1990, Periodontal disease and NIDDM in Pima Indians, Diabetes
Care, 13, 8: 836-840.
cost of food, is only one of the many risk factors for systemic 11. Sabrina Peressini et al., “Prevalence of dental caries among 7- and 13-year-old First Nations
and oral diseases in this population. children, District of Manitoulin, Ontario,” Journal of the Canadian Dental Association
[online]. June 2004, vol. 70, no. 6, p. 382. Available from World Wide Web: <http://www.cda-
adc.ca/jcda/vol-70/issue-6/382.pdf>.
Interesting associations also were found between dental pain 12. Saskatchewan Indian Federated College, Report on the 1996-7 Oral Health Survey of
Canada’s Aboriginal Children Aged 6 and 12 (Prince Albert, Sask.: National School of Dental
and youth personal wellness and mental health, and between Therapy, with the collaboration of the University of Saskatchewan College of Dentistry and
dental injuries and BMI (among 12–14 year olds only). A 13.
the College of Medicine, Department of Community Health and Epidemiology, 1998).
James L. Leake, ed., Oral Health Survey of Canada’s Aboriginal Children Aged 6 and 12,
thorough discussion of these associations is not offered here 1990-91 (Toronto, Ont.: Department of Community Dentistry, University of Toronto and
National School of Dental Therapy, 1992).
but suffice it to say that these findings are not surprising 14. Rosamund L. Harrison and Don W. Davis, April 1993, Caries experience of Native children of
given the evidence that health in general, and oral health in British Columbia, Canada, 1980-1988, Community Dentistry & Oral Epidemiology, 21, 2:
102-107.
particular, are products of multiple levels of influence that 15. Bonnie J. Trodden, 1991, Swampy Cree Tribal Council dental survey, Probe, 25, 2: 68-72.
16. Mark P. Zammit et al., Summer 1994, The prevalence and patterns of dental caries in Labrador
can include (but are not limited to) genetics, individual Inuit youth, Journal of Public Health Dentistry, 54, 3: 132-138.
behaviors and social environment. Any combination of these 17. P. F. Gagnon et al., 1991, Dental caries indices and treatment levels in a young Canadian Inuit
population, Arctic Medical Research, Supplement: 681-682.
factors can often result in poor systemic and oral health, 18. David Klooz, 1988, Dental health status of native children on selected Saskatchewan Reserves,
Canadian Journal of Community Dentistry, 3, 1: 32-39.
which in turn impact negatively on an individual’s quality of 19. L. MacDonald and R. MacMillan, 1988, Dental caries experience of Inuit children in the
life. Unfortunately, the problems of youth violence, suicide 20.
Keewatin region, Northwest Territories, 1983/84, Arctic Medical Research, 47, 1: 557-561.
James J. Messer, 1988, An overview of dental care delivery and dental health in Northern
and alcohol, solvent and drug abuse persist and continue to Newfoundland and Labrador, Canadian Journal of Community Dentistry, 3, 1: 45-53.
21. LeRoy Shaw, D. Christopher Clark and N. P. Edger, March 1987, The oral health status of
present First Nations communities with health challenges for Cree children living in Chisasibi, Quebec, Journal of the Canadian Dental Association, 53, 3:
the future. While these problems tend to dominate the 22.
201-205.
Keith C. Titley and Dennis H. Bedard, November 1986, An evaluation of a dental care
headlines, declining levels of physical activity and increasing program for Indian children in the community of Sandy Lake: Sioux Lookout Zone, 1973-
1983, Journal of the Canadian Dental Association, 52, 11: 923-928.
levels of obesity are also affecting the health of Aboriginal 23. John T. Mayhall, November-December 1975, Canadian Inuit caries experience, 1969-1973,
young people. 24.
Journal of Dental Research, 54, 6: 1245.
Gordon S. Myers and Melvin Lee, March-April 1974, Comparison of oral health in four
Canadian Indian communities, Journal of Dental Research, 53, 2: 385-392.
On a more positive note there have been a few new 25. J. A. Hargreaves and K.C. Titley, Oct 1973, The dental health of Indian children in the Sioux
Lookout Zone of Northwestern Ontario, Journal of the Canadian Dental Association, 39, 10:
preventative oral health programs put into place in an effort 709-714.
to alleviate the high levels of oral disease in Aboriginal 26. C. W. B. McPhail et al., 1972, The geographic pathology of dental disease in Canadian central
arctic populations, Journal of the Canadian Dental Association, 38, 8: 288-296.
children and youth in Canada and the U.S.53-56 While these 27. Health Canada, Non-insured Health Benefits Directorate Program Analysis Division, Non-
insured health benefits program annual report 2003-2004 [online]. Available from World
programs apparently have yet to reduce levels of dental Wide Web: <http://www.hc-sc.gc.ca/fnihb/nihb/annualreport/annualreport2003_2004.pdf>
caries to more manageable levels, inroads have been made 28. Gary D. Slade, December 2001, Epidemiology of dental pain and dental caries among children
and youth, Community Dental Health, 18, 4: 219-227.
towards reducing oral health inequities using population- 29. T. K. Young, M. E. Moffatt and J. D. O'Neill, 1992, An epidemiological perspective of injuries
in the Northwest Territories, Arctic Medical Research, 51, 7: 27-36.
based approaches to disease prevention such as water 30. Fred Wien and Lynn McIntrye, “Health and Dental services for Aboriginal People,” First
fluoridation. In some areas of the country, clinical dental Nations and Inuit Regional Health Survey [online]. [Ottawa, Ont.]: First Nations and Inuit
Regional Health Survey National Steering Committee, 1999, pp. 219-245. Available from
personnel have been reoriented to devote an increased World Wide Web: <http://www.naho.ca/firstnations/english/pdf/key_docs_1.pdf>.
31. Wayne J. Millar, “Dental consultations,” Health Reports 16, 1 (October 2004), pp. 41-44. See
proportion of available patient care time to primary also the detailed tables for the CCHS from the CANSIM database. Available from World Wide
preventive services. Until holistic views affecting health and Web: <http://cansim2.statcan.ca/cgi-
win/cnsmcgi.exe?LANG=e&ResultTemplate=CII&CORCMD=GETEXT&CORTYP=1&CO
welfare (some of which have been noted above) are further RRELTYP=4&CORID=3226>.
32. Health Canada, Statistics Canada and the Canadian Institutes for Health Information, “Dental
articulated, it may take time before oral health is recognized Visits,” Statistical Report on the Health of Canadians [online]. [Charlottetown, P.E.I.]: Health
as a primary health care priority for young First Nations Canada, Statistics Canada and the Canadian Institutes for Health Information, 1999, pp. 97-99.
Available from World Wide Web: <http://www.statcan.ca:8096/bsolc/english/bsolc?catno=82-
people. 570-X&CHROPG=1>.
Notes to Chapter 21 34. Carlos R. Quinonez, 2004, A political economy of oral health services in Nunavut,
International Journal of Circumpolar Health, 63, 2: 324-329.
35. Clemencia M. Vargas et al., Winter 2005, Dental pain in Maryland school children, Journal of
1. William J. Niendorff and Candace M. Jones, Special Issue 2000, Prevalence and severity of Public Health Dentistry, 65, 1: 3-6.
dental caries among American Indians and Alaska Natives, Journal of Public Health Dentistry, 36. David Locker, January-February 2005, Prevalence of traumatic dental injury in grade 8
60, 1: 243-249. children in six Ontario communities, Canadian Journal of Public Health / Revue Canadienne
2. Eric B. Broderick and William J. Niendorff, Special Issue 2000, Estimating dental treatment de Santé Publique, 96, 1: 73-76.
needs among American Indians and Alaska Natives, Journal of Public Health Dentistry, 60, 1: 37. Ronald C. Plotnikoff, Kim Bercovitz and Constantinos A. Loucaides, November-December
250-255. 2004, Physical activity, smoking, and obesity among Canadian school youth. Comparison
194
between urban and rural schools, Canadian Journal of Public Health / Revue Canadienne de
Santé Publique, 95, 6: 413-418.
38. S. Petti, G. Cairella and G. Tarsitani, December 1997, Childhood obesity: a risk factor for
traumatic injuries to anterior teeth, Endodontics & Dental Traumatology, 13, 6: 285-288.
39. Douglas Galan, Olva Odlum and Michel Brecx, February 1993, Oral health status of a group of
elderly Canadian Inuit (Eskimo), Community Dentistry & Oral Epidemiology, 21, 1: 53-56.
40. Douglas Galan, et al., July 1993, Medical and dental status of a culture in transition, the case of
the Inuit elderly of Canada, Gerodontology, 10, 1: 44-50.
41. Elizabeth Rea et al., February 1993, Adult dental health in the Keewatin, Journal of the
Canadian Dental Association, 59, 2: 117-118, 122-125.
42. Presson, Niendorff and Martin, Tooth loss and need for extractions in American Indian and
Alaska Native dental patients.
43. Skrepcinski and Niendorff, Periodontal disease in American Indians and Alaska Natives,
Journal of Public Health Dentistry.
44. James G. Messer, 1991, The effect of non-insured health benefits on dental treatment provided
in four coastal Labrador communities by salaried dentists, Arctic Medical Research,
Supplement: 662-663.
45. Mark P. Zammit, January 1993, Patterns of patient attendance and dental service utilization in
northern Labrador 1985-1989, Arctic Medical Research, 52, 1: 5-12.
46. P. T. McDermott, J. T. Mayhall and J. L. Leake, 1991, Dental therapists and the delivery of
dental care in Canada's Northwest Territories, Arctic Medical Research, Supplement: 668-671.
47. K.W. Davey, 1988, Primary dental care in Canadian Arctic communities, Arctic Medical
Research, 47, 1: 562-563.
48. W. R. Bedford and K.W. Davey, February 1993, Indian and Inuit dental care in Canada: the
past, the present, and the future, Journal of the Canadian Dental Association, 59, 2: 126, 130-
132.
49. Mark Zammit, 1991, Frustrations in delivering a dental service to the north coast of Labrador,
Arctic Medical Research, Supplement: 672-674.
50. K. C. Titley, July 1977, Dentistry and the Indians of Ontario, Ontario Dentist, 54, 7: 14-27.
51. David Locker et al., Spring 2004, Identifying children with dental care needs: evaluation of a
targeted school-based dental screening program, Journal of Public Health Dentistry, 64, 2: 63-
70.
52. Herenia P. Lawrence et al., Effects of a Community-based Prenatal Nutrition Program on the
Oral Health of Aboriginal Preschool Children in Northern Ontario, Probe [online]. July-
August 2004, vol. 38, no. 4, pp. 172-182, 184-186, 188, 190. Available from World Wide
Web: <http://www.caphd-acsdp.org/Aboriginal%20Preschool.pdf>.
53. Rosamund Harrison, May 2003, Oral health promotion for high-risk children: case studies
from British Columbia, Journal of the Canadian Dental Association, 69, 5: 292-296.
54. Lawrence et al., Effects of a community-based prenatal nutrition program on the oral health of
Aboriginal preschool children in Northern Ontario, Probe.
55. Dolores M. Malvitz and Eric B. Broderick, 1989, Assessment of a dental disease prevention
program after three years, Journal of Public Health Dentistry, 49, 1: 54-58.
56. David A. Nash, Winter 2005, Developing and deploying a new member of the dental team: a
pediatric oral health therapist, Journal of Public Health Dentistry, 65, 1: 48-55.
195
Table 1. Proportion of First Nations youth who had dental care in the previous year by age group
and selected respondent’s characteristics
12-14 years 15-17 years
Characteristic Total Dental care Weighted Total Dental care Weighted
n n % n n %
Overall 2,087 1,706 80.7 2,490 1,910 77.0
Gender
Male 1,006 800 78.8 1,229 911 75.0
Female 1,081 906 82.7 (NS) 1,261 999 79.2 (NS)
Mother and/or father was a student of
a residential school
Yes 545 446 79.5 778 615 83.2
No 1,268 1,048 81.5 (NS) 1,352 1,017 75.2
Last instance of consulting a traditional
healer
Within the last 12 months 180 155 88.4 (NS) 287 243 87.9
1-2 years ago 94 81 83.6 (NS 139 114 86.2 (NS)
Over 2 years ago 74 53 69.2 (NS 118 88 81.2 (NS)
I don’t remember 188 156 82.9 (NS 248 195 67.6
Never 1,385 1,117 79.3 (NS 1,515 1,134 75.1
Reported general health status
Excellent 587 491 86.0 466 383 82.6
Very good 728 600 80.3 (NS 857 661 83.2 (NS
Good 591 464 77.6 (NS 859 637 70.2
Fair 130 107 73.3 (NS 234 175 75.5 (NS
Poor 14 12 82.7 (NS 39 24 62.6 (NS
Highest level of education the
participant would like to attain
High school diploma 476 362 71.3 617 435 68.9
College/CEGEP (in Québec) diploma 210 117 82.8 (NS 288 235 84.5
Trade/technical/vocational school 91 77 85.5 (NS 149 104 69.3 (NS
University degree 697 586 83.0 (NS 751 605 79.5 (NS
Master’s degree 242 202 88.8 285 235 81.7 (NS
Doctorate degree 123 107 92.3 129 113 92.3
Data source: First Nations Regional Longitudinal Health Survey 2002-03; First Nations Information Governance Committee – Assembly of First
Nations, First Nations Centre at the National Aboriginal Health Organization.
196
Table 2. Reported types of dental treatment needs of First Nations youth by age group and gender
Current Dental Treatment Total Male 12-14 Male 15-17 Female 12-14 Female 15-17
Needs
(n=4,515) (n=981) (n=1,201) (n=1,089 (n=1,244)
Cavities filled or other
36.6% 31.7% 32.5% (NS) 38.6% 43.7% (NS)
restorative work
Maintenance 42.0% 37.0% 42.0% (NS) 41.7% 46.6% (NS)
Extractions 6.1% 3.9% 8.2% (NS) 4.5% 7.2% (NS)
Fluoride treatment 12.9% 12.6% 9.2% (NS) 17.7% 13.5% (NS)
Periodontal work 1.4% 0.3% 2.2% (NS) 0.9% 1.7% (NS)

197
Table 3. Proportion of First Nations youth who experienced problems with their teeth or dental
pain in the past month by age group and selected respondent’s characteristics

Characteristic Total Dental pain Weighted Total Dental pain Weighted
n n % n n %
Overall 2,210 395 19.0 2,588 486 19.2

Gender
Male 1,060 156 17.1 1,284 205 15.8
Female 1,150 239 21.1 (NS) 1,304 281 22.8 (NS)
Attendance of residential school by

participant’s mother and/or father
Yes 565 130200 26.6 779 161 19.4

No 1,340 15.4 1,410 255 20.7 (NS)
Attendance of residential school by

participant’s grandparent(s)
Yes 880 190 21.3 1,112 227 21.9

No 692 91 15.4 (NS) 642 108 17.2 (NS)
Reported general health status
Excellent 617 104 19.6 480 76 15.5

Very good 767 121 17.6 (NS) 912 148 19.4(NS)
Good 630 113 18.9 (NS) 882 175 17.4(NS)
Fair 138 37 21.9 (NS) 240 63 21.9(NS)
Poor 14 4 - 40 16 -
Current smoking status
Not at all 1,694 250 17.0 1,166 179 17.2

Occasionally 197 53 32.8 (NS) 378 70 16.7 (NS)
Daily 270 81 995 230 23.7 (NS)
Repeated a grade in school
Yes 674 156 27.3 1,206 287 25.4

No 1,510 233 14.9 1,324 193 12.8
Problems learning at school
Yes 882 202 20.1 947 225 26.1
No 1,307 191 18.2 1,607 255 14.5
198
Characteristic Total Dental pain Weighted Total Dental pain Weighted
n n % n n %
Level of agreement with self-worth

statements (e.g. “In general, I like the
way I am.”)
Strongly agree 864 140 17.2 986 160 13.1
Agree 992 169 19.3 (NS) 1,124 213 20.1
Neither agree nor disagree 162 30 18.9 (NS) 262 52 16.4 (NS)
Disagree 73 18 - 97 30 46.4
Strongly disagree 22 7 - 29 7 -
Level of agreement with self-
determination statements (e.g. “I often
feel helpless in dealing with the
problems of life.”)
Strongly agree 103 22 - 164 43 43
Agree 524 116 22.4 (NS) 576 133 18.9
Neither agree nor disagree 430 75 13.7 537 105 18.4
Disagree 801 114 15.1 920 147 15.9
Strongly disagree 133 21 - 188 28 -
Ratings on emotional well being
questions (e.g. “How stressed do you
feel?”)
Not at all 907 120 14.6 875 107 10.5
A little 721 131 16.0 (NS) 913 180 17.7
Moderately 155 39 33.1 262 60 22.9
Quite a bit 148 37 34.5 225 64 33.8
A lot 97 28 - 164 49 31.2
Ever felt depressed for 2 wks in a row
Yes 472 142 32.2 704 199 28.9

No 1,565 210 14.2 (NS) 1,668 250 14.9 (NS)
Any attempts to commit suicide during
participant’s life
Yes, when I was under 12 years 36 11 - 34 17 -
Yes, when I was an Youth 44 13 - 182 60 36.8 (NS)
Yes, during the past year 36 9 - 70 19 -
Never 1,997 339 18.3 (NS) 2,176 361 16.4
199
Table 4. Leading causes of dental injury in First Nations youth, by age group and relationship with
alcohol and drug use.
Alcohol or
Age Group Weighted % Drug-Related
Number of Number of
(12-14 yrs; With Dental Accident
Participants Alcohol or
Cause of Injury* n=2,253) Injury Resulting in
Reporting Drug-Related
(15-17 yrs; (12-14 yrs, n=81; Dental Injury
Accident Accidents
n=2,627) 15-17 yrs, n=119) (Weighted
%)**
Suicide attempt or 12 to 14 - - - -
self-inflicted injury
15 to 17 31 - - -
12 to 14 37 - - -
Motor vehicle
accident
15 to 17 75 - - -
Physical assault 12 to 14 58 - - -
(including domestic
violence) 15 to 17 127 - 47 -
12 to 14 - - - -
Hunting accident
15 to 17 - - - -
12 to 14 43 - - -
All terrain vehicle
(ATV) accident
15 to 17 69 - - -
12 to 14 364 11.1 - -
Sport
15 to 17 520 10.8 - -
Snowmobile 12 to 14 57 - - -
accident
15 to 17 89 - - -
Motor vehicle 12 to 14 - - - -
accident involving a
pedestrian 15 to 17 33 - - -
12 to 14 434 11.5 - -
Fall or trip
15 to 17 497 8.6 52 -
Motor vehicle 12 to 14 107 - - -
accident (MVA)
while riding a
15 to 17 122 - - -
bicycle
Bicycle accident not 12 to 14 222 - - -

related to MVA
15 to 17 217 - - -
*Multiple injuries accepted.
**Statistics have not been computed due to low cell frequencies.
- Data suppressed due to small cell size.
200
Chapter 22
Non-Traditional Use of Tobacco (Smoking), Alcohol, and
Drug Use
Abstract
Among the youth respondents of the 2002/03 First Nations Regional Longitudinal Health Survey
(RHS), 37.8% were current smokers. Smoking rates increased with age and females smoked more
within certain age groups. Smoking initiation peaked at age 13 and then decreased. A full 70% of the
sample reported trying to quit smoking at least once. Wanting a healthier lifestyle was the most
frequent reason for quitting. Alcohol drinking also increased with age; it was reported among 42.2%
of the youth. The illicit drug used most frequently was cannabis, at a rate of 32.7%. While cannabis
use increased with age, distribution by sex was similar across users. In order to decrease the
prevalence of these drugs, the authors recommend health promotion programs and interventions that
are designed towards households and families, as opposed to individuals. This approach may increase
awareness across all age groups, may prevent uptake among younger household members and may
increase the number of smoke-free households.
201
RHS 2002/03 Youth Survey – Chapter 22: Non-Traditional Use of Tobacco (Smoking), Alcohol, and Drug Use
comparison of Aboriginal to non-Aboriginal students

Introduction
(n=128) between the ages of 10 and 20 years old in
This chapter will present findings related to youth tobacco predominantly urban areas investigated alcohol and drug
smoking, alcohol use and illicit substance use. Descriptive use.4 After matching on age, sex, grade level, geographical
information, as well as some exploratory bivariate location and socio-economic status, there were no significant
associations between the survey variables and youth differences in the proportion of drug or alcohol users
smoking, alcohol and substance uses are illustrated to assess between the two groups of students within the previous 12-
any modifiable risk factors and to highlight protective month period. Tobacco, alcohol and cannabis were the drugs
factors. most often used. There were no significant differences in the
proportion of youth feeling drunk between both groups,
The First Nations Regional Longitudinal Health Survey
however among the monthly-drinkers, more Aboriginal
(RHS) 2002/03 is the first national survey to examine First students had at least one episode of heavy drinking (having
Nations youth living on-reserve. The previous 1997 First five or more drinks on one occasion). More recent data
Nations and Inuit Regional Longitudinal Health Survey demonstrate that Aboriginal youth are at two to six times
(FNIRLHS) did not contain a self-administered youth higher risk for alcohol-related problems compared to other
component. Instead, parents and/or guardians proxied on
Canadian youth.5 The 2002 Youth Smoking Survey included
behalf of their children and youth. Having this separate questions on alcohol and drug use. Aboriginal-specific data
survey for youth is a tremendous resource. In order to were not prepared. The data show that among the youth in
improve the health of First Nations youth, appropriate Grades 7–9, 55% had consumed alcohol in their lifetime.6
baseline data are necessary to monitor usage rates and Alcohol use increased from 38% in Grade 7 to 69% in Grade
behaviours. The RHS 2002/03 will now provide the data to 9. The most commonly used illicit drug was cannabis (18%).
achieve this through its longitudinal design. Cannabis use also increased from Grade 7 to Grade 9, from
8% to 30%. Six percent of the sample responded to using an
Literature Review illicit drug other than cannabis. Overall, these data revealed a
strong association between tobacco-smoking and alcohol and
Non-traditional tobacco use drug use.
Among the literature reviewed, rates of tobacco smoking
among First Nations youth varied considerably. According to Interpretation Methods
the Aboriginal Peoples Survey, the prevalence of tobacco The authors took an exploratory approach towards the
smoking among Aboriginal youth was 54% among the 15–19 analysis of this chapter. All survey items that might influence
year olds and 65% among the 20–24 year olds. Inuit youth the tobacco, alcohol and drug use of First Nations youth were
are more likely to smoke (73% in the 15–24 age group) examined. When interesting trends or patterns would emerge,
compared to the Métis or First Nations youth (56% and 59% whether or not an association was statistically significant, the
respectively in the 15–24 age group).1 Data from the 2002 data were reviewed in further detail and reported on. The
Youth Smoking Survey show that the prevalence of tobacco philosophy was to maximize the amount of information that
smoking among Canadian youth between Grades 5 and 9 was could be presented in order to provide a range of data for
23%, increasing from 7% in Grade 5 to 42% in Grade 9.2 A future research. Wherever possible, First Nations input was
sample of the survey’s youth identified themselves as included throughout the interpretation and write-up phases of
Aboriginal. Among them, 50.9% were never smokers and the analyses.
had never seriously thought of smoking (compared to 70.2%
among the non-Aboriginal survey participants), 10.1% were Approximately 12.2% of First Nations youth reported being
never smokers, but had seriously thought of smoking an “occasional smoker.” These youth were comparable to
(compared to 8.0%), 15.7% were considered puffers “daily smokers” in terms of their gender and age. Therefore,
(compared to 10.0%), 17.6% smoked beyond puffing, but to simplify the comparison between these youth, a “current
were not daily smokers (compared to 10.1%) and smoking status” variable was created combining “daily
approximately 5.7% were daily smokers (compared to 1.6% smokers” and “occasional smokers.” The intention of these
among the non-Aboriginal survey participants). More recent findings is to explore tobacco rates and behaviours, and
data demonstrates in a slightly older sample of Canadian ultimately to describe the characteristics of non-smokers in
youth a tobacco-smoking prevalence of 20% among 15–19 an effort to replicate their resiliency.
year olds and 27% among 20–24 year olds.3 Overall,
Aboriginal youth have an alarmingly higher smoking Results
prevalence compared to other youth in Canada.
Rates of use
Alcohol and substance use
Figure 1 illustrates the non-traditional tobacco smoking rates
Literature on alcohol and substance use and behaviours by age and gender among 4,860 First Nations youth. Overall,
among Canadian Aboriginal youth is limited. A matched
202
the smoking prevalence among this sample was 37.8%.i The Table 1. Proportion of youth using various substances at least
once in the past year (n=4,770)
prevalence increased with age, ranging from 10.9% among
Substance Proportion using (%)
12 year olds to 60.7% among 17 year olds.ii Between ages 12 Chewing tobacco 5.8
and 14, rates of smoking almost tripled, increasing up to Cannabis (marijuana, weed, grass) 32.7
29.5%. Rates of use are higher among females compared to PCP or angle dust 0.9
males, for certain age groups (for instance, 64.5% of 13 year Acid, LSD, or amphetamines 1.5
Ecstasy 0.8
old smokers were female). Inhalants (glue, gas, paint) 1.5
Figure 1. Tobacco smoking rates by age and gender (n=2.494) Sedatives or downers 0.8
Cocaine, crack, freebase 1.8
80%
Codeine, morphine, opiates 3.5
Heroin 0.2
66.6% 66.6%
60%
Male Tobacco smoking behaviours
Female 55.9%
Of the youth who were former tobacco smokers (meaning

45.9%
43.8% that the youth had been daily smokers and had quit or that
39.1% 39.3%
40% they had experimented with smoking and currently do not
smoke) (5.7%), the average age of initiation was 12.2 years
21.4% old. The average quitting age was 14 years old. These youth
18.2%
20% quit smoking for a variety of reasons. While respondents
9.4% could select more than one reason, the reason reported by the
highest proportion of youth was to choose a healthier
0% lifestyle (49.2%). The second highest response was quitting
13 14 15 16 17
Age (years) out of respect for loved ones (25.9%). The third ranked
*Percentage for age 12 is suppressed due to small sample size. response was having greater awareness or education on the ill
effects of tobacco on health (18.2%) followed by actually
When asked if during the past 12 months the youth had acquiring a health condition (13.0%).
consumed a drink of beer, wine, liquor or any other alcoholic Of the current tobacco smokers, the average age of initiation
beverage, 42.2% reported yes. Among these respondents, was about half a year later at 12.7 years old. Smoking
approximately 52.3% were female and 78.7% were between initiation began at age four, and then steadily increased up to
15 and 17 years old. The youth who had reported alcohol age 13. After peaking at age 13, smoking initiation decreased
consumption over the previous year were asked how often by age (35.9% of this sample initiated smoking after age 13).
they had consumed five or more drinks on one occasion. The youth smokers reported an average of 5.9 cigarettes each
While a small proportion (12.6%) responded they had had day. This group responded that over the past 12 months,
five or more drinks on one occasion more than once per approximately 69.5% had tried to quit smoking at least once
week. 64.6% of all youth reported this consumption at a rate (41.5% had tried 1–2 times, 13.5% had tried 3–4, and 14.5%
of at least once per month. Generally speaking, more had tried to quit at least 5 times).
frequent drinking occurred among older youth.
The prevalence and frequency distribution of substance use is Factors related to tobacco use
reported in Table 1. The majority of youth reported never An investigation into potential associations was conducted
using many of the substances inquired about. The substances between all of the survey items to the substances that were
reported among a larger portion of the sample were chewing used by at least 10% of youth: tobacco smoking, cannabis
tobacco (5.8%) and cannabis (32.7%). Higher proportions of use and alcohol consumption. An overview of the findings is
the chewing tobacco users were within the 15–17 age range. presented below.
Cannabis use was similar across gender: however there were
significant differences between age categories. Among the Lifestyle
12–14 year olds, 14.9% reported cannabis use compared to
47.5% of the 15–17 year olds. Tobacco smokers reported more cannabis and alcohol use
compared to non-tobacco smokers. This increased use of
cannabis was also reported among alcohol drinkers compared
to non- drinkers. Tobacco and alcohol users reported a higher
proportion of use of each of the substances (recreational
drugs/non-medical drugs) presented in Table 1. Similarly,
cannabis users were also more likely to use these substances
i
(aside from cannabis itself) than non-cannabis users. These
ii
Comparisons between groups or categories are statistically significant except where “NS” —not findings should be incorporated with caution, as the sample
intervals do not overlap at the 95% confidence level (after Bonferroni adjustment). sizes are quite small.
203
In order to estimate environmental tobacco smoke (second- Body Mass Index (BMI) values were calculated by cannabis
hand smoke) exposure, the respondents were asked if they use, tobacco smoking and alcohol consumption status. There
had a smoke-free home. The responses of the cannabis users were statistical differences for cannabis use and alcohol use.
and alcohol consumers were similar to non-users/consumers, There were no differences however for tobacco users
however tobacco smokers and non-smokers responded compared to non-users.
differently. Approximately half (52.7%) of the non-smokers
Each of the non-tobacco smokers, non-alcohol drinkers and
reported being exposed to second-hand smoke in their home
non-cannabis users groups of youth reported eating a
compared to 60.5% of smokers.
nutritious balanced diet more frequently compared to the
smokers, drinkers and users.
Household, living environment and ecological information
A variable was created to assess the remoteness of the Physical activity
respondents’ community of residence. There was no
Both alcohol consumers and non-consumers participate just
difference in the community remoteness when comparing the
as often in any kind of physical activity, while tobacco and
alcohol drinkers to non-drinkers. However there were
cannabis smokers/users participate less often compared to
significant differences in the distribution of tobacco smokers
non-smokers/users. Over one-third (35.9%) of non-smokers
compared to non-smokers across community remoteness, in
and non-cannabis users reported being physically active
that there was a higher proportion of youth who did not
everyday. This is in contrast to 27.4% of smokers and 26.8%
smoke living in non-isolated communities compared to
of cannabis users.
isolated communities.
Youth who smoke tobacco reported less time commitment
Education, language and traditional culture towards taking part ‘in sports and teams or lessons outside of
school’. The opposite pattern emerged from the responses
A higher proportion of First Nations youth who report never
about time spent with a job outside of school as youth
smoking cannabis, not drinking over the past 12 months or
tobacco smokers are more likely to report working at a job
being non-tobacco smokers ranked higher in liking school
four or more times a week compared to the non-smokers. A
‘very much’ as compared to youth smokers/users/drinkers.
different distribution was reported related to time spent
The youth were asked to report on the importance of taking part in art or music groups or lessons whereas there
speaking their First Nations language as well as to rank how were no differences among users of the three substances.
important traditional cultural events were in their lives. With regards to time involvement towards traditional
Overall, the youth responded similarly (with no significant singing, drumming or dancing groups or lessons, all youth
differences) to these survey questions despite their smoking, (despite usages) responded similarly.
drinking, and/or substance use behaviour(s).
The responses of the cannabis users, tobacco smokers and
alcohol drinkers compared to non-smokers/users/drinkers
General Health, personal wellness and support
varied for a series of self-worth and emotional wellbeing
In many surveys, respondents are asked to remark on their statements. Youth who were non-smokers/users/drinkers
health as being excellent, very good, good, fair or poor. were more likely to agree to some extent that: they like the
Results from this sample reveal that First Nations youth who way they are, they have a lot to be proud of, and a lot of
smoke tobacco, drink alcohol or use cannabis rank their things about them are good.
health status as excellent or very good less often compared to
Responses to a set of emotional wellbeing statements
non-smokers/users/drinkers. The largest difference in the
demonstrate that users and non-users feel differently about
distribution of responses to having excellent or very good
being lonely, loved and stressed (Figure 2). Indeed, alcohol
health was seen when comparing the tobacco smokers to the
and cannabis users as well as smokers are more likely to feel
non-smokers (46.8% and 62.7% respectively). Those who
lonely and stressed a lot, and are less likely to feel loved a lot
ranked their health as excellent or very good were asked
compared to non-users.
what things (from a scripted list of which youth could choose
more than one response) make them so healthy (for example, Emotional needs were assessed through eight questions
good diet, reduced stress, and good social supports). inquiring on First Nations youth’s perception of their support
However, there were no significant differences in the availability. Tobacco/cannabis smokers and alcohol drinkers
response pattern between smokers and non-smokers. were less likely than non users to state that there is someone
available who shows them love and affection all of the time.
Overall, a higher proportion of cannabis users and alcohol
Similarly, tobacco smokers and cannabis users are less likely
drinkers were dissatisfied to some extent with their weight
than non-users to report that they have someone to take them
compared to non-users and non-drinkers. For youth who to the doctor any time there is the need. Smokers were also
smoke or drink alcohol, a higher proportion of males ranked less likely than non-smokers to report that they have
being ‘very satisfied’ with their weight compared to females.
204
Figure 2. Proportion who are not lonely, feel loved a lot, and are not stressed by alcohol, cannabis, and cigarette use (n=4,440)
70%
Not at all lonely
Loved a lot
Not at all stressed
60% 57.9% 57.3%
56.6%
53.4%
52.2%
50.9%
50%
46.5%
43.5% 42.8% 43.1%
41.0%
39.1% 39.8%
40% 38.3% 37.6%
30.0% 29.7%
30%
26.8%
20%
10%
0%
No Yes No Yes No Yes
Alcohol use Cannabis use Cigarette use
Substance use
someone available to do something enjoyable with all of the Identifying information on age of smoking initiation will
time. assist in creating timely prevention programs. These data
reveal an early age of initiation that peaks at age 13, then
Non-drinkers, non-smokers, and those who did not use
declines. In Reading and Allard’s analysis of the 1996 RHS,
cannabis are more likely to report that they never had thought
their data revealed the same pattern with retrospective data as
about suicide compared to users of these substances.
well demonstrating that if initiation did not occur by the ages
The youth were asked if either or both of their parents were 18 or 19, individuals were unlikely to ever become
ever students of a residential school. There were differences smokers.10 Preventing smoking initiation may produce
between the responses of the tobacco smokers and alcohol secondary healthy effects by blocking the gateway drug
drinkers compared to the non-smokers/drinkers in that if a hypothesis. This theory suggests that tobacco is the primary
parent attended residential school, youth were more likely to drug used before subsequent and increasingly unhealthy drug
report drinking or smoking. More than 42.2% of the youth experimentation.11 RHS data supported this theory as drug
smokers had at least one parent who had attended a use was clustered among the smokers, cannabis users and
residential school compared to less than 28.4% of the non- alcohol drinkers.
tobacco smokers.
Although the prevalence of tobacco smoking among First
Nations youth surpasses that of other Canadian youth, the
Discussion number of cigarettes smoked per day is lower. Among the
More than 20% of First Nations people were between the fifth to ninth graders in the 2002 Youth Smoking Survey, on
ages of 10 and 19 years old in 1999 according to the First average youth smoked on average 8.1 cigarettes per day,
Nations and Inuit Health Branch.7 It is paramount to compared to 5.9 per day among this sample.12 Increasing
recognize that most of these youth are healthy! Furthermore, age/grade of the youth of both national surveys was
it is vital to keep these youth healthy and to create associated with higher rates of smoking, however gender
opportunities for others among them to prioritize their health showed significant difference distinctly between the two.
and well-being. Among the First Nations youth, females had a higher
proportion of smoking across certain age groups.13
While this data demonstrates that rates of alcohol
consumption and cannabis use are high, tobacco smoking is a It is important to recognize that there are similar
known incredibly significant modifiable risk factor to current characteristics between the youth who smoke and those who
and future health illnesses.8,9 For that reason it will be don’t. For instance, both groups report placing a lot of
discussed in more depth here. importance on speaking the language of their First Nation
and having traditional cultural events in their lives. The areas
205
with disturbing differences were in regards to the youth’s may increase awareness across all age groups and family
perceived emotional support and well-being. These data members (grandparents, parents, siblings, cousins, etc.). As
reveal poorer self-esteem, social support and resources well, it may prevent uptake among younger household
among smokers. members and may increase the number of smoke-free
households. This recommendation is supported by the data
Expressions and experiences of First Nations non-smoking that indicate youth smokers perceived less social support and
youth resources compared to non-smokers. A household/family
program might encourage a sense of togetherness, belonging,
It is important to describe what makes some youth resilient to
and support.
addiction to tobacco smoking. Former smokers and youth
who initiated smoking but did not progress to currently
smoking, quit to aspire to a healthy lifestyle or out of respect Notes to Chapter 22
for a loved one. Non-smokers are more likely to live in a
1. T. Stephens, Smoking among Aboriginal people in Canada, 1991 (Ottawa, Ont.: Ministry of
smoke-free home and in a non-isolated community. These Supply and Services Canada, 1994).
youth enjoy school very much and a high proportion of them 2. P. Smith et al., “Smoking Behaviour,” Youth Smoking Survey 2002 (Ottawa, Ont.: Health
Canada, 2004).
rank their health as excellent or very good. 3. Canadian Tobacco Use Monitoring Survey (CTUMS), Results from the first wave of 2004
(Ottawa, Ont.: Health Canada Tobacco Control Programme, 2004).
4. C. B. Liban and R. G. Smart, 1982, Drinking and drug use among Ontario Indian students,
Drug and Alcohol Dependence, 9: 161-171.
Recommendations and Solutions 5. K. A. Scott, “Substance use among Indigenous Canadians,” Aboriginal Substance Abuse:
Research Issues, proceedings of a joint research advisory meeting, edited by D. McKenzie
“We need to know more about our youth to understand (Ottawa, Ont.: Canadian Centre on Substance Abuse, 1994).
6. E. M. Adlaf and S. Racine, “Alcohol and Other Drugs,” Youth Smoking Survey 2002 (Ottawa,
them. Then we can help the move in making the right Ont.: Health Canada, 2004).
choices. It is very important you guys keep doing it and 7. First Nations and Inuit Health Branch, A statistical profile on the health of First Nations in
Canada (Ottawa, Ont.: Health Information and Analysis Division, Health Canada, 2003).
find out what is important to our youth. So we can have 8. U.S. Department of Health and Human Services, The health consequences of smoking:
cancer—a report of the Surgeon General (Rockland, Md.: Public Health Services, Office on
more influence on what they do and help make more Smoking and Health, 1982).
positive choices in the harsh world that we live in.” 9. U.S. Department of Health and Human Services, Preventing tobacco use among young people:
a report of the Surgeon General (Atlanta, Ga.: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Center for Chronic Disease
(Comment by a youth who participated in Prevention and Health Promotion, Office on Smoking and Health, 1994).
10. J. Reading and Y. Allard, The tobacco report, Ottawa, Ont.: First Nations and Inuit Regional
Aboriginal Youth Lifestyle Survey at the North Health Survey National Steering Committee, 1999).
11. U.S. Department of Health and Human Services, Preventing tobacco use among young people:
American Indigenous Games, 2002) a report of the Surgeon General.
12. Smith et al., “Smoking Behaviour,” Youth Smoking Survey 2002.
To decrease tobacco smoking, cannabis use and alcohol 13. Ibid.
drinking amongst First Nations youth, it is recommended that

health promotion programs and interventions be designed Further References
towards households and families, as opposed to individuals. A. J. Ritchie and J. L. Reading, 2004, Tobacco smoking status among Aboriginal youth, International
Journal of Circumpolar Health, 63, 2: 405-409.
A household oriented program for smokers and non-smokers,
drinkers and non-drinkers, drug users and non-drug users
206
Chapter 23
Abstract
The 2002-2003 First Nations Regional Longitudinal Health Survey (RHS) indicates that 28.4% of
First Nations youth (ages 12-17) report being sexually active, while 30.9% report being sexually
active in the last 12 months. These rates are considerably lower than the estimated 49.9% of
mainstream Canadian youth reported as sexually active. Significance is drawn from the sexual activity
patterns of First Nations youth by gender and age. 65.6% of First Nations males aged 17, and 57.3%
of First Nations females aged 17, report being sexually active. First Nations youth aged 13 and 14
report sexual activity at 2.6% and 18.8% respectively, or approximately 8 to 9% more than non-
Aboriginal youth. In comparison to the 70 to 80% of mainstream Canadian youth who report condom
use, 81.0% of First Nations youth report using a condom, with 66.6% reporting always using a
condom for protection to avoid sexually transmitted infections (STIs). 10.9% of First Nations youth
report using no form of birth control protection. 67.9% of First Nations females aged 17 report using
condoms for birth control protection, in comparison to 91.4% of First Nations males of the same age
group. 4.5% of First Nations youth report having been pregnant or getting someone pregnant. The
situation of First Nations females, in particular, suggests that current rates of teen pregnancy, STIs
and Human Immunodeficiency Virus (HIV) infection, coupled with reported birth control protection
patterns for this group, warrant immediate attention. In addition, the historical contexts of abuse,
trauma, and largely poor living conditions that contribute to an environment of socio-cultural change
must be considered in order to fully understand their impact upon the sexual health of First Nations
youth.
207
RHS 2002/03 Youth Survey – Chapter 23: Sexual Health Practices
First Nations males and females. These rituals are performed

Introduction
in order to educate youth of the power that sexuality
The sexual health of First Nations youth is an area that is possesses and to teach them of the ways in which this power
extremely neglected within health care and research connects human sexuality and spirituality (the western door).
communities. As with non-First Nations youth, an Traditional and cultural teachings of sexuality include
examination of the sexual health and sexual activity patterns particular moral codes that guide the behaviours and
of First Nations youth demonstrates there are reasons for activities of people. These moral codes offer directions about
concern. These include pregnancy at an early age, unplanned the relationships that exist between people, between sexuality
pregnancy, STIs, HIV, a limited awareness of the risks for and the individual, and between the life force within each of
disease or unwanted pregnancy, and a lack of culturally us and the Creator (the northern door).
appropriate programming. Due to historical and socio-
cultural change, the sexual health concerns and problems of Historical contexts
First Nations youth are pronounced when compared to non-
First Nations youth face challenges similar to those faced by
First Nations youth. Issues of alienation, discrimination,
non-First Nations Canadian youth in relation to their sexual
isolation, and marginalization are common themes that
health. However, the historical contexts in which First
provide much of the context for these concerns.
Nations youth have had to survive are in stark contrast to
This chapter analyzes data from the 2002-2003 First Nations those of mainstream Canadian youth. These contexts include
Regional Longitudinal Health Survey (RHS) in relation to high levels of neglect3, abuse4, poverty5, and the struggle to
the sexual health and sexual activity of First Nations youth locate and maintain a cultural identity, all factors that have
aged 12 to 17. A cultural framework guides the analysis and been sufficiently documented.6 These conditions warrant the
provides the context for human sexuality and what it means attention of governments and policy-makers when
to be sexually healthy. A historical overview of the many considering the culturally specific and appropriate
factors contributing to an environment of ill sexual-health for programming needs of First Nations youth in relation to their
First Nations youth is presented. Patterns of sexual activity sexual health and sexual health concerns.
and birth control protection are drawn, potential concerns and
Epic proportions of teen suicide,7 teen pregnancy,8 STIs and
problems for First Nations youth and their sexual health are
HIV,9 sexual abuse,10 and sexual exploitation11 exist among
discussed and points from relevant literature are discussed, in
First Nations youth in comparison to non-First Nations
order to acknowledge the immediate needs of First Nations
Canadian youth. The Aboriginal Nurse12 states that “our
youth in relation to their sexual health.
impressions of what is desirable and undesirable in terms of
sex and adolescents is very local, very specific to a moment
Cultural framework
in time, a group of people, and a place on the globe,” and
A four-directions model1 provides the foundation for the considers that these impressions are also political. For
cultural framework used in this analysis, and provides a instance, increased levels of trauma due to family violence
meaningful context for understanding traditional views of and sexual abuse are shown to have a negative effect on how
human sexuality. Non-traditional views of human sexuality we view sexuality.13 Within these contexts, First Nations
often possess explicit characteristics that associate sex and youth face issues of marginalization that persistently affect
sexuality with sin and uncontrollable passions that become a their patterns of sexual activity and their sexual health.
primary motivation for behaviour.2 Traditional views
Sexual orientation, social class, race or ethnicity and place of
perceive sex as a gift to humans from the Creator, and the act
residence are also considered factors affecting the
of sex as something that is meant to be pleasurable. This
marginalization of First Nations youth.14 This
dichotomy of views represents a source of conflict for First
marginalization or non-acceptance of First Nations youth is
Nations youth and supports the need to return to traditional
exemplified by the differences that exist between traditional
teachings and values that emphasize the relationships
and mainstream views of sexual orientation. Many traditional
between sexuality and spirituality, where having sex means
societies display an acceptance of multiple sexual
to touch the life force within us2 (the eastern door).
orientations, including gay and lesbian relationships,15
Traditional society possesses a clear definition of gender whereas European religious ideologies often forbid such
roles and their boundaries. A breakdown in understanding relationships. Past and current integration of European
these roles and boundaries has led to negative effects for religion into First Nations societies has created conflict for
First Nations youth in respect to sexual health, such as a lack First Nations youth and communities regarding this issue,
of knowledge of the responsibilities that each gender carries and has contributed to the difficult environment in which
and the associated notions of balance and harmony that these First Nations youth must navigate in relation to their sexual
roles support (the southern door). health.
Puberty within a traditional society signifies an awakening In addition, levels of alcohol and drug abuse16 among First
and dictates that certain rites or rituals take place for both Nations youth are higher than those in mainstream society.
208
This substance abuse is often rooted in a historical context, Figure 1. Sexual activity and intercourse by age
and can be attributed to assimilation policies and other 60%
effects of colonization that have led to widespread change for 12-14
Aboriginal societies, including the loss of land and culture17, 50%

15-17
50.2%
46.1%
high levels of poverty, reduced opportunities for employment,
and the Residential School Legacy.18 In turn, substance abuse 40%
is considered to be an important contributing factor to the
sexual practices of youth, and may result in incidences of 30%
unprotected sexual activity, often leading to teen pregnancy,
unwanted pregnancy, STIs and HIV.19
20%
Further, the tendency of governments and agencies to import

a ‘pan-Aboriginal’ approach in developing and delivering 10% 7.9% 8.5%
education or programs for Aboriginal peoples has been

shown to significantly affect the utility of these services.20 0%
This is particularly distressing with regard to First Nations Sexually active Intercourse in the past year
youth, considering their high rate of participation in all or These figures suggest that First Nations youth show similar
most ‘high risk’ health behaviours.21 A limited awareness of characteristics to the mainstream population when
those factors that put youth at risk for disease or unwanted considering younger versus older adolescents as a group.
pregnancy, and a lack of available culturally specific and However, according to individual age, First Nations youth
appropriate programming in relation to sexual health, are more sexually active than their non-First Nations
compound the current crisis situation. counterparts. Further significance of this data may relate to
the instances of sexual activity for First Nations youth at
Results and Discussion younger ages, such as 12, 13, and 14, and the instances of
sexual activity for First Nations females and males in
Patterns of sexual activity
comparison to mainstream females and males of the same
28.4%i of First Nations youth report being sexually active, ages. For instance, the 1996 National Longitudinal Survey of
and a similar percentage (30.9%) report having had sexual Children and Youth23 paints a portrait of Canadian teens
intercourse in the 12 months prior to the survey. As seen in where the “median age for intercourse for both men and
Figure 1, 7.9%ii of First Nations youth aged 12 to 14 report women is 17, and that in a group of teens who are 17 years of
being sexually active, and 46.1% of First Nations youth aged age we are probably looking at a group where half have
15 to 17 report being sexually active. In addition, 8.5% of experienced sexual intercourse.”24 If the group is 16 years of
First Nation youth aged 12 to 14 report having sexual age, about 40% have experienced sexual intercourse and if
intercourse in the last 12 months, and 50.2% of First Nations the group is 15, about 25% of females and 20% of males
youth aged 15 to 17 report having sexual intercourse in the have experienced sexual intercourse. Below the age of 15, 10
last 12 months. In comparison, a report released in 1999 to 13% have experienced sexual intercourse. As well, “less
estimated that 49.9% of Canadian adolescents were sexually than 2% initiate sex before age 14” and current research on
active.22 sexually active very young teens suggests that they are a
distinct subset of adolescents who differ from the majority in
Not surprisingly, older youth are more likely to be sexually their sexual practices.24
active than their younger counterparts. Responses regarding
the age at which First Nations youth report being sexually The breakdown of numbers of sexual partners or life partners
active break down as follows: 2.6% for age 13; 18.8% for in the last 12 months is as follows: 1 to 2 partners, 67.4%; 3
age 14; 32.5% for age 15; 45.8% for age 16; and 61.9% for to 4 partners, 18.7%; 5 to 6 partners, 6.0%; and, 7 to 10
age 17. Responses for having had sexual intercourse in the partners, 4.0%. Data that represents the numbers of partners
past twelve months by age break down as follows: 3.4% for in the last 12 months by gender shows that First Nations
age 13; 20.0% for age 14; 34.8% for age 15; 50.9% for age males, in general, tend to report more partners than First
16; and 66.5% for age 17. There are no significant Nations females. For example, only 58.1% of First Nations
differences in reported sexual activity by age between males females aged 17 report 1 to 2 sexual partners in the last 12
and females. months, whereas 75.1% of First Nations males report 1 to 2
sexual partners in the last 12 months. This data appears
similar to the data regarding numbers of sexual partners for
mainstream youth, where approximately “one quarter of
i
women and between 31% and 38% of men who are in their
efficient of variation of greater than 33.3%. A statistical appendix including confidence intervals for teens seem to report two or more partners in a year.”24
ii
Comparisons between groups reported in this chapter that are all significant unless “NS” —not
209
In light of these statistics describing the sexual activity relatively small sample size, these differences are not
patterns of First Nations youth, it is important to note that significant.31 Condom use by age groups is reported as
relevant literature acknowledges a direct correlation between 85.2%(NS) for those aged 12 to 14, and 80.5%(NS) for those
the age at which sexual activity begins and the increased aged 15 to 17.
risks to sexual health and overall health.25,26,27,28,29 For
The 1996 National Population Health Survey32 states that
example, “the younger the age at first sexual intercourse, the
70% of teenage females and 81% of teenage males reported
more lifetime partners teenagers accrued,” and the less likely
using a condom at last intercourse. Although First Nations
youth are “to use contraception, putting this group at much
males have a tendency for increased condom use (89.1%)
greater risk for pregnancy, STIs and HIV.”30
when compared to First Nations females (71.8%), the
Patterns of birth control protection percentage of First Nations males who report condom use is
Birth control protection falls under the two main categories: also considerably higher than mainstream males who report
protection to avoid pregnancy, and protection to avoid STIs. condom use. In addition, 67.9% of First Nations females
Figure 2 summarizes the most reported methods of birth aged 17 report using condoms for birth control protection,
control protection. Among First Nations youth who reported and 91.4% of First Nations males aged 17 report using a
having sexual intercourse in the past year, 81.0% reported condom for birth control protection. There were no
using condoms and 19.2% reported using birth control pills, significant changes in condom use by males according to
while 10.9% reported using no form of birth control age; however, older females were less likely to use condoms
protection. Reasons cited for using birth control methods than their younger counterparts (Figure 3).
include: birth control to avoid pregnancy (20.7%); protection Figure 3. Condom use by gender and age
from STIs (21.7%); and, both birth control to avoid
100%
pregnancy and protection from STIs (57.6%).
Figure 2. Leading birth control methods used by youth 90.0% 12-14
90% 87.7% 15-17
Birth control pill 19.2% 83.6%
80%
Condom 19.0%
Type of protection
70.0%
70%
Depo provera 6.4%
60%
Withdrawl 5.9%
50%
Male Female
None 10.9%
The Final Report of the Standing Senate Committee on

0% 5% 10% 15% 20% 25%
Aboriginal Peoples (2003), Urban Aboriginal Youth: An
Action Plan for Change,33 states that at least half of
The case for birth control methods as a form of protection
Aboriginal youth do not use condoms all the time or are
against pregnancy among First Nations youth is similar to
using condoms ineffectively. The data from the RHS does
that for non-First Nations youth. Although the increase in
not allow for analysis of the effectiveness of condom use or
birth control use by single year of age observed in non-First
other forms of birth control protection. Other reports34 show
Nations youth is non significant among First Nations youth
that trends in adolescent sexual behaviour are changing, as
(due at least in part to sample size), the same pattern exists in
there is a decrease in teens who report being sexually active
both populations. The proportions of youth using birth
and an increase in the number of teens who report using
control methods generally are not significant among
contraception; however, the “greatest declines” are reported
individual ages. The use of birth control pills as a
in the “lowest risk groups.”35 It is therefore suggested that the
contraceptive by age group breaks down as follows: 7.7% for
changes largely affecting the sexual behaviour of adolescents
those aged 12 to 14; and, 20.8% for those aged 15 to 17.
from low-risk groups are of limited significance for
The use of condoms among First Nations youth in relation to Aboriginal youth, who are considered to be the highest-risk
protection from STIs breaks down as follows: 66.6% report group of Canadian youth in terms of experiencing early
always using a condom; 19.1% report using a condom most pregnancy, STIs, sexual abuse, sexual exploitation,
of the time; 6.6% report occasionally using a condom; and, depression, and suicide.36 Further, limited applicability of the
7.7% report never using a condom. First Nations youth and factors that may affect sexual activity trends for mainstream
mainstream youth populations both appear less likely to use Canadian youth supports the need for research and increased
condoms as age increases - although, perhaps due to the
210
insight into those factors that are specific to First Nations aforementioned tendency of First Nations female teens to
youth and their sexual activity patterns. report the lowest use of contraception, warrant further
investigation and an immediate response to the special needs
Patterns of pregnancy or fathering a child of this specific age group and gender.
The 1999 Aboriginal Roundtable on Sexual and
Factors affecting sexual activity and sexual health
Reproductive Health37 cites statistics from Health Canada
indicating that “teenage pregnancy among First Nations Gender is considered to be significant in relation to the
youth in British Columbia, the Prairie and Atlantic provinces sexual health and sexual activity of all youth. While First
are up to four times higher than the national average. Nations females tend to report lower rates of condom use
Incredibly, for young women under 15 years of age, the rate than First Nations males, females are at an increased risk for
is estimated to be as much as 18 times higher than that of the the complications associated with unprotected sexual activity.
general teenage population.” For example, “64% of tubal infertility and 42% of ectopic
pregnancies are attributable to the sexually transmitted
4.5% of First Nations youth report having been pregnant or
infection chlamydia.43” Moreover, chlamydia rates within the
getting someone pregnant. Of the First Nations youth who
province of Alberta doubled in both males and females aged
reported ever having been pregnant or ever having gotten
15 to 19 between 1998 and 2002, with Aboriginal peoples
someone pregnant, percentages increase by age, (e.g. 6.1% at
remaining disproportionately affected by this infection.44
age 16 versus 14.4% at age 17).
Alcohol and drugs are also believed to have significant
Although the 2002-2003 RHS does not report data that
effects on the sexual activities and sexual health of youth.
reflect the current rates of First Nations female youth who
“Studies estimate that Aboriginal youth are at two to six
are pregnant, the birth rate for Aboriginal women is reported
times higher risk for every alcohol-related problem than their
to be twice that of the overall Canadian female population. In
non-Aboriginal counterparts in the Canadian population.45”
2005, Health Canada38 reported that Aboriginal mothers tend
In the last 12 months, 42.8% of First Nations youth report
to be younger: approximately 55% are under 25, versus 28%
having drunk alcohol. In relation to sexual activity (Figure 4),
of the non-Aboriginal population. Further, 9% of Aboriginal
60.7% of First Nations youth who report using alcohol in the
mothers are reported to be under the age of 18, versus 1% of
last 12 months also report having sexual intercourse in the
the non-Aboriginal population.
last 12 months, compared to only 9.0% who did not have a
Early teen pregnancy is strongly correlated with high rates of drink. Similarly, 8.6% of those who reported alcohol use in
early school drop-out,39 unemployment, low levels of the past year also reported having been pregnant or gotten
education, and an increased reliance on social assistance. As someone pregnant; this is substantially higher than the 1.8%
well, a tendency toward poor health of teen parents and their of those who did not consume any alcohol in the past year.
children is found in the 2002 Ontario Federation of Indian Figure 4. Sexual intercourse and previous pregnancies (or
Friendship Centres40 report, which states that “children of having fathered a child) by alcohol consumption
teen parents have been shown to have lower levels of 70%
cognitive and social development. They are more likely to be
60.7%
victims of abuse and neglect and are three times more likely 60%
to be incarcerated in their late teens and early twenties than Some consumption
are children of mothers who delay childbearing. Children of 50% No consumption
teen parents are more likely to have children when they

become teens.” Furthermore, The Aboriginal Nurse41 40%
suggests that early teen pregnancy leads to a life of poverty

30%
that perpetuates an ongoing cycle of social problems,
including substance abuse, child neglect, and family violence. 20%
In addition, the potential impact of teen pregnancy on First 9.0%

10% 8.6%
Nations youth and their communities necessitates the
recognition that, historically, the early onset of pregnancy 1.8%
0%
within First Nations communities may have been the norm. Intercourse in the past year Previously become pregnant or fathered a child
As such, the Aboriginal Roundtable on Sexual and
Reproductive Health42 acknowledges the early onset of Proper nutrition and adequate physical activity are two basic
parenthood as common in traditional Aboriginal societies, human needs that affect overall health and well-being.
and cites a “breakdown in traditional support structures and Nutrition as a factor that affects the sexual activity and
values” as responsible for the poor health and social sexual health of First Nations youth is suggested by the
problems that teenage parents and their families often converse relationship between youths who eat a nutritious
experience. These important trends, coupled with the balanced diet and their reported rates of sexual activity. For
211
example, 17.2% of First Nations youth who always or almost sexually active, compared to 27.7% of those youth whose
always eat a nutritious balanced diet report that they are grandparents never attended residential school. Comparisons
sexually active, while 38.3% of youth who never eat a to the mainstream population in this regard are not possible.
nutritious balanced diet report that they are sexually active. Nonetheless, as many as 34% of adult respondents in the
No differences were observed by frequency of participation 1997 RHS50 reported experiencing sexual abuse during their
in physical activity. childhood, and the effects of past sexual abuse on sexual
health are well documented.
The sporadic use of contraception by youth is an important
concern in relation to the sexual health of First Nations youth, Who teaches youth about sexual activity and sexual health?
and was not addressed in the RHS. Feldmann and “The family—parents, grandparents, aunts and uncles—is the
Middleman46 state that “there remains a need to address most important teacher of sexuality for children. Positive
questions of contraceptive efficacy, practicality, and partner ideas about sexuality and healthy sexual attitudes and
concerns,” and that youth continue to face multiple barriers behaviours are learned by example…throughout childhood.
in obtaining contraception. The three main reasons cited by There is a the need to feel comfortable with one’s own
First Nations youth for not using a condom include: being sexuality, as well as to possess knowledge of the issues when
with a steady partner (20.8%); not having a condom at the discussing sexual and reproductive health.”51
time (20.7%); and, being under the influence of alcohol or
The availability of culturally specific and appropriate
drugs (19.3%).
programs for First Nations youth impacts the number of
The rates of coital activity (sexual intercourse, anal youth who may access these services. For example, the
intercourse) versus non-coital activity (oral sex, practice of basing Federal funding on age categories and
masturbation) are not measured in the RHS. Little is known narrow definitions of “youth” has created a lack of accessible
about coital activity versus non-coital activity, and their services, particularly for teens aged 13 to 15.52 Culturally
respective effects on the sexual health and sexual activity of specific programs and services are paramount for First
youth.47 However, there are strong indications that activities Nations youth. The need for such services is reflected in the
such as oral sex have the potential to cause concerns and findings on Aboriginal youth at risk for sexual abuse or
problems in relation to the sexual health of youth. exploitation in the National Aboriginal Consultation
Project.53 The findings of this project state that “the youth
Access to counselling, psychological testing, or any other
made it clear that cultural, historical, and economic factors
mental health service is associated with rates of reported
are important in constructing the experiences of Aboriginal
sexual activity among First Nations youth —23.9% of First
children and youth, and these factors limit the application of
Nations youth who reported never accessing such a service
non-Aboriginal research, programs, and policy designed for
say they are sexually active, compared to 42.4% of First
youth-at-risk.”
Nations youth who did receive such services within the last
12 months. Lastly, we discuss the use of First Nations languages in
relation to sexual activity, and how this relationship may
Society’s view of sexuality has a huge impact on the sexual
affect the sexual health of First Nations youth. While First
health and sexual activity of youth. The National Aboriginal
Nations Elders tell us that a true understanding of cultural
Consultation Project48 states that “our impressions of what is
teachings can only be obtained through the use of our
desirable and undesirable in terms of sex and adolescents is
language, the percentage of First Nations youth who report
very local, very specific to a moment in time, a group of
an understanding of one or more First Nations languages is
people, and a place on the globe.” This may have particular
only 32.7%. However, the relationship of sexual activity to
impact on First Nations youth, as European and religious
one’s ability to understand or not understand a First Nations
ideas that go against traditional knowledge and teachings
language is unclear. For example, the 26.7% of respondents
help to create an environment where “two conflicting views
who have no understanding of their native language and
of sexuality exist.”49
report being sexually active is equivalent to the 32.2% who
Marginalization and historical impacts of colonialism and the have an understanding of their native language and also
Residential School Legacy are a cause for concern. Their report being sexually active. This suggests that more detailed
potential to negatively affect the sexual health and sexual information is required regarding the relationship between
activity of First Nations youth is only recently being sexual activity/sexual health and the ability to speak a Native
acknowledged within society. The RHS, however, reveals no language, in order to evaluate any significance in that
significant difference in this regard —30.7% of youth who relationship.
have at least one parent who attended residential school
report being sexually active, compared to 26.6% of those Conclusions and Recommendations
youth whose parents never attended residential school.
No significant differences in patterns of sexual activity were
Furthermore, 31.2% of youth who have at least one
found between younger versus older adolescents. However,
grandparent who attended residential school report being
significant differences were evident between First Nations
212
youth and youth in the general Canadian youth population - Moreover, it is often those factors that may be shown to
particularly when instances of sexual activity by specific age indirectly affect the sexual health and well-being of youth
and gender are examined. Of particular significance may be that create concerns and problems that are of paramount
the rates of sexual activity for those aged 13, 14, and 15 and consideration in any attempts to improve their sexual health.
the higher number of sexual partners among 17-year-old As such, the development of sexual health education and
males versus females. programs for First Nations youth, aimed at the improved
sexual health of this population, requires that a culturally
Birth control protection patterns of First Nations youth are
specific and appropriate framework be utilized in any
similar to those of mainstream youth, with birth control
endeavours.
practices to prevent pregnancy increasing with age, and birth
control practices for the sole purpose of preventing STIs Within a culturally specific framework, appropriate sex
decreasing with age. The percentages of First Nations youth education programming means programming that is specific
who use birth control protection are also similar to those of to gender, age, community, and traditional values and
mainstream youth - except for First Nations males aged 17, practices, while being cognizant of the healing required from
who report the highest use of condoms among all categories the effects of colonialism and the marginalization of First
of youth. Birth control practices of First Nations females are Nations youth. Further, sex education that does not
of concern, as the potential for problems related to sexual encompass traditional teachings on sexuality, gender roles
activity are believed to be greater for females who report and responsibilities, motherhood as a meaningful community
rates of pregnancy and STIs that are often more than double role and the inclusion of men in these practices and processes
those of non-Aboriginal females. In addition, the reported is deemed insufficient. Finally, the direct involvement of
rates among First Nations youth of pregnancy or fathering a youth in the development of sex education programs is
child exceed those of non-Aboriginal youth. These figures paramount to the success of those programs, while culturally
emphasize the urgent need to address the concerns of First trained educators are viewed as essential if the programs are
Nations youth in relation to sexual activity and birth control to successfully alleviate any feelings of alienation, isolation,
protection, as these teens also face issues of marginalization, self-worth, and discrimination.
discrimination, and sexual exploitation. Further, it is
First Nations youth face challenges similar to non-First
important to recognize that historical norms within First
Nations youth in relation to their sexual health and sexual
Nations communities may have included the early onset of
activity patterns. However, the historical contexts of abuse,
childbearing and that many of the problems that young First
trauma, and largely poor living conditions that contribute to
Nations parents experience are the result of a breakdown in
an environment of socio-cultural change must be considered
traditional beliefs and practices.
in order to fully understand their impact on the sexual health
Factors that affect the sexual activity and sexual health of of First Nations youth. This environment, in turn, supports
First Nations youth are similar to many of the concerns and the manifestation of crisis situations for First Nations youth.
problems of all youth. These include: differences in sexual It also demands the development and immediate availability
activity and birth control practices by gender; the affect of of culturally specific and appropriate sexual health education
alcohol and drug abuse on sexual activity and birth control and sexual health programming for First Nations
protection; the role of proper nutrition and adequate physical communities.
exercise in decisions regarding sexual activity and the use of
birth control protection; the sporadic patterns and effective Notes to Chapter 23
use of birth control measures; and, the coital and non-coital
sexual activities of youth. Factors affecting the reporting of 1. Note: For a detailed explanation of the cultural framework associated with the RHS see:
National Aboriginal Health Organization, The Peoples’ Report (Chapter 2) (Ottawa, Ont.:
sexual activity and sexual health of First Nations youth that National Aboriginal Health Organization, 2005).
2. David Newhouse, 1998, Magic and Joy: Traditional Aboriginal Views of Human Sexuality,
may be specific to First Nations youth include: access to The Canadian Journal of Human Sexuality, 7, 2: 183-187.
counselling or other psychological services; societal views of 3. Ministry of Children and Family Development, The B.C. Handbook for Action on Child Abuse
and Neglect [online]. 2001, Province of British Columbia. Available from World Wide Web:
sexuality that are in opposition to traditional views; <http://www.mcf.gov.bc.ca/child_protection/child_abuse_handbook/A5apph.htm>.
4. The Aboriginal Healing Foundation, Historic Trauma and Aboriginal Healing [online]. 2004.
marginalization and the historical impacts of colonialism and Available from World Wide Web:
the Residential School Legacy; appropriate and 5.
<http://www.ahf.ca/newsite/english/pdf/historic_trauma.pdf>.
Human Resources Development Canada and Statistics Canada, The 1996 National
knowledgeable teachers of sexual health and sexual health Longitudinal Survey of Children and Youth Cycle 2 (Ottawa, Ont.: Statistics Canada, 1997).
6. Madeleine Dion Stout and Gregory D. Kipling, Aboriginal Roundtable on Sexual and
education; the availability of culturally sensitive sexual Reproductive Health [online]. June 1999, First Nations and Inuit Health Branch. Available
health programming; and, the fluency of First Nations from World Wide Web:
<http://www.hc-sc.gc.ca/fnihb/sppa/ppp/sexual_reproductive_health.htm>.
languages among First Nations youth. 7. Turtle Island Native Network, Preventing Youth Suicide in First Nations [online]. March 2003.
Available from World Wide Web:
<http://www.turtleisland.org/discussion/viewtopic.php?t=481>.
It has been suggested that all of these issues are not directly 8. "Teen Pregnancy," The Aboriginal Nurse [online]. 2002. Available from World Wide Web:
or specifically addressed within the RHS and that they may <http://www.findarticles.com/p/articles/mi_qa3911/is_200201/ai_n9056290/print>.
9. Centre for Aboriginal Health Research and Northern Health Research Unit, Research on
be significant in relation to their potential impact on the HIV/AIDS in Aboriginal People: A Background Paper (Winnipeg, Man.: University of
Manitoba, 1998).
sexual activity and sexual health of First Nations youth.
213
10. National Aboriginal Consultation Project and Canadian Save the Children Fund, Sacred Lives:
Canadian Aboriginal Children and Youth Speak Out About Sexual Exploitation (Vancouver,
B.C. National Aboriginal Consultation Project, 2000).
11. Ibid.
12. "Educating Children and Youth about Sexuality,” The Aboriginal Nurse [online]. 2002, p. 1.
Available from World Wide Web: .
<http://www.findarticles.com/p/articles/mi_200201/ai_9056304/print>.
13. Ibid., p. 2.
14. “Youth Sexuality and Sexual Health,” The Aboriginal Nurse [online]. 2002. Available from
World Wide Web:
<http://www.findarticles.com/p/articles/mi_qa3911/is_200201/ai_n9056294/print>.
Canadian Aboriginal Children and Youth Speak Out About Sexual Exploitation.
16. Ibid.
17. Ibid.
18. The Aboriginal Healing Foundation, Aboriginal People, Resilience and the Residential School
Legacy [online]. 2003. Available from World Wide Web:
<http://www.ahf.ca/newsite/english/pdf/resilience.pdf>.
19. Strengthening the Relationship. Report on the Canada-Aboriginal Peoples Round Table
[online]. 19 April 2005. Available from World Wide Web:
<http://www.aboriginalroundtable.ca/rtbl/strenght_rpt_e.pdf>.
20. C. Airhihenbuwa, Health and Culture: Beyond the Western Paradigm (Thousand Oaks, Calif.:
Sage Publications, Inc., 1995).
21. Urban Aboriginal Youth: An Action Plan for Change. Report of the Standing Senate
Committee on Aboriginal Peoples [online]. 2004. Available from World Wide Web:
<http://www.naho.ca/firstnations/english/pdf/BN_urban_aboriginal_youth_plan.pdf>.
22. Jennifer Feldmann and Amy Middleman, October 2002, Adolescent sexuality and sexual
behaviour, Current Opinion in Obstetrics and Gynaecology, 14, 5: 489-493.
23. Human Resources Development Canada and Statistics Canada, The 1996 National
Longitudinal Survey of Children and Youth Cycle 2 (Ottawa, Ont.: Statistics Canada, 1997).
24. Eleanor Maticka-Tyndale, “Sexual Health and Canadian Youth: How Do We Measure Up?,”
The Canadian Journal of Human Sexuality [online]. Spring/Summer 2001, vol. 10, nos. 1-2,
pp. 1-17. Available from World Wide Web:
<http://www.sieccan.org/pdf/maticka-tyndale.pdf>.
25. Alberta Health and Wellness, Sexually Transmitted Infections (STI) Surveillance Report:
Alberta—1998 to 2002 [online]. [Edmonton, Alta.]: Alberta Health and Wellness, 2004.
Available from World Wide Web: <http://www.health.gov.ab.ca>.
26. Centre for Aboriginal Health Research and Northern Health Research Unit, Research on
HIV/AIDS in Aboriginal People: A Background Paper (Winnipeg, Man.: University of
Manitoba, 1998).
27. Alexander McKay, Summer 2000, Common Questions about Sexual Health Education, The
Canadian Journal of Human Sexualtiy, 9, 2: 129-137.
28. Pan American Health Organization, Promotion of Sexual Health: Recommendations for Action
[online]. 2000. Available from World Wide Web: <http://www.sieccan.org/pdf/antigua_2.pdf>.
29. A Steenbeek, 2004, Empowering Health Promotion: A Holistic Approach in Preventing
Sexually Transmitted Infections Among First Nations and Inuit Adolescents in Canada,
Journal of Holistic Nursing, 22, 3: 254-266.
30. Jennifer Feldmann and Amy Middleman, October 2002, Adolescent sexuality and sexual
behavior, Current Opinion in Obstetrics and Gynecology, 14, 5: 489-493, 490.
31. Feldmann and Middleman, Adolescent Sexuality and Sexual Behavior,” Current Opinion in
Obstetrics and Gynecology, 489-493.
32. Eleanor Maticka-Tyndale, “Sexual Health and Canadian Youth: How Do We Measure
Up?,"1996 Canadian National Population Health Survey, The Canadian Journal of Human
Sexuality [online]. Spring/Summer 2001, vol. 10, nos. 1-2, pp. 1-17. Available from World
Wide Web: <http://www.sieccan.org/pdf/maticka-tyndale.pdf>, (see p. 12).
33. Urban Aboriginal Youth: An Action Plan for Change. A Final Report [online]. 2004. Available
from World Wide Web: <http://www.turtleisland.org/news/absenuayrpt.pdf>.
34. Pan American Health Organization, Promotion of Sexual Health: Recommendations for Action
[online]. 2000. Available at: <http://www.sieccan.org/pdf/antigua_2.pdf>.
35. Feldmann and Middleman, “Adolescent Sexuality and Sexual Behavior,” Current Opinion in
Obstetrics and Gynecology, 489-493, 490.
36. Urban Aboriginal Youth: An Action Plan for Change. Report of the Standing Senate
Committee on Aboriginal Peoples [online]. October, 2003. Available from World Wide Web:
<http://www.naho.ca/firstnations/english/pdf/BN_urban_aboriginal_youth_plan.pdf>.
37. Stout and Kipling, Aboriginal Roundtable on Sexual and Reproductive Health [online].
38. Health Canada, The Health of Aboriginal Women [online]. 2005. Available from World Wide
Web: <http://www.hc-sc.gc.ca/english/women/facts_issues/facts_aborig.htm>.
39. Stout and Kipling, Aboriginal Roundtable on Sexual and Reproductive Health [online], p. 72.
40. Ontario Federation of Indian Friendship Centres, Tenuous Connections: Urban Aboriginal
Youth Sexual Health & Pregnancy (Toronto, Ont.: Ontario Federation of Indian Friendship
Centres, March 2002), p. 73.
41. “Teen Pregnancy,” The Aboriginal Nurse [online], p. 1.
43. Maticka-Tyndale, “Sexual Health and Canadian Youth: How Do We Measure Up?” The
Canadian Journal of Human Sexuality [online], p. 5.
44. Alberta Health and Wellness, Sexually Transmitted Infections (STI) Surveillance Report:
Alberta—1998 to 2002 [online].
46. Feldmann and Middleman, Adolescent sexuality and sexual behavior, Current Opinion in
Obstetrics and Gynecology, 489-493, 491.
47. Ibid., 489-493.
Canadian Aboriginal Children and Youth Speak Out About Sexual Exploitation.
49. Newhouse, Magic and joy: traditional Aboriginal views of human sexuality, The Canadian
Journal of Human Sexuality, 183-187, 183.
50. First Nations Information Governance Committee, First Nations and Inuit Regional Health
Surveys, 1997 [online]. 2004. Available from World Wide Web:
<http://www.naho.ca/firstnations/english/pdf/RHS_synthesis.report.pdf>.
51. “Educating Children and Youth about Sexuality," The Aboriginal Nurse [online], p. 3.
52. Urban Aboriginal Youth: An Action Plan for Change. A Final Report [online].
53. National Aboriginal Consultation Project, Sacred Lives: Canadian Aboriginal Children and
Youth Speak Out About Sexual Exploitation.
214
Chapter 24
The Impact of Parent and Grandparent Residential
School Attendance
Abstract
This chapter presents findings on the well-being of First Nations youth in relation to their parents’ and
grandparents’ residential school attendance. We report on the proportion of adolescents with parents
and grandparents that attended residential school. Statistics comparing youth whose parents and/or
grandparents were residential school survivors with youth who did not have parents or grandparents
attend residential school highlight survey findings. Findings suggest that youth are more apt than
children to have parents who attended residential schools. Many youth still believe that it is very
important that they speak a First Nations or Inuit language. A higher proportion of youth having at
least one parent who attended residential school were likely to have thought about suicide in their
lifetime, compared to youth whose parents/grandparents were not residential school survivors. It was
also found that the physical and mental health effects of the residential school legacy are not as
evident among youth in comparison to adults. We conclude by stating that a more in depth study on
the relationship between youth, the intergenerational effects of residential school and current social
influences affecting youth today might assist in understanding the contemporary experience of First
Nations youth.
215
RHS 2002/03 Youth Survey – Chapter 24: The Impact of Parent and Grandparent Residential School Attendance
language4, the majority still believe that it is very important

Introduction
that they speak a First Nations or Inuit language, regardless
The residential schools1 that operated from the mid-19th of exposure to the intergenerational effects of residential
century to the late 20th century continue to have indirect schools (see Table 2). iii
effects on First Nations youth today. The cumulative effects Table 1. Proportion of First Nations youth whose parents and
of residential schools on cultural identity, health and well- grandparents attended a residential school
being (and the continuous tensions between the values of Intergenerational attendees Percent
Aboriginal peoples and those of mainstream society)
complicate the efforts of youth to forge their identities and Mother or guardian attended a residential school 22.8%
find their way in the world.2
Father or guardian attended a residential school 25.1%
This chapter discusses the proportion of youth whose parents
and grandparents attended residential schools at one point. One or more parents attended a residential school 33.2%
The findings are discussed by comparing survey results from Maternal grandmother attended a residential school 50.9%
youth whose parents/grandparents are survivorsi with results
from youth whose parents and grandparents did not attend Maternal grandfather attended a residential school 42.1%
residential school. More specifically, this information is
applied to the following areas of interest: the importance of Paternal grandmother attended a residential school 40.3%
speaking a First Nations language; the ability of youth to Paternal grandfather attended a residential school 37.2%
speak one or more First Nations and Inuit languages fluently
or relatively well; the importance of traditional cultural One or more grandparents attended a residential school 65.0%
events; the prevalence of suicide; and the potential risk for At least one parent(s) and one grandparent(s) attended a
15.7%
being diagnosed with a health or mental illness. residential school
Results and Discussion Table 2. Importance of speaking a First Nations language - youth
Parent (one or more)
In comparison to children under the age of 12, adolescents Importance of speaking a First
Nations language
are more likely to have had parents who have attended Survivor Non-survivor
residential schools. About 33.2%ii of First Nations and Inuit
Very important 51.0% 42.9%
youth today have one or more parents who attended
residential school. Only 16.5% of First Nations and Inuit Somewhat important 37.0% (NS) 37.8%(NS)
children had one or more parent(s) who at some point Not very important 9.1%(NS) 12.3%(NS)
attended a residential school. Adolescents are equally as
likely as children to report a larger proportion of Not important 3.0% 6.9%
grandparents who had attended residential school. For
adolescents, 65.0% reported that one or more of their For example, about half (51%) of the youth interviewed who
grandparents were residential school survivors. For children, were children of survivor(s) stated that it was very important
the proportion of grandparent(s) who were in residential to them that they speak their own language. 42.9% of youth
schools was about 60% (58.6%). who did not have a parent that attended a residential school
Despite the number of books written on residential school believed that it was important for them to speak a First
systems and experiences, Chrisjohn and Young (1994) point Nations language. Only a small minority of the youth
out that the legacy3 of residential schooling has not been surveyed who were the children of survivors (3.0%) reported
investigated in a systematic manner. This is especially true that learning a First Nations language was not important,
when it comes to the study of indirect effects on today’s First compared to 6.9% of youth who were children of non-
Nations youth and children whose parents or grandparents survivors.
were survivors. The results for youth understanding and able to speak one or
With several generations of children having grown up in a more First Nations languages fluently or relatively well are
setting where any manifestation of Aboriginality was not significant (p>.05), and are not included in this report.
disparaged and devalued, it is not surprising that the cultures The results for understanding or being able to speak one or
and languages of many communities are now under severe more First Nations languages for youth who had
threat. Although youth have experienced the loss of their grandparents (one or more) attend residential school are also
not significant (p>.05).
i“
Survivor” refers to those First Nations peoples that have lived through the effects, or are currently
living through the effects, of the legacy of the residential school system in Canada.
ii
iii
efficient of variation of greater than 33.3%. A statistical appendix including confidence intervals for Comparisons between groups reported in this chapter are all significant unless “NS” —not
all reported figures is available at www.naho.ca/fnc/rhs significant— is specified in brackets. In this chapter, estimates are considered significantly different if
216
Culture and tradition By far the most notable difference between residential school
survivors and their descendents is that the latter generally
54.2% of the youth who had one or more parents that
have not faced long-term confinement in an institutional
attended a residential school believe that cultural events are
setting. Furthermore, most of the youth today have had the
very important. This was in slight contrast to youth whose
opportunity to interact with siblings and extended family
parents were not exposed to residential school (46.1%).
members. They also enjoy access to Elders and other positive
role models in their communities.6
Suicide
In Chapter 14, it was stated that one of the most telling and Table 5. Diagnosis of health and illnesses by parental residential
lasting effects of residential schools on adult survivors was school attendance
the frequency of early death5 as a result of suicide or other Diagnosis if Parent was a Diagnosis if Parent was
factors. For First Nations youth who had at least one parent Survivor not a Survivor
that attended residential school, 26.3% have thought about
suicide, compared to only 18.0% of those youth whose Cognitive or Mental Cognitive or
– –
Disability Mental Disability
parents did not attend residential schools. Although not
statistically significant, it is interesting to note that more Physical
Physical Disability – –
youth who were children of survivors attempted suicide at Disability
least once in their lifetime (13.1%), compared to youth who Diabetes – Diabetes 1.1%
did not have a survivor parent (7.8%) (see Table 3).
Obese 13.9% Obese 21.6%
Table 3. Proportion of suicide attempts and thoughts of suicide – Data suppressed due to insufficient sample size.
among youth with survivor and non-survivor parent(s)
Parent (one or more) Conclusion
Ever thought about suicide
Survivor Non-survivor The policies of forced assimilation via residential schools
Yes 26.3% 18.0% have affected First Nations and Inuit youth at every level of
experience, from individual identity and mental health to the
Never 73.7% 82.0% structure and integrity of families, communities, bands and
Parent (one or more)
nations.7 More research could be beneficial in reinforcing the
Ever attempted suicide validity of this statement to the Canadian mainstream. We
Survivor Non-survivor should also recognize that the experiences of First Nations
youth, some of which they have graciously provided in this
Yes 13.1% (NS) 7.8%
survey, need to be validated. Additionally, a more in depth
Never 86.9% (NS) 92.2% study on contemporary social influences and the indirect
effects of residential schools on today’s First Nations and
In support of holistic investigative frameworks, Stout and Inuit youth would help us to understand the current
Kipling (2003) believe that there is a probable link between experiences and adversities of First Nations youth.
the intergenerational effects of abuse and elevated risks of
suicide, violence-related injuries and alcohol involvement
among First Nations youth. There is a definite need to further Notes to Chapter 24
investigate these multi-faceted approaches in order to better
understand whether or not there are links between parental
1. • Jennifer J. Llewellyn, “Dealing with the Legacy of Native Residential School Abuse in
and/or grandparental residential school attendance and high Canada: Litigation, ADR, and Restorative Justice,” University of Toronto Law Journal 52
risk factors for youth such as suicide, alcohol abuse and (2002), pp. 253-300.
• S. Fournier & E. Grey, Stolen From Our Embrace: The Abduction of First Nation Children
violence-related injuries. and the Restoration of Aboriginal Communities (Toronto, Ont.: Douglas & McIntyre, 1997).
• Agnes Grant, No end of grief: Indian residential schools in Canada (Winnipeg, Man.:
The impact of intergenerational effects connected with Pemmican Publishers, 1996).
residential school attendance (where at least one parent Ont.: University of Toronto Press, 1996).
• John S. Milloy, A National Crime: The Canadian government and the residential schools
attended residential school) on all dimensions of health is not system, 1879 to 1986 (Winnipeg, Man.: University of Manitoba Press, 1999).
as extreme for adolescents in comparison with their parents. Note: For a definition of residential schools, see Chapter 14. For a general overview of the
history of the residential school system, Llewellyn (2002) suggests seeing S. Fournier & E.
Table 5 shows that youth who had one or more survivor Grey (1997) at chapter 2; Agnes Grant (1996); J. R. Miller (1996); and John S. Milloy (1999).
parents reported only slight differences in the rate of mental Litigation, ADR, and Restorative Justice,” University of Toronto Law Journal.
or health illness diagnosis from youth with parents who never 3. Note: For a definition of the Residential School Legacy, see Chapter 14.
4. Note: The results for understanding one or more First Nations or Inuit language by parental
attended residential school. This suggests that there are residential attendance were not significant (p. 5), and thus are not included with this report. In
addition, the results for ability to speak one or more First Nations or Inuit languages are also
several other variables that need to be investigated (other not significant (p. 5).
than intergenerational attendance at residential schools) with 5. Madeline Dion Stout and Gregory Kipling, Aboriginal People, Resilience and the Residential
School Legacy: The Aboriginal Healing Foundation Research Series (Ottawa, Ont.: The
regard to the overall health of First Nations adolescents. Aboriginal Healing Foundation, 2003).
217
6. Ibid., p. 5.
7. Laurence Kirmayer, Cori Simpson and Margaret Cargo, 2003, Healing traditions: culture,
community and mental health promotion with Canadian Aboriginal peoples, Australasian
Psychiatry, 11: 15-23.
Further References
Roland Chrisjohn and Sherri Young, 1991, Faith misplaced: lasting effects of abuse in a First Nations
community, Canadian Journal of Native Education, 18: 161-197.
218
Chapter 25
Emotional and Social Well-being
Abstract
First Nations youth, as part of the First Nations Regional Longitudinal Health Survey (RHS), were
asked a variety of questions relevant to their mental health, perceived personal wellness and sources
of personal support. The findings show the majority of First Nations youth self-report as doing well in
terms of their mental health and personal wellness. When First Nations youth are in need of assistance
in dealing with problems they face, they most often turn to their parents or guardians, friends their
own age or no one at all. The proportion of youth who do note as having difficulties with their mental
health is greater than those who appear to be accessing either Western-based mental health services or
consulting with traditional healers. Service providers within communities are not getting an
opportunity to provide help when it is most needed. It is recommended that the focus of programming
needs to change to a more holistic and traditionally consistent pattern of fulfilling extended family and
community roles. Additionally, communities need to develop strategies that will improve the extent to
which youth access these broadly defined mental health services. Other recommendations include
further research possibilities that would utilize the wealth of data from this round of the RHS as well
as information from other databases and community sources, with an overall goal of ultimately
contributing to improving the health status of all First Nations youth.
219
RHS 2002/03 Youth Survey – Chapter 25: Emotional and Social Wellbeing
to investigate whether the isolation or remoteness status of

Introduction
communities is somehow related to youth suicide. New data
First Nations youth, as do all youth, face many challenges in from the RHS examines the frequency of thoughts and
negotiating through this developmental phase of life while attempts of suicide among First Nations youth. This
maintaining a state of wellness.1 In this round of the RHS information is reported later on in this chapter.
data collection, youth ranging in age from 12–17 years were
Chandler and Lalonde’s research is encouraging because it
asked a variety of questions relating to their mental health,
begins to describe factors that communities may gain partial
perceived personal wellness and sources of support.
or full control over and examines community circumstances
Currently, there is not a great deal of available research that
that may be protective against suicide. For the BC
exames aspects of First Nations mental health in a holistic
population, clear evidence of an inverse relationship between
way. Little data is available regarding the epidemiology of
rates of First Nations youth suicide and ‘cultural continuity’
even the more common mental disorders (eg. depression,
was found. ‘Cultural continuity’ is a concept that relates to a
schizophrenia, anxiety disorders etc.) among First Nations
state of overall community wellness. The study defined it as
youth. This kind of information is important because
the community being involved in some aspects of: self-
depression is a well-known risk factor for suicide. The
government, land claims, having control over their
Canadian Community Health Survey of 2002 reported that
educational system, health services, police/fire services or
7.9% of Canadians aged 12 or older endorsed symptoms
having cultural facilities available for use by members.
suggesting that they had experienced at least one major
Communities that had more of the factors present— higher
depressive episode in the past 12 months,2 whereas the rate
levels of cultural continuity—also showed lower rates of
for the off-reserve Aboriginal population was 13.2%.3 The
suicide among their youth. Rates of suicide in communities
Canadian Institute of Child Health cited one study of
without any of these protective factors were 138 per 100,000
Mi’Kmaq youth between 12–18 years of age finding that
population versus 0 per 100,000 population for those with all
21% of males and 47% of females reported experiencing
six factors present.12 New data from the RHS, while not
feelings of sadness and depression within the past year.4
specifically asking about cultural continuity, examines some
Unfortunately, First Nations youth are most frequently of these cultural factors and their potential relationship to
portrayed in the mainstream media as a group in distress, suicidal thoughts and suicide attempts among First Nations
plagued by the problem of suicide. The tragic experience youth.
within some First Nations communities of losing young
Finally, there is very little existing information regarding the
people due to suicide at alarming rates has drawn
types of supports and services First Nations youth seek out
international attention.5 Suicide rates are often cited as one
when they experience emotional or mental distress. New data
indicator of a community’s state of emotional health.6
from the RHS will describe the patterns of help-seeking
Communities experiencing such devastating losses are left to
behaviors for a variety of psychosocial problems. These
decide whether to engage attention in a call for help or
findings will be important to communities in terms of
quietly address community development needs—a very
developing optimal, accessible and comprehensive mental
difficult decision to make in times of crises.7 Excluding the
health services (including both Western-based and
sparse epidemiological data on mental disorders, there is an
traditional) for First Nations youth.
array of literature that examines and attempts to explain the
high rates of suicide among First Nations youth today. Rates Results
of suicide among First Nations youth are estimated to be 5 to
6 times higher than the national average for non-Native Youth feeling in physical, mental, emotional, and spiritual
youth.8,9 balance
Some communities have shown disturbing trends of suicide Overall, the majority of First Nations youth surveyed
rates that continue to increase over time. Among the reported a feeling of being in a state of physical, emotional,
Nishnawbe-Aski youth in northern Ontario, the number of mental and spiritual balance all or most of the time. Physical
completed suicides increased an incredible 400% over a ten balance was most often reported, respectively followed by
year period from five in 1986 to twenty-five in 1995.10 The mental balance, emotional balance and spiritual balance.
implication derived from this pattern was that suicide rates Table 1 illustrates the reported responses.
may be somehow related to the geographical remoteness of
the communities. Nonetheless, Chandler and Lalonde, in Males are more likely than females to report that they are in
their British Columbia (BC) study of First Nations youth balance mentally and physically all of the time. Furthermore,
aged 15–24 years, found the opposite. They found higher younger youth (age 12–14) are more likely than their older
rates of suicide for youth living in urban settings (147.4 per peers (15–17) to state that they are in balance physically and
100,000 population) as compared to youth living in either spiritually all of the time. There were 12.1% of youth that
rural (95.1 per 100,000) or remote (78.2 per 100,000) reported almost never feeling in emotional balance. Youth
settings.11 These conflicting observations illustrate the need living in isolated communities are more likely than those in
220
non-isolated communities to report feeling in mental balance variables were further broken down into four groups: that
almost none of the time. Youth living in remote isolated they had such thoughts or made an attempt when they were
communities are more likely than those living in non-isolated under 12 years of age, that they had such thoughts or made a
communities to report being emotionally and physically in suicide attempt during adolescence (12–17 years old), that
balance all of the time. Youth who are from communities that they had such thoughts or made a suicide attempt within the
are not part of a health transfer agreement are more likely past year and they had never had such thoughts or made any
than those who are part of a community health transfer attempts to kill themselves. Figure 2 displays data regarding
agreement to report being in physical balance almost none of thoughts of suicide and Figure 3 displays data regarding
the time. Youth that are from communities that are part of a suicide attempts.
multi-community health transfer agreement are more likely Figure 1. Reports of sad, blue or depressed feelings for 2 weeks
than youth from communities that are not part of a health in a row (n=4,546)
transfer agreement to report that they are in spiritual balance
all of the time.
Table 1. Youth report on “How often do you feel that you are in
balances” Yes, 27.2%
Physical Mental Emotional Spiritual

Responses
Balance Balance Balance Balance
All of the time 33.7%i 31.2% 23.1% 25.5%

Most of the time 38.6% 34.8% 37.0% 32.9%
Some of the time 21.6% 18.2% 27.8% 26.8%
No, 72.8%
Almost none of the time 6.0% 15.7% 12.1% 14.8%
Depression
Just under three-quarters of youth (72.8%) surveyed reported Figure 2. Percentage of youth with thoughts of suicide (n=4,694)
that they had not ever felt sad, blue or depressed for 2 weeks
in a row while 27.2% of youth reported that they had felt sad, Yes in the past year,
4.9%
blue or depressed for 2 weeks in a row (Figure 1). There was
a significant difference between gender and reports of sad or Yes under 12, 5.0%
depressed feelings, with females reporting at much higher Yes, between 12-17,
11.2%
rates than males (37.1% versus 18.1%). For females aged
15–17 years, 44.3% reported such feelings compared to
22.1% males of the same age group. For females aged 11–14
years, 28.0% reported feeling sad or depressed while only
13.3% of their male counterparts acknowledged such
feelings. This data shows that females report depressive
No never, 78.9%
feelings at approximately double the rates that males do
which is comparable to the 1997 Nova Scotia study on
Mi’Kmaq Health.13 There was no significant association
found between reporting sad, blue or depressive feelings and
factors such as the remoteness/isolation status of Possible interactions between gender and age in terms of
communities or the health transfer status of the communities having thoughts of suicide or making previous suicide
in which the youth live. attempts were also explored. Figure 4 illustrates these results.
There was a significant relationship between age and gender,
Suicide and having thoughts of attempting suicide and having made a
previous suicide attempt during youth years. For the various
The youth were asked if they had ever thought about age groups, females were more likely than males to have
committing suicide or attempted to commit suicide. For the endorsed thoughts of suicide.
entire cohort, 78.9% of youth reported that they had not ever
thought about committing suicide and 90.4% reported that There was, however, no relationship found between youth
they had not ever made a suicide attempt. Results for both having thoughts of committing suicide or making previous
suicide attempts with the remoteness/isolation status or
i
health transfer status of communities.
221
Figure 3. Percentage of youth that attempted suicide (n=4,735) Figure 6: The first people youth go to for help with various
problems (n=4,414+)
Yes under 12, 1.4% 14.0%
Yes in the past year, Assault 13.1%
2.4% 56.4%
12.9%
Yes, between 12-17, Friendships 26.8%
5.8% 39.9% No One
Friends My Age
17.6%
Depression 21.9% Parent/Guardians
Type of problem
42.3%
15.0%
Anger 23.5%
41.5%
16.3%
Substance 20.0%
41.9%
20.9%
Finances 5.8%
62.8%
No never, 90.4%
15.2%
Relationships 52.6%
19.4%
0% 10% 20% 30% 40% 50% 60% 70%

Figure 4. Thought and attempt of suicide during adolescence by
age and gender (n=4,694)
30%
There are some youth issues which show variations with
regard to the people first accessed for help. In getting help
25%
25.0% with family problems: 41.0% will go to a parent or guardian
first, 27.3% will go to friends their own age first and 15.5%
Suicide thoughts between ages 12-17
20% Suicidal attempts between ages 12-17
will go to other family members. If there is an issue with
STDs: 45.1% will go to a parent or guardian first, 25.4% will
15% 14.4% go to a doctor/nurse/health aide first and 13.0% will go to no
one. To get help with birth control: 42.9% will go to
10% 9.3% parents/guardians, 20.6% will go to a doctor/nurse/health
6.7%
care aide and 16.6% will go to no one. If there are issues
5%
4.7% regarding pregnancy: 47.6% will go to parents/guardians
1.9%
2.6% first, 15.5% will go to no one and 12.3% will go to a
0%
doctor/nurse/health care aide. With more physical or
Males 12-14 Males 15-17 Females 12-14 Females 15-17 medically-related problems such as STDs, birth control and
Gender and age group (years)
pregnancy, it appears from the data that (compared to the
other psychosocial problems surveyed) youth are more
Accessing help: Who do youth turn to for help?
willing to first consult health care professionals (if they are
When First Nations youth are dealing with problems, there is available) in their communities.
a small group of people that the majority consistently first
turn to for assistance. Youth were asked questions regarding Accessing help: Use of Western-based mental health services
who they would go to first for help with; family problems, and traditional healing
boyfriend/girlfriend relationship problems, financial
Traditional healers, counselors, psychological testing or any
problems, drugs or alcohol, anger or feeling out of control,
other mental health service provided are generally not
depression, problems with friends, sexual or physical assault,
consulted by the youth interviewed for this survey. This is
sexually transmitted diseases, birth control and pregnancy.
consistent with the findings described in the section above
As a general finding, youth report that they will first turn to a
relating to who youth normally consult first when faced with
parent or guardian for help with all problems except
a variety of psychosocial problems (e.g.: parent or guardian).
relationship problems with a boyfriend or girlfriend. With
For example, only 1% of youth would go to a traditional
this issue they will first turn to friends their own age for help.
healer first if they had a problem with depression and only
The issues that youth seek assistance from parents/guardians,
1.8% of youth would consult a doctor or allied health
friends their own age and no one for are listed in Figure 6.
professional. There is no background information indicating
One of the most concerning findings is the percentage of
whether or not the youth were in need of these sources but
youth that will turn to no one when dealing with situations
chose not to access them or whether lack of opportunity to
(that are risk factors for suicidal or other behaviors that harm
consult these sources was a factor. Table 2 illustrates how
personal wellness) that involve relationship problems,
few youth have used such services.
substance use and depression.
222
Table 2. “When did you last consult a traditional healer,

counseling, psychological testing or any other mental health
service” Discussion
Counseling, Psych. As shown in the data, the majority of First Nations youth
Traditional
Testing, Other
Responses Healer
M.H. Service
report feeling in a state of balance in terms of their physical,
(n = 4,548) mental, emotional and spiritual health. It may be more
( n = 4,490)
helpful in future studies to ask youth if they feel in balance in
Within the last 12 months 12.8% 10.5% the holistic sense of their physical, emotional, mental and
1-2 years ago 4.7% 4.9% spiritual health.(Meaning assessment of all these aspects of
Over 2 years ago 4.4% 4.3% health combined rather than separately).
I don’t remember 13.1% 8.5% The data also illustrates that female youth endorse depressive
Never 65.0% 71.8% feelings in significantly higher numbers, (about double the
rates of self-reporting male youth). This finding is consistent
There was a significant relationship between gender and with previous studies, specifically the one noted earlier with
accessing mental health services, (with females more likely Mi’Kmaq youth.14 This raises the issue of whether or not
to have done so). 13.5% of females surveyed had accessed female youth actually experience depressive feelings in
mental health services within the last 12 months versus 7.8% greater numbers or whether male youth are reluctant to self-
of males and 75.4% of male youth surveyed reported having disclose such feelings in a survey situation. The same gender
never used any mental health services compared to 67.8% of pattern arose from the data on suicidality. There were
female youth. significantly higher numbers of female youth who reported
Summary of key findings having suicidal thoughts and making previous suicidal
attempts during their youth years. In the literature, it has been
• The majority of youth respondents feel that they are in shown that females in general report greater suicidal thoughts
balance in terms of their physical, emotional, mental and and attempts while males complete suicide at higher rates
spiritual aspects all or most of the time. than females.15 Again, it is not clear as to whether this
• 72.8% of youth reported that they have not ever felt sad, represents an actual finding; (ie.: females do experience more
blue or depressed for 2 weeks in a row. suicidal thoughts and make more attempts, though less lethal,
or whether males choose not to disclose their suicidal
• Females report feeling depressed at rates approximately thoughts or previous attempts). There also remains the
double that of males regardless of age. possibility of a gender difference related to suicide attempts
• Feeling sad or depressed was not significantly associated in terms of male youth making impulsive suicide attempts
with either the remoteness/isolation status of with a higher potential for lethality. Future studies could ask
communities or health transfer status of communities. both male and female youth about factors such as concurrent
• 78.9% of youth reported that they have not ever thought substance use (eg. alcohol) at the time of experiencing
about committing suicide and 90.4% of youth reported suicidal thoughts or making suicide attempts. Malchy and
that they have not ever made a suicide attempt. Enns found that blood alcohol levels were significantly
higher in First Nations individuals who completed suicide in
• Females reported thinking about committing suicide and Manitoba and a greater proportion of the completed suicides
making a suicide attempt during their youth years (age were male (70%).16 Clarifying gender differences in suicidal
12-17) at significantly higher rates than males. behaviors may be helpful in terms of developing more
• Thinking about committing suicide and making an effective suicide prevention programs for both male and
attempt at suicide was not significantly related to the female youth in communities.
remoteness/isolation status of communities.
For a variety of psychosocial problems, it was found that
• For a variety of psychosocial and medical problems, youth in general first go to a parent or guardian for help.
youth generally reported that they would first go to a Parents and guardians need to be prepared for this reality and
parent or guardian for help; it was also important to note have proper knowledge in order to help their youth with the
that youth reported (12.3%–20.9% of the time) they issues they may be experiencing. This may involve a
would not consult with anyone. continuum of support ranging from developing parenting
• Females accessed mental health services at significantly skills to ensuring parents are aware of the various health and
higher rates than males. social service agencies in the community and how to access
• 65% of youth report never consulting a traditional healer them. The second group that youth are most likely to turn to
while 12.8% of youth had seen a traditional healer for assistance is friends their own age. Friends may or may
within the last 12 months. not have the necessary skills to help their peers through
difficult situations. Service providers in First Nation’s
communities should consider developing programming
223
focused in areas of effective peer support. Developing

community-based programs to support best practices in Conclusions
parenting and family wellness as well as promoting the roles
The majority of First Nations youth surveyed felt in balance
and responsibilities of youth as peer counselors, natural
(physically, emotionally, mentally and spiritually). Many
healers and role models for one another was recommended
youth also report the absence of significant signs of
by the Suicide Prevention Advisory Group.17
emotional distress including: persistent feelings of
In terms of youth accessing mental health services, the data depression, suicidal thoughts or having made previous
shows that the majority of youth have never accessed either suicide attempts. It can be concluded that many First Nations
Western-based services or consulted with a traditional healer. youth, despite the challenges of adolescence, self-report that
Consulting a traditional healer was not significantly related they are doing well in terms of their mental and personal
to the remoteness/isolation status of communities whereas wellness. There is a smaller portion, however, who disclosed
accessing Western-based mental health services was. This significant emotional distress, including feelings of sadness
makes sense in that many remote communities have limited and depression lasting 2 weeks, having suicidal thoughts and
access to physician services and little access to more making previous suicidal attempts.
specialized care such as psychological testing.18 Youth may
It will be important for such youth to feel comfortable
be accessing service providers off-reserve that may not be
accessing mental health services in their communities, either
accounted for in the data. They also may have had previous
through family and peer support, social and mental health
negative experiences with mental health services due to
service agencies or traditional healers. In developing more
factors such as racism and a lack of cultural sensitivity in
optimal suicide prevention programs for youth, it will also be
treatment approaches. There was a significant gender
critical to elicit factors that are protective against suicidal
difference in accessing services, with female youth reporting
behaviours. The majority of First Nations youth, when faced
usage of these services at higher rates than male youth. It is
with a variety of psychosocial problems, choose to first go to
unclear whether this difference is related to female youth in
a parent or guardian for help. They also often choose to elicit
distress being more readily identified (and subsequently
help from friends their own age. Communities will need to
referred for services) or whether male youth are reluctant to
consider developing parenting/family wellness and peer
or unaware of how to access mental health services.
support programming so that these first-choice support
Communities need to develop strategies for identifying youth
systems are also able to assist youth in crisis. Low usage
at-risk or in distress and ensure that they are connected with
rates were reported by First Nations youth for both mental
appropriate assistance. It may be helpful to ask both male and
health services and traditional healers. As well, there exists a
female youth what they see as barriers to accessing mental
proportion of youth who report that they would consult no
health services as varying strategies may be identified for
one if faced with a significant psychosocial problem.
increasing the numbers of all youth who come forward to
Communities could consider clarifying with their youth as to
seek help. There are some innovative best practice models in
what their perceived barriers to access are. The optimal
communities. Eskasoni19 and Six Nations of the Grand
objectives would be to develop programming and improve
River20 offer comprehensive, holistic mental health services
access to mental health services that are holistic and
and are respectful of traditional ways so all community
comprehensive in their approach.
members, including youth, may achieve greater personal and
mental wellness. Recommendations/Solutions
Finally, the RHS data examined did not reveal many • Future studies may want to ask youth more contextual
significant relationships between factors including emotional questions concerning suicidal behavioural thoughts and
wellness and suicidality similar to the findings of Chandler attempts (For example, whether or not substance use was
and Lalonde.21 It may be that the methodology used was involved). This information may be helpful in
unable to pinpoint such relationships or it may be that customizing suicide prevention programs for both male
additional databases and sources of community information and female youth.
need to be incorporated to examine cultural continuity. For
• Communities could consider broadening the spectrum of
example, Chandler and Lalonde have found two new
services by developing family wellness and peer support
variables in their model: children in protective care and
programs that provide holistic health services for youth
women in government.22 The current chapter also did not
to assist them in times of distress.
include in its analysis factors such as community control over
education, police/fire services and the community having at • It may be helpful for communities to consult with youth
least one designated facility for cultural activities. Future to understand their perceived barriers in accessing
studies with the RHS data could also examine other possible mental health services and traditional healers.
protective factors against suicidal behavior such as • Communities need to develop strategies to identify
nutritional status, exercise/activity levels, and participation in youth at-risk and ensure that mechanisms are in place to
traditional and cultural activities. connect youth with appropriate services.
224
• Future studies utilizing the data from this round of the

RHS may wish to explore other possible protective
factors against mental breakdown (particularly suicide)
at the individual and family levels. For example,
promoting and implementing the benefits of good
nutritional status, healthy exercise/activity levels,
educational attainment and participation in traditional
and cultural activities are proven protective factors.
• Future studies may want to take a different approach to
examining the concept of cultural continuity and its
relationship to youth suicide. This is important because
Chandler and Lalonde’s work outlines community-level
factors that can be protective and can translate into
reduced youth suicide rates, with the ultimate benefit for
the entire community.23, 24
Notes to Chapter 25
1. M. J. Chandler and C. Lalonde, 1998, Cultural continuity as a hedge against suicide in

Canada’s First Nations, Transcultural Psychiatry, 35, 2: 191-219.
2. Statistics Canada, “Mental Health of Canada’s Immigrants in Canadian Community Health
Survey,” Supplement to Health Reports 13 (2002), p. 3.
3. Statistics Canada, “The Health of the Off-reserve Aboriginal Population,” Supplement to
Health Reports 13 (2002), p. 6.
4. “The Health of the Nova Scotia Mi’kmaq Population (1997),” The Health of Canada’s
Children: A CICH Profile, 3rd Edition (Ottawa, Ont.: Canadian Institute of Child Health,
2000), p. 164.
5. Suicide Prevention Advisory Group, Acting on What We Know: Preventing Youth Suicide in
First Nations (Ottawa, Ont.: Health Canada, 2002), p. 17.
6. “Aboriginal Peoples’ Health,” Improving the Health of Canadians (Ottawa, Ont.: Canadian
Population Health Initiative, Canadian Institute for Health Information, 2004), p. 80.
First Nations, p. 17.
8. Ibid., p.23.
9. Health Canada, A Statistical Profile on the Health of First Nations in Canada (Ottawa, Ont.:
First Nations and Inuit Health Branch, Health Canada, 2003), pp. 34-35.
First Nations, p.25.
11. Chandler and Lalonde, Cultural continuity as a hedge against suicide in Canada’s First
Nations, Transcultural Psychiatry.
12. Ibid.
13. “The Health of the Nova Scotia Mi’kmaq Population (1997),” The Health of Canada’s
Children: A CICH Profile.
14. Ibid.
15. Health Canada, A Statistical Profile on the Health of First Nations in Canada.
16. B. Malchy and M.W. Enns, 1997, Suicide among Manitoba’s Aboriginal people, 1988-1994,
Canadian Medical Association Journal, 156, 8: 1133-1138.
First Nations, p.16.
18. “Aboriginal Peoples’ Health,” Improving the Health of Canadians.
19. Ibid.
20. C. Wieman, An Overview of Six Nations Mental Health Services, proceedings of the Advanced
Study Institute: The Mental Health of Indigenous Peoples, edited by L. J. Kirmayer, M. E.
Macdonald and G. M. Brass (Montreal, Que.: Culture & Mental Health Research Unit, Report
No.10, 2000), pp. 177-185.
22. M. Chandler and C. Lalonde, Transferring Whose Knowledge? Exchanging Whose Best
Practices? On Knowing About Indigenous Knowledge and Aboriginal Suicide, edited by D.
Beavon and J. White, Aboriginal Policy Research (London, Ont.: Althouse Press, in press).
24. Chandler and Lalonde, Transferring Whose Knowledge? Exchanging Whose Best Practices?
On Knowing About Indigenous Knowledge and Aboriginal Suicide.
225
The Health of
First Nations Children
Chapter 26
Household Structure, Income, and Parental Education
Abstract
Based on the 2002/03 First Nations Regional Longitudinal Health Survey (RHS) study of children
(under age 12) in First Nations communities, observations were made about children’s families,
households, and childcare arrangements, and about the parents’ physical assets and educational
resources. The resulting descriptions of children’s situations in First Nations communities were not
unexpected. Surrounded by family even when in childcare, most children were well rooted in their
family and community. Some children were given the experience of formal childcare situations that
had the potential to meet the child’s developmental needs as well as their parents’ need for childcare
while in school or at work. The physical and educational resources of parents and other household
members continue to lag seriously behind the Canadian population. Fewer children in large First
Nations communities were in childcare situations and more lived in crowded homes compared to mid-
size communities. More children in non-isolated communities had family and housing resources than
those in communities that were isolated.
228
RHS 2002/03 Child Survey – Chapter 26: Household Structure, Income, and Parental Education

Introduction
This chapter lays the foundation for interpreting the health of Family and household structure
children living in First Nations communities through a
Two-thirds (66.3%)ii of the children living in First Nations
description of their family, household and childcare
communities lived in households with five or more people,
situations. Some of these situations have been shown to be
mostly family. The majority (83.2%) lived with two adults or
influential determinants of health, especially for children.
more; one-third (38.0%) lived with three children/youth or
The enquiry is intended to describe the extent to which these
more (children and youth other than themselves). The
children are potentially connected to and involved in their
number of household members ranged from two to twenty-
families. Following this, there will be an examination of
two with a mean of 5.5. Adults living in the household
some of the resources available to the families that might
ranged from one to eleven, with a mean of 2.3. The number
affect their physical and cultural well-being, as well as the
of children and youth ranged from age one to seventeen
health of their children.
(including children in the survey) with a mean of 3.1.
This chapter is written primarily from a perspective that
Almost all children living in First Nations communities
utilizes a First Nations cultural framework. The main starting
(94.6%) lived with one or more parents (biological, adoptive
points include consideration of the “total health” of the total
and/or step).
person in the “total environment”. This chapter is mainly
focused on family and community environments of children Figure 1. Parents or other relatives as caretakers in families of
in First Nations communities. First Nations children (n=6615)
While children are individuals, this chapter focuses on the

physical and social environments in which they live. The
children are seen in the context of their families and
households (considered to be primary influences for the
health and balance of body, mind, heart and spirit). One parent, 40.0%
Descriptions of the families and households include

information about household size, living with parents or Two parents, 54.6%
others, living in households with extended family members,

living with other children and youth, and childcare
arrangements. Grandparents, 3.4%
In addition to the makeup of the families and households, Aunts, uncles,

Foster parents, 1.5% cousins, 0.4%
there is also concern for the physical surroundings of the
children. Housing conditions are part of the very personal
physical environment of the children. Crowding especially Statistics Canada states that 65% of Aboriginal children
has implications for potential connections to family and other living on reserve (under age 15, compared to RHS children
household members. Characteristics of a child’s community reported here under age 12) resided with two parents, and
can also be indicators of Euro-centric influence. 33% resided with a lone parent.1 Aboriginal children living
in census metropolitan areas lived in equal numbers in two-
Regarding resources available to First Nations children, the parent and lone-parent households.2 In comparison, 75% of
survey includes information about housing size, extent of Canadian families with children under age 15 in 2002 lived
crowding, household income, and parental education. with two parents.3
Community characteristics that might affect resources or In children’s households with one or more parents present,
extent of exposure to Western culture are community size 37.9% had other adults living in the household.iii This was
and extent of the community’s geographic isolation. true for a larger proportion of households with one parent
For the most part, only those differences that were both present than households with two parents (61.4% vs. 24.6%).
socially and statistically significant were reported. i About half of the households with parents and other adults
included grandparents (16.5% of all households), and about
half included aunts, uncles or cousins (15.5%).
i
significant differences, although they may be based on quantitative data, are usually focused on
whether the observable differences really matter in the real world. In this chapter, differences of about
10% from one group to another were usually considered socially significant, although this was not a
rigid criterion. Readers may have different criteria than the authors. Statistically significant differences
ii
are mathematically derived and have to do with the accuracy of the estimates. Estimates of To simplify the text, confidence limits are only reported for overall children estimates with a co-
percentages and means that are based on samples are not exactly transferable to the populations that efficient of variation of greater than 33.3%. A statistical appendix including confidence intervals for
the samples represent. Each estimate comes with a range of values around it (a confidence interval) all reported figures is available at www.naho.ca/fnc/rhs
iii
that describes all the possible values that the percentage or mean can take in the population. Hence, in Comparisons between groups reported in this chapter are all significant unless “NS” —not
this chapter, statistically significant differences are concluded when the 95% confidence intervals did significant— is specified in brackets. In this chapter, estimates are considered significantly different if
not overlap. their confidence intervals do not overlap (95% confidence level).
229
In comparison, only 2% of Canadian families were multi- by non-relatives than relatives (43.4% vs. 31.5% of those in
generational in 2001.4 care). On the other hand, children in First Nations
communities had very few non-relative caretakers compared
Most of the children lived in households with other children
to those who were relatives (4.6% vs. 50.2% for ages one to
and/or youth (87.3%).
five).
Figure 2. Numbers of Children and/or Youth in Families of First
Nations Children (n=6637) Table 1. Percentage of children in child care with setting and
caretaker cariations in Child Care arrangements (n=2171)
Location
Onl y chi l d
5+chi l dr en
13%
17% In homes In formal settings
64.7% 31.3%
2 chi l dr en Nursery or
24%
pre-school,
Before and
day care
Child’s Others’ after
centers or
own home homes school
Caretaker private
3-4 chi l dr en programs
46%
home day
care
32.7% 32.0% 27.9% 3.4%
In the 1997 National Health Survey of First Nation and Siblings 9.1%
Labrador Inuit communities, the predecessor to this study,
the mean number of children and youth below age 17 was 2.6 Another
21.0% 28.9%
(compared to the current 3.2).5 Statistics Canada states that in relative
2001, of families with children at home in Canada, 43% had Non-
2.6% 2.4%
one child, 39% had two, and 18% had three or more.6 relative
Childcare arrangements Income and housing resources
When parents made childcare arrangements for their Although the children in this RHS study were apparently
children, the children were most often cared for by relatives surrounded by family, they were not as exposed to material
(thereby remaining with family when the parents were away). affluence. With an average (mean) household size of 5.5
Some children traveled outside their home for childcare, but adults and children, the households with children had a
a substantial portion did not leave their own homes. median household income of $19,716, and the median
number of rooms was 6. In the RHS adult survey, for
About one-third of the children had childcare arrangements households with no children, the income is higher (median =
made for them when parents were away for work or school $27,970) and the median number of rooms is lower (5).
(34.7%). Of the children in childcare settings, over half were
cared for by relatives in home settings (59.2%). Of all the In households with both parents present, the median income
children with childcare arrangements, more than twice as was $27,385, compared to households with one parent
many were cared for in homes (64.7%) as were cared for in present, where the median income was $17,737. Statistics
more formal settings (31.3%). For those in homes, they were Canada reported much higher median household incomes for
equally divided between their own homes and the homes of Canadian families, at $64,704 for two parent families and
others, most of them cared for by relatives. $31,200 for lone parent families.8
Statistics Canada reports that over half of children from six The number of rooms ranged from 1 to 13 or more. One of
months to five years of age (including children from some the most widespread mainstream indicators of crowding used
participating reserves) were in some form of childcare in by Western nations defines households as crowded if there is
2000/01.7 The RHS statistics for children living in First more than one person per room.9 Using this standard, 32.1%
Nations communities were lower for ages one to five, at of First Nations households with children were crowded.
44.3%. The forms of childcare also differed. Canadian Given that only 1% of households in the RHS adult survey
children aged one to five were much more likely to be cared with no children or youth in residence have crowding, it can
for in a home than a day care centre (75.0% in homes vs. be concluded that almost all of the households defined as
25.0% in centres, compared to 54.8% in homes vs. 42.8% in crowded include children.
centres for children aged one to five in First Nations The Treasury Board reported that, in 2001, 17% of off-
communities). Another major difference is that Canadian reserve Aboriginal people lived in crowded conditions (down
children cared for in homes were more likely to be cared for
230
5% from 5 years earlier) and that about 7% of all Canadians or vocational school, while a small minority had obtained a
lived in crowded conditions.10 Given that the First Nations bachelor’s or master’s degree or doctorate.
population is increasing, the need for additional appropriate Table 3. Children’s parents’ education
housing may grow even as solutions are implemented. In
March 2003, there was “an existing shortage of 20,000 Highest level of formal
Mother’s Father’s
housing units and a requirement of 4,500 new units per education education
schooling
(n=6401) (n=5566)
year”11 in First Nations communities.
As one would expect, the percentage of children in crowded Less than high school 46.0 56.6
living situations was greater for households with more
household members. In households with four or fewer High school graduate 24.4 20.3
members, crowding occurs 6% of the time. For households of Post-secondary diploma 24.5 20.4
five, the rate is 14%, but for larger households the rate
increases dramatically, with 46% for households of six and Bachelors 5.0 2.6
92% for households of nine or more. The pattern is similar
Masters or doctorate - -
when the number of children in the household is taken into
- Data suppressed due to insufficient cell size.
consideration (although crowded conditions occur for over
95% of households with seven or more children).
Parental education varies with a number of variables(See
Table 2. Percentage of children living in homes with more than Table 5). For parents with more education:
one person per room by household size and number of
children/youth (n=~6600) • the median income of the household in which the child
Estimate of % hh with crowding lived was greater
• more children had childcare arrangements made for
Based on number them
Based on number
of children and
of household
youth in • a higher percentage of homes had both parents present.
members
households
Table 5. Children’s household income, childcare arrangements
All hh with children 32.4% 32.3% and household structure by parents’ education.
Diploma, Bachelors,
Hh of 1 child n.a 3.9% < HS HS grad
etc. plus
Hh of 2 persons/children - 14.8 Mother
3 - 17.8 n= 3019 1451 1533 257
4 8.5 47.2 Median

$15,611 $23,170 $30,458 $56,843
Income
5 14.2 68.9
41.2%
Child care 29.5% 33.4% (NS) 45.1%
6 45.6 85.3 (NS)
Two parent
51.0 58.6 (NS) 56.4 (NS) 70.1
7 60.6 96.7 hh
8 71.3 90.6
Father
9+ 92.2 100.0
n= 3090 1072 1194 160
- Data suppressed due to insufficient cell size.
Median
Parental education Income
$17,037 $24,592 $36,056 $65,158
The following educational patterns for the parents of children

Child care
should not be assumed to represent the highest potential for (ns)
33.9 37.7 (NS) 36.6 (NS) 40.7 (NS)
educational attainment in a lifetime. Not only are many First
Nation parents still high-school age, it has been shown that Two parent
59.5 57.4 (NS) 69.8 73.0 (NS)
many First Nations adults return to school for post-secondary hh
education after a break of some years.
About half of the mothers and fathers of the children in the
survey had graduated from high school (see Table 3). About Communities of different sizes differed on two
half of those who had graduated from high school had gone characteristics: their households and childcare situations.
on to obtain a diploma from a university, college, technical Large communities were different from mid-size
231
communities, while non-isolated communities were most

different from remote, isolated and semi-isolated
Table 7. Household and childcare variations by degree of
communities.
isolation of community (n=4600)
There were no socially or statistically significant differences Isolation status
in numbers of household members for communities of Remote Semi- Non-
different sizes with regard to their relationships to children Isolated
and parents’ education; however, there were differences in Two parent households
childcare arrangements and the extent of crowding. In a % 49.2 = 51.3 = 45.6 56.5 =
comparison of situations with children in large and mid-size
Childcare
communities, more children in large communities lived in
crowded homes while fewer children were in childcare % in formal cc - 12.2 40.0 34.8
situations. Small communities (<300 persons) were not Housing
statistically significantly different than mid-size or large
Median # rooms 5 5 5 6
communities. This may sometimes be due in part to the small
% HH w crowding 47.7 45.6 46.4 25.8
sample size from small communities.
Parents education: % HS Grad and above
Table 6. Childcare and crowding variations by community size
(n=6,627) Mother 37.8 41.2 42.9 59.6
Community size HH income median $36,553 $18,035 $18,185 $21,026
*The dark bar between two adjacent cells indicates a statistically significant difference based on non-
Small Mid-size Larger overlap of confidence intervals. A light bar indicates overlap.
= in two non-adjacent cells indicates no statistically significant difference.
Childcare - Data suppressed due to insufficient cell size.
% in cc
33.3 37.6 (NS) 30.5*
(n=6554)
*Significantly different from mid-sized communities only. Conclusions and Recommendations
More children in non-isolated communities: Conclusions

• Came from two-parent households than children in Children living in First Nations communities who were
semi-isolated communities; surveyed for the RHS were surrounded by family (both
• Were in formal childcare situations compared to nuclear and extended) in households with many members.
children in remote and isolated communities; Almost all of these children lived with their parents and most
lived with siblings or other related children. Of the one in
• Had more rooms in their houses and less crowding; and,
three children with childcare arrangements, over half were
• Had mothers who were high school graduates or had cared for by relatives in home settings.
post-secondary education.
There is considerable evidence that children who have been
Remote isolated, isolated and semi-isolated communities
exposed to formal childcare situations have fewer problems
tended to be similar with regard to:
in school. Canadian children in the National Longitudinal
• Children coming from two-parent households; Survey of Children and Youth who attended day care and
• The percentage of children in formal childcare situations pre-school prior to Kindergarten had an advantage with
(not including semi-isolated); regard to reading, writing, math and communication skills in
Grade 1 (compared to children who attended only
• The number of rooms and crowding rates; and, Kindergarten or stayed at home until entering Grade 1).12
• The mother’s education. Children in First Nations communities were in formal
The pattern for children in remote isolated communities was childcare situations more often than all Canadian children,
unique in that households with children had a much higher but how this translates into formal educational advantages is
median income. yet to be determined. This may be because certain
developmental needs related to education are met in day care
that are not met by in-home childcare provided by relatives.
Although the children were apparently surrounded by family
resources, they were not as exposed to material affluence.
Median incomes for households with children were
considerably below the Canadian population. Crowding
(defined as more than one person per room) was a problem
for almost one in three children and was serious for over two-
232
thirds of all children living in households with five or more

children.
While the standards to measure crowding employed in this
report might be labeled as “Western”, the problem of
crowding is still real. For many First Nations families, the
preference is for living with extended kin. Nevertheless,
where there is a housing shortage, this may be a necessity. In
other instances, the typical houses are too small and the
resources for enlarging the houses do not exist.
Recommendations
Given that children have multiple needs that may be met by
different situations, a combination of quality childcare
arrangements that include time spent at home with family
and time spent in more formal child care situations could be
ideal for First Nations children. Where possible, this
opportunity should be provided for stay-at-home parents as
well. Given that this situation already exists through many
early childhood programs, the question on the future
questionnaires might be amended to capture this dual
arrangement situation.
Recommendations about crowding are apparent. Appropriate
housing is urgently needed to accommodate the preferences
of some First Nations families for living with extended
family and the need for adequate space in these large
households. At the same time, where the large households are
the result of an inadequate supply of houses, more houses are
needed.
Notes to Chapter 26
1. Statistics Canada, “The People: The Population: Aboriginal Peoples,” Canada e-book [online].
2003. Available from World Wide Web: <http://www.statcan.ca> Canada e-book > the People
> The Population > Aboriginal Peoples.
2. Ibid.
3. Statistics Canada, “The People: Household and Family Life: Family Arrangements,” Canada
e-book [online]. 2003. Available from World Wide Web: <http://www.statcan.ca> Canada e-
book > the People > Household and Family Life > Family Arrangements.
4. Ibid.
5. Harriet MacMillan et al., “Children’s Health,” First Nations and Inuit Regional Health Survey,
National Report, 1999 (Ottawa, Ont.: First Nations and Inuit Regional Health Survey National
Steering Committee, 1999).
6. Statistics Canada, “The People: Household and Family Life: Children,” Canada e-book
[online]. 2003. Available from World Wide Web: <http://www.statcan.ca> Canada e-book >
the People > Household and Family Life > Children.
7. Statistics Canada, “Child Care,” The Daily, February 7, 2005 [online]. Available from World
Wide Web: <http://www.statcan.ca/Daily/English/050207/d050207b.htm>.
8. Statistics Canada, “The People: Household and Family Life: The Family Budget,” Canada e-
book [online]. 2003. Available from World Wide Web: <http://www.statcan.ca> Canada e-
book > the People > Household and Family Life > The Family Budget.
9. Andrew Jackson and Paul Roberts, Physical Housing Conditions and the Well-Being of
Children (Ottawa, Ont.: Canada Council on Social Development, 2001).
10. Treasury Board of Canada, “Aboriginal Peoples,” Canada’s Performance 2004 (Ottawa, Ont.:
Treasury Board of Canada Secretariat, 2004).
11. Ibid.
12. MacMillan et al., “Children’s Health,” First Nations and Inuit Regional Health Survey,
National Report, 1999.
233
Chapter 27
Language, Culture, Headstart and School
Abstract
Children living in First Nations communities typically live in a bi-cultural world. Parents and
grandparents highly value their children’s knowledge of First Nations languages and their experiences
of traditional cultural events. At the same time, they assessed the academic performance of their own
children in Eurocentric school systems as average or above average. Through family, community
members and some schoolteachers, the potential exists for most children to remain connected to the
traditional cultures of their First Nations, and, to a lesser extent, to their First Nations languages.
Aboriginal Head Start, a variation of the original Head Start program in the U.S., was designed to
bridge the gap between home and school environments. The data in this study indicated that
Aboriginal Head Start attendance lowered the chance of children repeating grades in elementary
school.
234
RHS 2002/03 Child Survey – Chapter 27: Language, Culture, Headstart, and School
With regard to school experiences, the information gathered

Introduction
includes:
This chapter focuses on the relationship that Aboriginal
• Assessments of the children’s academic
children have with their traditional culture and language. It
performance by parents, grandparents or guardians
also takes note of the people from whom they learned their
who answered the questionnaire;
First Nations language and from whom they learned about
their traditional culture. School experiences were examined • Whether the children have skipped or repeated
briefly, as these are often environments where both grades; and,
traditional and Western cultures are transmitted. • Whether the children have been in the Aboriginal
This chapter is written primarily from a First Nations Head Start program.
perspective, considering the total health of the total person in
Community
the total environment, and reflecting a belief that body, mind,
heart, and spirit are necessary aspects of a total person. The For community characteristics, information was gathered
data are mainly focused on spirituality and connectedness, as about:
well as school experiences related to the mind and learning,
• Community size (with its potential effect on
for children living in First Nations communities.
resources); and,
Traditional culture • Relative isolation of the communities in which the
children lived (with its potential for limiting or
We are particularly concerned with children’s involvement in increasing exposure to Western cultures).
their respective traditional First Nations cultures. This
chapter focuses on the documentation of the types of people From a First Nations perspective, there are some exceptions
who help children understand their traditional cultures. to the First Nations orientation of this chapter. These
With regard to the child’s connectedness to traditional exceptions include: a comparison of children’s achievements
culture, information was gathered from the point of view of to those of other children; and, the assumption that math and
the parent, grandparent or guardian who answered the English or French language capabilities are the most
questionnaire on the child’s behalf about: important capabilities for judging the academic abilities of a
child (related to the pattern of repeating grades).
• The importance for the child of having knowledge
of a First Nation/Inuit language; For the most part, only those differences that were both
• Experiences of traditional cultural events; socially and statistically significanti were reported in this
• First Nation/Inuit languages understood and spoken chapter.
by each child; and,
• Family and community sources of help with a Results and Discussion
child’s cultural understanding, including Aboriginal Language and Culture
Head Start and schoolteachers who help children
understand their traditional cultures. Learning a First Nations/Inuit languageii and having
traditional cultural events in a child’s life were considered
School experiences important by a majority of the people who answered the
School experiences are a necessary component of every questionnaires about the children (92.9% and 83.2%
child’s life. They may partly complement traditional cultural respectively – see Table 1).iii iv Parents of First Nations
socialization, but definitely emphasize Western learning children not living in First Nations communities were asked
styles, models of education, and dominant cultural the same question about the importance of their children
expectations with regard to the greater importance assigned speaking and understanding an Aboriginal language. More
to some kinds of intelligences over others. The disconnect parents and grandparents of children in First Nations
between Western approaches to education and the needs of
Indigenous communities is obvious; one only need consider i
the high percentage of First Nations children who repeated significant differences, although they may be based on quantitative data, are usually focused on
whether the observable differences matter in the “real world”. In this chapter, differences of about
grades in a school system that was imported to their 10% from one group to another were usually considered socially significant, although this was not a
communities. Aboriginal Head Start is an attempt to bridge rigid criterion. Readers may have different criteria than the authors. Statistically significant differences
are mathematically derived and have to do with the accuracy of the estimates. Estimates of
the gap between traditional and home cultures and the bi- percentages and means that are based on samples are not exactly transferable to the populations that
the samples represent.
cultural school environment. ii
Although the general questions referred to First Nation/Inuit languages, only 8 Inuit children (ages 3
to 11, unweighted) were said to understand or speak Inuktitut. An additional 8 of them had only a few
words in their vocabulary. Based on this statistical insignificance, the references to Inuit languages
will be dropped from the report on the findings
iii
For clarification purposes, since 96% of the people who answered the questionnaires for the children
were parents and grandparents, they are referred to as such.
iv
To simplify the text, confidence limits are only reported for overall children estimates with a co-
235
communities felt that learning an Aboriginal language was There were 26 First Nations/Inuit languages that children had
very or somewhat important (93% vs. 67%).1 the ability to understand or speak fluently or relatively well.
Table 1. Importance of traditional culture in children’s lives*
Of these languages, more children had understanding of Cree
(n=6565) (6.5% of all children surveyed), Oji-Cree (2.6%), Ojibway
(2.2%, C.I. 1.0%-4.7%) and Montagnais (2.0%) than other
Importance of child Importance of First Nations languages. Languages understood fluently or
Importance learning First traditional cultural relatively well by 1% or more of the children were Mi’kmaq
Nations languages events in child’s life
(1.6%) and Attikamekw (1.3%).
Very important 64.3 44.5
Parents and grandparents frequently expressed satisfaction
Somewhat important 28.6v 38.7 with a child’s knowledge of their First Nation language. The
Not very important 4.8 9.6 level of satisfaction for parents and grandparents of all
Not important 2.3 7.1 children was 58.9% (19.1% very satisfied and 39.8%
* As assessed by parents, grandparents or guardians.
satisfied). For parents and grandparents of children ages 3 to
Children’s actual knowledge of First Nations languages lags 11, the level of satisfaction was 57.9% (satisfied or very
behind their parents’/grandparents’ sense of the importance satisfied). A similar question about children’s knowledge of
of such knowledge. Parents and grandparents who spoke a ‘Native culture’ in the previous RHS (1997) showed that
variety of First Nations languages were queried about the 69% of respondents were satisfied or very satisfied.
level of each child’s understanding of and speaking skills in However, it should be noted that the earlier question was
the language. The questions asked about the extent to which about culture and the later one was about knowledge of
each language could be understood and spoken (fluently, language.3
relatively well, a few words, or not at all). Generally, more
children understood than spoke their First Nations languages. Satisfaction with a child’s knowledge of the language of their
25.2% of children aged 3–11 were able to understand a First First Nation was somewhat related to both the extent of the
Nation language fluently or relatively well, and 19.3% were child’s knowledge and the importance placed on it by the
able to speak the language fluently or relatively well. Broken person, usually a parent or grandparent.
down by age category, the ability to understand and speak As reflected in Table 3, satisfaction levels break down as
fluently or relatively well improved with age, possibly follows for parents or grandparents who felt that knowledge
reflecting developmental stages in language acquisition: of a First Nation language for their children (aged 3-11) was
• For children aged 3–5, the findings were 18.6% for very important or somewhat important:
understanding and 13.3% for speaking. • Satisfaction levels were higher for parents/
• For children aged 6-8, the findings were 25.5% for grandparents of children who had knowledge of a
understanding and 19.2% for speaking First Nation language (over 83.6% satisfied or very
• For Children aged 9-11, the findings were 31.2% for satisfied).
understanding and 25.1% for speaking. • Satisfaction levels were lower, but not insubstantial,
for parents/ grandparents of children who had little
Table 2. Percentage of children who understand and/or speak a
First Nation language fluently or relatively well
or no knowledge of a First Nation language
(48.2%).
Speaking one or more
Understanding one or more Table 3. Satisfaction levels* (satisfied and very satisfied) with
Age First Nation languages
First Nation languages fluently knowledge of First Nations language of Children aged 3-11,
(years) fluently or relatively
or relatively well (n=5929) compared to levels of understanding and speaking (n=2957)
well (n=6147)
3-11 25.2 19.3 Understanding Speaking one or

one or more First more First
9-11 31.2 25.1 Nation languages Nation languages
6 -8 25.5 19.2 (NS)
3-5 18.6 13.3 (NS) Fluently or relatively well 83.6 89.5
Few words or none 48.2 49.5

According to the 2001 Aboriginal People’s Survey, 25% of * Of parents/grandparents who consider such knowledge as very important or somewhat important.
First Nations children (aged 3-14) living off-reserve could
speak or understand an Aboriginal language, which is Similarly, data from the 1997 RHS survey indicates that the
consistent with RHS findings.2 satisfaction with a child’s knowledge of Native culture was
based on whether the child understood and spoke an
Aboriginal language or not.4 The majority (81.0%) of
v
Comparisons between groups reported in this chapter are all significant unless “NS” —not children aged 6–11 speak English fluently, and 3.1% speak
significant— is specified in brackets. In this chapter, estimates are considered significantly different if French fluently.
236
for those with seven or more. The difference between the

questions posed in the APS and RHS should be noted. The
Family and community sources of help with understanding 2001 Aboriginal People’s Survey asked about sources of help
culture in learning the language while this RHS study asked about
sources of help for cultural understanding. The number of
An inquiry into the types of people who have helped the types of sources of help in cultural understanding for
child understand his or her culture showed that parents and children from First Nations communities ranged from 0 to 8
grandparents were the most mentioned (over 60% each).
in the RHS. The number of types of cultural sources in the
School teachers were mentioned as often as aunts and uncles RHS was related to a child’s reported understanding or
(approximately 30 to 35% each), but less often than parents speaking a First Nation language. (See Table 4) However,
and grandparents. Other people who were cited as being
the relationship in the RHS was not as strong as it was for
influential in the children’s understanding of their culture First Nations children not living in First Nations
were: other relatives, community Elders, other community communities surveyed in the APS.
members, and friends (ranging from 23% to 10%).
Table 4. Number, types and sources of help for children to
Figure 1. Relatives and community members involved in helping understand culture (n = 6657)
children understand their culture (n = 6422)
% of all % Understanding a % Speaking a
# sources children FN language* FN language*
Par ents 66.9%
(n=6659) (n=5398) (n=5400)
Gr andpar ents 62.0%
0 4.1 - -
School Teacher s 35.2% 1 31.3 17.2 (NS)** 13.5 (NS)
2 22.2 27.6 22.9
Aunts/ Uncl es 30.5%
3 17.1 24.2 (NS) 17.9 (NS)
Other Rel ati ves 22.6% 4 11.4 39.2 24.7
5 6.5 26.3 (NS) 21.2 (NS)
Communi ty El der s 16.7%
6 3.3 30.0 23.6
Other Communi ty Member s 16.5% 7 2.0 33.5 30.4
8 1.9 35.4 32.5
Fr i ends 10.1%
* children 3 – 11 years.
** not significantly different from 0 sources.
No one 5.2%
0% 20% 40% 60% 80%

The network of people helping children to understand their
culture expanded for older children. Relatives were as likely
A similar question about family and community members to be involved with children of all ages. Teachers,
who helped off-reserve First Nations children to learn a First community Elders, community members (only for 9-11 year
Nation language was asked in the 2001 Aboriginal People’s olds compared to 3-5 year olds) and friends (only for 9-11
Survey (APS). Although the APS analysis was limited to year olds compared to 3-5 year olds) were more involved as
children who had any capacity in speaking or understanding the children got older. At the same time, 3 to 5 year olds are
an Aboriginal language, the results were almost exactly the reportedly more likely to have no one involved in helping
same as the RHS responses for the question about those them understand their culture, compared to 9 to 11 year olds
helping children with cultural understanding. The one (7.0%, compared to 1.8%).
difference between the two surveys was that, for off-reserve Figure 2. Community members involvement in helping children
First Nations children in the APS, grandparents were cited understand their culture by age of children (n = 6422)
less often (55% compared to 62.0% in the RHS).5 60%
A small minority (5.2%) said that there was no one helping 50%
49.4%
46.3%
the child with cultural understanding, and this was mostly
attributable to results regarding very young children (16.6% 40%
3-5
6-8
for those under 1 year of age and 9.7% for those aged 1 to 2 - 9-11
significantly lower than the results for those aged 6–11). The 30% 28.6%
2001 Aboriginal Peoples Survey showed a relationship
21.7%
between the number of sources of help in learning a language 20%
19.9%
and the ability to do so. “The more a child can rely on 15.1%
11.7%
multiple sources for learning an Aboriginal language, the 10%
10.9%
7.0% 7.0%
more likely they are to speak and understand well an 3.1%
Aboriginal language”.6 For Inuit, First Nations and Métis
1.8%
0%
children not living in First Nations communities, the rates of Teachers Community Elders Friends No one
those who can speak and understand an Aboriginal language Individual
was 15% for those with one source of help, 38% for those In addition to expected age differences, there were other
with three sources of help, 54% for those with five, and 80% variations in children’s language and cultural experiences
237
and comprehension that could be associated with variations Pre-school, Head Start and schooling
in parents’ education as well as size and relative isolation of
The formal school system in Canada reflects a design
communities.
applicable mainly to those who, like the designers of the
Parents’ education levels apparently influenced First Nation system, are inclined to what is sometimes called an auditory-
language abilities and whether or not the parents helped with sequential learning style8. Although schools are changing as
the traditional cultural socialization of children aged 3 to 11 a result of audio-visual modes of instruction and computers,
(See Tables 5 and 6). the system is still dominated by curricula appealing to audio-
sequential learning styles. These styles work particularly well
• Mothers and fathers who had not completed high school for learning in the areas of mathematics and language. The
were more likely to have children who understood a result is a system that falls short of meeting the needs of
First Nation language. many children who have different learning styles than those
• More parents were cited as involved in their children’s valued by the most influential educators. Silverman estimates
understanding of their culture when the mothers had that about one-third of students in U.S. schools are visual-
completed some post-secondary education. spatial learners and that, while they are gifted, they are often
Table 5. Education of parents and child’s ability to
labeled as ‘underachievers’- or even outright “failures”,
understand/speak first nations languages (n= 5204) many of whom drop out.
Child’s ability to Child’s ability to There is some consensus concerning the impact that cultural
Parents’ education
understand 1+ FN speak 1+ FN bias in texts and other learning tools have on children from
level
languages languages the non-dominant cultures. This observation was a driving
force behind the development of the Aboriginal Head Start
Mother
program in Canada. Although the primary purpose of the
Not completed HS 29.9 21.1
program is to improve math and language capabilities, Head
HS grad + 21.2 17.5 (NS)
Start has been redesigned for Aboriginal children in Canada,
Father
to ease the transition from home to school. The curriculum
deliberately includes, and is to some extent based upon,
Not completed HS 29.0 20.7
many aspects of the traditional cultures of the children
HS grad + 20.6 17.5 (NS)
attending.vi Many teachers that are part of the regular school
system in First Nations communities have also included
traditional cultural knowledge in the classroom (this is
Table 6. Education of parents and parental involvement in statistically supported in that school teachers were named as
helping children (ages 3-11) understand culture (n=3477)
helpers in understanding traditional culture for 49.4% of 9 -
Parents education level
% of children whose parents helped 11 year olds in this study).
them understand culture
Parents and grandparents assessed their children’s scholastic
Mother
aptitude relative to other children in the same grade based on
Less than HS, HS Grad 65.8% report cards and schoolwork. Almost half (47.2%) of the
Post-secondary 72.4% children attending school were assessed as average. Of the
Father remaining children, more were considered above average or
67.4% slightly above average (40.2%) than were considered below
Less than Bachelors
74.2% average or slightly below average (12.6%).
Bachelors +
In contrast to the beliefs of parents and grandparents, 3.7% of
6 - 11 year olds had skipped a grade, while over 4 times as
First Nations children not living in First Nations
many (18.0%) had repeated a grade (See Table 7). Among 9 -
communities also had different rates of understanding and
11 year olds, 3 of 10 boys and 2 out of 10 girls had repeated
speaking a First Nation language that depended on the
a grade. Children were more likely to have repeated a grade
educational levels of parents. Thirty-three percent of the off-
if they came from households with incomes less than
reserve children whose parents who had not gone beyond
$30,000 (21.7%, vs. 8.7% for those from households with
elementary school were rated as having language ability,
incomes over $30,000).
compared with 21% for those whose parent had completed
some type of post-secondary education.7 Children living in Similar patterns were seen for Aboriginal children aged 6 to
First Nation communities had a language capability rating of 14 not living in First Nations communities. The income
29.9% for those with mothers who did not graduate from comparison used was household income below or above the
high school and 21.2% for those whose mothers had post- low-income cut-off (with 16% repeating a school year for
secondary diplomas and degrees.
vi
This typically includes First Nations languages, songs, stories, and other activities as well as posters
and other visual representations
238
those from households below the cut-off compared to 10% Table 8. First Nations languages and traditional culture by
community size (n = 5929)
for those from households above).9 Children of parents with
less education were also more likely to repeat a grade in the Community size
APS survey. 10 For children in First Nations communities
Small Mid-size Large
surveyed in the RHS, repeating grades did not vary by
parents’ education enough to be statistically significant. Understanding First Nations
9.1 21.1 32.1
languages
Figure 3. Parents’ and grandparents’ assessments of children’s
academic performance (n = 3000)* Speaking First Nations
4.9 14.3 25.4
languages
Above aver age 21.4%

Who influences culture of child?
Aunts/uncles 41.8 30.0 28.7
Sl i ghtl y above aver age 18.5%
Although having children who spoke a First Nation language

Aver age 45.8%
was valued as important by over 90% of the children’s
parents/grandparents, the actual ability to speak one or more
Sl i ghtl y bel ow aver age 9.5%
of 26 First Nations languages was reported for only 19.3% of
children aged 3–11. At the same time, 84.1% speak English
Bel ow aver age 4.8%
or French fluently and another 16% speak one of them
0% 10% 20% 30% 40% 50% relatively well.
* Ages 6 to 11.
Parents/grandparents in remote and isolated communities
favour having children learn a First Nation language and
Table 7. Percentage of children repeating grades (n=2662) support the learning of traditional culture from traditional
Percentage of children sources as might be expected of those with least exposure to
Ages 6-11 18.0 Western influence. Non-isolated communities showed
Ages 9-11 patterns of less support for First Nations language and culture
Boys 30.2 which may be considered consistent with their levels of
Girls 19.0 personal exposure to Western culture.
Ages 6-11 Table 9. First Nations languages and traditional culture by
HH income <$30,000 21.7 degree of isolation of community
HH income $30,000 + 8.7 Isolation status
Attending Head Start did appear to have an affect on whether Remote- Semi- Non-
Isolated
children (ages 6–11) had ever repeated a grade. Those who
had attended Aboriginal Head Start had a repeat rate of Importance of cultural events (n=5943)
11.6%, while those who did not attend Aboriginal Head Start
had a higher repeat rate of 18.7%. An interesting finding Very important 68.7% 36.4% 49.9%(NS) 45.0%
from the National Longitudinal Study of Children and Youth, Knowledge of First Nation languages (n=5539, 5742)
which cannot be replicated with RHS data, was that reading
to a child daily during their second and third years leads to Understanding 35.8 43.0 (NS) 32.4 (NS) 16.5
greater improvements in a particular vocabulary test than Speaking 20.6 32.8 (NS) 27.1 (NS) 11.1
learning these skills from an early education program.11 Who influences culture of child? (n=5999)
Reading several times a day gave the same statistical Elders 31.0 13.8 (NS) 18.8 (NS) 16.8
advantage that either income over $40,000 or mothers having
Grandparents 77.4 60.2 (NS) 65.1 (NS) 60.9 (NS)
post-secondary education gave.
NS - not significantly different from remote isolated communities
With only one exception, there were no significant
While community size and relative isolation seemed to be differences in academic performance, grade repetition or
related to First Nation language learning and cultural Aboriginal Head Start attendance for communities of
influences, these characteristics appeared to have little different sizes and degrees of isolation. In the remote
impact on the school experiences measured by this survey. communities the children were assessed more often as above
More children in large communities had knowledge of First average (37.3%) than slightly above average (6.3%), in
Nation languages, while more children in small communities contrast to the other types of communities, which had almost
were more likely to be helped in understanding their equal ratings in both of these categories.
language and traditional culture by aunts and uncles.
239
Table 10. Scholastic aptitude by degree of isolation of Recommendations and Solutions

community* (n=3669)
Isolation status While indications are clear that First Nations children have
potential for staying involved in their culture, it is likely that
Remote- Semi- Non- they will continue to be involved in a balanced way in both
Isolated
Western and traditional cultures as long as they remain in
their First Nations communities. Only a small minority of
Parents’ or grandparents’ assessment of scholastic aptitude of child
children does not or will not speak English or French. Given
Above average 37.3% 23.5% 22.5% 20.8%
the pervasiveness and pressures of Western society and the
diversity among First Nations, organized and concerted
Slightly above efforts will need to be made continuously in order to ensure
<10% 29.4% 19.7% 17.3% socialization into both cultures. This effort will be essential
average
for maintaining the spiritual ties to family, community and
*Children ages 3 through 11.
nation for generations to come.
Conclusions, Recommendations and Solutions Schools need to encourage and reinforce a bi-cultural
approach to children’s learning and evaluation in First
Conclusions
Nations schools.
Children living in First Nations communities had connections
The evidence that Aboriginal Head Start made significant
to their families and other aspects of their community. This
differences for a substantial proportion of children living in
was indicative of a strong potential for connections to their
First Nations communities indicates that the program needs
traditional culture. They were supported by parents and
to be expanded and developed so that it can be made
grandparents who valued the children’s ability to speak a
available for all children in those communities. As there are
First Nations language and, to a lesser extent, valued the
variations in the manner in which the program is delivered,
children’s involvement in traditional cultural events.
additional information should be obtained from further data
Children’s ability to speak First Nation languages fluently or analysis to determine if the positive effects were similar in
relatively well lagged behind the adults’ attitudes. Such a most communities or more concentrated in specific types of
lack of fluency indicates a potentially strong connectivity to community. The need for such information warrants further
Western cultures for almost all of the First Nations children in-depth investigation of the strengths of the more effective
on reserve. Ability to understand and speak a First Nation programs (this type of study is beyond the reach of the
language was more common among children in larger current RHS).
communities and least common in non-isolated communities
As well, since it has been demonstrated that reading daily to
(compared to remote, isolated and semi-isolated
a toddler affects their vocabulary development, a research
communities).
project on the effects of reading daily to First Nations
Families of First Nations children were among the most- children might include a culturally appropriate variation,
mentioned sources of cultural knowledge. Other community featuring stories told orally.
members were also involved in cultural transmission (more
so for older children). More sources of help in this particular Notes to Chapter 18
area meant that the child was more likely to speak a First
Nations language. Grandparents and Elders were more likely 1. Statistics Canada, “Aboriginal children and Aboriginal languages,” A Portrait of Aboriginal
to be involved in remote, isolated communities. Children living in Non-reserve Areas: Results from the 2001 Aboriginal Peoples Survey
2. Ibid.
Despite parental/grandparental assessments of their 3. Harriet MacMillan et al., “Children’s Health,” First Nations and Inuit Regional Health Survey,
National Report, 1999 (Ottawa, Ont.: First Nations and Inuit Regional Health Survey National
children’s scholastic abilities, which tended to rate these Steering Committee, 1999).
abilities as average or above average, a substantial 4.
5.
Ibid.
Statistics Canada, “Aboriginal children and Aboriginal languages,” A Portrait of Aboriginal
percentage of children (11.5%) repeated grades. Considering Children living in Non-reserve Areas: Results from the 2001 Aboriginal Peoples Survey.
6. Ibid.
the high rate of grade repetition, the appropriateness of the 7. Ibid.
predominating school curriculum for Aboriginal children 8. Linda Kreger Silverman, Upside-Down Brilliance: The Visual-Spatial Learner (Denver, Colo.:
DeLeon Publishing, 2002).
clearly needs to be reviewed, especially in light of the 9. Statistics Canada, “Education and learning among Aboriginal children,” A Portrait of
Aboriginal Children living in Non-reserve Areas: Results from the 2001 Aboriginal Peoples
differences noted earlier in this chapter between Survey.
visual/spatial and other learning methodologies and styles. 10.
11.
Ibid.
Garth Lipps and Jackie Yiptong-Avila, From Home to School—How Canadian Children Cope
Continuing with this thought, there is evidence that
Aboriginal Head Start experiences were important in
reducing the proportion of children repeating grades. This
evidence is among the strongest available for the
effectiveness of Aboriginal Head Start in Canada.
240
Chapter 28
Early Measures of Childhood Health: Birth Weight,
Maternal Smoking and Pregnancy
Abstract
From an Indigenous perspective, each new life might be considered as an opportunity from the creator
for hope and healing, for individuals, families, communities, and nations. On the medicine wheel
(Figure 1 in this chapter), infants sit beside elders. Like elders, they may be considered teachers.
Elders and infants are both close to the spirit world; the infants arriving from it, and the elders
traveling to it. This closeness to the spirit world may bring a spiritual strength, but it may also bring a
physical vulnerability and sensitivity to environmental disturbance. The medicine wheel life cycle
connects the experiences and wellness of infants to the experiences and wellness of children, youth,
young adults, parents, grandparents and elders, again from an individual, family, community, and
First Nations perspective.
241
RHS 2002/03 Child Survey – Chapter 28: Early Measures of Childhood Health: Birth Weight, Maternal Smoking and Breastfeeding
disease and diabetes to fetal, infant, and childhood

“If you want to understand the babies, then you experiences and exposures.3
will have to talk to the grandparents”
Data on important risk factors of infant health, such as
smoking and socio-economic characteristics are unavailable
-Jan “Kehehti:io: Longboat
in Canadian perinatal databases in any province. The rich
data on these exposures in the children’s component of the
Introduction and Literature Review
2002–03 First Nations Regional Longitudinal Health Survey
From an Indigenous perspective, each new life might be (RHS) offer us an unique opportunity to fill this gap by
considered as an opportunity from the creator for hope and assessing the inter-relationships between maternal smoking
healing, for individuals, families, communities, and nations. (active or passive), birth weight, breastfeeding and long-term
On the medicine wheel (Figure 1), infants sit beside elders. child health outcomes. This chapter is focused on an
Like elders, they may be considered teachers. Elders and important measure of infant health, birth weight, and two
infants are both close to the spirit world; the infants arriving important health behaviours, smoking during pregnancy and
from it, and the elders traveling to it. This closeness to the breastfeeding.
spirit world may bring a spiritual strength, but it may also
bring a physical vulnerability and sensitivity to Birth weight and infant health
environmental disturbance. The medicine wheel life cycle
Birth weight is recognized among non-Indigenous
connects the experiences and wellness of infants to the
populations as one of the most important measures of infant
experiences and wellness of children, youth, young adults,
health. Birth weight can be a sign of the conditions that the
parents, grandparents and elders.
baby was exposed to in the womb during the pregnancy, and
is also linked to health later in childhood and in adulthood
(for example, to the risk of coronary heart disease and Type 2
diabetes).4-6 In the document Healthy Canadians: A Federal
Report on Comparable Health Indicators, 2002, Health
Canada identifies infant mortality and the incidence of low
birth weight as the two primary maternal child health
indicators for Canadians.7 This is because babies that have a
low birth weight are more likely to get infections and other
illnesses. They are also at an increased risk for death. Birth
weight seems however a problematic health indicator for the
First Nations population: overall rates of infant mortality in
the First Nations population are substantially elevated, yet
the proportion of low birth weight babies (<2.5 kg) among
First Nations peoples has been shown to be very similar or
lower to that of the general Canadian population. 8-10 This
means that in First Nations populations, the rate of low birth
weight babies may not be as adequate a measure of infant
health as for non-First Nations populations, because even
when it is not elevated, First Nations babies may still be
experiencing higher rates of illness and death.
The proportion of high birth weight babies (≥4.0 kg) born to
First Nations mothers has been shown to be markedly higher
From a population health perspective, infant health measures
than non-Indigenous populations.11-16 Health researchers
are very much considered to be a core reflection of the health
associate high birth weight in non-Indigenous populations
of a community.1 Measures such as infant mortality and the
with maternal glucose disorders such as diabetes and
incidence of low birth weight have been firmly linked to
increased rates of birth injury.17 The significance of high
underlying determinants of health such as adequate food
birth weight among the First Nations population with respect
supply, adequate housing, employment, education level, and
to infant well-being is unclear. High birth weight among First
environmental exposures.2 Infants are considered to be
Nations peoples may be caused by diet, lifestyle, and genetic
vulnerable to adverse underlying social, economic, and
factors.18, 19 There is evidence to suggest that the fetal and
environmental conditions. It is this vulnerability that makes
metabolic changes that occur in the setting of maternal
infant health measures sensitive “sentinels” to underlying
diabetes may persist and contribute to the development of
population health determinants. Interestingly, over the past
insulin resistance in adulthood.20-22
decade, the “life cycle approach” to disease has begun to link
adult health conditions such as high blood pressure, heart
242
Smoking and infant health children, facilitates an earlier return to pre-pregnancy weight,
and reduces the risk of ovarian cancer.43, 44 The benefits of
Smoking during pregnancy exposes the unborn baby to
breastfeeding are maximized if the infant is breastfed for six
numerous toxic chemicals found in tobacco smoke, a
months or more.45
complex contaminant with 4,000 chemical compounds.
Tobacco smoke has been associated with a higher risk of
many chronic diseases in adults such as chronic lung
disorders and cancers, and has been consistently associated We used data for all children (n=6657) recorded in the 2002–
with over two times elevated risk of poor fetal growth.23, 24 2003 RHS. Hypotheses regarding possible relationships
Carbon monoxide, a gas from tobacco smoke, interferes with between birth weight, smoking during pregnancy, and
oxygen intake. This lack of oxygen can cause the baby to breastfeeding were generated based on a review of the
grow more slowly and gain less weight during the pregnancy, available results, scientific literature, and the cultural
and may impair the neurological development of the unborn framework. Consensus regarding hypotheses was reached
baby. Nicotine, which is another toxic substance contained in among members of our interdisciplinary team and data
cigarettes, can also harm the baby, because it restricts blood requests were generated and submitted to the RHS team.
flow to the placenta, meaning that the baby gets even fewer Data analysis was further refined in a series of follow-up
nutrients and less oxygen, and it also makes the baby's heart analysis requests. We used both descriptive and comparative
beat and breathing rate faster. approaches. Primary comparative results were tabulated in a
series of two-way tables. Statistical differences were assessed
Mothers who smoke during pregnancy have a greater risk of
using different methods than other chapters of this report.
miscarriages and birth complications.25 Mothers who smoked
Chi-square analyses were used to identify statistically
or were exposed to second-hand tobacco smoke during
significant differences in rates of outcomes among group
pregnancy usually have smaller babies than non-smoking
based on unweighted data. Percentages reported in tables and
mothers.26, 27 As described earlier, these low birth weight
graphs, though are based on weighted data, consistent with
babies are at a greater risk of illness and death.28 The effect
other chapters. Significance of results was set at p<0.05 and
of smoking on the growth of babies is at its worst during the
trends were discussed for results at p<0.10. In general, all
third trimester of pregnancy.29 Infants of mothers who were
reported results and associations are significant unless they
exposed to second-hand tobacco smoke during pregnancy are
are identified as a trend.
also at increased risk for sudden infant death syndrome.30 In
the long term, children of mothers who smoked tend to be The available numbers varied for individual variables as not
shorter than other children, and have more difficulty with all survey items were completed by every study participant.
reading and mathematics.31 For analyses involving family and community characteristics,
only those surveys completed by the biological mother were
Breastfeeding and infant health used. Analyses examining the long-term consequences of
birth weight, breastfeeding, and maternal smoking were not
Breastfeeding provides optimal nutrition for infants and is
restricted to biological mothers alone. Of the 6,657 surveys,
beneficial for both mother and child. A number of different
5,260 or 79.0% were completed by the child’s biological
health organizations, including Health Canada, the Canadian
mother. Family and community characteristics were
Paediatric Society, and World Health Organization,
examined, including maternal age, maternal education,
recommend that infants be exclusively breastfed for at least
family income, family history of residential schooling,
four months. Rates of breastfeeding for Aboriginal mothers
household crowding, community size, isolation or
have been consistently lower than the rate for the general
remoteness status, and transfer of health care status. Long
Canadian population. There is some evidence to suggest that
term consequences were examined including BMI, school
Aboriginal mothers who do breastfeed, do so for a longer
performance, general health, bronchitis or ear infection,
period of time.32 Other researchers have found that initiation
allergy or asthma, and psychological problems.
and duration of breastfeeding among First Nations mothers
has declined over the last three decades.33 An exploratory analysis was conducted to examine changes
over time in birth weight, breastfeeding status, and maternal
Infants benefit enormously from breastfeeding as it protects
smoking. To do so, we first examined the distributions
against gastrointestinal and respiratory infections.34-37
according to child’s current age, using one-year age groups.
Breastfeeding has been associated with a stronger maternal
The distribution of the surveys by age of the child is fairly
bond and a better quality mother-infant relationship.38 In the
even, except for children less than one year old, for whom
long term, breastfeeding has been associated with enhanced
there are significantly fewer completed surveys. As a result,
cognitive development.39-41 Researchers in the field of First
we have less information on pregnancy, birth, and the first
Nations health have consistently found that breastfeeding
year of life for children in the 2002–2003 period. To adjust
reduces the risk for ear infections (otitis media) and upper
for this, our final age analysis used three-year age categories.
respiratory tract infections.42 Breastfeeding also contributes
We excluded the 0–2 year age group for breastfeeding
to the health and well-being of mothers, as it helps to space
243
duration, as the breastfeeding duration categories were not Figure 2. Birth weight categories: First Nations compared with
the general Canadian population
meaningful for children under six months of age.
100%
When examining birth weight, comparisons to the general
Canadian population were made using data from Statistics 81.3%
80% First Nations (FNRHS
Canada for 1999. This set of vital statistics from Statistics 73.3%
2002-2003)
Canada includes First Nations infants born on-reserve who General Canadian
Population (NLSCY 1998-
completed birth registration. When examining breastfeeding 60%
1999)
and maternal smoking during pregnancy, comparisons to the

general Canadian population were made using the National 40%
Longitudinal Survey of Children and Youth in 1998–1999

(NLSCY 1998–1999).46 The NLSCY survey excludes First 20%
21.1%
Nations children living on-reserve. 13.1%

5.6% 5.6%
We used the 1997 First Nations and Inuit Regional 0%
Longitudinal Health Survey Children’s Health Chapter Low Birthweight (<2.5kg) Average Birthweight (2.5kg-
4.0kg)
High Birthweight (>4.0kg)
(FNIRLHS 1997) for a descriptive comparison of previous Birth weight cetegories

survey information specifically for First Nations on reserves
Table 1. Frequency of birth weight categories by child’s current
that was collected in 1997. It should be noted, however, that age (n=4836)
the FNIRLHS included a sample of Inuit children while the Low birth Average birth High birth
RHS 2002/2003 did not. weight weight weight
<2.5 kg 2.5-4.0 kg >4.0 kg
Results and Discussion Child Age
< 1 year to 2 years 5.5% 73.0% 21.5%
Birth weight 3 to 5 years 4.9% 73.3% 21.8%
6 to 8 years 5.2% 75.2% 19.6%
The average or mean birth weight for First Nations children 9 to 11 years 5.4% 75.3% 19.3%
was found to be 3.55 kg. Mean birth weight was higher for
males at 3.60 kg compared to females at 3.49 kg. This is
similar to non-Indigenous populations, where male infants Analyses to examine associations between birth weight and
tend to weigh slightly more than female infants at birth. maternal, family, and community characteristic were
conducted for only those children whose biological mothers
For this study, we defined low birth weight as less than 2.5
completed the survey (see Table 2). There were no
kg, normal birth weight as between 2.5 kg and 4.0 kg, and
significant associations with the other family and community
high birth weight as greater than 4.0 kg. The proportion of
characteristics that were examined.
low birth weight infants was 5.5%. This rate is comparable to
the previous rate for First Nations and Inuit (FNIRLHS We also tested for an association between birth weight and
1997), which was 5.4%. It is also comparable to the rate maternal smoking (see Tables 3 and 4). Low birth weight
among the general Canadian population (NLSCY 1998– infants were more likely to be born to mothers who smoked
1999), which was 5.6%. during their pregnancy. This link between maternal smoking
and low birth weight was marked when mothers smoked ≥ 20
The proportion of female and male infants with low birth
cigarettes per day.
weight was not significantly different. The proportion of high
birth weight infants was 21.0%. This rate is higher than the
previous rate for First Nations and Inuit (FNIRLHS 1997),
which was 17.8%. The current rate is markedly higher than
the proportion of high birth weight infants for the general
Canadian population (NLSCY 1998–1999), which was
13.1%. The proportion of male infants with high birth
weights was higher (24.6%) than for female infants (17.4%).
There was no association between birth weight and the age of
child (see Table 1). This means that the proportion of low
birth weight, average birth weight, and high birth weight
babies is relatively stable across the different age groups.
244
Table 2. Frequency of birth weight categories by maternal, Table 3. Frequency of birth weight categories by maternal
family, and community characteristics smoking categories (n=3922)
Low birth Average birth High birth Low birth Average birth High birth
weight weight weight weight weight weight
<2.5 kg 2.5-4.0 kg >4.0 kg <2.5 kg 2.5-4.0 kg >4.0 kg
Maternal Age at birth Maternal
(n= 4797) Smoking
<20 years 2.9% 75.0% 22.0% No 3.8% 73.1% 23.1%
20-34 years 6.1% 72.8% 21.1% Yes 7.6% 77.3% 15.0%
>35 years 7.7% 69.9% 22.4%
Maternal education
Table 4. Frequency of birth weight categories by maternal
(n= 4759)
smoking duration categories (n=1298)
Less than high school 6.5% 74.1% 19.5%
High school 4.4% 75.8% 19.8% Low birth Average birth High birth
College, technical, weight weight weight
5.6% 73.0% 21.4% <2.5 kg 2.5-4.0 kg >4.0 kg
vocational
University 3.2% 63.5% 33.3% Frequency of
Current household Maternal Smoking
income (n= 3480) 1-9 cigarettes/day 3.9% 77.9% 18.2%
≤ $10,000/year or 10-19 cigarettes/day 10.2% 77.6% 12.2%
5.9% 78.9% 15.2% ≥ 20 cigarettes/day 18.9% 72.9% 8.1%
income loss
$10,000-$14,999/year 3.4% 79.0% 17.6%
Figure 3. Birth weight categories and frequency of maternal
$15,000-$19,999/year 3.4% 68.8% 27.8% smoking (n=1,298)
$20,000-$29,999/year 4.8% 72.5% 22.7% 90%
$30,000-$49,999/year 6.0% 75.0% 19.0% 80% 77.9% 77.6%

72.9%
$50,000-$79,999/year 16.3% 64.8% 18.8 % 70%
>$80,000/year 1.3% 65.7% 33.0% 60%
Residential schooling1
50% Low birth weight
(n= 4836)
Average birth weight
No 6.1% 74.7% 19.2% 40%
High birth weight
Yes 5.1% 72.7% 23.3% 30%
18.20% 18.9%
Crowding (n= 4821) 20%
12.20%
10.2%
8.10%
Not crowded 4.7% 72.2% 23.2% 10%
3.9%
Crowded 2 7.4% 76.4% 16.2% 0%

1-9 cigarettes/day 10-19 cigarettes/day ≥ 20 cigarettes/day
Community size
(n= 4803) Number of cigarettes per day
<300 persons 7.3% 73.2% 19.4% In summary, the rates of low birth weight among First
300-1499 persons 4.2% 75.5% 20.3%
1500+ persons 7.1% 70.4% 22.4%
Nations living on-reserve are similar to those of the general
Remoteness (Isolation Canadian population. The rates of high birth weight among
status) (n= 4490) First Nations living on-reserve are close to twice those of the
Remote isolated 5.2% 81.3% 13.5% general Canadian population. Low birth weight is linked in
Isolated 7.9% 70.6% 21.5%
Semi-isolated 2.2% 72.0% 25.8%
this study to maternal smoking. This association is marked
Non-isolated 5.3% 73.9% 20.9% for heavy prenatal maternal smoking.
Health transfer status
(n= 4828) Breastfeeding
Not transferred 5.0% 75.5% 19.6%
The average proportion of children who were breastfed was
Community transferred 6.9% 69.0% 24.1%
62.5%. This rate is higher than the previous rate (50%)
Multi-community 4.8% 75.0% 20.1% reported for First Nations and Inuit (FNIRLHS 1997). It is
Note. Sample includes only those children whose biological mothers completed the survey.
1
lower than the rate (79.9%) that was reported for the general
Residential Schooling: Having at least one parent or grandparent who attended residential schooling.
2
Crowded: >1 person/room Canadian population (NLSCY 1998–1999). Of the children
who were breastfed, 21.6% were breastfed for 12 weeks or
less, and 35.2% were breastfed for three to six months and
43.3% were breastfed for more than six months. This rate of
sustained breastfeeding for more than six months appears to
be higher than the previous rate for First Nations and Inuit
(FNIRLHS 1997), which found that 22.5% of participant
children were breastfed for more than seven months. In
245
contrast, of infants from the general Canadian population (no scheduled flights) or non-isolated communities, and who
(NLSCY 1998–1999), 32.5% had been breastfed for 12 lived in a community that was part of a multi-community
weeks or less, 33.4% had been breastfed for three to six health services transfer arrangement. Breastfeeding rates
months, and 34.0% had been breastfed for more than six were lower for mothers with a household income <$15,000
months. per year. Infants were more likely to be breastfed for longer
Figure 4. Breastfeeding rate: Comparing First Nation with the
than seven months if their mothers were older, had a family
general Canadian population history of residential school attendance and/or lived in a
community that was part of a multi-community health
90%
services transfer agreement. There were no significant
79.9%
80% First Nations (FNRHS 2002-
2003)
associations with other characteristics.
70% General Canadian Population Table 7. Frequency of breastfeeding by maternal, family, and
(NLSCY 1998-1999)
60.3% community characteristics
60%
Breastfed
50% No Yes
43.3%
Maternal Age at birth (n=5181)
40%
32.5%
35.2%
33.4% 34.0% <20 years 40.1% 59.9%
30%
20-34 years 37.5% 62.5%
21.6%
>35 years 37.4% 62.6%
20% Maternal education (n=5121)
Less than high school 42.2% 57.8%
10% High school 40.0% 60.0%
College/technical/vocational 30.3% 69.7%
0%
Breastfed Breastfed (less than 12 Breastfed (3 to 6 Breastfed (more than 6
University 16.5% 83.5%
weeks) months) months) Current household income (n=3675)
≤ $10,000/year or income loss 49.3 % 50.7%
We examined the association between breastfeeding $10,000-$14,999/year 46.5% 53.5%
(incidence and duration) and the age of the child (see Tables
$15,000-$19,999/year 32.1% 67.9%
5 and 6). There was no significant association between
breastfeeding incidence or duration, and age of child. This $20,000-$29,999/year 33.0% 67.0%
means that the incidence of breast feeding and proportion of $30,000-$49,999/year 34.6% 65.4%
children who were breastfed for less than three months, three
$50,000-$79,999/year 26.2% 73.8%
to six months, and longer than six months, is relatively stable
across the different age groups. >$80,000/year 15.7% 84.3%
Table 5. Frequency of breastfeeding by child’s current age Residential schooling (n=5227)1
(n=5227) No 42.4% 57.6%

Breastfed Yes 34.0% 66.0%
No Yes
Crowding (n=5210)
Child Age
< 1 year to 2 years 61.2% 38.8% Not crowded 36.6% 63.4%
3 to 5 years 62.9% 37.1% Crowded 2
39.0% 61.0%
6 to 8 years 57.1% 42.9%
9 to 11 years 54.0% 46.0% Community size (n=5227)
<300 persons 37.6% 62.4%
300-1499 persons 37.2% 62.8%
Table 6. Frequency of breastfeeding duration categories by 1500+ persons 38.0% 62.0%
child’s current age (n=2287) Remoteness (Isolation status) (n=4864)
Duration of Breastfeeding Remote isolated 42.0% 58.0%
<3 months 3-6 months >6 months Isolated 46.9% 53.1%
Child Age Semi-isolated 49.2% 50.8%
3 to 5 years 20.4% 36.4% 43.2% Non-isolated 35.0% 65.0%
6 to 8 years 21.6% 36.5% 42.0% Health transfer status (n=5219)
9 to 11 years 19.1% 35.8% 45.1% Not transferred 37.6% 62.4%
Note – The category 0-2 years has been excluded in this analysis as the duration categories are not Community transferred 39.0% 61.0%
meaningful for children less than six months of age.
Multi-community 34.2% 65.8%
Analyses were conducted to examine associations between Note. Sample includes only those children whose biological mothers completed the survey.
breastfeeding (incidence and duration) and maternal, family, 1
2
Crowded: >1 person/room
and community characteristics (see Tables 7 and 8). Rates of
breastfeeding were higher for mothers with university
education, with a family income >$50,000/year, with a
family history of residential schooling, who lived in remote
246
Table 8. Frequency of breastfeeding duration categories of by Table 9 Frequency of breastfeeding categories by birth weight
maternal, family, and community characteristics categories (n=4822)
Duration of Breastfeeding Breastfeeding Category
<3 3-6 >6 No Yes
months months months Birth weight Categories
Maternal Age at birth (n=2761) Low birth weight (<2.5 kg) 53.0% 47.0%
<20 years 26.7% 34.5% 38.8% Average birth weight (2.5-4.0 kg) 40.8% 59.2%
20-34 years 20.6% 34.5% 44.9% High birth weight (>4.0 kg) 36.3% 63.7%
>35 years 18.8% 29.6% 51.7%
Maternal education (n=2743)
Less than high school 25.4% 31.1% 43.5% Table 10 Frequency of breastfeeding categories by maternal
High school 17.1% 34.8% 48.1% smoking categories (n=4169)
College/technical/vocational 19.1% 40.7% 40.2% Breastfeeding Category
University 24.7% 37.3% 37.9% No Yes
Current household income Maternal Smoking Categories
(n=2213) No 37.2% 62.8%
≤ $10,000/year or income loss 25.3% 38.0% 36.7% Yes 47.4% 52.6%
$10,000-$14,999/year 15.0% 32.1% 52.9%
$15,000-$19,999/year 23.6% 31.3% 45.0% Figure 5. Incidence of maternal smoking and incidence of
breastfeeding (n=4169)
$20,000-$29,999/year 23.2% 38.6% 38.2%
70%
$30,000-$49,999/year 19.2% 30.7% 50.1% Did not Smoke during pregnancy 62.8%
60% Did smoke during pregnancy

$50,000-$79,999/year 16.1% 34.7% 49.2%
52.6%
>$80,000/year 15.6% 42.3% 42.1% 50% 47.4%
Residential schooling1 (n=2788)

40% 37.2%
No 25.7% 33.2% 41.1%
Yes 19.0% 36.4% 44.6% 30%
Crowding (n=2783)
20%
Not crowded 23.3% 33.1% 43.6%
10%
Crowded 2 17.5% 40.0% 42.5%
Community size (n=2788)
0%
<300 persons 18.7% 38.0% 43.3% Did not Breastfeed Did Breastfeed
300-1499 persons 21.4% 39.0% 39.7%
1500+ persons 22.5% 28.8% 48.7%
Remoteness (Isolation status) In summary, the rate of breastfeeding among First Nations
(n=2528) on-reserve appears to be modestly lower than among other
Remote isolated 11.8% 32.3% 55.9% Canadians. However, First Nations infants on-reserve who
Isolated 15.0% 20.3% 64.7%
Semi-isolated 21.3% 44.4% 34.3%
are breastfed appear to be breastfed longer than breastfed
Non-isolated 23.6% 37.7% 38.7% infants in the general Canadian population. Rates of
Health transfer status (n=2784) breastfeeding among First Nations on-reserve appear to be
Not transferred 22.2% 33.9% 43.9% have increased since FNIRLHS 1997. Higher rates of
Community transferred 23.6% 36.1% 40.3% breastfeeding in this study are linked to higher rates of
Multi-community 15.5% 37.7% 46.8% maternal education, maternal affluence, maternal family
Note. Sample includes only those children whose biological mothers completed the survey. history of residential school attendance, communities that are
1
2
Residential Schooling: Having at least one parent or grandparent who attended residential schooling. remote, and communities that are part of a multi-community
Crowded: >1 person/room
transfer arrangement. Longer duration of breastfeeding was
We also checked to see if birth weight or smoking during linked to communities that are part of a multi-community
pregnancy were linked to breastfeeding rates (see Tables 9 transfer arrangement. Lower rates of breastfeeding were
and 10). Infants born with a low birth weight were less likely linked to maternal smoking and low birth weight. Higher
to be breastfed, and those born with a high birth weight were rates of breastfeeding were linked to high birth weight. The
more likely to be breastfed. Infants were more likely to be association of breastfeeding to maternal smoking is
breastfed if their mothers did not smoke during pregnancy. consistent with what is known about predictors of
breastfeeding in other populations.47, 48 Moreresearch is
required to better understand the links between breastfeeding
and residential school attendance, as well as community size,
community isolation status, and community health services
arrangements. Differing health services and programs in
247
remote and urban centres is one possible explanation for Table 11. Frequency of maternal smoking by child’s current age
(n=4180)
higher breastfeeding rates at both extremes of the community
isolation categories. Maternal smoking
No Yes
Child Age
Smoking during pregnancy < 1 year to 2 years 61.1% 38.9%
3 to 5 years 67.9% 32.1%
Rates of smoking during pregnancy were calculated for 6 to 8 years 69.3% 30.7%
children whose biological mothers completed the survey. The 9 to 11 years 69.2% 30.8%
average rate of smoking during pregnancy was 36.6%. This
rate is significantly higher compared to the general Canadian Table 12. Frequency of maternal smoking by child’s current age
population (NLSCY 1998–1999) which was 19.4%. The (n=1368)
rates of daily maternal smoking of cigarettes were: 20.2% for Maternal smoking duration pregnancy
1 to 9 cigarettes per day; 14.3% for 10 to 19 cigarettes per 1-9 10-19 ≥ 20
day; and 2.1% for 20 or more cigarettes per day. It is not cigarettes/day cigarettes/day cigarettes/day
Child Age
possible to make comparisons with the previous rates for < 1 year to 2
First Nations (FNIRLHS 1997) as these questions were not 60.6% 32.1% 7.3%
years
asked. The rate of daily maternal smoking for the general 3 to 5 years 61.3% 33.5% 5.2%
Canadian population (NLSCY 1998–1999) for more than 10 6 to 8 years 43.7% 44.6% 11.7%
9 to 11 years 47.7% 42.1% 10.2%
cigarettes per day was 5.3%, whereas in this survey the rate
for First Nations mothers was almost three times higher at
15.0%. The percentage of babies exposed to maternal Analyses were conducted to examine associations between
smoking during the third trimester was about one out of maternal smoking and maternal, family, and community
every three babies (32.2%). This is much higher than the rate characteristic (see Table 13). Rates of maternal smoking
from the NLSCY 1998–1999, which was 17.2%. The rate of during pregnancy were higher for younger mothers, mothers
environmental tobacco exposure (smoking in the pregnant with lower family incomes, mothers with less than university
First Nations mother’s home) was about one out of every two education, mothers with a family history of residential school
families (48.2%). attendance and in remote and isolated communities. Rates of
maternal smoking during pregnancy were lower in
Figure 6. Maternal smoking: Comparing First Nations with the
communities involved in multi-community transfer of health
general Canadian population
services, compared to single community transfer or non-
40%
36.6% transferred communities. There were no significant
35%
First Nations (FNRHS 2002-2003) associations between maternal smoking and the other family
32.2%
General Canadian Population (NLSCY
1998-1999)
and community characteristics that we examined. Finally,
30%
maternal smoking was linked in the birth weight and
25% breastfeeding analyses to lower birth weights and lower rates
19.4%
of breastfeeding, respectively (previously described above).
20%
17.2%
15.0%
Finally, maternal smoking was linked in the birth weight and
15%
breastfeeding analyses to lower birth weights and lower rates
10% of breastfeeding, respectively (see the Smoking During
5.3% Pregnancy section).
5%
0%
Ever Smoked > 10 cigarettes per day Exposure to smoking in 3rd
trimester
There was no significant association between the incidence

of maternal smoking and age of child (see Table 11). This
means that the incidence of maternal smoking is relatively
stable across the different age groups. There was a significant
association between the quantity of maternal smoking and
age of child (See Table 12). There is decrease across age
groups in the frequency of heavy smoking (≥ 20
cigarettes/day), and an increase across age groups in the
frequency of light smoking (1-9 cigarettes/day).
248
Table 13. Maternal smoking by maternal, family, and community good’ or excellent’ health. There were no other significant
characteristics
associations for the other outcomes (Figures 4, 5, 6 and 7).
Maternal Smoking
No Yes
Maternal Age at birth (n=4142) Table 14. Long term health consequences by birth weight
<20 years 58.1% 41.9% categories
20-34 years 63.3% 36.7% Low birth Average High birth
>35 years 71.2% 28.8% weight birth weight weight
Maternal education (n=4110) <2.5 kg 2.5-4.0 kg >4.0 kg
Less than high school 63.8% 36.2% BMI (CDC Standards for
High school 58.4% 41.6% Children) (n=2540)
College/technical/vocational 63.9% 36.1% Underweight 31.2% 7.2% 4.8%
University 71.4% 28.6% Acceptable 28.7% 33.8% 24.4%
Current household income (n=3005) At risk of overweight 4.4% 13.4% 18.5%
≤ $10,000/year or income loss 53.5% 46.5% Overweight 35.7% 45.7% 52.3%
$10,000-$14,999/year 50.2% 49.8% Current general health
(n=5772)
$15,000-$19,999/year 65.5% 34.5% Poor or Fair 25.2% 5.8% 7.7%
$20,000-$29,999/year 65.9% 34.1% Good 19.0% 23.1% 16.9%
Very good or Excellent 55.8% 71.1% 75.4 %
$30,000-$49,999/year 59.3% 40.7% Current school
performance (n=3346)
$50,000-$79,999/year 68.4% 31.6% Below average 5.7% 3.8% 4.4%
>$80,000/year 78.7% 21.3% Slightly below average 12.7% 8.9% 7.3%
Average 46.2% 47.2% 47.5%
Residential schooling (n=4180)
1
Slightly above average 24.7% 17.3% 16.6%
No 65.2% 34.8% Above average 10.7% 22.9% 24.2%
Yes 62.1% 37.9% Current health problems
Chronic bronchitis or
Crowding (n=3894) chronic ear infections 15.3% 11.4% 14.7%
Not crowded 62.6% 37.4% (n=667)
Allergies or asthma
Crowded 2 64.8% 35.3% 36.0% 21.7% 19.3%
(n=1231)
Community size (n=4180) ADD/ADHD, cognitive or
<300 persons 63.6% 36.4% mental disability or learning 23.2% 3.0% 4.2%
300-1499 persons 62.3% 37.7% disability (n=239)
1500+ persons 65.0% 35.0%
Remoteness (Isolation status) (n=3914) Figure 7. Birth weight categories and current body mass index
Remote isolated 65.7% 34.3% categories (n=2540)
Isolated 60.1% 39.9%
60%
Semi-isolated 65.6% 34.4%
Low Birth Weight
Non-isolated 63.4% 36.6% 52.3%
Average Birth Weight
Health transfer status (n=4172) 50%
High Birth Weight 45.7%
Not transferred 63.3% 36.7%
Community transferred 61.1% 38.9% 40%
35.7%
Multi-community 68.8% 31.2% 31.2%
33.8%
1 30% 28.7%
2
Crowded: >1 person/room 24.4%
Note. Sample includes only those children whose biological mothers completed the survey.
20% 18.5%
13.4%
Long-term consequences of birth weight
10% 7.2%
We further compared the long-term consequences of 4.8% 4.4%
different birth weight categories (see Table 14). Caution is 0%

advised for interpreting some results of these analyses on low Underweight Acceptable At risk of overweight Overweight
birth weight due to the relatively low frequency of some BMI Category (CDC Std. for Children)
events. Children with low birth weight were more often

reported to be underweight at the time of the survey, more
often in fair or poor health, and to have allergies or asthma
(considered together) as well as ADD/ADHD,
cognitive/mental or learning disabilities (combined).
Children born with a high birth weight were more often
‘overweight’ or at risk of overweight and less often
‘underweight’, and were more often described to be in ‘very
249
Figure 8. Birth weight categories and current health (n=5772) were more often in ‘very good’ or ‘excellent’ health, and less
80%
75.4% likely to have chronic bronchitis or chronic ear infections or
70% Low Birthweight
71.1% ear problems when compared to children who were not
Average Birthweight breastfed. The results are shown in Figures 8, 9, 10, and 11.
60% High Birthweight
55.8%
Table 15. Long-term health consequences by breastfeeding
50% status
Breastfed
40%
No Yes
30%
BMI (CDC Standards for Children) (n=2664)
25.2%
23.1% Underweight 9.9% 8.9%
20%
19.0%
16.9% Acceptable 26.6% 33.3%
At risk of overweight 15.7% 13.2%
10% 5.8%
7.7%
Overweight 47.9% 44.6%
Current general health (n= 6486)
0%
Poor or Fair Good Very Good or Excellent
Poor or Fair 5.8% 7.8%
Current General Health
Good 27.5% 19.1%
Very good or Excellent 66.8% 73.1%
Figure 9. Birth weight and current school performance (n=3346) Current school performance (n=3783)
50%
47.2%47.5% Below average 5.2% 3.5%
46.2%
Slightly below average 8.8% 8.4%
Average 47.9% 44.9%
40%
Low Birth Weight
Slightly above average 16.9% 20.6%
Average Birth Weight Above average 21.2% 22.7%
High Birth Weight
30%
Current health problems
24.7%
Chronic bronchitis or chronic ear infections (n=721) 14.4% 10.8%
24.2%
22.9% Allergies or asthma (n=1346) 19.3% 23.2%
ADD/ADHD, cognitive or mental disability, or
20%
17.3%16.6% 4.3% 4.5%
learning disability (n=275)
12.7%
10.7%
8.9%
10%
7.3% Figure 11. Breastfeeding and current general health (n=6486)
5.7%
3.8% 4.4% 60%
0%
Below Average Slightly Below Average Slightly Above Above Average 50% 47.9%
Not Breastfed
Average Average
44.6%
Current School Performance Breastfed
40%
Figure 10. Birth weight categories and current health problems
33.3%
40%
36.0% 30%
26.6%
Low Birthweight
30% Average Birthweight 20%

15.7%
High Birthweight 13.2%
23.2% 9.9% 8.9%
21.7% 10%
19.3%
20%
15.3% 14.7% 0%
11.4% Underweight Acceptable At risk of Overweight Overweight
10% BMI Categories (CDC Standards for Children)
4.2%
3.0%
0%
Chronic bronchitis or chronic Allergies or asthma (n=1231) ADD/ADHD, cognitive or mental
ear infections (n=667) disability, or learning disability
(n=239)
Current Health Problems
Long-term consequences of breastfeeding

Analyses were conducted to examine the long-term
consequences of breastfeeding (see Table 15). Children who
were breastfed were less likely to be “overweight” compared
to children who were not breastfed. Children who were
breastfed were less likely to be ‘overweight’ and more likely
to be at an ‘acceptable’ weight compared to children who
were not breastfed. In addition, children who were breastfed
250
Figure 12. Breastfeeding and current general health (n=6486) were not exposed to smoking during pregnancy. The
80% distribution in school performance indicated a trend towards
73.1%
66.8%
overall worse performance for infants whose mothers
smoked during pregnancy. The results are shown in Figures
60% Not Breastfed
12, 13, 14, and 15.
Breastfed
Table 16. Long-term health consequences by maternal smoking
Maternal Smoking
40%
during Pregnancy
27.5% No Yes
BMI (CDC Standards for Children)
19.1%
20% (n=2187)
Underweight 8.2% 12.4%
7.8%
5.8% Acceptable 32.7% 29.7%
At risk of overweight 13.7% 13.2%
0%
Overweight 45.3% 44.7%
Current general health (n=5105)
Poor or Fair 7.9% 5.1%
Figure 13. Breastfeeding and current school performance Good 17.7% 26.1%
(n=3783) Very good or Excellent 74.4% 68.8%
60% Current school performance (n=2960)
Below average 3.5% 4.0%
50% 47.9% Slightly below average 7.6% 10.9%
44.9%
Not Breastfed Average 49.2% 39.6%
40% Breastfed
Slightly above average 16.7% 22.8%
Above average 23.1% 22.8%
Current health problems
30%
Chronic bronchitis or chronic ear infections
22.7% 10.2% 15.1%
20.6% 21.2% (n=553)
20% 16.9% Allergies or asthma (n=1060) 22.0% 23.1%
ADD/ADHD, cognitive or mental
4.9% 3.5%
10% 8.8% 8.4% disability, or learning disability (n=211)
5.2%
3.5%
0% Figure 15. Smoking during pregnancy and current body mass

Below Average Slightly Below Average Slightly Above Above Average index categories (n=2187)
Average Average
50%
Current School Performance 45.3%
Did Not Smoke During Pregnancy 44.7%
Figure 14. Breastfeeding and current health problems Smoked During Pregnancy
40%
25%
23.2%
32.7%
29.7%
19.3% 30%
20%
Not Breastfed
Breastfed
15% 14.4% 20%
13.7% 13.2%
10.8% 12.4%
10% 10% 8.2%
5% 4.3% 4.5%
0%
Underweight Acceptable At risk of overweight Overweight
BMI Categories (CDC Standards for Children)

0%
Chronic bronchitis or chronic Alllergies or asthma (n=1346) ADD/ADHD, cognitive or mental
ear infections (n=721) disability or learning disability
(n=275)
Long-term consequences of smoking during pregnancy

Analyses were conducted to examine the long-term
consequences of smoking during pregnancy (see Table 16).
Children exposed to smoking during pregnancy were less
often in ‘excellent’ or ‘very good’ health, were more likely to
have chronic bronchitis or ear infections and slightly more
likely to have asthma or allergies, compared to children who
251
Figure 16. Smoking during pregnancy and current general health compared to the rest of the Canadian population.49, 50 This
80%
74.4%
study provides some novel information regarding the health
68.8% status of First Nations infants living on-reserve. Key findings
Did Not Smoke During Pregnancy
Smoked During Pregnancy
from this study follow.
60%
• Rates of low birth weight are similar to those of the
general Canadian population, suggesting that low birth
40% weight is not a key concern for First Nations on-reserve.
Nevertheless, low birth weight is a serious concern for
26.1% heavy smokers among First Nations on-reserve,
20% 17.7% suggesting the need for targeted intervention for the
promotion of smoking cessation among First Nations
7.9%
5.1% women at childbearing age.
0%
• Rates of high birth weight among First Nations are much
higher than those of the general Canadian population.
This strongly calls for additional studies to examine the
Figure 17. Smoking during pregnancy and current school biological and clinical implications of high birth weight
performance (n=2960) and the associated medical needs for First Nations
60% perinatal care.
49.2% • Rates of breastfeeding are modestly lower than those of
50% Did not Smoke During
Pregnancy other Canadians. The protective benefits of
40%
Smoked During 39.6% breastfeeding against obesity in this study suggest the
Pregnancy
continued need to promote breastfeeding among First
30% Nations.
22.8% 23.1%22.8%
• Rates of maternal smoking in pregnancy among First
20% 16.7% Nations are much higher than those of other Canadians.
10.9% The clear strong link between maternal smoking and
10%
3.5% 4.0%
7.6%
long-term adverse health outcomes for children strongly
suggests the urgent need for strategies to reduce
0%
Below Average Slightly Below Average Slightly Above Above Average maternal smoking among First Nations.
Average Average
Current School Performance

• The rate of household smoking during pregnancy is also
very high. Passive smoke exposure during pregnancy
Figure 18. Smoking during pregnancy and current health occurred in close to 50% of First Nations homes.
problems
25%
Clearly, the health of First Nations infants is linked to family,
22.0%
23.1% community and cultural factors.
20% Did Not Smoke During This study confirms some links known to exist in other
Pregnancy
Smoked During
populations between family and community factors and
15%
15.1% Pregnancy infant wellness. These include links between maternal
education level51 and breastfeeding; maternal smoking and
10.2% breastfeeding;52 young age (i.e., being a young mother)53,
maternal education, 54 and maternal smoking; and prenatal
10%
4.9%
smoke exposure to certain long-term child health outcomes.
5%
3.5%
The study identifies several other predictors of infant health
status and determinants that have not been previously
0%
Chronic bronchitis or chronic Allergies or asthma (n=1060) ADD/ADHD, cognitive or mental demonstrated in the literature. These include explorations on
ear infections (n=553) disability or learning disability
(n=211) the effects of novel community characteristics variables
(including family income, community isolation, residential
school attendance, and community control of health services)
Conclusion and Recommendations
in relation to birth weight, maternal smoking and
The holism of Indigenous and ecologic models of health and breastfeeding. Additionally, the study found low birth
wellness are founded on rich interconnections between weight, not breastfeeding, and maternal and household
different aspects of personhood, lifecycle and environment. It smoking during pregnancy were associated with increased
is already known that First Nations infants are experiencing risks of long-term health problems. These novel findings
rates of death and illness that are disproportionately high underscore a clear need for the promotion of smoking
252
cessation and breastfeeding among First Nations. They also

identify a need for further studies on the significance of high Notes to Chapter 19
birth weight among First Nations as well as studies that
examine the interrelationships between community 1. Health Canada, Healthy Canadians: A Federal Report on Comparable Health Indicators
characteristics and infant health outcomes. The 2.
(Ottawa, Ont.: Health Canada, 2002, cat. no. H21-206/2002).
M. S. Kramer, 1987, Determinants of low birth weight: methodological assessment and meta-
appropriateness of the 4.0 kg cut-off to define “high” birth analysis, Bulletin of the World Health Organization, 65: 663-737.
3. D. J. Barker, 1995, Fetal origins of coronary heart disease, British Medical Journal, 15, 311:
weight for First Nations infants needs to be linked to 171-174.
perinatal and long-term health outcomes. These links are not 4.
5.
Ibid.
P. D. Gluckman and M. A. Hanson, 2004, Living with the past: evolution, development, and
currently clear in this study or in the published literature. patterns of disease, Science, 305, 5691: 1733-1736.
6. D. J. Barker et al., 1993, Type 2 (non-insulin-dependent) diabetes mellitus, hypertension and
hyperlipidaemia (syndrome X): relation to reduced fetal growth, Diabetologia, 36: 62-67.
This study raises more questions than it answers. All of the 7. Health Canada, Healthy Canadians: A Federal Report on Comparable Health Indicators.
relationships described above invite further explorations. A 8. Z. C. Luo et al., 2004, Infant mortality among First Nations versus non-First Nations in British
Columbia: temporal trends in rural versus urban areas, 1981-2000, International Journal of
better understanding of the stories that these infants and their Epidemiology, 33: 1252-1259.
9. Z. C. Luo et al., 2004, Risks of adverse pregnancy outcomes among Inuit and North American
families are trying to tell us will require both an Indigenous Indian women in Quebec, Perinatal and Paediatric Epidemiology, 18: 40-50.
and a population health perspective. We need further 10. H. MacMillan et al., “Children’s health,” First Nations and Inuit Regional Health Survey,
National Report, 1999 (St. Regis, Que.: Akwesasane Mohawk Territory, 1999).
understanding of (and insight into) the experiences of First 11. Luo et al., Risks of adverse pregnancy outcomes among Inuit and North American Indian
women in Quebec, Perinatal and Paediatric Epidemiology.
Nations mothers and fathers, grandmothers, and grandfathers. 12. MacMillan et al., “Children’s health,” First Nations and Inuit Regional Health Survey,
We need to connect these experiences to the social, National Report, 1999.
13. M. Thomson, 1990, Heavy birth weight in Native Indians of British Columbia, Canadian
economic, historic, and political contexts of First Nations Journal of Public Health, 81, 6: 443-446.
14. E. Armstrong, E. J. Robinson and K. Gray-Donald, 1998, Prevalence of low and high birth
communities. We need to understand in a holistic way what weight among the James Bay Cree of Northern Quebec, Canadian Journal of Public Health,
activities, resources, and infrastructures facilitate health and 89, 6: 419-420.
15. L. E. Caulfield et al., 1998, Maternal nutritional status, diabetes and risk of macrosomia
healthy behaviour. among Native Canadian women, Early Human Development, 50, 3: 293-303.
16. S. Rodrigues et al,. 2000, High rates of infant macrosomia: a comparison of a Canadian Native
The application of these research findings will take place in 17.
and a non-Native population, Journal of Nutrition, 130, 4: 806-812.
R. Schwartz and K. A. Taramo, 1999, What is the significance of macrosomia? Diabetes Care,
the already existing network of programs and services for 22, 7: 1201-1205.
18. Ibid.
young First Nations families on-reserve. We need to be able 19. M. E. Boyd, R. H. Usher and F. H. McLean, 1983, Fetal macrosomia: prediction, risks,
to link with existing First Nations perinatal 20.
proposed management, Obstetrics & Gynaecology, 61, 6: 715-722.
D. Dabelea et al., 1999, Birth weight, type 2 diabetes, and insulin resistance in Pima Indian
programs/services and learn from them. Finally, we need to children and young adults, Diabetes Care, 22, 6: 944-950.
21. D. R. McCance et al., 1994, Birth weight and non-insulin dependent diabetes: thrifty genotype,
be able to apply all the knowledge that has been gathered to thrifty phenotype, or surviving small baby genotype?, British Medical Journal, 308: 942-945.
plan, implement, and evaluate health programs and services 22. R. F. Dyck, H. Klomp and L. Tan, 2001, “Thrifty genotype” to “hefty fetal phenotype”: the
relationship between high birthweight and diabetes in Saskatchewan Registered Indians,”
that are meaningful to First Nations communities. Canadian Journal of Public Health, 92, 5: 340-344.
23. Kramer, Determinants of low birth weight: methodological assessment and meta-analysis,
Bulletin of the World Health Organization.
These actions will require the best tools from both 24. M. C. Henson and P. J. Chedrese, 2004, Endocrine disruption by cadmium, a common
Indigenous and population health knowledge systems. We environmental toxicant with paradoxical effects on reproduction, experiments in biological
medicine (Maywood), 229: 383-392.
will need traditional teachings, stories, oral histories and 25. Office of the Surgeon General, “Health Consequences of Tobacco Use Among Women,
Reproductive Outcomes,” Women and Smoking (Rockville, Md.: U.S. Department of Health
Indigenous knowledge frameworks. We also need to gather and Human Services, 2001), pp. 272-307.
additional data and conduct more studies (including linkage 26. Kramer, Determinants of low birth weight: methodological assessment and meta-analysis,
Bulletin of the World Health Organization.
of more extensive community and individual level 27. Office of the Surgeon General, “Health Consequences of Tobacco Use Among Women,
Reproductive Outcomes,” Women and Smoking.
characteristics to birth outcomes and long-term child health; 28. Ibid.
longitudinal follow-up surveys; better vital statistics for First 29.
30.
Ibid.
Ibid.
Nations; and participatory action research). Most 31. J. C. Kleinman and J. H. Madans, 1985, The effects of maternal smoking, physical stature, and
educational attainment on the incidence of low birth weight, American Journal of
importantly, we will need partnerships between front line Epidemiology, 121: 843-855.
community workers, health policy makers, program planners, 32. MacMillan et al., “Children’s health,” First Nations and Inuit Regional Health Survey,
National Report, 1999.
researchers and community members. 33. P. J. Martens, 2002, Increasing breastfeeding initiation and duration at a community level: an
evaluation of Sagkeeng First Nation’s community health nurse and peer counselor programs,
Each new life might be considered an opportunity for hope 34.
Journal of Human Lactation, 18, 3: 236-246.
Canadian Pediatric Society, Dieticians of Canada and Health Canada, Nutrition for Healthy
and healing. Prioritizing the health and wellness of young Term Infants (Ottawa, Ont.: Minister of Public Works and Government Services Canada,
1998).
First Nations families is an upstream health strategy that 35. American Academy of Pediatrics, Work Group on Breastfeeding, 1997, Breastfeeding and the
makes sense both from an Indigenous and a population health 36.
use of human milk, Pediatrics, 100, 6: 1035-1039.
R. A. Lawrence and R. M. Lawrence, Breastfeeding, a guide for the medical profession, 5th
perspective. This study confirms the need to invest in edition (St Louis, Mo.; Mosby, 1999).
37. M.S. Kramer et al., 2001, Promotion of breastfeeding intervention trail (PROBIT): a
research, health services, and health programs that will randomized trial in the Republic of Belarus, Journal of the American Medical Association,
promote healthy early life environments for First Nations 38.
285: 413-420.
N. M. Else-Quest, J. S. Hyde and R. Clark, October 2003, Breastfeeding, bonding, and the
infants. mother infant relationship, Merrill-Palmer Quarterly, 49, 4: 495-517.
39. J. W. Anderson, B. M. Johnstone and D. T. Remley, 1999, Breastfeeding and cognitive
development: a meta-analysis, American Journal of Clinical Nutrition, 70: 525-535.
40. E. L. Mortensen et al., May 2002, The association between duration of breastfeeding and adult
intelligence, Journal of the American Medical Association, 287, 18: p 2365-2371.
41. P. J. Quinn et al., October 2001, The effect of breastfeeding on child development at 5 years: a
cohort study, Journal of Paediatrics and Child Health, 37, 5: 465-469.
42. Martens, Increasing breastfeeding initiation and duration at a community level: an evaluation
of Sagkeeng First Nation’s community health nurse and peer counselor programs, Journal of
Human Lactation.
253
43. American Academy of Pediatrics, Work Group on Breastfeeding, Breastfeeding and the use of
human milk, Pediatrics.
44. Lawrence and Lawrence, Breastfeeding, a guide for the medical profession.
45. M. S. Kramer and R. Kakuma, The Optimal Duration of Exclusive Breastfeeding: A
Systematic Review (Geneva, Switzerland: World Health Organization, 2002).
46. Human Resources Development Canada and Health Canada, The well-being of Canada’s
young children: Government of Canada Report (Ottawa, Ont.: Health Canada, 2002, cat. no.
RH64-20/2002).
47. Office of the Surgeon General, “Health Consequences of Tobacco Use Among Women,
48. Canadian Perinatal Surveillance System, Canadian Perinatal Health Report 2003 (Ottawa,
Ont.: Health Canada, 2003, cat. no. H49-142/2003E).
49. Luo et al., Infant mortality among First Nations versus non-First Nations in British Columbia:
temporal trends in rural versus urban areas, 1981-2000, International Journal of Epidemiology.
50. Luo et al., Risks of adverse pregnancy outcomes among Inuit and North American Indian
women in Quebec, Perinatal and Paediatric Epidemiology.
51. Canadian Perinatal Surveillance System, Canadian Perinatal Health Report 2003.
52. Office of the Surgeon General, “Health Consequences of Tobacco Use Among Women,
53. Canadian Perinatal Surveillance System, Canadian Perinatal Health Report 2003.
54. Ibid.
254
Chapter 29
Abstract
Strategies addressing physical activity and nutrition are required to influence a variety of other sectors
in holistic health systems, and to target different population groups in culturally appropriate ways.
Periodic repetition of the First Nations Regional Longitudinal Health Survey (RHS) is required to
assess the effectiveness of such strategies over time.
Data on physical activity rates of children in Canada is lacking and what exists is often based on
parental/guardian reports. However, we know that pediatric obesity in the general population has
increased by nearly 0.1 kg/m2 per year since 1981. This chapter examines physical activity and diet,
and their relationship to body mass, among on-reserve First Nations children under the age of 12.
Walking is the most frequently reported physical activity among First Nations children, followed by
running, swimming and bicycling. Over half of children always or almost always eat a balanced,
nutritious diet, and this is higher among children who are active daily compared to those who are
occasionally active. Just over one-third of children are obese. Children who are active daily, and who
always or almost always eat a balanced diet, are more likely to cite excellent health.
The high rates of overweight and obese First Nations children are of great concern, as the immediate
consequences of childhood obesity may include diabetes, asthma, gallstone development, hepatitis,
obstructive sleep apnea, orthopedic problems (e.g., bowing of the legs ), menstrual abnormalities and
neurological conditions. Strategies addressing diet and physical activity are a critical part of balancing
energy intake and expenditure, and these strategies need to be culturally appropriate. Given the
enormity of the problem, the measures gathered in the First Nations Regional Longitudinal Health
Survey (RHS) should continue to be monitored and measured, and height, weight and waist
circumference should be added.
255
RHS 2002/03 Child Survey – Chapter 29: Physical Activity, Body Mass Index, and Nutrition
representing 59% of deaths worldwide.13 Indeed, chronic

Introduction
diseases such as type II diabetes and hypertension - which
Chronic conditions are often the result of a lifestyle of are more prevalent among individuals with higher levels of
inactive behaviors that begin as early as childhood and body fat - have traditionally been observed in adults, but are
adolescence.1 Physical inactivity during childhood has also now observed among obese pre-pubescent children.14 Three
been linked to physically inactive or sedentary behaviors in modifiable or preventable factors in adults — changes in
adulthood.2 Therefore, regular physical activity during diet, physical activity and tobacco use — have a significant
childhood may be key in maintaining an active lifestyle as an impact in reducing chronic disease.15 Modifiable and
adult and in preventing certain chronic conditions. Regular preventable factors are those that a person has control over,
physical activity is recognized for its role in preventing or can modify in order to reduce the chance of developing a
several chronic and physical conditions, including coronary chronic disease.
heart disease, hypertension, obesity, type II diabetes,
While risk factors for chronic disease appear across the
osteoporosis, certain site-specific cancers such as colon
general population, disparities are evident based on gender,
cancer, and functional limitation with aging.3 Other benefits
age, income, education and ethnicity. For example, the data
of physical activity for children have been well documented.
reveal that Canadians of Aboriginal descent have consistently
Physical activity results in increased self-esteem and
higher rates of being overweight and obese compared to the
perceived physical competence, factors that enable children
overall Canadian population.16,17 First Nations children have
to cope with mental stress.4 Moreover, children and youth
a particularly high risk of obesity.18,19,20 This is a serious
who participate in regular physical activity are less likely to
concern, given that childhood obesity is associated with
smoke, consume alcohol or take drugs.5
chronic health problems such as type II diabetes, and the
Data on physical activity rates of children in Canada are higher prevalence of these conditions in First Nations
lacking, and what exists is often based on the reports of communities.21 This chapter will examine physical activity
parents or guardians. However, we know that pediatric and aspects of nutrition, and their relationship to body mass
obesity has increased by nearly 0.1 kg/m2 per year since among First Nations pediatric populations. Suggestions and
1981. The prevalence of children who are overweight has recommendations are made that may help guide First Nations
increased from 15% in 1981 to 29% in 1996 for boys, and peoples, decision makers in First Nations communities, and
from 15% to 24% for girls. In addition, prevalence rates of policy developers, in the process of shaping national
obesity over the same time period have increased from 5% to strategies for healthy living.
14% for boys, and from 5% to 12% for girls.6 The World
Health Organization (WHO) states that childhood obesity General Approach
rates are already considered an “epidemic” in some countries
It is important to examine these health issues using a multi-
and that 22 million children less than five years of age are
faceted cultural framework, as outlined in detail in the
overweight worldwide. In the United States, the prevalence
opening chapter of this report. This cultural framework
of being overweight has doubled for children and tripled for
embodies a “total person” and “total environment” model
youth in the last 20 years or so, reflecting Canadian trends.7
involving aspects of:
Pediatric research indicates that the interaction of a variety of
factors plays a role in contributing to obesity. These factors • An individual’s spiritual, emotional, mental, and physical
include metabolic or genetic factors,8 environmental factors well-being;
(including improved technology and suburban environments • Their culture’s values, beliefs, identity, and practices;
favoring motorized vehicles9), and behavioral factors • Their community and relationship to the physical
(including modifiable factors such as physical activity and environment; and,
diets with high fat and low carbohydrate intake).10 Although
• Connectivity to their family.
consistent and national nutrition data is limited in Canada,
the data does indicate that fruit and vegetable consumption is The cultural framework is consistent with a population health
negatively associated with being overweight, and that total or ecological approach that takes into account:
energy intake for Canadians has increased via carbohydrate
intake, particularly soft drink consumption.11 This has • Aspect of the individual (awareness, attitudes, and
occurred during a period when the physical demands of behaviors);
everyday life are decreasing as a result of technological • Social factors (social support from family, friends, and
innovation. The situation is compounded in First Nations peers);
communities by the decrease in physical activities that are
• Environmental factors (physical environment, geography,
related to traditional hunting and fishing.12
and accessibility);
Non-communicable or chronic diseases are associated with • Societal factors (culture and community); and,
being overweight or obese, and are the major cause of death,
256
• Policy related factors (at a band level or government 3-5 year olds, and 17.2% of 9-11 year olds participate 4-6
level). times a week compared to 10.6% of 3-5 year olds).
This balanced approach will be used as a basis for this Table 1. Prevalence (%) of physical activities among children,
chapter. First, descriptive data on the physical activity, diet overall and by gender (n=6,510)
and body mass index of children will be reported, then Rank Activity Total Boys Girls
associations between these three factors and elements of the
cultural framework are made. Due to the health orientation of 1 Walking 86.9% 85.5% 88.4%(NS)
this chapter, Cole’s cut points will be used to categorize body 2 Running 73.3 74.2 72.4(NS)
mass index. These cut points are tied to health outcomes
3 Swimming 68.8 68.5 69.1 (NS)
indirectly, since they predict children’s future body mass
index as adults, and a high BMI is known to be associated 4 Bicycle riding 68.3 68.0 68.6 (NS)
with elevated health risks.22 Berry picking or other food
5 38.0 35.8 40.4 (NS)
gathering
RESULTS 6 Skating 37.8 40.7 34.7 (NS)
7 Dancing 33.1 25.3 41.5
Physical Activity and Sedentary Activity
8 Fishing 28.1 33.7 22.1
Walking is the most frequently reported physical activity in
which First Nations children participated over the year prior 9 Competitive or group sports 27.8 32.5 22.8
to the survey (86.9%), according to their parents/guardians.
10 Rollerblading, in-line skating 19.1 22.0 15.9
This is followed by running (73.3%), swimming (68.8%),
bicycling (68.3%), berry picking or food gathering (38.0%), 11 Hiking 16.8 17.7 15.7 (NS)
skating (37.8%) and forms of dancing (33.1%). Roughly one
12 Bowling 14.4 14.8 14.0 (NS)
in four children reportedly fish (28.1%) and participate in
competitive sports (27.8%). Less than 20% are involved in 13 Hunting 13.3 17.4 9.0
rollerblading (19.1%), hiking (16.8%), bowling (14.4%), and
hunting (13.3%).i ii 14 Skateboarding 12.4 19.6 4.6
Table 1 summarizes the gender differences in reported 15 Golf 9.6 13.6 5.3
physical activities. Gender differences are apparent for 16 Canoeing 8.6 9.2 8.0 (NS)
certain physical activities. For example, girls are more likely 17 Skiing 5.8 6.7 4.9 (NS)
than boys to participate in dancing and aerobics or fitness
classes. Boys, however, are more likely than girls to 18 Aerobics or fitness class 5.3 4.3 6.5
participate in fishing, hunting, rollerblading, skateboarding, 19 Martial arts 3.9 4.3 3.4 (NS)
golf, and competitive or team sports such as baseball, hockey
20 Snowshoeing 3.8 4.6 3.0 (NS)
and lacrosse. Regardless of age, walking is the most
frequently reported physical activity.
Children in households with lower incomes are reportedly
Parents and guardians report few gender differences in how more likely than those in higher income brackets to never
often their children participate in physical activities, with one participate in physical activities (i.e. 10.0% in households
exception: girls (57.1%) are reportedly more likely to never with incomes less than $10,000 compared to 4.2% in
participate in non-school related sports teams or lessons households with incomes of $50,000 or more).
compared to boys (48.7%), whereas boys (33.3%) are
reportedly more likely than girls (23.6%) to participate in Boys spend more time playing video games than girls
these types of activities one to three times a week. (averaging 7.3 hours per week compared to 4.2 hours per
week for girls). Older children (9-11 years olds) spend more
Younger children appear more likely to participate in time using a computer and assisting in chores than younger
physical activity everyday compared to older children (i.e., children (6-8 year olds). Three to five year olds spend more
50.3% of 3-5 year olds compared to 37.3% of 9-11 year time in childcare than older children, and 1-2 year olds spend
olds). Conversely, older children are reportedly more likely more time in childcare than other age groups.
than younger children to participate less often (30.6% of 9-11
year olds participate 2-3 times a week compared to 22.8% of
i
To simplify the text, confidence limits are only reported for overall children estimates with a co-
ii
257
Figure 1. Proportion reporting no participation in physical children always or almost always eat a nutritious or balanced
activity by income
diet.
$50 000+ 10.0% Although just as likely to do so daily, older children are more
likely than younger children to consume soft drinks a few
$30 000-$49 999 9.0% times a week (51.0% of 9-11 year olds compared to 42.4% of
3-5 year olds). Older children are also more likely to add salt
$20 000-$29 999 8.1% to their food several times a day (9.1% of 3-5 year olds
versus 17.9% of 9-11 year olds).
$15 000-$19 999 6.5%
Body Mass Index
$10 000-$14 999 7.1% Estimation of body mass index (BMI) cut-points for children
requires calculation by single-year age group.23 Therefore,
< $10 000 or income loss 4.3% classifications of normal (or under) weight, overweight, and
obese are arrived at by first calculating body mass index and
0% 2% 4% 6% 8% 10% 12% then using age-appropriate cut-off points for the BMI
measure. These cut-off points are defined by an
Nutrition internationally accepted definition of “overweight” and
According to parental reports, over one half of First Nations “obese” for children.24 No cut-off points were available for
children always or almost always eat a nutritious and an underweight classification; therefore underweight children
balanced diet (55.4%), whereas 39.6% only sometimes do.iii are combined with the normal category in this analysis.
The remaining 5% either rarely (4.3%) or never (0.7%) eat a According to this classification, 41.5% of children are
balanced and nutritious diet. considered to be normal or under weight. However, 22.3% of
First Nations children are considered overweight. Moreover,
Although no differences were reported between boys and 36.2% are deemed obese.
girls, age related differences are apparent in terms of eating a
balanced and nutritious diet, and in the frequency of No differences were apparent in body mass index between
consumption of unhealthy foods. Generally speaking, parents Aboriginal boys and girls. Older children (9-11 years) are
of older children (9-11 year olds) are less likely than those of twice as likely to be overweight (28.8%) compared to
younger children (less than 2 years of age) to report that the younger children (3-5 years) (13.1%); however, the inverse
Figure 2. Frequency of consuming a nutritious and balanced diet by age (n=6,604)
90%
Always or almost always

79.3%
80% Sometimes
Rarely
70% Never
61.9%
60% 57.3%
52.4%
49.8%
50%
43.1% 42.7%
39.3%
40%
33.9%
30%
20%
15.9%
10% 7.0%
4.3% 3.5% 3.2% 3.8%
0.6% 0.6% 0.3% 0.7% 0.6%
0%
<1 year 1 - 2 years 3 - 5 years 6 - 8 years 9 - 11 years
Age Group
iii This is not to say that education does not need to occur with with regard to what constitutes a
balanced diet (see page 10 statistics regarding adding salt).
258
relationship is true for obesity (48.7% for 3-5 year olds • Fast food (21.7% of those who are active daily versus
compared to 26.4% for 9-11 year olds). 44.9% of those never active);
Figure 3. Proportion of children meeting BMI criteria by age • Baked goods such as cakes, pies and cookies (13.5% of
group (n=2,521) those who are active daily versus 46.6% of those never
60%
Normal or underweight active); and,
Overweight
48.7%
Obese • Snack food such as French fries, potato chips, and
44.8% pretzels (11.5% of those who are active daily versus
40% 38.2%
39.3%
41.2%
36.4% of those never active).
Conversely, children who are active daily are more likely to
28.8%
26.4%
consume protein-based traditional foods (31.8%) and
traditional berries and wild vegetation (25.7%) than those
19.5%
20% who are never active (19.1% for protein-based foods and
13.1% 9.5% for vegetation).
Children who always or almost always consume a nutritious
0%
and balanced diet reportedly watch fewer hours of television
3-5 6-8 9-11 than those who rarely consume such a diet. Children who
Age group (years)
consume soda pop or eat baked goods (pies, cakes and
cookies) a few times a week reportedly spend more hours
Relationships between physical and sedentary activity, watching television than those children who never or hardly
nutrition and body mass index ever consume these items. In contrast, children who often eat
Children who participate in physical activity every day are traditional protein-based meat and wild vegetation are more
reportedly more likely to eat a balanced and nutritional diet likely to spend time outdoors than those who do not.
always or almost always (60.9%) compared to those who The number of hours spent outdoors is directly related to
participate less than once a week (45.5%). There is a marked how often children are active. Children who are active every
difference between those who are active daily and those who day are more likely to spend time outdoors (16.7 hours per
are never active in terms of never or hardly ever consuming week) than those who are never active (10.2 hours per week).
the following: Generally speaking, more frequent participation in sports
• Soda drinks (18.7% of those who are active daily versus teams and lessons is associated with fewer hours in child-
54.9% of those never active); care (12.2 hours a week in child care for those participating
Figure 4. Frequency of physical activity participation by body mass index (n=2,321)

50%
44.2% 43.7%
Less than a week
40% Once a week 38.4%
2 - 3 times a week
4 - 6 times a week
Everyday 30.9%
30% 28.4%
27.3%
20% 18.9%
16.5%
14.4%
10% 8.0%
7.9%
6.6% 6.3%
5.7%
2.9%
0%
Normal or Underweight Overweight Obese
259
in sports teams 1-3 times a week versus 19.1 hours a week in four to six times a week are less likely than those who never
child care for those who never participate). participate to get along very well with the rest of the family,
yet are almost twice as likely to reportedly get along with
According to the Regional Health Survey, children of
them quite well with hardly any difficulties. Age may
varying body weights hold similar nutritional or dietary
influence these findings to a certain degree. For example,
practice patterns. However, children who are overweight
older children (age 9-11) who are active every day (52.7%)
(7.9%) or obese (8.0%) are reportedly more likely than
are more likely than those who are active occasionally or not
normal or underweight children (2.9%) to participate in
at all (29.7%) to get along with their family very well.
physical activities less than once a week.
Conversely, younger children (age 1-2) who are active
occasionally or not at all (75%) are more likely to get along
Physical activity, nutrition and body mass in a cultural
with their family very well than those who are active four to
framework perspective
six times a week (43.7%).
Table 2 summarizes the significant findings related to
Children who participate in physical activities every day
physical activity, nutrition and body mass index according to
(24.4%) are more likely than those who participate less than
a cultural framework that considers the total person and total
once a week (10.2%) to be considered above average in their
environment. In addition to relationships with individual
grade compared to their peers.
factors described in the first three sections of this chapter,
significant relationships to societal, social and physical and Children who always or almost always eat a balanced diet
mental health factors are described. are more likely than those who sometimes do to cite excellent
Table 2. Relationship of Key Indicators with Physical activity,
health (47.4% for those who always do versus 32.1% of
Diet and Body Mass (BMI) those who sometimes do). However, those who rarely eat a
Physical balanced diet are more likely (32.3%) to report being in good
Diet BMI
activity health compared to those who always or almost do (16.8%).
Individual factors Children who always or almost always eat a balanced and
Age a a a nutritious diet (56.0%) are more likely than those who rarely
Gender (sports)a x x eat a balanced diet (36.3%) to get along with the rest of the
Income a x x family very well.
Health factors Children living in small communities (less than 300
General Health Status a a a residents) are reportedly almost twice as likely to consume
Sedentary activity x a x traditional protein-based meat products (44.8%) and eat
Participation in physical
traditional berries and wild vegetation (33.7%), compared to
activity or sports
n/a a a those in communities of 1,500 residents or more (where
BMI a x n/a 23.3% report eating traditional meat and 17.8% report eating
wild vegetation).
Balanced and nutritious diet a n/a x
Mental health factors Parents of obese children are more likely than parents of
Emotional or behavioral normal or underweight children to say their children are only
x x x in good health (35.6% versus 15.1% respectively). Children
problems
Societal factors who are obese are reportedly less likely (13.5%) than normal
or underweight children (25.1%) to be considered above
Community size x (trad)a a
Comparison to other children
average in their grade during the year compared to their
in grade a x a peers. Children living in small communities (<300 residents)
Skipped a grade due to are less likely than those in communities of more than 1,500
x x x residents to be classified as obese (25.7% in small
academic achievement
Repeated a grade a x x communities versus 44.2% in large communities).
Social factors
Interaction with family a a x
a Significant association at the p=.05 level
Trad Refers to an association with the consumption of traditional foods only
x No observed association
n/a Not applicable
Children who are active on a daily basis (46.2%) are more

likely than those active one to three times a week to report
excellent health (26.7% of those active once a week and
34.6% of those active two to three times a week).
Interestingly, children who participate in physical activities
260
Figure 5. School achievement by physical activity participation* (n=3,785)
60%
53.9%
50%
Never
45.8%
Less than a week
41.6%
Everyday
40%
30%
25.0% 25.6%
24.4%
20%
16.6%
15.3%
10.2% 9.8%
10% 7.7% 7.6% 7.9%
5.3%
3.3%
0%
Above average Slightly above average Average Slightly below average Below average
School achievement
*Comparing only those who participate in physical activity every day versus those who do so less than
once a week.
result from obesity and being overweight. Obese children
have less confidence in their body image. This low self-
Figure 6. Frequency of consuming a healthy diet by social esteem can translate into lower academic achievement and
factors (n=5,705)
other undesirable effects. Differences in self-esteem can also
60%
56.0% be based on age, culture and socioeconomic status. Longer-
term consequences of obesity often include adult morbidity
50% 47.8%
and mortality.27 Strategies for diet and physical activity are
41.7% part of ensuring a balance of energy intake and expenditure,
40%
Repeated a grade
36.3% and these strategies need to be culturally appropriate. Given
Got along very well with family that four in ten children only sometimes eat balanced and
30%
Has emotional or behavioural problems 26.0% nutritious meals, dietary strategies need to inform on how to
19.6%
21.4% include nutritious foods during this critical period for growth
20%
15.3% 14.9% and development. Daily physical activity is also
10.5%
12.7%
11.4% recommended for optimal growth and development,28 yet
10%
children 9-11 years old are unlikely to be active daily.
Strategies for physical activity need to specifically consider
0%
Always or almost Sometimes Rarely Never approaches to increase participation in daily physical activity
always
Consumption of a health diet among this age group. An interesting finding in the data
reveals that children who hardly or never drink soda pop or
eat baked goods (pies, cakes and cookies) spend less hours
Discussion and Recommendations watching television than those children who consume larger
The data on the proportion of overweight and obese children amounts (a few times a week) of pop and baked goods. This
from the RHS support the necessity of other research on First is supported by content analysis research showing that a child
Nations children (22.3% of First Nations children are can be exposed to one food commercial for each five minutes
considered overweight and 36.2% obese). A primary reason of Saturday morning television viewing29, and that television
for this is that children make up one-third of the Aboriginal food advertising has a negative influence on a child’s ability
population.25 As mentioned in the introduction, immediate to identify a healthy food choice from paired items.30,31
consequences of childhood obesity may include diabetes, Besides parental/guardian responsibility for reducing or
asthma, gallstone development, hepatitis, obstructive sleep restricting the amount of television a child watches,
apnea, orthopedic problems (bowing of the legs as an government policies regarding television content and
example), menstrual abnormalities and neurological advertising may be useful.
conditions.26 In addition, social and emotional problems may
261
Although pervasive in the pediatric population as a whole, Healthy living strategies need to consider the role of potential
physical inactivity and poor quality diet are more prevalent in protective factors other than physical activity and nutrition in
certain population segments than in others. Indeed, certain improving health and reducing rates of overweight and obese
physical activities are more popular among certain children. These would include policies addressing socio-
population groups than others, and this needs to be reflected economic disparities, community opportunities, physical
in the development of strategies for improving participation environment and social support. Moreover, harmonized
rates in physical activity. For example, participation in programs that involve school, community, and family are
traditional physical activities, team sports and activities of important in developing healthy eating and activity behaviors
greater intensity are more prevalent among First Nations among children by creating supportive social norms and
boys, whereas individual activities of more moderate opportunities. Additional holistic models should be used to
intensity are more popular with First Nations girls. further investigate how a combination of factors could
influence healthy lifestyle practices and obesity rates among
Walking remains prevalent among both girls and boys and
First Nations communities and children in particular. For
across age groups. These patterns are consistent with parental
example, steps could be taken to ensure that the 4-
data32,33 and need to be considered in developing policies and
dimensional aspects of “total person” and “total
strategies targeting certain groups.
environment” are considered when developing strategies for
The nutrition data gathered by the RHS is consistent with First Nations children. An Aboriginal cultural perspective is
other studies examining food intake and food habits of essential in promotion strategies and understanding the many
Aboriginal children. For example, along with the RHS, data benefits and barriers to activity.37 For example, this study
in other studies found that fat composition in diet to be reveals that children who regularly participate in physical
related to accumulation of body fat.34 Several interesting activity are more likely to receive above average grades
findings indicated that children who always or almost always compared to peers. A list of recommended approaches to
eat a balanced and nutritious diet are more likely to get along increasing physical activity of children in the more general
with the rest of the family very well compared to those who population is available.38,39,40 These approaches could be
never eat a balanced diet. This suggests that having a vetted with community elders, school officials and
nutritious diet may confer greater benefits for children than recreational service providers, to see what is culturally
only physical health benefits. Why are children not eating a appropriate for certain Aboriginal communities depending on
balanced diet? Is it related to food preferences, access issues their size, location, and accessibility to opportunities.
or lack of knowledge on how to create such a diet? Much
Much more information is required on food intake, and on
more work is required to determine the absolute amount of
diet quality and its determinants, (including food insecurity),
physical activity undertaken, nutrients in the diet, and access
and this information should be monitored on a regular basis.
to opportunities for physical activity and nutritious choices,
This would ideally include collection of objective measures
before understanding the issues related to achieving energy
of energy intake. Similarly, monitoring physical activity
balance among First Nations children.
levels through objective measurement of energy expenditure
Understanding of children’s physical activity and dietary should continue and expand to include total physical activity
patterns flows from an ecological and cultural framework across domains. Objective anthropometric measures (e.g.,
that considers: physiological levels, such as level of growth height, weight, and waist girth) are required. These data on
and development; psychological factors such as motivation, dietary and physical activity are essential to design
confidence and self-efficacy; socio-cultural factors, such as appropriately targeted strategies. Only through their regular
the role of family and socio-economic status; and ecological collection can progress in the critical factors influencing the
factors, such as geography, climate, the availability of growth and development of First Nations children be tracked,
opportunities to be active, and the availability of —and to ensure that the changes to policy and strategies sparked
opportunity to obtain— nutritious foods.35 Thus, policies and from the information gathered by the Regional Health Survey
strategies to increase physical activity and improve diet need are effective.
a broad perspective that considers the agriculture,
transportation, recreation, and social sectors. A review of
Notes to Chapter 29
existing policies and practices in these sectors should
examine how they influence access to opportunities among 1. C. B. Corbin and R. P. Pangrazi, Physical activity for children: A statement of guidelines
boys and girls of different ages, as well as the families and (Reston, Va.: National Association for Sport and Physical Education, 1998).
2. R. M. Malina, 2001, Physical activity and fitness: pathways from childhood to adulthood,
communities in which they live. As physical activity and American Journal of Human Biology, 13: 162-172.
nutrition contribute to optimal development both physically Surgeon General (Atlanta, Ga.: U.S. Department of Health and Human Services, Centers for
and as a ‘total’ person (e.g., in educational attainment), Disease Control and Prevention, National Center for Chronic Disease Prevention and Health
Promotion, 1996).
independent but complementary strategies need to be 4. T. DeMarco and K. Sidney, 1989, Enhancing children’s participation in physical activity,
Journal of School Health, 59, 8: 337-340.
developed within a common framework to increase synergy 5. T. Stephens and C. L. Craig, The Well-being of Canadians: Highlights of the 1988 Campbell’s
in developing interventions for children and adults.36 Survey (Ottawa, Ont.: Canadian Fitness and Lifestyle Research Institute, 1990).
262
6. M. S. Tremblay and J. D. Willms, 2000, Secular trends in the body mass index of Canadian
children, Canadian Medical Association Journal, 163, 11: 1429-1433.
7. World Health Organization, Obesity and overweight [on-line]. Cited 2005. Available from
World Wide Web: <http://www.who.int/dietphysicalactivity/media/en/gsfs_obesity.pdf>.
8. R. F. Dyck, H. Klump and L. Tan, 2001, From "thrifty genotype" to “hefty fetal phenotype”:
the relationship between high birthweight and diabetes in Saskatchewan Registered Indians,
9. C. L. Craig et al., 2004, Twenty-year trends of physical activity among Canadian adults,
693-700.
11. K. D. Raine, Overweight and Obesity in Canada: A population health perspective (Ottawa,
12 . T. K. Young et al., 2000, Childhood obesity in a population at high risk for type 2 diabetes,
13. World Health Organization, Global Strategy on diet, physical activity and health [online].
Cited March 2005. Available from World Wide Web:
<http://www.who.int/dietphysicalactivity/media/en/gsfs_general.pdf>.
14. World Health Organization, Obesity and overweight [online]. Cited March 2005. Available
from World Wide Web: <http://www.who.int/dietphysicalactivity/media/en/gsfs_obesity.pdf>.
15. World Health Organization, The Global Strategy on diet, physical activity and health [online].
16. M. Tjepkema, "The health of off-reserve aboriginal population,” Health Reports 13,
17. NAHO preliminary results.
693-700.
19. L. Bernard et al., 1995, Overweight in Cree school children and adolescents associated with
diet, low physical activity and high television viewing, Journal of American Dietician
Association, 95: 800-802.
20. N. D. Willows, 2005, Overweight in First Nations children: prevalence, implications, and
solutions, Journal of Aboriginal Health, 2, 1: 76-86.
21. Ibid.
22. T.J. Cole et al., May 2000, Establishing a standard definition for child overweight and obesity
worldwide: international survey, British Medical Journal, 320: 1240-1243.
23 Ibid.
24. Ibid.
25. Statistics Canada, Aboriginal Peoples of Canada: A demographic profile [online]. Cited 14
April 2005. Available from World Wide Web:
<http://www12.statcan.ca/english/census01/Products/Analytic/companion/abor/pdf/96F0030X
IE2001007.pdf>.
26. A. Must and R. S. Strauss, 1999, Risks and consequences of childhood and adolescent obesity,
International Journal of Obesity, 23, 2: S2-11.
27. Ibid.
28. Corbin and Pangrazi, Physical activity for children: A statement of guidelines.
29. R. Boyton-Jarret et al., 2003, Impact of television viewing patterns on fruit and vegetable
consumption among adolescents, Pediatrics, 113: 1321-1326.
30. N. Signorielli, and J. Staples, 1997, Television and children’s conception of nutrition, Health
communication, 9: 281-301.
31. ——— and M. Lears, 1992, Television and children’s conception of nutrition: unhealthy
messages, Health communication, 4: 245-257.
32. Statistics Canada, 2003, Canadian Community Health Survey (CCHS).
33. C. Cameron et al., Increasing physical activity: Supporting an active workforce (Ottawa, Ont.:
Canadian Fitness and Lifestyle Research Institute, 2002).
34. J. H. Himes et al., 2003, Impacts of the Pathways intervention on dietary intakes of American
Indian schoolchildren, Preventive Medicine, 37: S55-61.
35. C. H. Lindquist, K. D. Reynolds and M. I. Goran, 1999, Sociocultural determinant of physical
activity among children, Preventive Medicine, 29: 305-312.
36. World Health Organization, Press release: World Health Assembly adopts global strategy on
diet, physical activity and health, May 22, 2004 [online]. Available from World Wide Web:
<http://www.who.int/mediacentre/releases/2004/wha3/en/>.
37. T. Dwyer et al., 2001, Relation of academic performance to physical activity and fitness in
children, Pediatric Exercise Science, 13: 225-237.
38. S. E. Cragg, C. L. Craig and S. J. Russell, Increasing Physical Activity: Enhancing municipal
opportunities (Ottawa, Ont.: Canadian Fitness and Lifestyle Research Institute, 2001).
39. C. Cameron et al., Increasing Physical Activity: Encouraging physical activity through school
40. C. L. Craig et al., Increasing physical activity: Supporting children’s participation (Ottawa,
Ont.: Canadian Fitness and Lifestyle Research Institute, 2001).
263
Chapter 30
Abstract
This chapter explores disability and long-term health conditions among First Nations children 0–11
years. Children with disabilities are in much the same familial living arrangements as other First
Nations children. They are as likely to be attending school but tend to fare less well, academically.
Their involvement in non-school cultural and physical activities is as other children.
The research found no statistically significant differences in the household incomes of First Nations
children with and without disabilities or in the respective education levels of parents.
The most commonly reported long-term conditions among First Nations children are asthma, allergies
and chronic ear infections/problems. Less widely reported but having potentially harmful or
challenging implications are chronic bronchitis, Attention Deficit Hyperactivity Disorder (ADHD),
learning disability and Foetal Alcohol Syndrome and Foetal Alcohol Effects (FAS/FAE). With the
exception of allergies and perhaps learning disabilities, the quality of treatment for these conditions
among First Nations children is poor.
It is fairly common for First Nations children with disabilities to have more than one long-term
condition. Their general health is poorer than that of their counterparts without disabilities and a
significantly higher proportion have emotional and behavioural difficulties, a problem more
pronounced among boys than girls.
First Nations children with disabilities are more likely to face various barriers to accessing health care
services.
264
RHS 2002/03 Child Survey – Chapter 30: Disability and Chronic Conditions
Results
Introduction
Basic demographics of childhood disability
Chapter Overview
This chapter explores disability and long-term health General prevalence
conditions among First Nations children 0 to 11 years. It
Unpublished data provided to The Roeher Institute by the
examines general demographics (e.g., prevalence of
Office for Disability Issues (ODI) and based on the disability
disability by age, gender and various other dimensions; living
questions for the 2001 Census indicate that disability is 1.5
arrangements, schooling and participation in community
times more prevalent among First Nations children 0 to 14
activities; family income and parents’ formal education) and;
years than among non-Aboriginal children in Canada.iv These
specific health-related conditions and issues of access to
findings are similar to those reported by ODI for Aboriginal
health-related services. This chapter provides selected
adults in Canada.1
comparisons of First Nations children with and without
disabilities, as well as comparisons of First Nations children Using only the data on activity limitations at home, school or
and their counterparts in the broader mainstream child other activities, which are ‘high level’ disability indicators
population of Canada. common to the RHS children’s survey and the NPHS, 7.8%v
of First Nations can be classified as having disabilities.
For comparative purposes this chapter includes data from the
general files and health files of the Statistics Canada’s Using only the data that are unique to the RHS on activity
National Population Health Survey (NPHS) of 1998–99.i For limitations that stem from any specific long-term health
explanatory purposes, in a few places the discussion draws conditions, 8.1% of First Nations can be classified as having
from Statistics Canada’s Participation and Activity disabilities.
Limitation Survey (PALS) of 2001, a survey with a focus on
disability.ii There is some overlap and differentiation between these
approaches. Table 1 shows the estimated prevalence of
The research conducted for this chapter generally used the disability among First Nations children using each approach
NPHS instead of PALS for disability comparisons with the and both approaches together. Overall, based on combining
First Nations Regional Longitudinal Health Survey (RHS) both approaches, 11.7% of First Nations children have
because the purpose and context of the RHS is a closer match disabilities.
with the NPHS than with than with PALS. The high level
indicators of disability in the RHS are also more similar to Taking the RHS figure as a benchmark and comparing with
the corresponding data from the NPHS, childhood disability
those in the NPHS.iii
may be as much as 1.8 times higher among First Nations
Some of the differences between disability indicators in the children. vi
RHS and in Statistics Canada’s surveys are discussed in Table 1. Prevalence of disability in First Nations children
Chapter 4: Disability and Chronic Conditions.
Definition 2: Limited because of any
Definition 1: Limited at long-term health condition
Working Definition of Childhood Disability home, school or other
Similar to Statistics Canada’s approach, the RHS flags activities Total with
Others Disability
disability
children whom, because of a physical or mental condition or
health problem, are limited in the kinds or amount of activity Others 3.9% 3.9%
they can do at home and school or in other activities such as Disability 3.6% 4.3% 7.8%
leisure or travelling. Respondents (e.g., parent/guardian) can
indicate whether the child is limited “often” or “sometimes”. Total 3.6% 8.1% 11.7%
The RHS also asks a battery of questions about long-term
health conditions and about whether any of these limit the Prevalence and gender
kinds or amount of activity a child can do. Research studies The research found that disability is just as common among
define children as having a disability if they are indicated as First Nations boys as girls 13.3% of First Nations boys have
limited in their activities across any of these questions. disabilities compared with 10.1% of girls (NS).vii
iv
The term “Aboriginal people” as used by ODI includes First Nations, Métis and Inuit people.
v
To simplify the text, confidence limits are not reported for overall children’s estimates unless the co-
efficient of variation is greater than 33.3%.
i vi
The NPHS provides information on the health and health-related behaviours of Canadians. It did not The 7.8% prevalence estimate shown on Table 1 is based on an approach to identifying disability
survey people in the military or who lived in institutional collective dwellings, the northern territories similar to that used in the NPHS, which yields a 4.4% prevalence of childhood disability in the general
or on First Nations reserves. population; 7.8 ÷ 4.4 = 1.8. Rounding errors are responsible for the totals not syncing.
ii vii
PALS did not survey people who lived in the northern territories or on First Nations reserves. Comparisons between groups reported in this chapter are statistically significant except where “NS”
iii
The more recent Canadian Community Health Survey does not include children younger than 12 —not significant— is noted. For this chapter, differences are judged to be significant if the
years. Bonferroni-adjusted 95% confidence intervals do not overlap.
265
Of all First Nations children with disabilities, 58.2% are 90% of other First Nations children (NS). Roughly half
boys. Among First Nations children without disabilities, (50.6%) of First Nations children with disabilities live with
50.5% are boys (NS). Although not significant, the general their biological fathers compared with about the same
direction of this finding is similar to that based on the NPHS, proportion of other First Nations children (52.2%) (NS).
which shows that 60.1% of all children with disabilities are About thirty-six percent of children with disabilities live with
boys. PALS data indicate that 62.6% of children with brothers or sisters compared with 34.8% of non-disabled
disabilities (0–14 years) are boys.2 children (NS). Some 11.4% and 10.9%, respectively, live
with their grandparent(s) while 7.9% and 8.8%, respectively,
Prevalence and age live with an aunt, an uncle or cousins (NS).
Disability can be difficult to detect in the very early years. Figure 1. Prevalence of disability by community size (n=6657)
Accordingly, it is common to see higher reported prevalence 15%
rates among older children.3 However, according to the RHS, 13.0%

12.4%
among First Nations children 0– 5 years, 9.5% have 11.7%
disabilities compared with 13.5% in the 6–11 age group. Of 10.7%
all First Nations children with disabilities, 63.1% are in the 10%
6–11 age group compared with 53.5% of their counterparts

without disabilities.
Prevalence, isolation status and size of community of 5%
residence
The RHS flags children according to the isolation status of
their community of residence. The definitions of isolation 0%
status are as follows. <300 300-1499 1500+ Total
Community size (persons)
• Remote isolated: no scheduled flights

Schooling
• Isolated: flights, good telephone but no road access
• Semi-isolated: road access greater than 90 km to Among those old enough to attend school, First Nations
physician services children with disabilities are about as likely as their
counterparts without disabilities to be attending school
• Non-isolated: road access, less than 90 km from (76.4% compared with 71.8%, respectively). They are also
physician services about as likely to have attended an Aboriginal Head Start
The prevalence of childhood disability is roughly twice the program (39.5% compared with 36.4%).
overall rate in isolated communities (20.3%). Of all First The academic progress of First Nations children with
Nations children with disabilities, 32.8% live in isolated disabilities is a mixed picture. On one hand they are twice as
communities compared with 17.4% of children without likely as other children to be doing below or slightly below
disabilities, however this difference is not significant. average compared with other pupils in their grade (22.9%
Figure 1 shows the percentages of children with disabilities compared with 11.1% respectively). On the other hand, they
in communities of various sizes. Children with disabilities are also about as likely as other First Nations children to be
are more likely to be found in small communities of less than doing above or slightly above average (40.2% compared with
300 persons (12.4%) and in larger communities of 1,500 or 40.3%). First Nations children with disabilities make up
more people (13%). Of all children with disabilities, 40.6% 22.6% of all First Nations children who are reportedly doing
live in communities of 1,500 or more people compared with below or slightly below average and 12.4% of children doing
35.9% of children without disabilities, however this above or slightly above average. First Nations children with
difference is not statistically significant. disabilities are somewhat more likely than their non-disabled
counterparts to have repeated a grade (15.2% compared with
Living arrangements, schooling and activities in the 11.0%) (NS).
community
Cultural and other activities in the community
Living arrangements The research for this chapter found no major differences in
Generally, First Nations children with disabilities are in the extent to which First Nations boys with and without
similar living situations as those of other First Nations disabilities participate in non-school activities such as art or
children. Some 88.5% of First Nations children with music groups/lessons and traditional singing, drumming or
disabilities live with their biological mothers compared with dancing groups/lessons. Nor did the research find major
266
differences in terms of the frequency of boys reading or conditions not specifically presented on the children’s
being read to daily or a few times a week. questionnaire. Among the conditions for which structured
questions were asked, some are very low prevalence and
There is a significant difference, however, in the extent to
involve high sampling variability so are not shown on the
which First Nations boys 6–11 years with disabilities ever
Table. These include cognitive or mental disability, epilepsy,
take part in non-school sports teams or lessons only 44.5%
cerebral palsy, physical disability other than cerebral palsy,
do so compared with 67.4% of boys this age without
HIV – AIDS, kidney disease, liver disease and diabetes. That
disabilities.viii
they are very low prevalence conditions might be considered
Concerning First Nations girls with and without disabilities, a bit of ”good news”.
there are no significant differences in the extent to which
Column D on Table 2 shows that asthma, allergies and
they take part in sports teams or lessons, in traditional
chronic ear infections/problems are the most common of the
singing, drumming or dancing, or reading/being read to daily
conditions reported for First Nations children. Chronic
or several times a week.
bronchitis is not so prevalent but presents serious health
Looking at the frequency of participation in any kind of risks. ADHD, learning disability and FAS/FAE are again
physical activity, the research found no significant fairly low in prevalence but can involve multiple challenges
differences between First Nations children with and without to academic performance and social integration that can
disabilities, among whom 7.2% and 9.4% are never persist into and throughout adulthood.
physically active, respectively, and among whom 57.1% and
Asthma is a chronic inflammation of the airways that causes
59.3%, respectively, are physically active at least 4 times or
swelling and narrowing of the airways, resulting in difficulty
every day in a given week.
breathing. The bronchial narrowing is usually either totally or
Family income and education at least partially reversible with treatments. Triggers include
allergens and irritants (respiratory infections, tobacco smoke,
Household income smog and other pollutants, Aspirin, other non-steroidal anti-
inflammatory drugs, physical exercise and various other
Overall, the research found no statistically significant environmental, emotional and hormonal factors).4
differences in the household incomes of First Nations
children with and without disabilities. Some 62.9% of At 14.6%, the prevalence of asthma among First Nations
children without disabilities are in households with incomes children is quite high given that the prevalence among
less than $30,000 as are 63.5% of First Nations children with children in the general population is 8.8%. First Nations
disabilities. Similarly, 37.1% of children without disabilities children with disabilities and asthma are more likely than
are in household with incomes above $30,000 as are 36.5% other First Nations children with asthma to have had an
of children with disabilities. Even when breaking down the asthma attack in the past 12 months (41.0% compared with
incomes into finer categories and taking sampling variability 19.0%). Overall, 57.2% of First Nations children with asthma
into account, the income profiles of families look similar, are being treated for this condition.
regardless of the presence of childhood disability. The Allergies are exaggerated reactions of the immune system in
income profiles also look similar for families with and response to bodily contact with certain foreign substances
without children with disabilities when comparing the 0–5 that are usually harmless. Allergy-producing substances
and 6–11 age groups. (allergens) include pollens, dust mites, moulds, danders, and
foods.5 Allergies are quite prevalent among First Nations
Parents’ education level children (12.2%) and among other children in Canada
The research generally found no significant differences in the (16.4%). Of First Nations children with allergies, only 29.5%
level of formal education attained by the mothers of First are being treated.
Nations children with and without disabilities, nor in the Bronchitis is a respiratory disease that inflames the mucous
formal education levels of fathers. membrane in the lungs' bronchial passages. As the irritated
membrane swells and grows thicker, it narrows or shuts off
Health and related issues the airways in the lungs, resulting in coughing spells
accompanied by thick phlegm and breathlessness. The
Long-term Conditions and Disability in Childhood disease comes in two forms: acute (lasting less than 6 weeks)
Table 2 shows the prevalence of selected long-term and chronic (reoccurring frequently for more than two years).
conditions the RHS classifies as health conditions among Acute bronchitis is responsible for the hacking cough and
First Nations children. The RHS enquired into 19 such phlegm production that sometimes accompany an upper
conditions and allowed for open-ended responses about respiratory infection.
viii
34.1% of First Nations boys with disabilities do so at least once a week compared 54.9%
of their counterparts without disabilities.
267
Table 2. Selected long-term health-related conditions among First Nations children, by two disability statuses
A B C D E F
% with any Total % (with and Of those with Of those with the
% with no disability
disability reporting without disabilities) the condition, condition, % with
Long-term conditions reporting the long-
the long-term reporting the long- % with any disability caused
term condition
condition term condition disability by that condition
Chronic bronchitis 2.6% E 10.5% E 3.6% E 34.3% 16.9% E
Allergies 9.2% 35.3% 12.2% 32.9% 18.8%
Asthma 10.9% 43.5% 14.6% 34.4% 26.5%
Blindness or serious vision problems 0.8% – E 1.1% 36.9% – E
Chronic ear infections or ear problems 7.7% 20.7% 9.2% 26.1% 15.2%
Hearing impairment 1.2% 4.4% E 1.6% 32.5% – E
ADD/ADHD (1) 2.0% 7.4% E 2.6% 32.7% 28.3%
FAS/FAE (2) 1.5% – E 1.8% – – E
Learning disability 1.3% 15.4% 2.9% 60.1% 37.0%
Tuberculosis 0.5% E – E 0.5% E – – E
Heart condition or problem 1.6% E 5.7% E 2.1% E 32.6% – E

1. Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder
2. Foetal Alcohol Syndrome or Foetal Alcohol Effects
children.8 Only 27.4% of First Nations children with this
Chronic bronchitis is a serious long-term disorder that often condition are receiving treatment for it.
requires regular medical treatment.6
Attention Deficit Hyperactivity Disorder (ADHD) refers to a
While sampling variability is high and estimates need to be family of related chronic neurobiological disorders that
used with caution, it would appear that chronic bronchitis is interfere with an individual's capacity to regulate activity
more prevalent among First Nations children at 3.6% than level (hyperactivity), inhibit behaviour (impulsivity), and
among children in the general population, where the attend to tasks (inattention) in developmentally appropriate
prevalence is only 1.4%. Only 24.0% of First Nations ways. Children with ADHD have functional impairment
children with chronic bronchitis are being treated for this across multiple settings including home, school, and peer
condition.ix relationships. ADHD can have long-term adverse effects on
Chronic otitis media is a persistent inflammation of the academic performance, vocational success, and social-
middle ear. Following an acute infection, fluid may remain emotional development. Children with ADHD may
behind the eardrum for up to 3 months before resolving. experience peer rejection and engage in a broad array of
Chronic otitis media may develop after a prolonged period of disruptive behaviours. They have higher injury rates and for
time with fluid or negative pressure behind the eardrum. The many the impact of ADHD continues into adulthood.9
condition can cause ongoing damage to the middle ear and ADHD seems to involve genetic links. Children who have
eardrum and there may be continuing drainage through a hole this condition usually have at least one close relative who
in the eardrum. Chronic otitis media often starts painlessly also has it; at least one-third of all fathers who had ADHD in
without fever. Sometimes a subtle loss of hearing can be due their youth have children with ADHD; and if an identical
to chronic otitis media.7 twin has the condition the other twin is likely to have it as
well.
Some 9.2% of First Nations children have chronic ear
infections/problems that are probably otitis media. The While 2.6% of First Nations children have been diagnosed as
NPHS does not provide data on the prevalence of this having ADD/ADHD only 37.6% with this condition are
condition in the broader child population in Canada so receiving treatment for it.
comparisons between First Nations and other children cannot Learning Disability (LD) is a condition that affects people’s
be drawn. Other researchers have expressed concern that ability to either interpret what they see and hear or to link
otitis media may be a growing problem among Inuit information from different parts of the brain. These
limitations can show as specific difficulties with spoken and
ix
The percentage receiving treatment should be used with caution owing to high sampling variability.
268
written language, coordination, self-control, or attention. level of disability, with the exception of learning disability.
Such difficulties extend to schoolwork and can impede Here, 60.1% of children with this condition experience
learning to read or write, or to do math. LD can involve activity limitations due to various factors. These figures
lifelong conditions that, in some cases, affect many parts of a suggest that there is about a 1 in 3 chance that children who
person's life: school or work, daily routines, family life, and have any of the conditions shown on Table 2 will have some
sometimes even friendships and play. In some people, many level of disability, and that children with learning disabilities
overlapping learning disabilities may be apparent. Other are likely to face activity limitations. Of particular concern
people may have a single, isolated learning problem that has are high prevalence conditions such as asthma, allergies and
little impact on other areas of their lives. To be diagnosed as chronic ear infections.
a learning disability, specific criteria must be met. Genetic
While the figures for low prevalence conditions cannot be
factors, maternal use of tobacco or alcohol or drugs during
shown owing to high sampling variability, children reported
pregnancy, complications during pregnancy, environmental
as having a cognitive or mental disability, epilepsy and
toxins and chemotherapy and radiation treatment of children
cerebral palsy were found to have activity limitations in the
with cancer have all been linked as risk factors for LD.10
majority of cases. x
Of the 2.9% of First Nations children with learning
Column F on Table 2 again takes as the units of analysis the
disabilities, 36.8% are being treated for it.
‘universes’ of children with a given long-term condition but
While prevalence estimates of LD and ADD/ADHD vary shows the extent to which children with a given condition
according to a range of factors, a rate between 2% and 4% is incur disability (are limited in their activities) as a result of
to be anticipated based on statistical probabilities.11 Some that condition. Here the figures range from 15.2% to 37%. In
prevalence estimates of ADHD are higher, ranging from 3% all cases the prevalence of condition-specific disability is
to 5% and even as high as 7.5%.12 The rates of LD (2.9%) lower than the prevalence of disability shown in Column E
and ADD/ADHD (2.6%) among First Nations children because the figures in Column E represent disability
would seem to be in line with rates to be expected in the stemming from any cause and are inclusive of the figures
broader population. shown in Column F.
Foetal Alcohol Syndrome (FAS) is the sum total of the
Multiple childhood disabilities and health conditions
damage done to the child before birth as a result of the
mother drinking alcohol during pregnancy. Common and It is not uncommon for First Nations children to report more
consistent features of FAS involve diminished growth, than one long-term health condition and more than one type
irritability, hyperactivity, impaired motor performance, of disability. The average number of long-term health
significantly diminished intelligence, smaller head size, conditions among children without disabilities is 0.4. Among
various atypical facial and skeletal attributes and heart children with disabilities the average number is 1.8. Children
murmur. Foetal Alcohol Effects (FAE) is a ”softer” diagnosis with any disability are limited in their activities by 1.2 long-
than FAS and is considered when the person has some signs term conditions on average.
of FAS, does not meet all of the necessary criteria for FAS,
and when there is a history of alcohol exposure before Among First Nations boys with and without disabilities the
average number of long-term health conditions is 0.7 and the
birth.13 1.8% of First Nations have been diagnosed as having
FAS/FAE. Sampling variability is very high so the data can’t average number of disabilities is 0.2. Among girls the
be released concerning the extent to which these children are average number of long-term health conditions is 0.4 and the
receiving treatment. It would appear, however, that relatively average number of disabilities is 0.09.
few are being treated.
Childhood disability and general health
Column C on Table 2 shows the percentage of children with
disabilities who have the long-term conditions reported in The general health of First Nations children with disabilities
Column A. High percentages of children with disabilities is poorer overall than that of other First Nations children. For
have asthma (43.5%), allergies (35.3%) and chronic ear instance, the parents/guardians of 41.5% of children with
problems (20.7%). disabilities rated their children’s health as good or excellent
compared with 73.7% of children without disabilities. Some
Column E takes as the units of analysis the ”universes” of 28.2% of children with disabilities are in fair or poor health
children who have a given condition and then shows the compared with only 4.1% of other First Nations children. In
percentage of these children who have a disability, whether the general child population in Canada, 11.2% of children
caused by that condition, by one or more additional long-
term conditions, or by factors that are not specified but that
result in activity limitations at home, school or other
situations. Generally, about one-third of children with the x
The numbers of First Nations children with HIV – AIDS are virtually non-existent based on the
RHS. The numbers of children with kidney disease, liver disease and diabetes are very low and
long-term health conditions shown on the table have some involve rates of disability that vary considerably at the 95% confidence level. Accordingly, no
plausible conclusions can be drawn as to the prevalence of disability for children with such conditions.
269
with disabilities are in fair or poor health and 56.1% are in For girl children 0–5 years with disabilities and
excellent or very good health.xi emotional/behavioural problems, the sampling variability is
very high and the data are not releasable except to say that
The sampling variability is high and the figures need to be
the percentage is similar to the 5.8% for girls without
used with caution for First Nations children with disabilities
disabilities. First Nations girls 6–11 years with disabilities
in the 0–5 and 6–11 age groups. However:
are more extensively reported as having emotional or
• The general health of 34.3% of First Nations children 0– behavioural difficulties – 39.3%xiv compared with 14.5% of
5 years with disabilities is reported as fair or poor, other girls this age. Overall, 27.8% of First Nations girls with
compared with only 3.2% of their counterparts without disabilities are reported as having emotional/behavioural
disabilities. problems compared with 10.5% of girls without disabilities.
• The general health of 24.6% of First Nations children 6– 22.1% of all First Nations girls who were reported on the
11 years with disabilities is fair or poor, compared with RHS as having emotional or behavioural problems are girls
5% of their counterparts without disabilities in this age with disabilities.
group. Some 29.2% of all First Nations children with emotional or
Children with and without disabilities are about as likely to behavioural difficulties are children with disabilities.
eat a nutritious and balanced diet always or almost always
(62.3% compared with 54.5%) (NS). Childhood disability and access to healthcare
Table 3 shows the extent to which parents/guardians
Childhood disability and dental care encountered barriers to receiving health care for First Nations
Most First Nations children with disabilities had received children with and without disabilities in the twelve months
dental care sometime in the twelve months before the RHS before the RHS was conducted. The sampling variability is
was conducted (71.3%), which was also the case for their fairly high (but within acceptable limits) for First Nations
non-disabled counterparts (67.0%) (NS). First Nations children with disabilities so the figures for these children
children with disabilities are more likely than their should be used with caution. The table shows that, generally
counterparts without disabilities to have ever received dental speaking, First Nations children with disabilities and their
care (90.9% compared with 79.5%). parents/guardians are more likely to face various barriers.
Lack of service availability and long waiting lists, adequacy
Children with and without disabilities are about as likely to and cultural appropriateness of service, difficulties arranging
need routine dental maintenance, extractions, fluoride transportation and difficulties accessing traditional care stand
treatment, orthodontic work and urgent dental care. Children out as particular problems for children with disabilities and
with disabilities stand in slightly more widespread need of their parents/guardians. Lack of prior approval for services
having cavities filled and other restorative work such as under NIHB is also a problem, but because sampling
crowns and bridges (36.2% compared with 25.7%). variability is high on this question it is difficult to establish
how much of a problem.
Childhood disability and behavioural issues
Even where there are no statistically significant differences
The RHS asked parents/guardians about children’s in the extent to which children with and without disabilities
behavioural and emotional problems as compared with the encounter barriers (e.g., health facility or doctor/nurse not
children’s non-disabled peers. While the sampling variability available, affordability of direct services), the lack of access
is high for First Nations boys 0–5 years and the estimate is likely to have a significant impact on a human level as the
needs to be used with caution, 41.1% of these boys are level and urgency of need for service can be aggravated
reported as having emotional or behavioural difficultiesxii when a child has one or more disabilities.
compared with 10.9% of their non-disabled peers of the same
age. Similarly, 46.8% of First Nations boys with disabilities
6–11 years are reported as having emotional or behavioural
problemsxiii compared with 16.9% of their age peers without
disabilities. Overall, 44.7% of First Nations boys with
disabilities have such difficulties compared with 14.2% of
their counterparts without disabilities. 33.5% of all First
Nations boys who were reported on the RHS as having
emotional or behavioural problems are boys with disabilities.
xi
Some 91.8% of children without disabilities are in excellent or very good health. The number of
children in the general population without disabilities and in fair or poor health is so small that the
percentage cannot be released.
xii xiv
The coefficient of variation is within acceptable limits – 27.7% The coefficient of variation is high but within acceptable limits at 26.1%, so the percentage of girls
xiii
The coefficient of variation is again fairly high but acceptable at 19%. 6-11 years with disabilities and behaviour/emotional difficulties should be used with caution.
270
Table 3. Percentages of First Nations children with and without disabilities having difficulties accessing health services, by nature of
difficulty
Others With disability Sig. Total
Availability
Doctor or nurse not available in respondent's area 11.6% 17.8% E 12.3%
Health facility not available in respondent's area 8.0% 9.3% E 8.1%
Service was not available in respondent's area 7.3% 19.3% E * 8.7%
Waiting list too long 21.5% 37.6% * 23.3%
Cost and eligibility for coverage under public programs
Not covered by Non-insured Health Benefit 7.9% 13.7% E 8.6%
Prior approval for services under NIHB was denied 4.9% – E 5.9%
Could not afford direct cost of care or service 6.3% 10.9% E 6.9%
Could not afford transportation costs 8.5% 13.9% E 9.1%
Could not afford childcare costs 8.8% 13.9% E 9.4%
Adequacy and appropriateness
Felt health care provided was inadequate 9.6% 25.5% E * 11.5%
Felt service was not culturally appropriate 6.3% 16.9% E * 7.6%
Chose not to see health professional 3.9% 4.1% E 3.9%
Other
Unable to arrange transportation 9.4% 17.9% E * 10.3%
Difficulty getting traditional care 6.2% 13.0% E * 7.0%
E High sampling variability. Coefficients of variation are within acceptable range (<33.3%) but figures should be used with caution.
* Statistically significant difference between children with and without disabilities at 95% confidence interval.
perhaps learning disabilities, the levels of treatment for these
Summary of Key Findings conditions are low.
This chapter explored disability and long-term health It is fairly common for First Nations children with disabilities
conditions among First Nations children 0–11years. The to have more than one long-term condition. Their general
research found that childhood disability is more prevalent health is poorer than that of their First Nations counterparts
among First Nations children than in the general population. without disabilities. A significantly higher proportion have
Children with disabilities are in much the same familial emotional and behavioural difficulties, a problem more
living arrangements as other First Nations children and are as pronounced among boys than girls.
likely to be attending school but tend to fare less well, First Nations children with disabilities are more likely to face
academically. They are about as involved in non-school various barriers to accessing health care services.
cultural and physical activities.
The research found no statistically significant differences in Recommendations
the household incomes of children with and without Noteworthy are what seem to be relatively equal levels of
disabilities or in the respective education levels of parents. participation by First Nations children in cultural and
The most commonly reported long-term health-related physical activities, regardless of disability, age or gender.
conditions among First Nations children are asthma, allergies While attention is perhaps needed to ensure that non-school
and chronic ear infections/ear problems. Less widely sports programs are accessible to and supportive of the
reported but having potentially harmful or challenging participation of boys and girls with disabilities, communities
implications are chronic bronchitis, ADHD, learning and community leaders should be recognized for their efforts
disability and FAS/FAE. With the exception of allergies and of inclusiveness and should be encouraged to continue on
that path.
271
The low levels of treatment for potentially serious health If the poorer general health and modest levels of intervention
conditions such as chronic bronchitis and ear infections are for long-term health-related conditions are not addressed for
somewhat alarming. Parents/guardians need to be alerted to today’s First Nations children, and if the educational and
the potential health risks and about how to manage these. emotional difficulties reported in this chapter are not
Health care services need to be proactive in detection and adequately addressed, the consequences are likely to become
treatment efforts. more entrenched, complex, difficult to manage and costly in
human and financial terms for future generations.
The significantly poorer general health of First Nations
children with disabilities needs attention through research
and health promotion initiatives that target not only Notes to Chapter 30
individual health behaviours of children and their parents but
broader social and economic determinants of health as well. 1. Social Development Canada, Advancing the Inclusion of Persons with Disabilities, 2004
(Ottawa, Ont.: Social Development Canada, 2004), p. 9 and Endnote 14.
Also needed are measures to ensure that children are not 2. Statistics Canada, 2001 Participation and Activity Limitation Survey, A Profile of Disability in
Canada, 2001—Tables (Ottawa, Ont.: Minister of Industry, 2002), Table 9.1.
prevented from accessing needed services and facilities due 3. Statistics Canada, 2001 Participation and Activity Limitation Survey, A Profile of Disability in
Canada, 2001—Tables, Table 10.1.
to non-availability, as are measures to ensure that prohibitive 4. MedicineNet.com, Asthma [online]. Cited 29 September 2005. Available from World Wide
direct service costs do not fall to First Nations families who Web: <http://www.medicinenet.com/asthma/article.htm>.
5. MedicineNet.com, Allergy [online]. Cited 5 October 2005. Available from World Wide Net:
by and large are not wealthy. It is not clear why non- <http://www.medicinenet.com/allergy/article.htm>.
6. MedicineNet.com, Understanding Bronchitis [online]. Cited 5 October 2005. Available from
affordable direct service costs are falling to about 1 in 10 World Wide Web: <http://www.medicinenet.com/bronchitis/article.htm>.
families of children with disabilities. Nor is it clear why 7. MedicineNet.com, Otitis Media [online]. Cited 5 October 2005. Available from World Wide
Web: <http://www.medicinenet.com/otitis_media/article.htm>.
about 1 in 8 of children with disabilities have difficulties 8. H. Kramer and D. W. McCullough, “The prevalence of otitis media with effusion among Inuit
children," International Journal of Circumpolar Health [online]. 1998, vol. 57, supplement 1
gaining coverage under the Non-Insured Health Benefits [cited 5 October 2005], pp. 265-267. Available from World Wide Web:
(NIHB) of the specific services, medications and equipment <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1009
3287&dopt=Abstract>.
that are not covered. The process for securing prior approval 9. MedicineNet.com, Attention Deficit Hyperactivity Disorder (ADHD)(ADD) [online]. Cited 5
October 2005. Available from World Wide Web:
for services under the NIHB program may also warrant <http://www.medicinenet.com/attention_deficit_hyperactivity_disorder_adhd/article.htm>.
attention. These are difficulties that children with and 10. MedicineNet.com, Learning Disability [online]. Cited 5 October 2005. Available from
<http://www.medicinenet.com/learning_disability/article.htm>.
without disabilities and their families face. 11. LDOnline, Attention Deficit Disorder and Learning Disability: United States, 1997-1998
(Summary) [online]. Cited 5 October 2005. Available from World Wide Web:
Measures are needed to ensure the adequacy and cultural <http://www.ldonline.org/ld_indepth/add_adhd/add_ld_1997_1998.html>.
12. National Resource Centre on AD/HD, Statistical Prevalence [online]. Cited 5 October 2005.
appropriateness of health services provided. These measures Available from World Wide Web: <http://www.help4adhd.org/en/about/statistics>.
13. MedicineNet.com, Fetal Alcohol Syndrome [online]. Cited 5 October 2005. Available from
should involve service design and quality monitoring of World Wide Web: <http://www.medicinenet.com/fetal_alcohol_syndrome/article.htm>.
parents of First Nations children with disabilities and parents
of children with long-term health conditions who may not
have disabilities. These children, after all, are among the end-
users of the services that should be equitably available,
effective and culturally appropriate. Federal,
provincial/territorial, and First Nations governments and
political leaders have a significant role to play, here, as do
other First Nations authorities responsible for health services.
Also requiring attention are the reasons why some of the
dental needs of First Nations children with disabilities are
going unfulfilled to a greater extent those of other children.
What should be of concern are the low levels of reported
intervention to address the needs of children with: learning
disabilities; ADHD and FAS/FAE; high levels of behavioural
and emotional difficulties among First Nations children with
disabilities; their generally lower academic performance and;
higher levels of grade retention. Further analysis of the links
between the long-term conditions, emotional/behavioural
difficulties and difficulties at school are warranted.
Also required are effective, respectful behavioural support
services and effective educational strategies and support
systems for pupils, teachers and families. These types of
resources can assist children with cognitive, emotional and
other challenges—and their families and teachers—to find
ways of coping and thriving.
272
Chapter 31
Injuries
Abstract
Injuries are the leading cause of death in children throughout Canada, The 2002/03 First Nations
Regional Longitudinal Health Survey (RHS) results show that First Nation children are more likely
than Canadian children in general to report various types of injuries. The most common causes of
injury mentioned were falls, sport related and bicycle accidents. Older children, and those who are
more physically active, are at increased risk of injury but there are few differences by gender. Nor do
children’s injuries seem to be related to a variety of family and community characteristics; the sole
exception is that rates appear to be higher in children whose parents attended residential schools. It is
not clear if this reflects parenting practices, or if residential school attendance is a proxy for some
other variable such as geographic location. Since certain types of injuries are more common at
specific ages, interventions to reduce childhood injuries need to be carefully targeted. Concerted
action by different sectors of the community, ranging from parents and families through to community
institutions such as schools, recreation facilities and health centres is likely required.
273
RHS 2002/03 Child Survey – Chapter 31: Injuries
Results
Introduction
Injury is probably the most under-recognized public health Types and causes of injuries
problem facing First Nations today. Although injury rates are
All told, 17.5%i of the children included in the RHS had
lower in childhood than at older ages, they are nonetheless
experienced at least one injury serious enough to need
the leading cause of death in children.1,2,3 Motor vehicle
medical attention in the year prior to the survey. Previous
crashes, drowning and fires are among the most common
research has found that injury rates in Aboriginal children
causes of injury death in children, while other types of injury
living off-reserve are close to the Canadian average5, 6 but the
(such as falls, scalds or accidental poisoning) can require
RHS results suggest that the rates are much higher for
medical attention or hospitalisation. A recent study of
children living in First Nations communities.
children in Alberta showed that 84 % sustained an injury that
required medical attention before the age of 10, and 73 % Table 1. Proportion of children injured seriously enough to
sustained at least two such injuries. The same study found require medical attention in the year prior to the survey,
compared to other populations
that First Nations children under 10 were 71 % more likely
First Nations on-
than non-First Nations children to suffer four or more injuries reserve (RHS
Aboriginal off- Canada as a whole
requiring medical attention.4 Disfigurement, disability, 2002/03)
reserve (2000/01) (2000/01)
developmental delay and emotional problems are major
17.5% 12% 10%
consequences of accidental injuries to children. Many of
Sources: RHS and National Longitudinal Survey of Children and Youth7
these injuries could be prevented. * Question wording and age groups were identical across these surveys.
Injuries involve a complex interaction of factors. In studies The most common types of injuries that First Nations
of the general population, childhood injuries have been children reported were major cuts, scrapes, or bruises,
linked to parental formal education, socioeconomic status fractures, and major sprains or strains. The pattern for
and mental health. The larger environment also plays a role. Canadian children in general is identical.8 In other words,
Appreciable improvements in child injury rates have First Nation children experience the same types of injuries as
followed the introduction of regulations governing infant others, but at higher rates.
clothing, cribs, baby-walkers and car seats. Nevertheless, the
Table 2. Proportion of children who experienced various types of
number of injuries to First Nations children remains injuries (n=6654)
unacceptably high. This chapter presents information on the
Nature of injury % of children
nature and causes of injuries in First Nations children and on
some of the factors linked to injuries. Major cut, scrape, bruises 9.8%
Fracture 4.0%
Major sprain/strain 3.0%
The RHS asked about three aspects of injury: the nature of
Dental injury 2.5%
the injury, its cause and whether alcohol was involved. A
first set of questions asked parents if, in the year prior to the Burns/scalds 2.3%
survey, their child had required medical attention for any of a Concussion 0.9%
list of injuries such as major cuts, sprains, broken bones or
Dislocation 0.7%
concussions. Each of these questions was answered with
“yes” or “no,” so the resulting numbers reflect how many The most frequently mentioned causes of injury were, in
children experienced a particular type of injury, rather than order: falls/trips, bicycle accidents and sports injuries.
how many injuries happened in total. The different types of Almost none of these injuries were reported to be alcohol-
injury are not mutually exclusive, and some children might related.
have been injured more than once during the year.
A second set of questions asked about the causes of injury, Injuries and personal characteristics
such as falls, car crashes, sports, etc. Again, these were Some children may be at greater risk of injury because of
yes/no questions. their age, sex, or everyday activities. It is interesting that
The third set asked about alcohol involvement with respect to although the RHS found noticeable gender differences in
any injury that occurred. Because of the way the questions injury rates for teenagers and adults, in children there was no
were set up, some assumptions had to be made when statistically significant differenceii. These results contrast
analysing the responses in this third set. Many people refused
the alcohol questions. Under-reporting is likely because of ii
To simplify the text, confidence limits are only reported for overall child estimates with a co-
the stigma associated with alcohol use, especially if the efficient of variation of greater than 33.3%. A statistical appendix including confidence intervals for
alcohol-related injury involved a child. In short, the numbers ii
on alcohol involvement should be treated as estimates only. their confidence intervals do not overlap (95% confidence level).
274
with some previous studies of Canadian children in general, Figure 3: Proportion of children injured in past year, by
frequency of physical activity (n=6405)
which have tended to find that boys have higher injury rates.9
25%
The RHS results do, however, show that injury rates vary by
age, with older children being significantly more likely to be
19.3%
injurediii (Figure 2). The sample size does not allow us to 20%
look at specific types of childhood injury by age. However,

Canada-wide studies suggest that as children grow older, 15%
their risk of injuries such as fractures typically increases but 11.4%

the risk of scalds goes down.10 10%
Figure 1. Proportion of children reporting various causes of

injury (n=6657)
5%
Fall/trip 7.6%
0%
Bicycle 2.8% Once a week or less (incl. never) More than once a week (incl. daily)
Frequency
Sports 2.1%
Injuries and family characteristics
Motor vehicle 1.5%
Family characteristics such as who the child lives with,
Burns/scalds 0.9%
household size, household income or parental education
might be expected to be related to injury rates, but the RHS
Dog bite 0.8% results show few differences on these dimensions. There
were no statistically significant differences in injury rates
Other 3.6% according to whether the child lived with his/her biological
parents or with other family; no differences according to
0% 1% 2% 3% 4% 5% 6% 7% 8%
household income; and none according to how many children
* “Motor vehicle” includes cars, trucks, all-terrain vehicles, snowmobiles, and collisions between
motor vehicles and bicycles or pedestrians.
(fewer than six vs. six or more) lived in the household. Nor,
surprisingly, was there any significant relationship between
Figure 2. Proportion of children with one or more injuries in the injury rates and how well the child had gotten along with
previous year, by age group (n=6657) his/her family in the previous six months.iv
25%
The results with respect to parental education are interesting.
20%
On the one hand, there is no significant relationship between
20% either the mother’s or father’s level of formal education and
the child’s injury rates. On the other hand, injury rates do
15% 14.4% seem to be related to whether the mother or father attended a
residential school. There are several possible explanations for
this. First, the residential schools have been accused of
10%
raising people with few parenting skills.11 This might be
reflected in the home environment and in supervision
5% practices, and hence have an effect on children’s injury rates.
Alternatively, residential school attendance may be serving
as a proxy indicator of something else that affects a child’s
0%
0-5 6-11 risk for injury—such as the parent’s age, or the family’s
Age group (years) province of residence (injury rates are known to be higher in
Given that both sports and bicycle accidents are among the certain provinces and territories).12, 13
most frequently mentioned causes of injury for children, it is
no surprise to find that injury rates vary with the child’s Injuries and community characteristics
activity level. Children who engage in physical activity more Although there seems to be a relationship between some
than once a week are significantly more likely to report an community characteristics and adult injury rates, this
injury than children who are active once a week or less relationship is only somewhat apparent for children’s
(19.3% vs. 11.4%). injuries. Parents in semi-isolated communities are more
likely than those in non-isolated communities to cite
iv
These findings may simply reflect the lack of variation in the answers to this question: 93% of all
iii
The difference between preschoolers and children six years and over is not statistically significant if parents said that their child got along well with his/her family. This reduces the question’s usefulness
infants are excluded from the analysis (injury rates in infants being extremely low). as a predictor of other behaviours or events.
275
children’s rates of injuries. Similar to adults in general, reason, bicycle paths and other measures to reduce the
children’s rates of injuries are not clearly related to either the probability of bicycles and vehicles colliding are useful.18
size of the community or its transfer status.
Figure 4. Proportion of children injured in past year, by whether Motor vehicle crashes
or not parents attended residential school (n=6268)
As noted above, most children’s, motor vehicle injuries
30%
involve collisions between vehicles and bicycles. Few
children were reported to have been injured as passengers in
24.6%
25%
23.3% motor vehicles; most of the remaining incidents involve
collisions between vehicles and pedestrians. Studies
20% elsewhere in the world have identified some measures that
16.8% 16.8% help to reduce these collisions between pedestrians and
15% vehicles. Sidewalks help, and one-way streets apparently
reduce pedestrian-vehicle collisions by 20-50%.19 Lowering
10% and enforcing speed limits also helps: in Holland, the
introduction of traffic-calming measures reduced injuries by
5% Attended
25%.20 Reflective clothing makes pedestrians visible at 213
Did not attend
metres, as compared to just 45m for a person wearing dark
clothing.21
0%
Mother/female guardian Father/male guardian
Conclusions
Specific causes of injury to children Like previous studies, the RHS results show that children in
First Nation communities experience injuries at higher rates
Falls than average. Preventing such injuries may require a
combination of education (of the children themselves, if old
Falls were the most frequently reported cause of injury in the enough, or of parents, families, and the larger community),
RHS: 7.6% of children had had at least one fall that required equipment modifications and making the larger environment
medical attention during the year. This is not unusual. Across safer.
Canada, falls are so common that one in every twelve
children under age six needs hospital treatment for a fall.14 There is now considerable evidence of the effectiveness of
Falls are most common in younger children. At this stage, legislation and public health education in preventing
most falls happen in the home, and involve things like falls children’s injuries. For example, the Flammability Fabrics
from stairs, strollers or furniture such as changing tables, or Act of 1967 substantially reduced the number of burns in
with baby-walkers.15 In older children, serious falls tend to young children by reducing the flammability of children’s
involve sports, trees, or playground equipment—especially if sleepwear. Smoke detectors have reduced injuries and
the ground below the equipment is hard or uneven.16 lowering the temperature of hot water tanks has helped to
Preventing these injuries usually involves modifying the reduce the number of scalds. Similarly, the introduction of
environment to make it safer (for instance, installing baby child-resistant packaging for chemicals and drugs has helped
gates, or providing a sufficient depth of sand below to reduce the number of accidental poisonings in children.
playground equipment. Protective equipment for sports may Nevertheless, much remains to be done to reduce First
also prevent some injuries). Nation’s children’s injury rates. When designing prevention
programs, it is important to keep in mind that certain injuries
Incidents involving bicycles cluster around certain ages, so interventions need to be
Bicycles were the second most commonly reported cause of appropriately targeted. For instance, scalds and accidental
injury in the RHS, with 2.8% of all children having had a poisonings are most common in toddlers, while fractures are
bicycle accident in the preceding year and another 1.1% common in older children. Babies and young children can
having experienced some type of collision between a bicycle fall from stairs and household furniture while older children
and a motor vehicle. In fact, the bulk of the motor vehicle are more likely to fall from playground equipment or during
accidents for children involved bicycle-vehicle collisions. sports. Young children are most likely to be injured in the
Action to prevent such injuries can occur on several levels. home, making their immediate families and home
Helmets help appreciably in preventing serious injuries and environment the best targets for prevention efforts; while
deaths. They reduce the risk of head injury by 85%. In older children are more likely to be injured outside the home.
Australia, mandatory helmet laws have reduced deaths by Action to prevent children’s injuries would logically involve
59%.17 However, when bicycles collide with vehicles, many different sectors of the community including parents,
cyclists typically injure more than just their heads. For this extended families, Elders, a variety of community services
276
such as schools, recreation centres) police and traffic

services, and health centres.
Notes to Chapter 31
1. Health Canada, A Statistical Profile on the Health of First Nations in Canada (Ottawa, Ont.:
2. Health Canada, Unintentional and Intentional Injury Profile for Aboriginal People in Canada,
1990-1999 (Ottawa, Ont.: Health Canada, 2001).
3. P. McFarlane, Winter 1997, Accidents waiting to be prevented, In Touch, 7, 3 (issue devoted
to injury prevention).
4. Ryan Smith, “Injuries to children show definite patterns, study shows,” ExpressNews [online].
1 April 2004, University of Alberta. Available from World Wide Web:
<www.expressnews.ualberta.ca/print.cfm?id=5703>.
5. Michael Tjepkema, “Non-fatal Injuries among Aboriginal Canadians,” Health Reports 16, 2
(March 2005), p. 18.
6. Martin Turcotte and John Zhao, “Well-being of Off-reserve Aboriginal Children,” Canadian
Social Trends (Ottawa, Ont.: Statistics Canada, Winter 2004, cat. no.11-008), pp. 22-27.
7. Tjepkema, “Non-fatal Injuries among Aboriginal Canadians,” Health Reports, pp. 9-22.
8. Barry Pless and Wayne Millar, Unintentional Injuries in Childhood: Results from Canadian
Health Surveys [online]. [Ottawa, Ont.]: Public Health Agency of Canada, 2000. Cited
September 2005. Available from World Wide Web: <www.phac-aspc.gc.ca/dca-
dea/publications/pdf/unintentional_e.pdf>.
9. Ibid.
10. Ibid.
11. Madeleine Dion-Stout and Greg Kipling, Aboriginal People, Resilience, and the Residential
School Legacy (Ottawa, Ont.: Aboriginal Healing Foundation, 2003), pp. 33-34.
12. Pless and Millar, Unintentional Injuries in Childhood: Results from Canadian Health Surveys
[online].
13. Statistics Canada, National Population Health Survey Overview 1996/97 (Ottawa, Ont.:
Statistics Canada, 1998), p. 3.
14. Gordon Trueblood, Prevention of Falls and Fall-Related Injuries among First Nations and
Inuit, draft document (Ottawa, Ont.: First Nations and Inuit Health Branch, Health Canada,
2002).
15. Ibid.
16. Ibid.
17. Direction de la santé publique de Montréal-Centre, Prévenons les blessures chez nos enfants:
guide à l’intention des intervenants (Montreal, Que.: Régie régionale de la santé et des services
sociaux de Montréal-Centre, 2001).
18. Ibid.
19. R. Kroplauch and K. Crigler, “Model Pedestrian Safety Program User’s Guide Supplement”
(McLean, Va.: Federal Highway Administration, 1987) as cited in Prévenons les blessures
chez nos enfants: guide à l’intention des intervenants by Direction de la santé publique de
Montréal-Centre et al. (Montreal, Que.: Régie régionale de la santé et des services sociaux de
Montréal-Centre, 2001).
20. T. Hummel, “Dutch Pedestrian Safety Research Review,”as cited in Prévenons les blessures
chez nos enfants: guide à l’intention des intervenants by Direction de la santé publique de
Montréal-Centre et al. (Montreal, Que.: Régie régionale de la santé et des services sociaux de
Montréal-Centre, 2001).
21. Direction de la santé publique de Montréal-Centre, Prévenons les blessures chez nos enfants:
guide à l’intention des intervenants.
277
Chapter 32
Dental Treatment Needs and Use of Dental Services
Abstract
This chapter describes the treatment needs and dental care utilization patterns of the First Nations
population (aged 0–11 years) as estimated from the 2002/03 First Nations Regional Longitudinal
Health Survey (RHS). Data were gathered via proxy interviews with a parent or guardian. Overall,
69.1% of children had dental care in the past year. Dental care in the past 12 months was associated
with child’s age and maternal parents’ education. This cohort reported needing dental fillings
generally starting at age one. The proportion of preschool children requiring fillings was found to be
the same as that of school aged children. Twenty-nine percent of 3–5 year-olds were affected by Baby
Bottle Tooth Decay (BBTD) and 67% of those were treated for the disease. BBTD experience was
related to dietary factors and the use of medications. The likelihood of having BBTD declined with
the parents’ level of education and household income. BBTD also was associated with isolation status
of the community. The overall prevalence of dental trauma was 2.5%. Despite geographical barriers in
the north, utilization of dental care services by First Nations children is high. However, the early onset
of oral disease and the increasing levels of treatment needs for children call for a greater emphasis on
effective prevention and oral health promotion in First Nations communities.
278
RHS 2002/03 Child Survey – Chapter 32: Dental Treatment Needs and Use of Dental Services
Note: Due to spacing issues, all tables may be found at the Nations communities (3.5 for 3 year olds and 4.8 for 5 year
end of the chapter. olds).40
Despite its prevalence, BBTD is a preventable disease.
Traditionally, BBTD’s etiology has been largely associated
Introduction
with feeding practices of infants and toddlers and is often
The burden of tooth decay in First Nations children referred to as nursing bottle caries. This name highlights the
major dietary cause of the disease: the prolonged ad lib use
At present, there are deep and continuing disparities between
of the bottle with sugar-containing liquids, especially at night
First Nations and non-First Nations Canadians both in their or naptime.41-44 Although there is little doubt that the addition
general health and in their oral health.1-7 The reasons for of sucrose to the contents of the nursing bottle heavily
these disparities are complex and relate to a number of
predisposes children to BBTD, the first United States (U.S.)
different factors, influenced by socio-economic conditions in Surgeon General’s report on oral health notes that sex, age,
First Nations communities and compounded further by income, and race or ethnicity are also important determinants
geographical barriers that impede access to health and dental of oral health status.45
services in remote northern communities. Data from the 2001
Census showed that the First Nations population is growing Recent studies on the etiology of BBTD use an infectious
at a rate of 3% per year; more than double the Canadian rate.8 disease model to explain the association between the primary
The First Nations population is also younger, on average, caregivers’ oral health status and the oral health status of
than the rest of the Canadian population. Compared to the their young children.46 Opportunities for vertical oral
general population, the proportion of First Nations children transmission of bacteria from mother to child occur most
under five years of age is 70% greater.9 often during breastfeeding contact or by the sharing of
spoons and pacifiers. However, evidence from the literature
Among First Nations children, tooth decay is one of the most
does not support a strong and consistent relationship between
prevalent chronic childhood diseases. The prevalence of prolonged breastfeeding47 or pacifier use48 and the
dental caries in school-aged First Nations children living on- development of BBTD. Among First Nations populations,
reserve ranged from 30% to 98% in studies in the 1970s10
the strongest predictors for BBTD remain parenting practices
and 1980s11, 12 and remained at roughly the same levels related to prolonged use of the bottle or sippy cups with
throughout the 1990s (range: 60-96%).13-16 However, over sugar-containing drinks and a high frequency of sugary
the same period of time we saw a dramatic increase in the
snacks per day.49,50,51 A study in First Nations reserves in the
prevalence and severity of tooth decay in the primary Sioux Lookout zone in Northwestern Ontario found that
dentition.17-32 Decay affecting the deciduous teeth can begin bottles with condensed milk or sugary drinks are being used
as soon as the infant’s teeth erupt. This can progress more
for soothing throughout the day and night and not just for
rapidly and end up being more destructive than caries in the feeding.52 The study also found that the caregiver’s dental
permanent teeth.33 The term often used to describe this health knowledge did not impact on the child’s BBTD
devastating form of caries is Baby Bottle Tooth Decay experience, but a caregiver’s dentate status (i.e., number of
(BBTD), but the term most accepted by health professionals natural teeth present), regular use of dental services and the
for the disease is Early Childhood Caries (ECC).34 BBTD, or
number of children in the home were important determinants
ECC, affects a disproportionately higher number of First of a child’s oral health. In addition, children’s good oral
Nations, Inuit and Métis children than non-Aboriginal hygiene practice and a preventive dental visit on, or before,
children under five years of age in Canada and is the number
the child’s first birthday were related to a decreased risk for
one cause of health disparities between Native and non- BBTD.53
Native children. Prior to this study, there have been no
national figures on the extent of caries in the primary Child dental care in remote communities
dentition for children under the age of five. Local studies
Treating BBTD can be expensive if the disease is not
have revealed that less than 11% of children entering
identified and managed early. Preventive resin restorations
kindergarten in North York,35 Ontario, have visible,
(‘tooth-coloured’ fillings) or amalgams (‘silver’ fillings)
untreated decay, while approximately 78%36 to 87.5%37 of
have a high failure rate amongst this age cohort, so the
Canadian Aboriginal children have experienced tooth decay
treatment regime of choice remains a more aggressive one
by 60 months of age. According to studies completed after
involving the placement of stainless steel crowns and teeth
the year 2000 in First Nations communities, the severity of
extractions under general anesthesia (GA) or conscious
disease in the primary dentition, as expressed by the mean
sedation. Since many of the First Nations children who suffer
number of decayed, missing or filled teeth per person
from the disease reside in remote communities, they must
(DMFT index), varies from 10 to 13.7 for 3- to 5-year-old
either be flown to a centrally located hospital or receive care
children in Northwestern Ontario38 and Northern Manitoba,39
from dentists who travel to the communities to carry out the
but the DMFT index is lower in Southern Ontario First
procedure, sometimes using oral sedation to make the
treatment easier on their young patients. This means that it is
279
generally more cost-effective to use GA instead of nitrous Links between child’s oral health, general health and quality
oxide or oral sedation, particularly if the child needs more of life
than three conscious sedation appointments to complete the
The consequences of BBTD are a significant problem not
treatment.54 However, treating children in hospital under GA
only in monetary terms to parents and federal or provincial
adds substantially to the cost of the procedure and does not
agencies paying for the care, but in risks to the health and
guarantee a reduction in the child’s susceptibility to future
well-being of the child with the disease. Medical reviews and
caries.55, 56
xylitol (a sucrose substitute) clinical trials suggest that BBTD
A retrospective analysis of dental records of 884 First may be linked to increased episodes of infectious diseases,
Nations children, aged one to six years, who were treated for especially recurrent pneumonia, tonsillitis and otitis media. 63,
64
BBTD between 1980 and 1988 in the province of Manitoba, Low birth weight and asthma have also been associated
estimated the mean cost to Health Canada for GA dental with an increased risk for BBTD.65-67 More recently,
treatment to be $3,067 CDN per child.57 Approximately two- childhood obesity has been linked with high dental caries
thirds of this cost was attributed to hospital services, travel rates.68 Obesity is linked to a wide range of co-morbidities
and lodging, while only one-third were dental costs. In the including Type II diabetes, which is prevalent among
U.S., when all treatment factors, including operating room Aboriginal adults and children.69,70 Overweight or obese
(OR) and transportation costs were considered, the potential individuals are known to have poor nutrition; in particular
cost of BBTD treatment per non-Native, and Native, Alaskan they consume excessive amounts of sugar. Because diet has a
child enrolled in Head Start programs was $2,003–$3,083 major influence on dental caries, it is important to ascertain
U.S.,58 and was $2,141.45 U.S. per Choctaw Native- what portion of the First Nations children population are at
American Head Start child in Mississippi,59 if GA was used risk for obesity, and what proportion is at risk for increased
(OR and dental costs only). levels of dental caries. Confirming these associations would
have important implications for preventive efforts aimed at
It has now been nearly 30 years since dental delivery services
improving the oral health of young First Nations children.
were first introduced into remote First Nations communities
following the creation of a contractual partnership between The range of adverse outcomes that can result from BBTD
Health Canada and the Faculty of Dentistry at the University suggests that this condition and related treatment are also
of Toronto, together they developed a National School of likely to have an impact on the overall quality of life of those
Dental Therapists in Fort Smith, N.W.T., whose graduates suffering from the disease. Children suffering from BBTD
went on to serve in remote locations.60 In 1983 the school at endure episodes of recurring mouth pain, problems with
Fort Smith was moved to Prince Albert, Saskatchewan. The chewing and eating as well as sleepless nights. Along with
program is now administered by the Saskatchewan Indian low self-esteem issues (because of the appearance of their
Federated College (SIFC) in conjunction with the University mouth), it is factors such, as these that can negatively affect
of Saskatchewan's College of Dentistry. The NSDT was childhood development. All too often extractions of infected
designed to educate dental therapy students in the provision teeth are done on First Nations children as young as 12
of basic oral health care services, including fillings, months of age as a result of dental abscesses. As these
extractions, preventive care and oral health promotion. The children gain their full complement of deciduous teeth, their
dental therapists are jointly employed by the federal dental problems become so severe that full mouth
government and the provincial governments to provide rehabilitation, including restorations and extractions, must be
services in rural and remote communities. At present, dental performed under general anesthesia or deep sedation because
therapists are only licensed in Saskatchewan, the Northwest such young children lack the ability to cope with the
Territories, Nunavut and some remote parts of Northern procedures. Such procedures do not prevent the recurrence of
British Columbia. Access to dental practitioners and dental the disease but act only as a “stop-gap” measure. At the same
hygienists and therapists is provided under the Non-Insured time, the psychological stress of undergoing such treatments
Health Benefits Program of the Medical Services Branch of can be troubling for the child and for the families that share
Health Canada. The Non-Insured Health Benefits (NIHB) this burden. However, studies in homogeneous, non-Native
Program provides approximately 749,825 registered Indians populations have found statistically significant data connects
(and recognized Inuit and Innu) in Canada with a range of BBTD with retardation in growth. Following successful
health benefits not included in provincially/territorially treatment of BBTD, a slight increase in the incremental
administered insured health care programs.61 Of the total weight of children occurs.71-73 Despite the risk for mortality,
NIHB expenditures in 2003/04 ($736.9 million), dental costs dental care under general anesthesia for preschool children
totalled $134.5 million or 18.3%.62 Twenty-nine percent of has a high degree of acceptance by parents and is perceived
all dental claimants were children under 15 years of age and to have a positive impact on their child.74-77 Pain relief is the
8% were four years and younger. greatest predictor of parents’ perception that their child’s
quality of life was improved following treatment.78
280
Dental injuries: An emerging dental problem The survey also included a number of other questions that
provided background information about the respondent.
In recent years, the importance of childhood injuries has
Questions addressed the respondent’s household, the
received recognition as a leading cause of hospitalization and
community in which the child lived, the role of traditional
death among Canadian children. To address the problem, in
culture in the life of the child, the child’s general health and
1997 Health Canada created a comprehensive database on
incidence of injuries, diet and nutrition, child care
the incidence and circumstances of these injuries through the
arrangements, and education. The selection of independent
Laboratory Centre for Disease Control, Canadian Hospitals
variables was drawn from these broader areas to conform
Injury Reporting and Prevention Program (CHIRPP).79 These
with the First Nations’ understanding of “total health”
data are being used to develop intervention programs and to
whereby each area of health is related to other areas of health
evaluate the results of such programs because it is estimated
and to the “total” environment.86
that 90% of injuries among children are preventable. Data for
the Canadian population of children and youth up to 19 years Results
of age reveal that adolescents sustained more sports-related
injuries than younger children. Younger children were
injured much more frequently in their homes than older “Reporting to have seen a dental health care provider in the
children and adolescents. Most importantly, head and neck past year” is the traditional indicator used to measure access
injuries, including the oral-facial region and intraoral sites, to professional dental services in specific communities and/or
accounted for two-thirds of all injuries.80 among particular cohorts. In the children’s 2002/03 RHS, the
parent or guardian was asked about the last time the child had
Epidemiologic data from around the world indicate that in 5-
any dental care. Response options ranged from “less than 6
year-old children, approximately one-third have suffered a
months ago,” “between 6 months and 1 year ago,” “between
traumatic dental injury involving primary teeth, most often
1 and 2 years ago,” “more than 2 years ago,” to “never.” The
tooth luxation (e.g. loose teeth).81,82 Traumatic dental injuries
corresponding population-weighted responses were 44.2%,
in the primary dentition peak between the ages of two and
24.9%, 9.0%, 2.8% and 19.1%.i These results indicate that
three, when motor coordination is developing and children
69.1% of First Nations children received some form of dental
begin to move about more easily on their own. In the
care in the past year, with no apparent differences between
permanent dentition, incidence is at its highest for boys ages
the sexes (Figure 1). However, when the results for the same
9 and 10 years. This occurs when they are actively engaged
question are analyzed by age group, the emerging pattern
in vigorous play and sporting activities. Boys tend to
shows that school age children are more likely to have
experience more dental trauma in the permanent dentition
received dental care in the past year, followed by preschool
than girls, however, there does not appear to be a difference
age children. Almost no dental care for infants and toddlers
between sexes in the primary dentition.83
was shown, even though they are a part of the cohort most at
Analysis and interpretation of data high risk for BBTD (Figure 2).
The analysis and process used to interpret the data were Figure 1. Last instance of obtaining dental care for First Nations
based on the RHS Cultural Framework.84 This framework children by gender
50%
encompasses “the total health of the total person within the 45.6%
total environment.”85 Thus dental health and care data are 43.0%
presented in relationship to the First Nations vision of their 40%

Boys
own health. Three areas of that vision stand out in particular; Girls
the first being the desire for individuals in these communities 30%
to be free of disease, the second being the ability of the 24.5% 25.3%
community to provide all its members with health services,
18.9% 19.3%
and the third being the importance of oral health as an 20%
integral component of overall health and well-being. This

10.7%
holistic definition of health provided the framework for the 10%
7.1%
selection of variables used in the analysis. Specifically, the 2.9% 2.7%
dependent variables were derived from questions that asked
0%
the child’s last instance of obtaining dental care, what type of < 6 months ago 6 to 12 months 1 to 2 years 2+ years ago Never
treatment was needed, and the child’s current or previous Time period
experience with Baby Bottle Tooth Decay (BBTD). If the

child had BBTD, the interviewee was asked whether the
child had received dental treatment to deal with the disease.
A physical injury, including dental injury, which occurred in
the past 12 months and required medical attention, was also i
one of the dependent variables in the analysis. of variation of greater than 33.3%. A statistical appendix including confidence intervals for all
281
Figure 2. Last instance of obtaining dental care for First Nations children by age group
70%
60% 57.4%
53.5%
Last instance
50% <6 months

6 to 12 months
1-2 years
2+ years 40.4%
40%
33.1%
30% 28.1%
25.2%
20.2%
20%
14.8%
10% 8.3% 8.7% 8.0%

5.4% 5.0%
3.5% 3.0% 3.7%
1.6%
0.0% 0.2% 0.0%
0%
<1 1-2 3-5 6-8 9-11
Age group (years)
In Table 1, the relationships between dental care in the past may be partly explained by the child oral health initiatives
year and selected family and community characteristics are sponsored by Health Canada that increased access to care in
explored, by age group.∗ The mother’s level of education, many communities. Nonetheless, the programs have not
which is recognized as a strong determinant of the use of overcome the persistent problem of reaching the most remote
health care services, played a significant role in whether the First Nations communities. Similarly, a community’s health
child received dental care in the past year. If the category transfer status did not differentially affect dental care
“graduate degree” is not considered (the proportion of First utilization for these age groups (Table 1). This finding
Nations adults who completed university degrees is 5.0% suggests that the communities engaged in the health transfer
compared with 16.8% for Canadians),86 there is a process already had a well-developed health care system
significantly greater proportion of children that had dental (including dental care) compared with those that were not
care in the past year as a function of the level of maternal transferred.89
education for those children ages 9 to 11 years. In other
Dental treatment needs
words, the more educated the mother, the more likely a child
of that age to have seen a dental provider in the past year. A total of 6,286 responses were available for the analyses of
dental treatment needs. The most frequently reported type of
Contrary to expectations, dental care for these age cohorts
dental treatment children required was maintenance, i.e.,
did not vary by household income (Table 1). Generally,
teeth cleaning and check-ups (42.7%). This was followed by
people in lower income households are less likely than those
dental fillings or crowns (26.9%). Tooth extraction(s) was
in high income households to use dental services, especially
reported by 7.0% of respondents, fluoride treatment by
for preventive reasons.88 However, due to the fact that 90-
12.4% and orthodontic treatment by 5.2%. This is in
100% of dental services for children are reimbursed to
accordance with the expected low level of tooth loss and gum
dentists by Health Canada’s First Nations and Inuit Health
disease at this age. Urgent dental care (e.g. due to acute
Branch and that federal funding for child health care
dental pain) was reported 2.0% of the population.
programs remains a high priority, families in the lower
income brackets tended to use these services as often as those When it comes to the need for different types of dental
in higher incomes. treatment by age and sex groups, older children generally
have higher dental treatment needs than younger children,
There is little difference between preschool and school
while there was no difference between boys and girls (Table
children living in small, medium or large size communities
2). It should be noted that aside from orthodontic treatment,
with regard to dental care in the previous year (Table 1). This
which is normally initiated at 11 or 12 years of age, similar
numbers of three to five year olds require dental fillings or
∗
282
extractions. This finding reflects the high incidence rates of A non-significant trend was also found between a smoke-free
BBTD in First Nations preschool children. home and lower incidence of BBTD in children (Table 3).
Environmental tobacco smoke (ETS) has been associated
Figure 3 shows that the need for dental fillings by school
with a number of negative health outcomes for exposed
aged children is directly related to the degree of community
children. Most recently, ETS was found to be associated with
isolation. Remote or isolated communities have found it
an increased risk of caries among children.91, 92
difficult to attract and keep dentists who might be able to
provide restorative care. The costs of delivering services, In looking at community characteristics and their effects on
either by flying children to tertiary health care centres, or caries in children, there were significant differences in the
sending teams of dentists and dental hygienists or therapists proportion of children affected by BBTD between isolated
out to these communities have proven expensive and a and non-isolated communities and between children in
burden on the health care system that does not always communities of multi-community health transfer agreements
succeed in meeting the demands of those in need.90 and community health agreements (Table 3).
Figure 3. Need for dental fillings in First Nations children by age Table 4 summarizes the results for the comparisons between
group and isolation status of community
children with BBTD and those without BBTD, separate for
70%
Remote isolated ** **
63.0%
children under two years of age and those aged three to five.
60%
*
57.0%
Isolated
Semi-solated
60.8%
Compared to children without BBTD, children with BBTD
Non-isolated
51.9% spent, on average, less time in childcare (true for children
50% 46.3% under two years only). Crowding remains a recognized
44.1%
problem in First Nations communities. One measure of
39.1%
40%
crowding is based on dividing the number of people in the
32.3%
household by the number of rooms.93 When the ratio exceeds
30%
24.0%
27.0%
25.2% one person per room, the home is considered crowded.
20% 18.6% Crowding in the home can also lead to cross-infection and
family tensions that prompt parents to resort to coping
10% mechanisms, such as the use of the bottle as a pacifier (with
sugary liquids), that in turn result in a higher incidence of
0% BBTD.94
3-5 6-8 9-11
Age group (years)
Dental injuries
Chi-squared test; *p=0.019, **p<0.001
Traumatic dental injuries, although not as common as dental
caries in this child population, showed an overall prevalence
Baby bottle tooth decay of 2.5%.
This section presents results from the questions on BBTD, Among the many causes of dental injuries, violence, traffic
also referred to as early childhood caries (ECC). Of the 2,837 accidents and sporting activities have contributed to the
children five years and under in the study, 11.9% of children excess incidence of dental trauma in boys.95 As evidenced in
less than three years had BBTD. Just over one-fourth Table 5, falling or tripping were found to be associated with
(29.4%) of the 3 to 5 year-old children for whom data were dental injury. Figure 4 reveals that, on average, children with
collected had been affected by BBTD (Table 3). a higher Body Mass Index (BMI) score were less likely to
Despite its prevalence, BBTD can be prevented through good have had dental injury that required the attention of a health
oral hygiene practices and a well-balanced, nutritious diet. care professional in the past 12 months; however, this was
Not surprisingly, a strong association was found between only the case for children less than three years old.
consumption frequencies of various foods with low Family violence against children and youth has been found to
nutritional value and a high sugar content and BBTD be associated with dental trauma, as 37.5% to 66.2% of all
experience among three-five year olds. Table 3 presents the cases of child abuse involved trauma to the head, face,
results for frequency of consumption of soft drinks, but data mouth, or neck.96, 97
analyses also revealed that children who more frequently ate
fast food, French fries, potato chips, pretzels, etc., were also In young children, the majority of unintentional injuries to
more likely to have been affected by BBTD. (Table 3). the primary dentition occur at home. A significant finding
was that the number of hours per week the child spends in
With respect to caregivers’ characteristics as risk factors for childcare was related to dental injuries, but this is only
BBTD, there is some variation with low parental level of apparent for children under three (Fig. 5). When childcare
education and household income with the disease or its was needed while the parents were at work or studying, the
treatment. most frequently reported childcare arrangement was care in
someone else’s home by a relative, followed by a day care
283
centre, and care in child’s home by a relative (other than one-third (26.9%) of the children reported needing dental
brother or sister). fillings and nearly 43% reported the need for dental check-
ups or teeth cleaning. This cohort required dental fillings as
early as age one and the proportion of preschool children
Figure 4. Mean body mass index scores by age group and (age three-five years) requiring fillings was found to be the
reported dental injury (past 12 months) same as that of school aged children. Twenty-nine percent of
25
* three-five year-olds were affected by BBTD but
22.1
21.8 * *
20.6
21.4 approximately 33% of those affected remained untreated.
20.0
20 19.6
18.5
18.1 A greater emphasis on effective early preventive care and
oral health promotion for First Nations children is
15 recommended. Rather than simply treating illnesses,
community-based initiatives, which address some of the
10
determinants of poor oral health for First Nations peoples
may help to combat problems before they arise. Initiatives to
teach prenatal women, new mothers, grandparents or other
Dental Injury
5
No Dental Injury relatives who take care of the children to provide good oral
hygiene care for newborns have resulted in reductions in
0
caries experience among these children.98 Programs directed
<3 3-5 6-8 9-11 at school children have produced similar positive results.
Age group (years)
Along these same lines, initiatives to raise the awareness of
*T-tests, significance level set at p≤0.01
the risks of oral-facial injuries among young children and the
creation of safe environments at childcare and sports
Figure 5. Mean number of hours per week spent in childcare by facilities may also help to reduce the number of children who
age group and reported dental injury (past 12 months) yearly suffer from dental trauma. Consistent with findings
40% based on data from cycle 1 of the Canadian National
*
34.1%
Longitudinal Survey of Children and Youth (NLSCY)
collected in 1995 for children aged 0–11 years, boys
30%
Dental Injury
No Dental Injury
***
27.9%
experience more physical injuries than girls. Falls are among
26.8%
the most common sources of maternally reported injuries
followed by environmental hazards for young children and
sports injuries for school aged children.99
20.8%
20% 18.6%
**
14.1% Meeting the restorative treatment needs of First Nations
10.2%
11.0% children is another challenge that must be addressed. To
10%
overcome this challenge, the current supply and distribution
of health care providers will have to be altered. In the last
decade, the supply of dentists to remote regions of the
0% country has decreased or remained the same, putting added
<3 3-5 6-8 9-11
Age group (years) pressures on those seeking the services of licensed dentists.
While communities in remote areas cry out for help, the
Chi-squared tests, *p=0.062, **p<0.05, ***p<0.01
dental hygienists and therapists remain limited in the kinds of
treatment they can render independent of a dentist.
Conclusions and Recommendations Approximately 2,000 dental therapists practice in Canada;
most work in Native communities, but a national shortage of
Despite the limitations of self-reported data (proxy
interviews with a parent/guardian), this is the second national dental therapists in Canada is slowing efforts to fight the
health survey conducted entirely by and for First Nations problem of tooth decay in remote areas. Legislation in
peoples living on-reserve, and the first national health survey Alaska is set to allow dental therapists to treat people with
to include dental care and health data for children younger remote dentist supervision. These “Dental Health Aide
than six years of age. Of the 6,657 children 0 to 11 years of Therapists” will be required to have two years of full-time
age representing 52 First Nations sub-regions of the country, training at a dental school and will perform oral exams,
over two-thirds (69%) received dental care in the past year. cleanings/scaling, fluoride treatments, sealants, x-rays,
Dental care in the past 12 months was associated with child’s fillings, stainless steel crowns and extractions.100 A similar
program in Canada would benefit First Nations communities
age and maternal parent’s education. Unfortunately, the high
by increasing both the number of frontline health care
utilization rate of dental care services by this cohort of First
workers and the number of children able to access preventive
Nations children did not reflect fewer treatment needs. About
and restorative care.
284
13. James L. Leake, ed., Oral Health Survey of Canada’s Aboriginal Children Aged 6 and 12,
Nonetheless, disparities in oral health status cannot be 1990-91, unpublished (Department of Community Dentistry, University of Toronto and
reduced exclusively by providing universal access to National School of Dental Therapy, 1992).
14. R. L. Harrison and D. W. Davis, April 1993, Caries experience of Native children of British
restorative care.101, 102 There is convincing evidence in the Columbia, Canada, 1980-1988, Community Dentistry & Oral Epidemiology, 21, 2: 102-107.
15. M. P. Zammit et al., Summer 1994, The prevalence and patterns of dental caries in Labrador
literature that unhealthy behaviours that begin very early in Inuit Youth, Journal of Public Health Dentistry, 54, 3: 132-138.
life can contribute to the development of high levels of dental 16. S. Peressini et al., "Prevalence of dental caries among 7- and 13-year-old First Nations
children, District of Manitoulin, Ontario," Journal of the Canadian Dental Association
caries in childhood.103 The earliest opportunity to prevent [online]. June 2004, vol. 70, no. 6, p. 382. Available from World Wide Web:
<http://www.cda-adc.ca/jcda/vol-70/issue-6/382.pdf>.
dental decay occurs during prenatal counselling about diet, 17. C. W. B. McPhail et al., 1972.
oral hygiene practices, appropriate uses of fluorides, and 18. K. C. Titley and D. H. Bedard, November 1986.
19. D. Klooz, 1988.
educating parents about the hazards of transmission of 20. R. L. Harrison and D. W. Davis, April 1993.
21. M. P. Zammit et al., Summer 1999.
bacteria from parent to child. Unfortunately, many 22. M. E. J. Curzon and J. A. Curzon, September 1970, Dental caries in Eskimo children of the
parents/caregivers underestimate the importance of baby Keewatin district in the Northwest Territories, Journal of the Canadian Dental Association,
36, 9: 342-345.
teeth and few see the need to take their children to the dentist 23. J. A. Hargreaves and K. C. Titley, October 1973, The dental health of Indian children in the
Sioux Lookout Zone of Northwestern Ontario, Journal of the Canadian Dental Association,
in the first years of life. A much larger proportion of children 39, 10: 709-714.
do, however, go to the doctor for medical care or “well- 24. G. S. Myers and M. Lee, March-April 1974, Comparison of oral health in four Canadian
Indian communities, Journal of Dental Research, 53, 2: 385-392.
baby” check ups. First Nations communities provide 25. J. T. Mayhall, November-December 1975, Canadian Inuit caries experience, 1969-1973,
Journal of Dental Research, 54, 6: 1245.
pediatric care and immunization clinics on a regular basis 26. M. E. J. Curzon and J. A. Curzon, March 1979, Dental caries prevalence in the Baffin Island
and these health care providers could help to identify Eskimo, Pediatric Dentistry, 1, 3: 169-173.
27. L. Shaw, D. C. Clark and N. P. Edger, March 1987, The oral health status of Cree children
children with BBTD. Dental-medical partnerships in which living in Chisasibi, Quebec, Journal of the Canadian Dental Association, 53, 3: 201-205.
28. J. G. Messer, 1988, An overview of dental care delivery and dental health in Northern
oral health screening and disease prevention are carried out Newfoundland and Labrador, Canadian Journal of Community Dentistry, 3, 1: 45-53.
by physicians, who then refer cases to dentists for treatment, 29. R. J. Albert et al., October 1988, Nursing caries in the Inuit children of the Keewatin, Journal
of the Canadian Dental Association, 54, 10: 751-758.
could address some of the dental problems of First Nations 30. O. Odlum and C. Lachance, 1991, A study to establish parameters for the use of pit and
children before they become too severe.104,105 For any fissure sealants in a group of Indian children with high caries rates, Arctic Medical Research,
Supplement: 675-676.
combination of these recommendations to be successful in 31. G. Houde, P. F. Gagnon and M. St-Germain, 1991, A descriptive study of early caries and
oral health habits of Inuit pre-schoolers: Preliminary results, Arctic Medical Research,
establishing good oral health and overall well-being of First Supplement: 683-684.
32. B. J. Trodden, 1991, Swampy Cree Tribal Council dental survey, Probe, 25, 2: 68-72.
Nations children, First Nations communities must be full 33. A. R. Milnes, Spring 1996, Description and epidemiology of nursing caries, Journal of Public
partners in setting dental heath care priorities and designing Health Dentistry, 56, 1: 38-50.
34. T. F. Drury et al., Summer 1999, Diagnosing and reporting early childhood caries for
and implementing community-based intervention programs research purposes: a report of a workshop sponsored by the National Institute of Dental and
Craniofacial Research, the Health Resources and Services Administration, and the Health
that are tailored to their needs, responsive to their concerns Care Financing Administration, Journal of Public Health Dentistry, 59, 3: 192-197.
and grounded in their cultural and community values. 35. P. L. Abbey, “A case-control study to determine the risk factors, markers and determinants
for the development of nursing caries in the four-year-old population of North York, ”
Master’s thesis (unpublished): University of Toronto, 1998.
36. S. Peressini et al., March 2004, Prevalence of early childhood caries among First Nations
children, District of Manitoulin, Ontario, International Journal of Paediatric Dentistry, 14, 2:
101-110.
Notes to Chapter 32 37. H. P. Lawrence et al., July-August 2004, Effects of a community-based prenatal nutrition
program on the oral health of Aboriginal preschool children in Northern Ontario, Probe, 38,
1. Canadian Population Health Initiative, Canadian Institute for Health Information, “Aboriginal 4: 172-182, 184-6, 188, 190.
Peoples’ Health,” Improving the Health of Canadians (Ottawa, Ont.: Canadian Institute for 38. Ibid.
Health Information, 2004), pp. 73-104. 39. R. J. Schroth et al., “Prevalence of caries among preschool-aged children in a northern
2. Roy J. Romanow, “A New Approach to Aboriginal Health,” Building on values: the future of Manitoba community,” Journal of the Canadian Dental Association [online]. January 2005,
health care in Canada—final report (Saskatoon, Sask.: Commission on the Future of Health vol. 71, no. 1, p. 21. Available from World Wide Web: <http://www.cda-adc.ca/jcda/vol-
Care in Canada, 2002), pp. 211–231. Also available from World Wide Web: <http://www.hc- 71/issue-1/27.pdf>.
sc.gc.ca/english/care/romanow/hcc0086.html>. 40. S. Peressini et al., March 2004.
3. Health Canada, A second diagnostic on the health of First Nations and Inuit people in 41. P. Weinstein et al., November-December 1996, Epidemiologic study of 19-month-old
Canada [online]. [Ottawa, Ont].: Health Canada, November 1999. Available from World Edmonton, Alberta children: caries rates and risk factors, Journal of Dentistry for Children,
Wide Web: <http://www.hc-sc.gc.ca/fnihb/cp/publications/second_diagnostic_fni.htm>. 63, 6: 426-433.
4. James B. Waldram, D. Ann Herring and T. Kue Young, “New epidemics in the twentieth 42. J. M. Douglass et al., 2001, Dental caries patterns and oral health behaviors in Arizona
century,” Aboriginal Health in Canada: Historical, Cultural, and Epidemiological infants and toddlers, Community Dentistry & Oral Epidemiology, 29, 1: 14–22.
Perspectives (Toronto, Ont.: University of Toronto Press Inc., 1995), pp. 65-96. 43. G. Veilleux, M. Généreux and J. Durocher, “Parental behaviours related to children’s dental
5. Fred Wien and Lynn McIntrye, “Health and Dental services for Aboriginal People,” First health,” Québec Longitudinal Study of Child Development (QLSCD 1998-2002)—From Birth
Nations and Inuit Regional Health Survey [online]. [Ottawa, Ont.]: First Nations and Inuit to 29 Months (Québec, Qué: Institut de la statistique du Québec, 2002), vol. 2, no. 6.
Regional Health Survey National Steering Committee, 1999, pp. 219-245. Available from 44. C. H. Shiboski et al., Winter 2003, The association of early childhood caries and
World Wide Web: <http://www.naho.ca/firstnations/english/pdf/key_docs_1.pdf>. race/ethnicity among California preschool children, Journal of Public Health Dentistry, 63, 1:
6. H.P. Lawrence and J. L. Leake, “The U.S. Surgeon General’s Report on Oral Health in 38–46.
America: A Canadian Perspective,” Journal of the Canadian Dental Association [online]. 45. U.S. Department of Health and Human Services, Oral health in America: A report of the
November 2001, vol. 67, no. 10, p. 587. Available from World Wide Web: <http://www.cda- surgeon general [online]. [Rockville, Md.]: U.S. Department of Health and Human Services,
adc.ca/jcda/vol-67/issue-10/587.html>. National Institutes of Health, National Institute of Dental and Craniofacial Research, 2000.
7. Statistics Canada, National Longitudinal Survey of Children and Youth—Cycle 5 [online]. NIH publication 00-4713. Available from World Wide Web:
[Ottawa, Ont.]: Statistics Canada, 21 February 2005. Available from World Wide Web: <http://www.nidcr.nih.gov/AboutNIDCR/SurgeonGeneral/>.
<http://www.statcan.ca/cgi- 46. C. W. Lewis et al., 2002, Oral health of young Alaska Native children and their caregivers in
bin/imdb/p2SV.pl?Function=getSurvey&SDDS=4450&lang=en&db=IMDB&dbg=f&adm=8 Southwestern Alaska, Alaska Medicine, 44, 4: 83-87.
&dis=2#1>. 47. R. Valaitis et al., November-December 2000, A systematic review of the relationship
8. Statistics Canada, Aboriginal Peoples of Canada: A Demographic Profile, 2001 Census between breastfeeding and early childhood caries, Canadian Journal of Public Health / Revue
[online]. [Ottawa, Ont.]: Statistics Canada, 21 January 2003. Available from World Wide Canadienne de Santé Publique, 91, 6: 411-417.
Web: <http://www.statcan.ca/english/IPS/Data/96F0030XIE2001007.htm>. 48. S. Peressini, January 2003, Pacifier use and early childhood caries: an evidence-based study
9. Ibid. of the literature, Journal of the Canadian Dental Association, 69, 1: 16-19.
10. C. W. B. McPhail et al., 1972, The geographic pathology of dental disease in Canadian 49. H. P. Lawrence et al., July-August 2004
central arctic populations, Journal of the Canadian Dental Association, 38, 8: 288-296. 50. J. Tsubouchi et al., July-August 1995, A study of dental caries and risk factors among Native
11. K. C. Titley and D. H. Bedard, November 1986, An evaluation of a dental care program for American infants, Journal of Dentistry for Children, 62, 4: 283-287.
Indian children in the community of Sandy Lake, Sioux Lookout Zone, 1973-1983, Journal of 51. P. Weinstein et al., March-April 1999, Dental experiences and parenting practices of Native
the Canadian Dental Association, 52, 11: 923-928. American mothers and caretakers: what we can learn for the prevention of baby bottle tooth
12. D. Klooz, 1988, Dental health status of native children on selected Saskatchewan reserves, decay, Journal of Dentistry for Children, 66, 2: 120-126.
Canadian Journal of Community Dentistry, 3, 1: 32-39. 52. H. P. Lawrence et al., July-August 2004
53. Ibid.
285
54. J. Y. Lee, W. F. Vann and M. W. Roberts, January-February 2000, A cost analysis of treating 96. M. A. da Fonseca, R. J. Feigal and R. W. ten Bensel, May-June 1992, Dental aspects of 1248
pediatric dental patients using general anesthesia versus conscious sedation, Pediatric cases of child maltreatment on file at a major county hospital, Pediatric Dentistry, 14, 3: 152-
Dentistry, 22, 1: 27-32. 157.
55. R. J. Berkowitz et al., May-June 1997, Clinical outcomes for nursing caries treated using 97. S. A. Jessee, July-August 1995, Physical manifestations of child abuse to the head, face and
general anesthesia, Journal of Dentistry for Children, 64, 3: 210-211, 228. mouth: a hospital survey, Journal of Dentistry for Children, 62, 4: 245-249.
56. A. G. Almeida et al., July-August 2000, Future caries susceptibility in children with early 98. R. Harrison and L. White, March 1997, A community-based approach to infant and child oral
childhood caries following treatment under general anesthesia, Pediatric Dentistry, 22, 4: health promotion in a British Columbia First Nations community, Canadian Journal of
302-306. Community Dentistry, 12, 1: 7-14.
57. R. Milnes et al., 1993, A retrospective analysis of the costs associated with the treatment of 99. Dafna E. Kohen, Hassan Soubhi and Parminder Raina, A Canadian Picture of Maternal
nursing caries in a remote Canadian aboriginal preschool population, Community Dentistry & Reports of Childhood Injuries [online]. [Vancouver, B. C.]: B.C. Injury Research and
Oral Epidemiology, 21, 5: 253-260. Prevention Unit, 1999. Available from World Wide Web:
58. D. B. Jones, C. M. Schlife and K. R. Phipps, 1992, An oral health survey of head start <http://www.injuryresearch.bc.ca/Publications/Reports/Maternal%20Report.pdf>.
children in Alaska: oral health status, treatment needs, and cost of treatment, Journal of 100. Dentists in the United States Public Health Service—Alaska Dental Health Aide [online].
Public Health Dentistry, 52, 2: 86-93. Program information available from World Wide Web: <http://www.phs-
59. H. W. Cook et al., 1994, The cost of nursing caries in a native American Head Start dental.org/depac/newfile50.html>.
population, Journal of Clinical Pediatric Dentistry, 18, 2: 139-142. 101. J. G. Messer, 1991, The effect of non-insured health benefits on dental treatment provided in
60. P. T. McDermott, J. T. Mayhall and J. L. Leake, 1991, Dental therapists and the delivery of four coastal Labrador communities by salaried dentists, Arctic Medical Research,
dental care in Canada’s Northwest Territories, Arctic Medical Research, Supplement: 668- Supplement: 662-663.
671. 102. H. I. Ismail and W. Sohn, March 2001, The impact of universal access to dental care on
61. Health Canada, Non-insured Health Benefits Directorate Program Analysis Division, Non- disparities in caries experience in children, Journal of the American Dental Association, 132,
insured health benefits program annual report 2003-2004 [online]. Available at: 3: 295-303.
<http://www.hc-sc.gc.ca/fnihb/nihb/annualreport/annualreport2003_2004.pdf>. 103. M. A. Peres et al., February 2005, Social and biological early life influences on severity of
62. Ibid. dental caries in children aged 6 years, Community Dentistry & Oral Epidemiology, 33, 1: 53-
63. R. Christensen, April 1990, Health problems among Alaskan Eskimo infants and young 63.
children, Arctic Medical Research, 49, 2: 63-67. 104. R. G. Rozier et al., August 2003, Prevention of early childhood caries in North Carolina
64. M. Uhari, T. Tapiainen and T. Kontiokari, 2000, Xylitol in preventing acute otitis media, medical practices: implications for research and practice, Journal of Dental Education, 67, 8:
Vaccine, 19, 1: S144-147. 876-885.
65. B. A. Burt and S. Pai, 2001, Does low birthweight increase the risk of caries? A systematic 105. G.G. dela Cruz, R. G. Rozier and G. Slade, November 2004, Dental screening and referral of
review, Journal of Dental Education, 65, 10: 1024-1027. young children by pediatric primary care providers, Pediatrics, 114, 5: e642-52.
66. J. D. Shulman, S. E. Taylor and M. E. Nunn, 2001, The association between asthma and
dental caries in children and adolescents: a population-based case-control study, Caries
Research, 35, 4: 240-246.
67. D. K. Reddy, A. M. Hegde and A. K. Munshi, 2003, Dental caries status of children with
bronchial asthma, Journal of Clinical Pediatric Dentistry, 27, 3: 293-295.
68. J. D. Shenkin et al., January-February 2003, Soft drink consumption and caries risk in
children and adolescents, General Dentistry, 51, 1: 30-36.
69. H. L. MacMillan et al., May-June 2003, The health of Ontario First Nations people: results
from the Ontario First Nations Regional Health Survey, Canadian Journal of Public Health /
Revue Canadienne de Santé Publique, 94, 3: 168-172.
70. Canadian Population Health Initiative, Canadian Institute for Health Information, “Obesity,”
Improving the Health of Canadians (Ottawa, Ont.: Canadian Institute for Health Information,
2004), pp. 105-147.
71. G. Acs et al., September-October 1992, Effect of nursing caries on body weight in a pediatric
population, Pediatric Dentistry, 14, 5: 302-305.
72. H. Ayhan, E. Suskan and S. Yildirim, 1996, The effect of nursing or rampant caries on
height, body weight and head circumference, Journal of Clinical Pediatric Dentistry, 20, 3:
209-212.
73. C. W. Thomas and R. E. Primosch, March-April 2002, Changes in incremental weight and
well-being of children with rampant caries following complete dental rehabilitation, Pediatric
Dentistry, 24, 2: 109-113.
74. W. Low, S. Tan and S. Schwartz, September-October 1999, The effect of severe caries on the
quality of life in young children, Pediatric Dentistry, 21, 6: 325-326.
75. G. Acs et al., September-October 2001, Perceived outcomes and parental satisfaction
following dental rehabilitation under general anesthesia, Pediatric Dentistry, 23, 5: 419-423.
76. H. White, J. Y. Lee and W. F. Vann, Jr., 2003, Parental evaluation of quality of life measures
following pediatric dental treatment using general anesthesia, Anesthesia Progress, 50, 3:
105-110.
77. S. L. Filstrup et al., September-October 2003, Early childhood caries and quality of life: child
and parent perspectives, Pediatric Dentistry, 25, 5: 431-440.
78. G. Acs et al., September-October 2001,
79. Health Canada, Laboratory Centre for Disease Control, Canadian Hospitals Injury Reporting
and Prevention Program (CHIRPP) Database, 1998.
80. Ibid.
81. J. O. Andreasen et al., Traumatic Dental Injuries: A Manual, 2nd ed. (Copenhagen, Denmark:
Blackwell Munksgaard, 2003).
82. M. T. Flores, December 2002, Traumatic injuries in the primary dentition, Dental
Traumatology, 18, 6: 287-298.
83. J. O. Andreasen et al.,2003.
85. Ibid.
86. Ibid.
87. First Nations Centre, National Aboriginal Health Organization, Preliminary Findings of the
First Nations Regional Longitudinal Health Survey (RHS) 2002-03. Adult Survey (Ottawa,
Ont.: First Nations Centre, National Aboriginal Health Organization, First Nations
Information Governance Committee, September 9, 2004).
88. W. J. Millar and D. Locker, 1999, Dental insurance and use of dental services, Health
Reports 11, 1: 55-67 (English), 59-72 (French).
89. Fred Wien and Lynn McIntrye, 1999.
90. R. Milnes et al., 1993.
91. L. K. Wendt and R. Jonsell, 1996, Illness and use of medicines in relation to caries
development and to immigrant status in infants and toddlers living in Sweden, Swedish
Dental Journal, 20, 4: 151-159.
92. C. A. Aligne et al., March 12, 2003, Association of pediatric dental caries with passive
smoking, Journal of the American Medical Association, 289, 10: 1258-1264.
93. First Nations Centre, National Aboriginal Health Organization, Preliminary Findings of the
First Nations Regional Longitudinal Health Survey (RHS) 2002-03. Adult Survey (Ottawa,
Ont.: First Nations Centre, National Aboriginal Health Organization, First Nations
Information Governance Committee, September 9, 2004).
94. H. P. Lawrence et al., July-August 2004.
95. J. O. Andreasen et al. 2003.
286
Table 1: Proportion of First Nations Children Who Had Dental Care in the Past Year by Age Group, Selected Household and
Community Characteristics, and Respondent’s Rated Importance of Traditional Cultural Events in the Child’s Life.
Dental Care in the Past Year by Age Group

CHARACTERISTICS 0 to 2 yrs 3 to 5 yrs 6 to 8 yrs 9 to 11 yrs
Total Weighted Total Weighted Total Weighted Total Weighted
n % n % n % n %
Total 1,188 24.9 1,571 66.1 1,703 85.6 1,806 86.6
Household characteristics
Mother’s education
Did not graduate from high school 605 26.5 763 62.0 761 87.8 831 82.9
High school diploma 278 21.4 (NS) 358 64.4 (NS 410 78.3 (NS 380 79.5 (NS
Some postsecondary 235 24.6 (NS 349 74.6 (NS 453 89.0 (NS 484 93.3
Bachelor’s degree 68 28.3 (NS 96 80.8 (NS 75 91.0 (NS 107 94.7
Graduate degree 2 - 5 - 4 - 4 -
Father’s education
High school diploma 205 20.8 (NS 278 55.9 (NS 275 77.7 (NS 298 88.3 (NS)
Some postsecondary 199 33.7 (NS 307 63.9 (NS 340 96.2 (NS 343 88.9 (NS)
Bachelor’s degree 26 - 43 86.7 (NS 43 92.3 (NS 49 95.4 (NS)
Household income
Under $10,000*** 181 21.5 219 72.0 187 79.0 210 82.6
$10,000 to $14,999 104 - 160 63.4 (NS) 195 88.0 (NS) 212 90.3 (NS)
$15,000 to $19,999 93 - 118 64.9 (NS) 139 92.5 (NS) 145 90.8 (NS)
$20,000 to $29,999 160 29.5 (NS) 215 71.9 (NS) 272 79.5 (NS) 275 87.1 (NS)
$30,000 to $49,999 152 23.8 (NS) 240 66.8 (NS) 270 78.4 (NS) 315 87.5 (NS)
$50,000 to $79,999 89 - 136 65.3 (NS) 158 89.6 (NS) 181 92.7 (NS)
$80,000 and over 22 - 28 - 42 96.5 (NS) 37 86.0 (NS)
Remoteness factor****
Non-isolated 893 26.3 1,157 68.5 1,262 88.9 1,400 87.9
Remote 44 27.0 (NS) 62 58.3 (NS) 79 73.7 (NS) 87 84.4 (NS)
Isolated 121 16.5 (NS) 150 60.2 (NS) 160 78.9 (NS) 155 80.7 (NS)
Semi-isolated 80 25.6 (NS) 140 55.1 (NS) 138 77.9 (NS) 144 79.0 (NS)

287
Dental Care in the Past Year by Age Group
0 to 2 yrs 3 to 5 yrs 6 to 8 yrs 9 to 11 yrs
CHARACTERISTICS
Total Weighted Total Weighted Total Weighted Total Weighted
n % n % n % n %
Community characteristics (cont’d)
Health Transfer Status*****
Not transferred 662 22.7 915 64.5 984 89.0 1,058 86.9
Community transferred 359 31.7 (NS) 428 71.1 (NS) 474 81.2 (NS) 510 87.3 (NS)
Part of multi-community transfer 195 19.2 (NS) 278 60.6 (NS) 289 82.0 (NS) 329 83.9 (NS)
Community size******
Small (<300) 122 - 183 72.1 209 79.7 242 83.2
Medium (300-1,499) 670 30.0 (NS) 948 65.6 (NS) 1,000 88.9 (NS) 1,159 86.5 (NS)
Large (1,500+) 428 18.8 (NS) 493 64.2 (NS) 540 82.2 (NS) 499 87.8 (NS)
Traditional Culture
Rated importance of traditional culture in the child’s
life
Very important 506 32.0 725 62.9 799 90.6 951 88.4
Somewhat important 420 25.3 (NS) 576 68.3 (NS) 652 86.3 (NS) 661 86.7 (NS)
Not very important 124 23.7 (NS) 162 65.6 (NS) 144 63.2 (NS) 164 88.7 (NS)
Not important 72 - 95 67.1 (NS) 94 85.6 (NS) 65 77.9 (NS)
***Includes no income and income loss. Total household income from all sources, for all household members, including the respondent, before deductions, for the year ending December 31, 2001.
****The remoteness factor (isolation status) of the respondent’s community of residence according to 2002 data provided by First Nations and Inuit Health Branch (FNIHB, Health Canada). Remote isolated = no scheduled flights; isolated = flights, good telephone, no
*****Health Transfer Status of the community in which the respondent resides. Data are based on August 2002 data from FNIHB, Health Canada. Primary, secondary and tertiary level services were combined. Not transferred = respondent’s community of residence is
not part of a health transfer agreement; community transfer = respondent’s community of residence has responsibility, through “Health Transfer” for primary and/or secondary and/or tertiary services; multi-community = respondent’s community of residence is part of a
multi-community health services transfer agreement for primary and/or secondary and/or tertiary services.
******The size of the on-reserve population in the respondent’s community of residence based on adjusted 2002 Indian Register counts for the population living on-reserve or on crown land associated with the band. Counts were adjusted for under-reporting and late
288
Table 2: Reported Types of Dental Treatment Needs of First Nations Children by Age Group and Sex.
Age Group
TYPE OF DENTAL TREATMENT 0 to 11 months 1 to 2 years 3 to 5 years 6 to 8 years 9 to 11 years
Total Weighted Total Weighted Total Weighted Total Weighted Total Weighted
n % n % n % n % n %
Cavities filled or other restorative work
(e.g. crowns, bridge)
27.9 31.9 29.6
Boys 116 - 438 11.0 791 870 922
29.0 39.4 29.5
Girls 134 - 432 8.1 (NS) 779 850 954
(NS) (NS) (NS)
Both sexes 250 - 870 9.5 1,570 1,720 1,876
28.4 35.4 29.6
Maintenance (e.g. check-ups or teeth
cleaning)
32.2 47.1 42.6 51.2
Boys 116 - 438 791 870 922
28.7 44.3 40.7 53.0
Girls 134 - 432 779 850 954
(NS) (NS) (NS) (NS)
Both sexes 250 - 870 1,570 1,720 1,876
30.4 45.9 41.7 52.1
Extractions (‘taking teeth out’)
Boys 116 - 438 2.2 791 7.6 870 9.6 922 3.9
Girls 134 - 432 5.4 (NS) 779 8.4 (NS) 850 9.7 (NS) 954 7.2 (NS)
Both sexes 250 - 870 3.9 1,570 8.0 1,720 9.6 1,876 5.6
Fluoride treatment
17.2 15.3
Boys 116 - 438 - 791 12.4 870 922
16.3 13.8
Girls 134 - 432 - 779 9.7 (NS) 850 954
(NS) (NS)
Both sexes 250 - 870 5.3 1,570 11.2 1,720 1,876
16.8 14.6
Orthodontic work (braces)
Boys 116 - 438 - 791 - 870 5.0 922 9.3
Girls 134 - 432 - 779 - 850 - 954 18.5
Both sexes 250 - 870 - 1,570 - 1,720 3.8 1,876 13.9
Urgent (dental problems requiring
immediate attention)
Boys 116 - 438 - 791 - 870 - 922 -
Girls 134 - 432 - 779 - 850 - 954 -
Both sexes 250 - 870 - 1,570 3.2 1,720 - 1,876 -
- Data suppressed due to insufficient sample size.
289
Table 3: Prevalence of, and Treatment for, Baby Bottle Tooth Decay (BBTD) in First Nations Infants, Toddlers and Preschool Age
Children, by Characteristics of the Child, the Caregiver, the Household, and the Community.
Weighted % Weighted Weighted % Weighted %

Affected by BBTD % Treated for BBTD Affected by BBTD Treated for BBTD
CHARACTERISTICS
Total Child Aged BBTD Child Aged Total Child Aged BBTD Child Aged
n 0 to 2 yrs n 0 to 2 yrs n 3 to 5 yrs n 3 to 5 yrs
Total 1,217 11.9 131 27.4 1,620 29.4 370 67.4
Child’s characteristics
Sex
Boys 599 12.5 64 - 807 28.4 182 62.3
Girls 618 11.4 (NS) 67 - 813 30.4 (NS) 188 72.4 (NS)
Consumption of soft drinks or pop
Never or hardly ever 723 5.8 39 - 378 17.5 55 89.9
About once a week 204 - 27 - 438 28.9 (NS) 106 67.7 (NS)
A few times a week 212 27.2 48 - 616 30.9 151 67.6 (NS)
Once a day 37 - 6 - 101 44.8 30 -
Several times a day 41 - 11 - 87 - 28 -
Consumption of cakes, pies, cookies,
candy, or chocolate
Never or hardly ever 472 - 14 - 259 33.1 61 64.3
About once a week 286 15.6 43 - 487 27.4 (NS) 92 49.6 (NS)
A few times a week 372 17.3 62 - 696 26.4 (NS) 163 79.1 (NS)
Once a day 56 - 5 - 126 29.5 (NS) 32 -
Several times a day 31 - 7 - 52 - 22 -
Child was breast-fed
Yes 729 11.2 83 29.5 984 24.4 209 69.2
No 473 13.2 (NS) 48 24.5 (NS) 617 38.8 (NS) 159 64.8 (NS)
Child’s general health
Excellent 556 9.1 44 28.5 704 26.1 133 56.8
Very good 356 10.3 (NS) 42 37.0 (NS) 495 31.0 (NS) 127 75.5 (NS)
Good 241 - 27 - 346 34.5 (NS) 88 69.2 (NS)
Fair 55 - 15 - 62 - 16 -
Poor 2 - 0 - 9 - 4 -
290
Has asthma (as specified by a health care

professional)
Yes 121 - 22 - 215 33.0 55 50.3
No 1,035 11.4 (NS) 106 27.3 (NS) 1,344 28.3 (NS) 310 72.2 (NS)
Had an asthma attack in the past 12
months
Yes 37 - 6 - 61 - 14
No 73 - 15 - 130 40.5 37
Has chronic ear infections or ear
problems (as specified by a health care
professional)
Yes 102 - 15 - 139 45.2 47 50.8
No 1,062 11.9 (NS) 114 26.7 (NS) 1,421 27.3 (NS) 320 72.1 (NS)
Currently taking traditional medicines
Yes 75 - 13 - 82 - 27
No 1,125 10.9 (NS) 114 23.7 1,517 28.7 (NS) 336 66.1 (NS)
Caregiver’s characteristics
Relationship to child
Birth parent 1,164 11.9 127 27.7 1,515 29.4 349 65.9
Adoptive parent 9 - 1 - 21 - 4 -
Foster parent 9 - 1 - 17 - 2 -
Step parent 1 - 0 - 1 - 0 -
Sister or brother 2 - 0 - 6 - 2 -
Grandparent 26 - 1 - 50 - 12 -
Other 6 - 1 - 10 - 1 -
Sex
Male 157 - 10 - 211 38.3 44 46.6
Female 1,060 13.2 121 27.4 (NS) 1,409 27.7 (NS) 326 72.7 (NS)
Mother’s education (highest attained)
Did not graduate from high school 601 14.2 79 - 764 38.5 213 58.3
High school diploma 279 10.5 (NS) 30 - 356 21.7 72 83.5 (NS)
Postsecondary diploma – non-degree 232 - 16 - 343 21.4 (NS) 55 82.6 (NS)
Bachelor’s degree 66 - 4 - 97 18
Graduate degree 2 - 0 - 5 0
291
Father’s education (highest attained)

High school diploma 207 - 21 - 272 27.3 (NS) 63 54.6 (NS)
Postsecondary diploma – non-degree 195 - 11 - 304 18.8 52 80.7 (NS)
Bachelor’s degree 26 - 1 - 42 - 6 -
Household characteristics
Household income
Under $10,000**** 177 - 17 - 217 49.9 81 67.8
$10,000 to $14,999 104 - 16 - 158 23.1 49 75.0 (NS)
$15,000 to $19,999 90 - 11 - 116 20.5 29 -
$20,000 to $29,999 161 - 20 - 214 20.5 41 85.5 (NS)
$30,000 to $49,999 150 - 10 - 241 19.0 42 85.4 (NS)
$50,000 to $79,999 88 - 8 - 132 - 20 -
$80,000 and over 22 - 0 - 28 - 0 -
Smoke free home
Yes 839 10.2 85 - 1,031 28.2 224 62.9
No 370 15.0 (NS) 44 - 571 30.9 (NS) 137 72.9 (NS)
Remote 44 - 6 - 61 - 14 -
Isolated 121 - 16 - 144 52.0 57 48.5 (NS)
Semi-isolated 79 - 13 - 143 - 26 -
Non-isolated 890 7.7 73 - 1,154 22.0 227 78.6
Not transferred 654 9.8 67 - 906 29.2 193 62.9
Community transferred 364 - 27 - 426 27.2 (NS) 97 73.1 (NS)
Multi-community transfer 195 26.5 37 - 285 33.7 (NS) 80 75.4 (NS)
Community size*******
Small (<300) 126 - 19 - 182 21.8 29 -
Medium (300-1,499) 666 8.0 58 - 946 25.7 (NS) 206 70.8
Large (1,500+) 425 15.1 (NS) 54 - 492 35.8 (NS) 135 60.6
- Data supressed due to insufficient sample size.
****Includes no income and income loss. Total household income from all sources, for all household members, including the respondent, before deductions, for the year ending December 31, 2001.
*****The remoteness factor (isolation status) of the respondent’s community of residence according to 2002 data provided by First Nations and Inuit Health Branch (FNIHB, Health Canada). Remote isolated = no scheduled flights; isolated = flights, good telephone, no
******Health Transfer Status of the community in which the respondent resides. Data are based on August 2002 data from FNIHB, Health Canada. Primary, secondary and tertiary level services were combined. Not transferred = respondent’s community of residence
is not part of a health transfer agreement; community transfer = respondent’s community of residence has responsibility, through “Health Transfer” for primary and/or secondary and/or tertiary services; multi-community = respondent’s community of residence is part of
a multi-community health services transfer agreement for primary and/or secondary and/or tertiary services.
*******The size of the on-reserve population in the respondent’s community of residence based on adjusted 2002 Indian Register counts for the population living on-reserve or on crown land associated with the band. Counts were adjusted for under-reporting and late
292
Table 4: Selected Characteristics of the Child, the Caregiver, and the Household, by Baby Bottle Tooth
Decay (BBTD) Experience in First Nations Infants and Toddlers, and Preschoolers.
Child Aged Child Aged

0 to 2 yrs 3 to 5 yrs
CHARACTERISTICS
BBTD BBTD BBTD BBTD
Yes No Yes No
Total number 131 1,084 374 1,245
Child’s characteristics Mean (CI95) Mean (CI95) Mean (CI95) Mean (CI95)
Body Mass Index (BMI) score 22.2 (20.3, 24.0) 21.7 (20.9, 22.6) 19.8 (18.7, 20.8) 19.4 (18.7, 20.2)
Birth weight (kg) 3.7 (3.5, 3.8) 3.6 (3.5, 3.7) 3.6 (3.5, 3.7) 3.6 (3.6, 3.7)
Number of months child was

breast-fed 5.8 (4.3, 7.3) 6.3 (5.7, 6.9) 8.3 (6.5, 10.1) 9.1 (8.2, 10.0)
Number of hours per week
child spent in child care *21.6 (17.4, 25.9) 27.8 (26.0, 29.5) 18.9 (15.2, 22.6) 21.3 (19.7, 22.8)
Caregiver & household
characteristics
Age of caregiver (yrs) 27.1 (25.6, 28.6) 28.2 (27.5, 28.9) 30.0 (28.6, 31.4) 30.8 (30.3, 31.4)
Number of children living in

household: <18 3.2 (2.7, 3.7) 3.1 (2.9, 3.2) 3.3 (3.0, 3.7) 3.1 (3.0, 3.2)
Number of adults living in
household: 18+ 2.4 (2.1, 2.8) 2.5 (2.4, 2.6) 2.4 (2.3, 2.5) 2.2 (2.1, 2.3)
Number of rooms in the home 5.5 (5.0, 6.0) 5.9 (5.8, 6.0) 5.3 (4.9, 5.7) 5.8 (5.6, 5.9)
CI95 = 95% Confidence Interval

*Significant at p<0.05.
293
Table 5: Prevalence of Dental Injury in First Nations Children, by Age Group, Sex and Risk Factors.
Total No. Weighted %

Odds
Risk Factor for Dental Injury* of With Dental 95% CI P-value
Ratio
Children Injury (CI95)**
2.5
Total Number 6,657 --- --- ---
n=119
Age Group (yrs)

0 to 2 1,255 - 1.00 Reference ---
3 to 5 1,665 3.8 (NS) 2.02 1.23-3.34 0.003
6 to 8 1,781 - 0.67 ns 0.172
9 to 11 1,953 2.8 (NS) 1.49 ns 0.107
Sex
Boys 3,319 2.9 1.45 1.05-2.02

0.020
Girls 3,335 2.0 (NS) 1.00 Reference
Bicycle accident not related to
motor vehicle accident
Yes 188 - 7.81 4.89-12.38
<0.001***
No 6,466 2.1 1.00 Reference
Sport, not including bicycle or
hunting
Yes 160 - 5.40 3.11-9.27
<0.001***
Snowmobile accident
Yes 19 - 4.58 ns
0.082***
Fall or trip, not including
bicycle, sport or snowmobile
Yes 603 10.2 6.25 4.46-8.74
<0.001
Physical assault (including
domestic violence)
Yes 18 - 4.87 ns
0.074***
- Data supressed due to insufficient cell size.
*Multiple injuries accepted.
**CI95 = 95% Confidence Interval to highlight extreme variability, if applicable.
ns = not statistically significant.
***P-value from Fisher Exact test; otherwise, Chi-square test.
Data source: First Nations Regional Longitudinal Health Survey 2002-03; First Nations Information Governance Committee – Assembly of First Nations, First Nations Centre at the National Aboriginal Health
Organization.
294
Chapter 33
The Impact of Parent and Grandparent Residential
School Attendance
Abstract
This chapter presents findings on the well-being of First Nations children in relation to their parents
and grandparents residential school attendance. In this chapter, we report on the proportion of children
whose parents and/or grandparents are survivors of the residential school system. We compare survey
findings on children of survivors, against findings on children whose parents or grandparents did not
attend residential schools. One key finding is that children are more likely to have grandparents who
are survivors of residential schools than parents who are survivors. The majority of parents and
grandparents who attended residential school believe that it is very important that their children learn
a First Nations language; in fact, children of survivors are more likely to speak one or more First
Nations language(s). About half of the survivors state that traditional cultural events are very
important in the life of their child. We also find that the effects of the residential school legacy are not
as evident among children in comparison to youth and adults. The findings of this study indicate that
it is difficult to deduce how the residential school legacy influences the health and social determinants
of today’s First Nations children. This is not to say that such influences do not exist; it may, for
instance, be too early for the effects of residential schools to have presented themselves in the lives of
First Nations children.
295
RHS 2002/03 Child Survey – Chapter 33: The Impact of Parent and Grandparent Residential School Attendance
Table 1. Proportion of First Nations children who had parents

Introduction and grandparents that attended residential school
From the late 1800s until the 1980s1 the Federal Government Intergenerational Attendees Percent
of Canada provided education to Aboriginal children through Mother or guardian attended a residential school 9.3%
a system of residential schools.2 Residential schools were
phased out in Canada in the 1960s and 1970s. The residential Father or guardian attended a residential school 11.3%
school legacy3 has had lasting effects on not only the One or more parents attended a residential school 16.5%
students who attended the schools, but also on succeeding
generations. Maternal grandmother attended a residential school 38.8%
In the 2002/03 First Nations Longitudinal Regional Health Maternal grandfather attended a residential school 37.0%
Survey (RHS) adult results indicate that for those adults who
Paternal grandmother attended a residential school 34.6%
attended residential schools, the damage to the physical,
mental, emotional, and spiritual aspects of health has been Paternal grandfather attended a residential school 33.7%
profound. First Nations children and grandchildren (12 years
old and under) of residential school survivors are at risk of One or more grandparents attended a residential school 58.6%
being impacted by their parents’ and grandparents’ At least one parent(s) and one grandparent(s) attended a
residential school attendance. 11.9%
residential school
In this chapter, we discuss the proportion of children whose

What is especially troubling about the legacy of residential
parents and grandparents have attended residential schools.
schools is the way in which the effects of the schools have
These figures are compared to the results for children and
been passed down to the children and grandchildren of
grandchildren who did not have either a parent or
survivors. Nonetheless, the survey indicates that effects of
grandparent that attended the schools. The comparison is
the legacy are not as evident among children of survivors in
made in relation to the following themes: the importance of
comparison to youth and adults who were children of
learning a First Nations language; the loss of language; the
survivors. This is reflected in areas such as: the importance
importance of traditional cultural events; parents opinion
of learning a First Nations language; the loss of language; the
about the overall health of their child; and, the potential risk
importance of traditional cultural events and the potential
for being diagnosed with a mental or health illness.
risk for being diagnosed with a mental or health illness. In
examining the differences between children and youth who
Results
are children of residential school survivors, one might
Findings for this study indicate that 16.5%i of First Nations conclude that the effects of the legacy are declining. It may,
children have one or more parent who attended residential however, be that indicators suggest the effects of the legacy
schools and that 58.6% of First Nations children had one or on the well being of children present themselves later in life.
more grandparent who attended residential school. The A detailed longitudinal comparison of statistics on First
difference in the attendance rate of parents and grandparents Nations children of survivors in childhood and youth is
is reflective of the disappearance of residential schools required to conclude whether or not effects of the legacy are
beginning in the 1960s. In Chapter 13, it was reported that actually on the decline, or if they are simply showing up later
20.3% of the adults surveyed were students of residential in the child’s life. Most children 12 years old and younger
schools. Other studies have reported that well over 100,000 are not likely to be the children of survivors. Only 9.3% of
First Nations children attended residential schools during the today’s children have a mother or guardian who attended
residential school era. In practical terms, this means that as residential schools, and only 11.3% have a father or guardian
many as nine out of every ten First Nations people today who attended residential schools (see Table 1).
know someone who went to a residential school.4 While nine
About 75.8%ii of those parents (one or more) who attended
out of ten First Nations children know someone who went to
residential school believe that it is very important that their
residential school, this study demonstrated that at least six
child learn a First Nations or Inuit Language, compared to
out of ten children are related to someone who went to
62.2% of parents who never attended residential school.
residential school.
About 67.5% of grandparents (one or more) who attended
residential school also believed that it was very important
that their grandchild/child5 learn a First Nations or Inuit
language, compared to 59.5% of those grandparents who did
not attend residential schools (see Table 2).
ii
i
To simplify the text, confidence intervals are not reported for estimates unless the coefficient of significant— is noted. Differences, in this chapter, are considered significant when confidence
variation is greater than 33.3%. intervals do not overlap at the 95% confidence level (after Bonferroni adjustment).
296
Table 2. Proportion of First Nations survivors (parents and This is a positive sign, indicative of cultural revitalization
grandparents) and the importance of learning a First Nations or
among these individuals.
Inuit language for children
Parent Grandparent When the findings were presented, it is was difficult to
Level of (one or more) (one or more) deduce how the health and social determinants of First
Importance Nations children today are influenced by the effects of the
Non- Non-
Survivor
Survivor
Survivor
Survivor legacy of residential schools. No significant relationships
between children’s health and well-being and their parents’
Very important 75.8% 62.2% 67.5% 59.5% and/or grandparents’ attendance at residential school could
Somewhat
be found. It may be that the effects of residential schools
20.1% 30.1% 26.7% 31.5%
important (NS) (NS) have not yet presented themselves in First Nations children.
The majority of survivors (90.7%) and non-survivors
Not very (95.1%) reported that their child was in good to excellent
3.7%(NS) 5.0%(NS) 4.6%(NS) 5.3%(NS)
important
health. We can safely conclude at this time that First Nations
Not important _ 2.7% 1.2% 3.7% children’s health and overall well-being is not related to their
– Data suppressed due to insufficient sample size. parents’ or grandparents’ attendance at residential schools.
(NS) refers to non-significant relationship
There is little difference between children of survivors and Conclusion

children of parents who did not attend residential schools in There were no significant relationships found between
terms of understanding one or more First Nations/Inuit children’s physical, mental, emotional or spiritual health and
languages fluently or relatively well (see Table 3). the attendance of their parents and/or grandparents at
Interestingly, children of survivors (22.6%) are more likely residential schools. Most parents felt their children were in
than children whose parents did not attend residential school good health. From one perspective, the health and social
(16.4%) to speak one or more First Nations languages determinants and/or overall well-being of First Nations
fluently. children today are mostly the result of several factors other
Table 3. Proportion of children who are able to understand and than the attendance of their parents and/or grandparents
speak one or more First Nations or Inuit languages by their attendance at residential schools —especially since the
parents’ residential school attendance
majority of children under 12 years do not have parents who
Parent (one or more) attended residential schools. However, it is important to note
Non- that poor parenting skills, resulting from residential school
Survivor
Survivor
attendance may have passed from generation to generation
Understanding of a First Nations language
—although it can also be said that parenting skills are
No First Nations language 71.8%(NS) 76.7%(NS) improving because of the resilience and healing of First
One or more First Nations language 28.2%(NS) 23.3%(NS) Nations survivors and communities. The loss of parenting
skills places First Nations children today at a higher risk for
Ability to speak a First Nations language
some negative health and overall well-being outcomes. The
No First Nations language 77.4% 83.6% findings in this study confirm that any future research on
residential schools and First Nations children less than 12
One or more First Nations language 22.6% 16.4% years old should focus on the recovery from residential
(NS) refers to a non-significant relationship.
schooling for both First Nations children and their parents
Just over half of the parents (55.1%) who attended residential and grandparents. Furthermore, findings reported in this
school stated that traditional cultural events are very chapter suggest that it would be beneficial to conduct a more
important in their child’s life. These parents are more likely detailed longitudinal comparison of statistics on First Nations
to attribute a higher degree of importance to traditional children in both childhood and youth, in order to conclude
culture than those parents who did not attend residential whether or not effects of the legacy are actually on the
school (42.3%). Only 5.0% of parents who are survivors decline, or if they are simply showing up later in the child’s
stated that traditional cultural events are not important in life.
their child’s life and this is not significantly different from
parents who did not attend residential school. In short, the
data illustrate that children of survivors are more likely than
children of parents who never attended residential school to
speak one or more First Nations languages. In addition,
parents of survivors are more likely to attribute a high level
of importance to their children’s learning a First Nations
language, and to the importance of traditional/cultural events.
297
Notes to Chapter 33
1. • John S. Milloy, A National Crime: The Canadian government and the residential schools
system, 1879 to 1986 (Winnipeg, Man.: University of Manitoba Press, 1999).
• Jennifer J. Llewellyn, “Dealing with the Legacy of Native Residential School Abuse in
Canada: Litigation, ADR, and Restorative Justice,” University of Toronto Law Journal 52
(2002), pp. 253-300.
Note: Sources differ on the date the last schools closed; many place the date somewhere in the
mid-1980s. The differences seem to result from the fact that the federal government had no
control over residential schools after the mid-1980s, although some schools continued to
operate after this time under the control of First Nation groups. The last of these schools closed
in 1996 in Regina, Saskatchewan. Milloy (1999) cites 1986 as the last year in which the federal
government had exclusive control over a residential school (cited in Llewellyn, 2002).
2. • Llewellyn, “Dealing with the Legacy of Native Residential School Abuse in Canada:
Litigation, ADR, and Restorative Justice,” University of Toronto Law Journal.
• S. Fournier & E. Grey, Stolen From Our Embrace: The Abduction of First Nation Children
and the Restoration of Aboriginal communities (Toronto, Ont.: Douglas & McIntyre, 1997).
• Agnes Grant, No end of grief: Indian residential schools in Canada (Winnipeg, Man.:
Pemmican Publishers, 1996).
Ont.: University of Toronto Press, 1996).
• Milloy, A National Crime: The Canadian government and the residential schools system,
1879 to 1986.
Note: For a definition of residential schools, see Chapter 14. For a general overview of the
history of the residential school system, Llewellyn (2002) suggests seeing S. Fournier & E.
Grey (1997) at chapter 2; Agnes Grant (1996); J. R. Miller (1996); and John S. Milloy (1999).
3. Note: For a definition of the Residential School Legacy, see Chapter 13.
Litigation, ADR, and Restorative Justice,” University of Toronto Law Journal.
5. Note: Responses from grandparents (one or more) who attended residential school are either
answering on behalf of, or in response to, children under 12 years of age. This writer is not
able to determine if grandparents are answering for their own grandchildren, children they are
raising, or both.
298
Chapter 34
Emotional and Social Well-being
Abstract
The emotional and social well-being of First Nations children is impacted by a variety of factors such
as the residential school legacy, importance and participation in cultural and traditional activities,
school attendance, activity participation and limitations, diet and residential school attendance of
parents and grandparents. In addition, the emotional and social well-being of our children is impacted
by their parent(s) educational attainment. The higher the level of education attained by parent(s) the
more likely First Nations children will eat well, be less likely to have behavioural problems, be
involved in reading activities everyday and be in good general health. Being able to define what
constitutes “educational attainment” so that it functions in concert with aspects of community self-
determination needs to be carefully thought out, articulated and implemented. That is, education
should come to mean not just increasing education rates, but recognizing the value of traditional
cultural education as well. Trying to actualize these types of social phenomena is often complex and
can cause emotional and social stress. Children are the future of our communities; understanding their
emotional and social well-being will help us build strong communities for the future.
299
RHS 2002/03 Child Survey – Chapter 34: Emotional and Social Well-being
will present data related to the Heart, including emotional

Introduction
and behavioural problems and family connectedness. Section
The 2002/03 First Nations Regional Longitudinal Health three will present data related to the Mind, including parental
Survey (RHS) asked seven key questions concerning the education levels, children’s schooling and reading. Section
emotional and social well-being of children surveyed. This four will present data related to the Body, including nutrition,
was part of a comprehensive strategy through a culturally activity participation and limitation.
appropriate, holistic framework to gain insight of the
emotional and social well-being of First Nations children as East–Spirit
an important indicator of the overall health of our children.
This chapter provides analysis and interpretation of the data Residential schools
collected and compares them with similar data of the
emotional and social well-being of children in the general In its report Aboriginal People, Resilience and the
Canadian population. Residential School Legacy, the Aboriginal Healing
Foundation defines residential schools as “the Residential
Emotional and social well-being have come to be included as School system in Canada attended by Aboriginal students,
a key part of what constitutes health. The World Health including industrial schools, boarding school, homes for
Organization (WHO) defines health as “a state of complete students, hostels, billets, residential schools, residential
physical, mental and social well-being and not merely the schools with a majority of day students or a combination of
absence of disease or infirmity.”1 Components of our lives any of the above.”2 The report further describes that
that impact our emotional and social well-being can include: Aboriginal children were “enrolled on the pretext that they
engagement in community activities, such as sports, arts, and would receive a “Christian” education and be protected from
traditional activities; extra-curricular activities; and the their parents’ “backward” influence, many thousands of
resultant emotions and behaviours these activities involve. Aboriginal children were sent to residential schools during
Similarly, First Nations children’s emotional and social well- the time the schools existed.”3
being can be impacted by various factors such as the
participation in cultural and traditional activities, school Residential school attendance has been repeatedly cited to
have adversely influenced the health and well-being of
attendance, activity participation and limitation, diet, and
residential school attendance of parents and grandparents. Aboriginal peoples. In the context of the emotional and
social well-being of children, it is significant to keep in mind
RHS Cultural Framework the intergenerational impacts of the residential school
system. The intergenerational effects of colonialism are well
A cultural framework was employed to collect and analyze
documented. Intergenerational impact refers to the “effects
the emotional and social well-being of First Nations children.
of physical and sexual abuse that were passed on to the
Emotional and social well-being in this chapter is represented
children, grandchildren and great-grandchildren of
in a First Nations holistic fashion using the medicine wheel
Aboriginal people who attended the residential school
model. The working wheel framework is based on a four-
system.”4 The impacts that intergenerational survivors of
directional model comprised of Body, Spirit, Heart and
residential school experience are extensive and vary in
Mind. The emotional and social well-being of children is
severity. With respect to emotional and social well-being,
connected to all elements of the four directions.
some of the more prominent impacts include: psychological
Emotional and social well-being impacts and is manifested in and emotional problems and abuse, fear of personal growth,
the body. It can manifest itself by affecting physiological and transformation and healing, dysfunction in family and social
biological functions, which might impact behaviours, relationships, educational impacts (such as aversions to
dispositions, and psychological states. It also impacts and is formal learning programs that seem “too much like school”),
manifested through our spirit, which might affect our fear of failure, self-sabotage, and disunity/conflict between
relationship with the earth and the Creator and, in turn, affect individuals, families and factions within the community.5
our traditional culture, spirituality, assimilation and
Of the respondents to the RHS Children’s questionnaire,
residential schools. The heart also impacts emotional and
9.3% indicated that their mother had attended residential
social well-being in terms of connection to family, emotional
school and 11.3% said their father had attended residential
stability, harmony and balance. Finally, the mind plays a
school. Over one in ten (11.9%) had at least one parent and
pivotal role in children’s emotional and social well-being,
one grandparent who attended residential school. Moreover,
which includes school attendance, activity limitations,
58.6% of all children had at least one grandparent who
extracurricular activities, reading and behavioural conduct.
attended residential school.
This chapter is organized according to the medicine wheel
Children were able to get along well with their families no
model. Section one will present data related to the Spirit,
matter which, if any, of their parents or grandparents
including residential schools, health transfer status and
attended residential school. In addition, residential school
participation in cultural and traditional events. Section two
attendance (of the parent, grandparent, or both) was not
300
found to be significantly related to an increased prevalence of South–Heart

emotional or behavioural problems.
Family connectedness
Community characteristics: health transfer status, isolation,
Family connectedness is how children relate to and get along
and size
with their families. This is an important consideration in their
Several community characteristics were available for cross- emotional and social well-being. It has been widely
tabulation with the child’s emotional and mental well-being. recognized that social environments and support networks
These include, health transfer status, degree of isolation, and play a significant role with respect to the emotional and
community size. physical well-being of children. One of the essential elements
of this social environment is the family.8 The 2003 federal
With respect to health transfer status, First Nations
government report on the well-being of Canada’s young
communities continue to assert the link between community
children highlighted research demonstrating that family
efforts toward self-government and the community’s health.
dynamics is one of the most important elements affecting
Recent research conducted on cultural continuity and self-
healthy childhood development.9 Family dynamics includes
government has supported this link.6 When asked about the
factors such as family functioning. Family functioning refers
status of health transfer, 56.5% indicated that they had not
to how well family members communicate with each other,
transferred their health status, and 29.4% indicated that their
work together and treat each other.10 The RHS Children’s
community had taken responsibility for the delivery of on-
Survey measured these sorts of family dynamics by asking
reserve health services under health transfer policy.
respondents how well the child got along with his/her family
The data shows no significant relationships between the over the preceding six months.
health transfer status of the community and the prevalence of
Overall, the vast majority of First Nations children did get
parents reporting that their child had problems getting along
along with their families. 51.9% indicated very well with no
with the family. Similarly, health transfer status was not
difficulties; 41.7% said quite well with hardly any
related to the rate of emotional or behavioural problems, nor
difficulties; 5.9% said not too well with lots of difficulties;
did it influence the parent-reported general health of the
and 0.6% indicated that the child was not getting along at all
child.
well with constant difficulties. There were no significant
Community isolation or size also had no significant effects gender differences observed. However, older children were
on the prevalence of emotional or behavioural problems or more likely to have difficulties getting along with their
problems with getting along with their families. families (4.7% of those under six years of age compared to
7.9% of those six and older).
Importance of cultural events The 1997 First Nations and Inuit Regional Longitudinal
Current research also reinforces the link between cultural Health Survey (FNIRLHS) asked this same question with
continuity and the health of First Nations individuals and slightly better results. In 1997, approximately three-quarters
communities.7 Emotional and social well-being are linked to of First Nations and Inuit children surveyed got along well
cultural continuity, and the RHS included key questions on with their families. As in the 2002/03 survey, the 1997
culture in its Children’s Questionnaire. With respect to FNIRLHS indicated that the age of the child did impact on
emotional and social well-being, respondents were asked the respondent’s answers. The older the child, the more likely
about the importance of traditional cultural events in the they were to have difficulties getting along.
child’s life.
Emotional and behavioural problems
When asked about the importance of cultural events in the
child’s life, 83.2% indicated they were somewhat or very A comprehensive review of the emotional and social well-
important, and 16.8% said that they were not important. being of children includes an examination of emotional and
behavioural problems, which can include expressed emotions
In addition, the importance of cultural events in the child’s
such as anxiety, aggression, emotional disorders, or more
life is strongly associated with the frequency of a child
physically manifested behaviours such as hyperactivity,
participating in activities such as traditional singing,
conduct disorders and behavioural disorders. The RHS
drumming or dancing groups or lessons. Parents who believe
Children’s Questionnaire asked one question regarding
cultural events to be somewhat or very important are much
emotional and behavioural problems of children (in
more likely to have their children participate in traditional
comparison to children of his/her age).
activities such as singing, drumming, or dancing than those
who felt that it was not important–(31.0% versus 4.0% Overall, 15.4% of children reported an emotional or
participating least once a week respectively). behavioural problem. Boys were more likely (18.4%) than
girls (12.2%) to have an emotional or behavioural problem.
Moreover, younger males (under six years) were more likely
301
than their female counterparts to have an emotional or Table 1. Highest level of education attained by the child’s mother
and father
behavioural problem –(4.3% versus 5.9%). This difference is
not significant among boys and girls six years of age and Level of education attained Mother Father
older where the overall rate is nearly one in five (19.5%).
Did not graduate high school 46.0% 56.6%
Not surprisingly, children with emotional or behavioural
problems (22.2%) were more than five times more likely High school graduate 24.4% 20.3%
than those without (3.9%) to have not gotten along with their Post-secondary diploma 24.5% 20.4%
family over the past six months.
Bachelor's degree 5.0% 2.6%
In 1997, the FNIRLHS also collected data on the behavioural
and emotional problems of children, and 17% of parents Graduate degree - -
indicated that their child had more behavioural or emotional
problems in the past six months than other children the same Further analysis of the RHS data reveals that there is a clear
age. Moreover, in the children surveyed who were aged 12 pattern that indicates the higher the level of education
and over, about 25% of respondents reported to have attained by the mother or father, the more likely the mother
behavioural and emotional problems.11 Although the data or father responded that their child was in very good or
collected in 1997 is not First Nations specific, it would excellent general health. Mothers with a university degree
appear that the rates of emotional and behavioural problems were more likely (81.7%) than mothers without a high school
are similar to the rates found in the RHS Children’s study. diploma, high school graduates, or diploma recipients (67.2%
to 72.5%) to rate their child in very good or excellent health.
Some data for the general Canadian children’s population has
The effect of the child’s father’s educational level is less
been collected on emotional and behavioural problems.
pronounced. Those with post secondary education were more
However, much of this data does not compare children
likely than non-high school graduates to have a child in very
surveyed to other children their age (of specific cultural
good or excellent health.
groups and/or populations). As such, a comparison between
the data collected in the RHS and the general Canadian Educational rates for First Nations populations have
children’s population is difficult to make. The National continually been lower than that of the Canadian population.
Longitudinal Survey of Children and Youth (NLSCY) cycle The third cycle of the National Longitudinal Survey of
3, for example, cited that the majority of children (in the Children and Youth in Canada (NLSCY) provides
general Canadian population) do not exhibit signs of comparative data on the education level of parents of young
behavioural problems. 13.8% of children surveyed in the children (1998-1999). According to the NLSCY, 12.1 % of
NLSCY showed signs of anxiety; 12.2% showed signs of mothers of young children did not graduate high school, 16.1
hyperactivity and inattention; 13.6% showed signs of % were high school graduates, 26.4% had gone beyond high
physical aggression; and 10.1% showed low signs of pro- school and 45.4 % obtained a college diploma (including
social behaviour. In general, it would appear that there is not trade) or university degree. Further, the NLSCY showed that
a significant difference in the emotional and social behaviour 13.6% of fathers of young children did not graduate high
of First Nations and non-First Nations children, although a school, 15.6 % were high school graduates, 22 % had gone
more suitable comparison could be undertaken.12 beyond high school and 48.7 % had obtained a college
diploma (including trades) or university degrees (Table 2).14
West–Mind Table 2. Education level of parents RHS (2002/03) vs. NLSCY
(1998-99)
Parental education levels Mother Father
Level of education
Intuitively, the educational level of parents should have an RHS NLSCY RHS NLSCY
impact on the health and well-being of their children. The
Government of Canada’s report on children’s well-being, for Not graduated high
46.0% 12.1% 56.6% 13.6%
example, highlighted the significant contribution of maternal school
education on child outcomes and development.13 Today’s High school
economy is knowledge-based with a strong emphasis on 24.4% 16.1% 20.3% 15.6%
graduate
education. A parent’s education impacts the type of
employment opportunities available to them, which is a key Diploma or
29.7% 45.4% 23.1% 48.7%
University Degree
determinant of health. Their education impacts their own
emotional and social well-being, and by extension that of
their children. The RHS Children’s Questionnaire asked While the figures for educational rates in the Canadian
about parental educational levels; the parents or guardians population are in sharp contrast to the figures collected
detailed the highest level of formal schooling completed (see through the RHS, this difference is not a new discovery. The
Table1). current data collected in the RHS reinforces the need to make
302
First Nations education a priority, with a focus on attainable most prominent difference occurs between mothers without a
results not only to increase education rates, but recognizing high school diploma and those with post-secondary
the value of traditional cultural education as well. education. In the case of the father, their children are more
likely to have been read to if the father at least completed
Children’s schooling high school.
Children were asked about their attendance in school and in
North–Body
Aboriginal Head Start Programs. 67.9% of children between
3 and 5 and 84.5% between 6 and 11 were reported to be
Nutrition
currently attending school. When asked if the child had ever
attended Head Start, 38.8% indicated yes and 63.2% said no. The RHS Children’s Questionnaire asked respondents if the
Regular school attendance is higher than Head Start child surveyed ate a nutritious and balanced diet. 55.6% of
attendance. The impact of Head Start on-reserve is not easily respondents said their children always or almost always ate a
measured as it is, at least at this point, difficult to indicate if nutritious balanced diet; 39.6% reported that their child
the low numbers reflected disinterest or inaccessibility. sometimes ate a nutritious balanced diet; the balance said that
Further investigation is needed to understand the underlying they rarely (4.3%) or never (0.7%) ate a nutritious balanced
social phenomena impacting attendance levels especially diet.
with the communities that offer Head Start programs
The data indicates there is no relationship between the
mother’s level of educational attainment and their child’s
Children’s reading
diet. Similarly, there were no significant relationships
Research indicates that, for children, reading or being read to between a child consuming a nutritious balanced diet and
by significant others is an important determinant to a child’s total household income or community health transfer status.
healthy development. Reading activities have developmental
benefits, and facilitate and fosters relationship building and Participation in extracurricular activities
emotional connectedness.15 As such, the emotional and well-
being component of the RHS Children’s survey asked The participation of children in extra-curricular activities
parents how often their children read for fun or were read to imparts their emotional and social well-being. The
(outside of school). involvement of children in activities outside of school has
been linked to fewer academic difficulties, increased social
Of the respondents, 33.1% indicated they read for fun or skills, increased self esteem and increased fitness levels.16
were read to every day, 40.9% at least once a week, 10.5% at The RHS Children’s Questionnaire asked respondents how
least once a month and 15.5% never do. As seen in Table 3, often their child participated in various extra-curricular
girls are more likely to be read to everyday, while boys are activities (such as sports teams or lessons, art or music
more likely to never have been read to. groups or lessons, and traditional singing, drumming or
Table 3. Proportion of children who are read to by gender dancing groups or lessons), and how many hours per week
the child took part in other activities, such as watching
Frequency Male Female Total television, playing video games, using computers, playing
outdoors, and assisting in household chores.
Everyday 27.4% 39.2% 33.1%
Statistics for the general Canadian population obtained from
At least once a week 41.9% 39.8% 40.9%
the National Longitudinal Survey on Children and Youth
At least once a month 12.4% 8.6% 10.5% (1998-1999) indicated that approximately 87% of Canadian
children aged 4 to 15 participated in extra-curricular
Never 18.3% 12.6% 15.5% activities, and that approximately 13% of children rarely or
never participated.17 In comparison, First Nations children
Further to this, analysis of the data indicates that children have much lower participation rates. When the respondents
who are currently attending school are more likely to read for were asked about activity participation (non-school) in sports
fun or are read to everyday. However, it appears that teams, 52.8% indicated they never participated, 11.4%
frequency of reading is not linked to or impacted by whether participated less than once per week, 28.6% participated one
or not the child ever attended an Aboriginal Head Start to three times per week, and 7.2% participated four or more
program. times per week. This can have significant implications in
Frequency of reading or activities that incorporate some First Nations rates of obesity as well as the state of emotional
aspect of reading are also linked to the educational and mental well-being.
attainment of the mother and father. The higher the level of When asked about participation in art, music groups or
education attained by the mother or father, the more likely lessons, 81.8% reportedly never participated, 7.3%
the child will read on their own be read to everyday. The participated less than once per week, 9.3% indicated they
303
participated one to three times per week, and 1.6%

participated four or more times in art, music groups or Notes to Chapter 34
lessons outside of school.
1. Preamble to the Constitution of the World Health Organization as adopted by the International
When the respondents were asked about participation in Health
Conference, New York, June 19-22, 1946. Signed on July 22, 1946 by the representatives of
traditional singing, drumming or dancing groups or lessons 61 States
(Official Records of the World Health Organization, no. 2, p. 100) and entered into force on
outside of school, 74.3% never participated, 14.9% April 7, 1948.
participated less than once per week, 9.3% participated one 2. Aboriginal Healing Foundation, Aboriginal People, Resilience and the Residential School
Legacy (Ottawa, Ont.: Aboriginal Healing Foundation, 2003).
to three times per week and 1.6% participated four or more 3. Ibid.
4. Aboriginal Healing Foundation, Aboriginal Healing Foundation Program Handbook, 2nd
times per week. edition (Ottawa, Ont.: Aboriginal Healing Foundation, 1999).
5. Aboriginal Healing Foundation, Where Are The Children? Healing the Impacts of the
The questionnaire also asked parents about the importance of Residential Schools [online]. 2005. Available from World Wide Web:
<http://www.wherearethechildren.ca/en/impacts.html>.
their child learning a First Nations or Inuit Language. The 6. M. Chandler and C. Lalonde, 1998, Cultural continuity as a hedge against suicide in Canada’s
First Nations, Transcultural Psychiatry, 24, 2: 191-219.
data indicates that parents who believe it is very important 7. Ibid.
that their children learn a First Nations or Inuit language are 8. Health Canada, Healthy Development of Children and Youth (Ottawa, Ont.: Health Canada,
1999).
more likely to have their children participate in traditional 9. Government of Canada, The Well-Being of Canada’s Young Children (Ottawa, Ont.:
Government of Canada, 2003).
activities four or more times a week. Of those parents who 10. Human Resources Development Canada and Statistics Canada, National Longitudinal Survey
have their children participating in traditional activities four 11.
of Children and Youth, Cycle 4 (2000-2001) (Ottawa, Ont.: Statistics Canada, 2001).
Health Canada, First Nations and Inuit Regional Health Survey, Synthesis Report (Ottawa,
or more times a week, 90.6% reported that it was very Ont.: Health Branch, 1997).
12. Human Resources Development Canada and Statistics Canada, National Longitudinal Survey
important for their child to learn a First Nations or Inuit of Children and Youth, Cycle 3 (1998-1999) (Ottawa, Ont.: Statistics Canada, 1999).
language, 7.1% said it was somewhat important, and 2.4% 13.
14.
Government of Canada, The Well-Being of Canada’s Young Children.
Government of Canada, The Well-Being of Canada’s Young Children (Ottawa, Ont.:
said it was not important. Conversely, the data revealed that Government of Canada, November 2002).
15. Invest in Kids Foundation, Reading: Importance of reading to your child [online]. 2005.
there was no relationship between traditional activity Available from World Wide Web:
participation and general health. 16.
<http://www.investinkids.ca/DisplayContent.aspx?name=cpt_reading>.
Human Resources Development Canada and Statistics Canada, National Longitudinal Survey
of Children and Youth: Participation in Activities (1998-1999) (Ottawa, Ont.: Statistics
Respondents indicated that the average time spent watching Canada, 1999).
17. Ibid.
television was 12.8 hours, playing video games was 6.1 18. Note: Ownership, Control, Access and Possession (OCAP) are First Nations principles applied
hours, using a computer (other than to play video games) was to research and data collection initiative.
4.0 hours, playing outside was 13.9 hours, and assisting in

household chores was 3.6 hours (see Table 26.13). These
rates show that although our youth engage in activities that
involve outside activity and assisting in household chores
they are more likely to be sedentary, engaged in non-physical
activities often not related to our First Nations way of life.
The way forward

The data collected through the First Nations Regional
Longitudinal Health Survey (RHS) with respect to the
emotional and social well-being of First Nations children will
be instrumental in future policy and program decisions. It
will be a significant part of the longitudinal survey as it
details how our children are doing now. The data collected
through the RHS process has highlighted that First Nations
Children continue to be marginalized in several aspects of
their emotional and social well-being. Key to minimizing
marginalization is the meaningful engagement of First
Nations in the development of the policies and programs that
impact on their health. A focus on familial support and
education initiatives will be essential components of any
such strategies. First Nations must be fully engaged in the
development of programs aimed at improving the emotional
and social well-being of First Nations children – programs
that fully embody First Nations holistic conceptions of health
and incorporate First Nations principles of OCAP18 in their
development and application.
304
305
306
RHS 2002/03 – Appendix A
Appendix A
Acknowledgements
This report was written under the guidance and direction of the First Nations Information Governance
Committee (FNIGC) and implemented by the RHS Regional Coordinators (RC’s) and the RHS Team
at the First Nations Centre at the National Aboriginal Health Organization. Many individuals
dedicated their expertise and commitment to the successful conclusion of this report.
First Nations Information Governance First Nations Information Governance

Committee (FNIGC) – Current Committee (FNIGC) – Past
Dr. Valerie Gideon, AFN, FNIGC Co-chair Linda Day, BC

Ceal Tournier, SK, FNIGC Co-chair Deanna Jones-Keeshig, ON
Jay Lambert/Lori Meckelborg, BC Charlie Gaudet, NWT
Jackie Oka, AB Jordan Head, AB
Irene Linklater, MB Doreen Sanderson, MB
Tracy Antone, ON Darin Stevenson, MB
Nadine Gros-Louis/Nancy Gros-Louis- Jenni Wastesicoot, MB
McHugh, QB
Wendy Paul Rosenrauch, NB
Sally Johnson, NS
Lori Duncan, YK
Telmo Dos Santozs, NWT
RHS Regional Coordinators (RC’s) – Current RHS Regional Coordinators (RC’s) – Past
Linda Kay Peters, BC Sherri Waterchief, AB

Monica Chiefmoon, AB Noella Littlemustache, AB
Martin Paul, SK Rachel Snow, AB
Kathi Avery Kinew, MB Darrin Stevenson, MB
Donna Loft, ON Janet Longclaws, MB
Nancy Gros Louis McHugh, QC Edith Sanderson, MB
Wendy Paul Rosenrauch, NB Deborah Wilde, MB
Nigel Johnson, NS Nancy Dussuault, QC
Helen Stappers, YK Sharon Wabegijig, ON
NWT – Vacant Nancy MacLeod, NS
Elaine Shorty, YK
Sonny ‘Barrett’ Lenoir, NWT
Mariah McSwain, NWT
Gary Juniper, NWT
307
RHS 2002/03 – Appendix A
RHS National Staff FNC Staff
Odessa Belanger Julian Robbins

Jane Gray Donna Lyons
Phat Ha Colleen Toulouse
Brian Schnarch Andrew Webster
Thank you to the following individuals who worked on ideas, concepts and provided technical
assistance over the past years.
Doug Anderson Tom Goss
Ellen Bobet Karine Pepin
Jim Dumont John Phillips
Paul Emond Richard Powless
Christine Cameron Susan McBroom
Cora Lynn Craig Mike Mitchell
Anthony Da Ros Andrea J. Williams
Mark Dockstator Kienan Williams
David Flaherty Krista Yao
A special thanks to the report contributors contracted to assist in the development of various sections
of the report. For the complete list, please refer to Appendix B - Report Contributors.
Special acknowledgements to all the individuals who shared the vision for this survey and contributed
their support and resources to the success of this project:
Katherine Stewart, Health Canada
Rene Dion, Health Canada
Judith Dowler, Health Canada
Keith Conn, Health Canada/now with AHRSDC
A special thank you to the First Nations Centre and to the National Aboriginal Health Organization
for the coordination of the RHS 2002/03.
And finally, a very special acknowledgment and thank you to the RHS Regional Advisory
Committees, community data collectors who are too numerous to mention but not forgotten for their
contributions and commitment to this process.
308
RHS 2002/03 – Appendix B
Appendix B
Report Contributors
The First Nations Information Governance Committee wishes to acknowledge the following
individuals who were contracted to assist in the development of various sections of the report through
their knowledge and expertise.
• Josie Auger-Cardinal • Katherine Minich

• Kim Barker • Kelly McShane
• Ellen Bobet • Dawn Martin-Hill
• Christine Cameron • Earl Nowgesic
• Cora Craig • Darryl O’Brien
• Cameron Crawford • Darryl Quantz
• Mark Dockstator • Jeff Reading
• Jim Dumont • Amanda Ritchie
• Nicole Eshkakogan • Laurie Ringaert
• Linda Fisher • Diane Scribe-Niiganii
• Crystal Holly • Danielle Soucy
• Sonia Isaac-Mann • Janet Smylie
• Andrea L.K. Johnston • Sarah Marie Steeves
• Andrew Kmetic • Dennis Wardman
• Olga Krassiokova • Cornelia Wieman
• Malcolm King • Andrea J. Williams
• Josée Lavoie • Kienan Williams
• Herenia Lawrence • Erin Wolski
• Angeline Letendre • Gustavo Zayas
• Zhong-Cheng Lou
309
RHS 2002/03 – Appendix C
Appendix C
Participating Communities
The following First Nations communities participated in the First Nations Regional Longitudinal
Health Survey (RHS) 2002/03:
Alberta Sechelt Indian Band
Alexander First Nation Skway First Nation
Driftpile First Nation Sliammon
Kainai Soowahlie First Nation
Kapawe'no First Nation Stone Indian Band (Yunesit'in)
Nakoda Bearspaw Takla Lake First Nation
Piikani First Nation Tl'azt'en Nation (Tslasden)
Siksika Nation Tsartlip First Nation
Sucker Creek First Nation Tseshaht First Nation
Swan River First Nation Tzeachten First Nation
Westbank First Nation
British Columbia Williams Lake Indian Band (Sugar Cane)
Adams Lake Indian Band
Cambell River (We Wai Kum First Nation) Manitoba*
Canim Lake Indian Band Barren Lands
Columbia Lake Indian Band Bloodvein
Cowichan Tribes Borkenhead Ojibway First Nations
Ehattesaht First Nation Canupawakpa Dakota First Nation
Fort Nelson First Nation Ebb and Flow
Gitlakdamix Village Government (New Aiyansh) Fairford
Glen Vowell Indian Band Fisher River
Gwa'sala-Nakwaxda'xw Nation Fort Alexander
Heiltsuk Nation Garden Hill First Nation
Katzie First Nation Grand Rapids First Nation
Kwadacha Band Hollow Water
Laxgalts'ap Village Government Kinojeoshtegon First Nation
Leq'a':mel First Nation Little Black River
Malahat First Nation Long Plain
Metlakatla Band Mathias Colomb
Mount Currie Band Council Norway House First Nation
Musqueam Indian Band Opaskwayak Cree Nation
Nadleh Whuten Band (Nadleh Whuden) Pine Creek
Nanoose First Nation Rolling River
Nee-Tahi-Buhn Band Roseau River
N'Quat'qua Band Sayisi Dene First Nation
Okanagan Indian Band Sioux Valley Dakota Nation
Osoyoos Indian Band Split Lake Cree, First Nation
Scowlitz First Nation St. Theresa Point
Seabird Island Band Waywayseecappo
310
Wuskwi Sipihk First Nation Couchiching First Nation

York Factory First Nation Delaware FirstNation (Moravian of the Thames)
Eabametoong First Nation
New Brunswick* Eagle Lake
Big Cove Ginoogaming First Nation
Eel Ground Grassy Narrows First Nations
Kingsclear Kee-Way-Win
Madawaska Maliseet First Nation Lac Seul
Saint Mary's Mohawks of the Bay of Quinte
Woodstock Naotkamegwanning Anishinabe First Nation
Ojibways of Batchewana
Northwest Territories* Ojibways of Pic River First Nation
Dechi Laot'I First Nations Oneida Nation of the Thames
Deh Gah Gotie Dene Council Sachigo Lake
Deninu K'ue First Nation Sagamok Anishnawbek
Dog Rib Rae Sandy Lake
Fort Good Hope Saugeen
Gwitchia Gwich'in Temagami First Nation
Hay River Dene Upper Mohawk: Six Nations (plus other 12
bands)
Jean Marie River First Nation
Wabigoon First Nation
Liidii Kue First Nation
Wahta Mohawks
Lutsel K'e Dene
Wasauksing First Nation
Pehdzeh Ki First Nation
Whitefish Lake First Nation
Tetlit Gwich'in
Whitefish River
Tulita Dene
Wha Ti First Nation
Québec
Yellowknifes Fene First Nation
Betsiamites
Eagle Village - Kipawa
Nova Scotia/Newfoundland
Essipit
Acadia
Gesgapegiag
Afton (Paq'tnkek)
Kanesatake
Annalopis Valley
Kawawachikamach
Bear River
Kitigan Zibi
Chapel Island First Nation (Potlotek)
Lac Simon
Eskasoni
Listuguj
Horton
Malécites de Viger
Membertou
Manawan
Miawpukek
Mashteuiatsh
Millbrook
Natashquan
Pictou Landing
Odanak
Shubenacadie
Opticiwan
Wagmatcook
Pakua Shipi
Waycocomagh (We'koqma'q)
Pikogan
Timiskaming
Ontario
Uashat Mak Mani-Utenam
Aundeck Omni Kaning First Nation
Unamen Shipu
Bkejwanong Territory ( Walpole Island)
Wemotaci
Chippewas of Kettle and Stony Point
Wendake
Chippewas of Mnjikaning First Nation
Wôlinak
Chippewas of the Thames First Nations
311
Saskatchewan Ocean Man First Nation

Ahtahkakoop First Nation Ochapowace First Nation
Beardy's and Okemasis First Nation Okanese First Nation
Big River First Nation One Arrow First Nation
Birch Narrows First Nation Onion Lake First Nation
Black Lake First Nation Pasqua First Nation #79
Buffalo River Dene Nation Peepeekisis First Nation
Canoe Lake First Nation Pelican Lake First Nation
Carry The Kettle First Nation Peter Ballantyne Cree Nation
Clearwater River Dene First Nation Pheasant Rump Nakota First Nation
Cote First Nation 366 Piapot First Nation
Cowessess First Nation Poundmaker First Nation
Cumberland House Cree Nation Red Earth First Nation
Day Star First Nation Red Pheasant First Nation
English River First Nation Sakimay First Nation
Fishing Lake First Nation Saulteaux First Nation
Flying Dust First Nation Shoal Lake of The Cree Nation
Fond du Lac First Nation Star Blanket First Nation
Gordon First Nation Sturgeon Lake First Nation
Hatchet Lake First Nation Sweetgrass First Nation
Island Lake First Nation Thunderchild First Nation
James Smith First Nation Wahpeton Dakota Nation
Kahkewistahaw First Nation Waterhen Lake First Nation
Kawacatoose First Nation Whitebear First Nation
Keeseekoose First Nation Whitecap Dakota/Sioux First Nation
Key First Nation Witchekan Lake First Nation
La La Ronge First Nation Wood Mountain First Nation
Little Black Bear First Nation Yellow Quill First Nation
Little Pine First Nation
Makwa Sahgaiehcan First Nation Yukon
Mistiwasis First Nation Kluane First Nation
Montreal Lake First Nation Kwanlin Dun First Nation
Moosomin First Nation Little Salmon Carmacks First Nation
Mosquito-Grizzly Bear's Head First Nation Ross River Dena Council
Muscowpetung First Nation Selkirk First Nation
Muskeg Lake First Nation Teslin Tlingit Council
Muskoday First Nation Tr'ondëk Hwëch'in
Muskowekwan First Nation Vuntut Gwitchin First Nation
Nekaneet First Nation
*community names are those used in the 2002 Indian Register maintained by Indian and Northern Affairs Canada and
may not be the communities’ preferred names/spellings.
312
This is Exhibit “F” referred to in the Affidavit of Grand Chief

Reclaiming connections
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Reclaiming Connections:
Understanding Residential
School Trauma Among
Aboriginal People
A Resource Manual
The Aboriginal Healing Foundation

© 2005 Aboriginal Healing Foundation
Published by:
Aboriginal Healing Foundation
75 Albert Street, Suite 801, Ottawa, Ontario K1P 5E7
Phone: (613) 237-4441
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Table of Contents
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
A Snapshot of Life Prior to Contact and Colonization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Section I: Pre-Contact History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Inuit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
First Nations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Post-Contact History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Emergence of the Métis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Aboriginal People Today . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Section II: Residential Schools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Impacts of “Aggressive Assimilation” and Traumatic Disconnection . . . . . . . . . . . . . . . . . 43
Section III:What is Trauma? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Section IV: Healing is Sacred: Stories, Dreams, Dance, Drum & Ceremony . . . . . . . . . . . . . . . . . 65
Healing From Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Checklist to Prevent Re-Victimization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
“Just” Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Working With Clients to Promote Safety and Prevent Re-Victimization . . . . . . . . . . . . . 81
Section V: Impacts of Trauma on Workers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

Strategies for Self-Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Appendix A: Fact Sheets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1

Appendix B: Aboriginal Healing Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-1
Appendix C: Annotated Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-1
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .References-1
Acknowledgements
Reclaiming Connections is based on a A focus group comprised of eight

manual developed by the Wabano Centre for frontline workers and Elders was also held at
Aboriginal Health in Ottawa, Ontario, as a the Aboriginal Healing Foundation in
resource tool for frontline workers and December 2003 to gather additional feedback
educators. It has been adapted from this as part of the process of revising the manual.
earlier version to suit the needs of a larger, The final product reflects the experience
national audience. and perspectives of workers and helpers on
By increasing awareness of the history the front lines, as well as their proven
and impacts of residential school abuse, it is commitment to a holistic, culture-based
hoped this manual will mobilize service approach to recovery.
providers and educators to work more closely As well, we acknowledge and honour the
together in support of a common vision for Elders from the urban community of Ottawa
healing. whose cultural wisdom guided us throughout
This manual represents a collaborative the process.They are:
effort shared by many people deeply • Irene Lindsay
committed to promoting recovery from the • Angaangaq
trauma of residential school abuse and its • Jim Albert
intergenerational impacts. • Paul Skanks
Because of their unique position on the Thank you also to the Aboriginal Healing
front lines of trauma recovery work, Foundation (AHF), whose support of this
Aboriginal counsellors and helpers have an initiative would not have been possible.The
important role in transforming a painful past AHF funded both the initial retreat for
into hope for a new future.Their insights into frontline workers and production of the
the needs of people in pain, their compassion earlier version of Reclaiming Connections, as
and practical good sense were instrumental in well as revisions and production of this
shaping both the content and format of this manual.
manual.
Finally, a special acknowledgement to the
We gratefully acknowledge the Survivors of residential schools whose
contributions of twenty-three frontline courage to heal themselves, their families and
workers from Aboriginal services in Ottawa their communities is an ongoing source of
and Eastern Ontario.Their willing participation inspiration.They are living embodiments of the
in a weeklong retreat, designed to identify key resilience, beauty and tenacity of Inuit, Métis
aspects of trauma and recovery this manual and First Nation people in Canada.
must address, and ensured its relevance and
effectiveness as an ongoing resource.
1
Preface
In a service delivery context, many Transforming the Pain of the Past into
Aboriginal frontline workers, counsellors, Hope for the Future
teachers, traditional people and Elders are
either Survivors of residential schools or have In the spring of 1987, a social worker
experienced its intergenerational impacts. with clients from the Nl’akapxm First Nation
in British Columbia took the first action in a
With the long silence shattered and more series of events that would finally reveal the
stories being told, the full scope of the tragedy true story of the experiences of Aboriginal
of residential school abuse has finally been children in Canada’s residential schools.
revealed. 1
Examining client histories and disclosures
Aboriginal frontline workers have much of child sexual abuse in order to better
to teach about a holistic, culture-based understand their chronic addictions problems,
approach to recovery from the impacts of this she made a chilling discovery. Over a period
abuse, beginning with how to restore faith in spanning many generations, most of the
those whose trust in others and in “the Nl’akapxm, who had attended St. George’s
system” has been badly broken. Residential School as children, had been
sexually abused there.
“How we differ from mainstream is the love that In the criminal investigation that followed,
we have. This is the foundation of the work and a former dormitory supervisor was one of
what keeps us going and what makes our work as
many charged for his role in the sexual abuse.
good as it is.”
When the judge hearing the case announced
(Aboriginal Frontline Worker/Retreat Participant, 2000) the sentence, he linked 140 to 700 incidents of
sexual abuse against children to this one
person.The judge also stated his belief that
The Healer’s Retreat: sexual abuse was a “major contributing factor”
Working Effectively With Trauma in an in the level of alcoholism and suicide among
the Nl’akapxm.
Aboriginal Context
Though Aboriginal people from all parts
The materials in this manual were of Canada had long reported abuses at
generated out of a weeklong retreat from residential schools, no previous attempt had
twenty-three frontline workers held in the ever been made to investigate the full scope of
summer of 2000. the problem or to link it with the shockingly
By integrating interactive, practice-based high rates of suicide and addictions in the
workshops on trauma and healing with Aboriginal population.
ceremonies, such as smudging, Qulliq lamp The Nl’akapxm First Nation investigation
lighting, drumming and song, the retreat and the media attention it generated meant
reflected a practical, balanced and spiritually- the voices of thousands of residential school
grounded approach to healing. Survivors would be heard at last.
1
See the Fact Sheets titled Human Rights Violations and Residential School History.
3
At the dawn of a new millennium, the Their descendants, hoping for some
long silence imposed by Canada’s denial of the evidence the government also accepts
suffering of Aboriginal people was finally over. responsibility for the impacts of this abuse that
In 1998, eleven years after Nl’akapxm passed from parent to child and generation to
and thousands of other such investigations, generation, are still waiting.
with the churches and government facing Although no apology was forthcoming,
unprecedented litigation, the Government of the Canadian government established, in 1998,
Canada issued this statement. a 350 million dollar Healing Fund to address
the healing needs of all those impacted by
residential abuse, including its
“The Government of Canada acknowledges the intergenerational impacts (Aboriginal
role it played in the development and Healing Foundation, 2004).
administration of these schools.
Particularly to those individuals who experienced
the tragedy of sexual and physical abuse at
residential schools, and who have carried this
burden believing that in some way they must be
responsible, we wish to emphasize that what you
experienced was not your fault and should never
have happened.
To those of you who suffered this tragedy at
residential schools, we are deeply sorry.”
(The Honourable Jane Stewart, 1998:2)
4
Introduction
This manual was created as a learning and and sexual abuse many children experienced
reference tool for groups and organizations at these schools, often by multiple
providing services to Aboriginal people. Its perpetrators and many for the entire duration
focus is trauma recovery for Survivors of of their childhood.
residential school abuse, as well as for their The tools of cultural genocide are
descendants who suffer the intergenerational cultural shame, cultural disconnection and
impacts. trauma. It is now understood that unresolved,
It is designed to serve two purposes. multiple disconnections and historical trauma
First, it provides a culture-based approach to are directly responsible for many of the
trauma recovery in the context of residential problems facing Aboriginal people today.
school abuse for frontline workers. Secondly, The title Reclaiming Connections was
it is an educational tool to raise awareness of chosen to underscore the message that
Aboriginal culture and history in Canada. restoring Indigenous languages and the
wisdom of culture will restore pride in
Definition of “Residential School” Aboriginal identity and ancestry.This is the
The Aboriginal Healing Foundation basis of healing in families, communities and
defines residential school as: “the Residential nations.
School System in Canada, attended by By reclaiming these connections and
Aboriginal students. It may include industrial healing from the past, Aboriginal people also
schools, boarding schools, homes for students, reclaim a future of purpose and hope for the
hostels, billets, residential schools, residential next generation of Inuit, Métis and First
schools with a majority of day students, or a Nation children.
combination of any of the above” (Aboriginal
Healing Foundation, 2001:5). Why this Manual was Created
Aboriginal people are over-represented in
The Meaning of the Title
all risk-groups associated with preventable
The purpose of residential schooling was social and economic problems, such as
to assimilate Aboriginal children into homelessness, poverty, addictions, violence,
mainstream Canadian society by disconnecting chronic illness and diseases that include
them from their families and communities and tuberculosis, HIV/AIDS and diabetes.Yet,
severing all ties with languages, customs and providers offering prevention and intervention
beliefs.To this end, children in residential programs fail to draw Aboriginal people to
schools were taught shame and rejection for their services.
everything about their heritage, including their
One reason is the paternalistic and
ancestors, their families and, especially, their
prejudicial attitudes that continue to exist
spiritual traditions.
toward Aboriginal people in mainstream
The impacts of disconnection and society. The persistence of these attitudes is
shaming were compounded by the physical directly related to lack of knowledge about
5
Aboriginal culture and history and Although this manual does not provide a
underscores the urgent need for culture-based set recipe for such relationships, it is meant to
training and educational resources. promote the type of active, intercultural
Elder Paul Skanks suggests knowledge of learning that generates new thinking and new
Aboriginal culture and history is essential in approaches.
order to provide effective services. He poses Using a community development process,
the following question to non-Aboriginal this manual was created out of the ideas,
service providers. insights and experiences of frontline workers,
helpers and Elders in the Ottawa region. It
does not contain all of the answers about
“How can you serve a people you don’t trauma and healing nor is this approach the
understand? How can you have empathy for people only one.To what extent others find it helpful
without an understanding of the issues that brought and useful will depend on their own
that person to you for help in the first place that
community context, resources and
impact on them or their family?”
perspectives.
(Paul Skanks, 2002)2
How to Use this Manual
Another barrier to access is a service This manual provides information about
system that has become badly fragmented and the impacts of residential schooling on
over-specialized. An uncoordinated service Aboriginal people in Canada. It is not meant
system leaves many Aboriginal clients feeling as an intensive study of complex and
re-traumatized by numerous disclosures important historical events. Readers wanting
required for multiple intake and assessment more information are referred to the list of
procedures without finding the respect, resources recommended and the annotated
compassion and practical support so urgently bibliography.
needed. All information in this resource manual is
Although the range of services run by to be used, copied and/or adapted to suit the
and for Aboriginal people is expanding, they needs of those using it. Sections can be used in
often lack the resource capacity to fully meet whole or in part as handouts for public or
the level of need. An accessible, coordinated professional education workshops, or as a way
and culturally-sensitive service system is of generating discussion about history, culture
essential. or trauma recovery related to residential
school abuse and its impacts.
To achieve this vision, Aboriginal and non-
Aboriginal service providers must work Section I of the manual provides a brief
collaboratively to create an atmosphere of overview of Indigenous cultures prior to
mutual respect, cooperation and trust.The European contact. Because the Canadian
painful lesson of our shared history should be educational system neglects the important
to keep our hearts and minds open to every contributions of Aboriginal people to society as
opportunity for a new beginning. we know it today, this section of the manual is
essential reading. It is hoped this section also
prevents Aboriginal people from being defined
2
Personal communication with the author in 2002.
6
solely in terms of victimization by colonizers, intergenerational impacts, self-care is a crucial
which comprises only a small part of the overall component of effective service delivery.
history of the original inhabitants of this land. The Fact Sheets in Appendix A are designed
Section II begins with an overview of the to be easily photocopied as handouts for public
policies that first led to Indian residential education presentations in high schools, at
schooling and then to the so-called 60s Scoop community forums, or for staff training within
where thousands of Inuit, Métis and First health and social service organizations.
Nation children were forced into foster care Appendix B is a synopsis of three Aboriginal
and adoption. healing models specific to trauma recovery and
This section also describes abuses endured residential abuse.
by these children and their families—abuses that, Appendix C is an annotated bibliography of
in many cases, were much worse than the initial related resources and recommended readings.
living conditions from which authorities decided
the children needed protection. Also included
are the intergenerational impacts of historical Limitations of this Manual
trauma and accumulated loss from the The Elders caution non-Aboriginal
perspective of frontline workers and Elders readers against thinking that written
who participated in the retreat. information alone is a sufficient way to learn
Section III contains an overview of about other cultures.The beliefs, values,
contemporary theories about post traumatic traditions and customs of Inuit, Métis and
stress disorder in the context of ethnogenocide First Nation people are too diverse and
and historical trauma. It is meant to bring a complex to be adequately conveyed in this
shared focus to the work with Aboriginal format.
trauma Survivors in the context of residential As well, written information is easily
school abuse. misinterpreted and remains fixed over time.
Section IV provides a very brief and general The true value of written information can be
overview of some traditional Aboriginal assessed by two criteria:
practices that promote healing; a holistic trauma 1. Does it affirm what you already know at
recovery model compatible with the needs is some level, based on your own
summarized. experience?
Section V outlines an Aboriginal approach to 2. Does it arouse either your curiosity or
maintaining healthy, balanced people and your discomfort enough that you are
organizations in the course of trauma recovery motivated to further your own learning in
work.Work with trauma survivors has a a particular area?
profound influence on the physical, emotional,
mental and spiritual health of frontline workers For Aboriginal people, experiential learning
and helpers. Because Aboriginal frontline is the fundamental principle behind the
workers are often personally impacted by the acquisition of knowledge and skills.
trauma of residential school abuse and its
7
Traditional methods of teaching and
learning involve doing and the Elders tell us:
“The way we are taught is as important as
what we are taught.”
The readers of this manual are
encouraged to actively and respectfully seek
out other opportunities for cross-cultural,
experiential learning.
For further information about cultural
events that welcome public participation, we
encourage you to explore the following:
• community pow wows or other cultural
celebrations in your area;
• Aboriginal Day celebrations and special
events held annually on June 21st;
• contact the community centres in your
area, such as Native Friendship Centres,
Aboriginal Health Centres, or Inuit or
Métis Community Resource and
Information Centres;
• contact any of the national Inuit, Métis or
First Nations organizations listed in this
manual; or
• visit any of the websites listed in this
manual for further information on inter-
cultural events and learning opportunities.
8
A Snapshot of Life
Prior to Contact and Colonization
Writings of the first Europeans about the

On Interpersonal Relations
inhabitants of Turtle Island can be used as
snapshots to create a picture of indigenous life
prior to colonization.
“Excesses” of emotion and behaviour were rare,
and “their language is chaste.” Indeed … “they
On Parenting and Children have … an admirable composure, and do not know
what it is to burst out into insults. I do not
remember ever seeing any one of them angry”.”
“Indian ‘children are not obstinate, since they give (Demos, 1994:149)
them everything they ask for, without ever letting
them cry for that which they want. The greatest
persons give way to the little ones. The father and
the mother draw the morsel from the mouth if the On Character
child asks for it. They love their children greatly.’”
(Miller, 1996:55)
“They are of body lustie, strong and very nimble:
they are a very understanding generation, quicke of
apprehension, suddaine in their dispatches, subtile
in their dealings, exquisite in their inventions, and
industrious in their labour.”
“Out of a hundred that have passed through our (Whitaker, 1613 cited in Pearce, 1988:13)
hands scarcely have we civilized one … We find
docility and intelligence in them, but when we are
least expecting it they climb over our enclosure and
go to run the woods with their relatives, where they
find more pleasure than all the amenities of our
On Governance
French houses. Savage nature is made that way;
they cannot be constrained and if they are they
become melancholy, and their melancholy makes “Finally, there is a civill governement amongst
them sick. Besides, the Savages love their children them which they strictly observe, and shew thereby
extraordinarily and when they know they are sad that the law of Nature dwelleth in them: for they
they will do everything to get them back.” have a rude kinde of Common-wealth, and rough
governement, wherein they both honour and obey
(Fournier and Crey, 1997:51-52) their Kings, Parents, and Governours, both greater
and lesse, they observe the limits of their owne
possessions, and incroach not upon their
neighbours dwellings ...”
(Whitaker, 1613 cited in Pearce, 1988:13-14)
9
The Situation in Europe
During the time when Europeans first
arrived on the shores of Turtle Island between
late 1400 to the end of 1800, the following
was the situation they left behind in “civilized”
Europe.
The Inquisition
From 1257 to 1816, 500 years of terror
were decreed by Papal authority under the
“Inquisition” in which over one million people,
mostly women and homosexuals, were brutally
murdered.Written by a priest, the Inquisitor’s
handbook titled Malleus Maleficarum
recommended heretics (non-believers in
Christianity) and witches be “often and
frequently exposed to torture” (Lovelace and
Rice, 1999:479), before burning them alive.
Children in Europe
Both pre- and post-industrial Europe
were defined by the terrible exploitation of
children as young as 6 years old who were
forced into labour as prostitutes, factory
workers, miners, chimney sweeps and beggars.
The cruelties inflicted against children from
the lower classes of society resulted in terrible
injury and death for many thousands. Les
Misérables, a play written by Victor Hugo in
1862, describes vividly the lives of European
children at the time their missionaries were
civilizing the savages of the new world.
10
Section I
Section I:
Pre-Contact History
Section I:
Pre-Contact History
Introduction their descendants had settled throughout the

continent.
The term Aboriginal People refers to the
descendants of the original inhabitants of what Others counter the theory of a single-
First Nation people call Turtle Island —now entry point.They argue that similarities of
known as North America. symbols and construction methods at sacred
sites from Peru and Mexico to Africa, Egypt,
The Canadian Constitution recognizes
Ireland and Bretagne are too common to be
three separate groups of Aboriginal people,
merely coincidental.These similarities more
each having unique heritages, languages,
likely reflect the wide travels and intercultural
cultural practices and spiritual beliefs. They
exchanges of early seafaring peoples.
are the Métis, Inuit and First Nations.3
(The term First Nation(s) came to use in the Historians now generally agree that
1970s to replace the term Indian, which many humans were present in the Americas by
people found offensive. Another offensive 15,000 BC and that, from 5,000 to 1,000 BC,
term, Eskimo, has been replaced by Inuit.) agriculture, pottery and complex social and
economic systems existed.This marked the
From a cultural and spiritual perspective,
end of the Stone Age period and the beginning
Indigenous people expressed their beliefs in
of what is known in history books as the High
their origins through Creation stories passed
Indian civilizations.
down from generation to generation by the
Elders. Inuit Creation stories tell of the first Population estimates for the Americas
man, Aakulagjug, and the first woman, prior to sustained European contact in 1500
Umarniqtu. Prior to Christianity, Inuit shamans are as high as 112.5 million people speaking an
would ask for their help and guidance through estimated 2,200 languages. In what is now
difficult times (Kulchyski et. al., 1999). Canada, the population is estimated to have
been anywhere from 500,000 to over 2 million
Creation stories from the South were as
people.4 Within this population were many
diverse as the many First Nations and tribes.
hundreds of diverse nations, tribes, languages
In the Mohawk version, Sky Woman fell to
and dialects (Dickason, 2002).
earth onto the back of a great turtle, which
grew to become known as Turtle Island Among these richly diverse cultures,
(Kulchyski et. al., 1999). there were striking commonalities in
worldview. Respect for self-discipline,
From an anthropological and historical
appreciation for humour, the law of hospitality
perspective, there are two main theories of
and a deep faith in the unity of all living things
the origins of human life on this continent.
were beliefs shared by many.
One is that the first humans crossed the
Bering Strait from Asia sometime between
50,000 to 30,000 BC and that, by 8,000 BC,
3
See the Fact Sheets in Appendix A for additional information on Métis, Inuit and First Nation cultures.
4
By early 1900, however, the Indigenous population of the Americas had shrunk by 93 per cent, mainly due to European deseases
and genocide.
11
A shared understanding of the lives,
strengths, customs and beliefs of Indigenous
people prior to European contact is crucial in
order to fully grasp the scope of the impacts
of assimilation strategies, such as residential
schooling.
The government of Canada marked a
new era in the history of relations with
Aboriginal people when it recognized the
importance of this shared understanding.The
following is an excerpt from the government’s
Statement of Reconciliation released in 1998.
“The ancestors of First Nations, Inuit and Métis

peoples lived on this continent long before explorers
from other continents first came to North America.
For thousands of years before this country was
founded, they enjoyed their own forms of
government. Diverse, vibrant Aboriginal nations had
ways of life rooted in fundamental values
concerning their relationships to the Creator, the
environment, and each other, in the role of Elders as
the living memory of their ancestors, and in their
responsibilities as custodians of the lands, waters
and resources of their homelands.”
(The Honourable Minister Jane Stewart, 1998:1)
12
Inuit
Inuit and Inuvialuit are people very difficulties and maintain harmony within the
distinct from both First Nations and Métis, and camps.The social and psychological systems
who occupy vast areas of the Canadian Arctic. developed by Inuit over thousands of years
Inuvialuit live in the Western Arctic and ensured good mental health for individuals and
speak Inuvialuktun. Inuit live primarily in families in spite of perilous and demanding
Nunavut, the Northwest Territories, northern conditions.
Labrador and Quebec and their language is These social and psychological systems
Inuktitut. Inuvialuit and Inuit share a strong placed high value on ajurnarmat (it cannot
connection with other circumpolar Inuit of be changed) and issumatuq (the wisdom that
Russia, Alaska and Greenland in terms of their comes with time and experience) (Minor,
cultural history, as well as their stories, 1992).
traditions, crafts and tools. Interpersonal communications skills are
It was not until the nineteenth century highly developed in Inuit and Inuvialuit,
that any form of regular contact took place especially intentional listening (clarifying a
between Inuit and the Europeans.There is, listener both heard and understood what a
however, ample evidence that Inuit and speaker had said) and giving/receiving
Inuvialuit were active trading partners with respectful advice. Strategic uses of humour
First Nations from the south for thousands of and silence enabled people to live together in
years prior to the arrival of Europeans. harmony throughout the long months of
Living in small, well-organized camps of winter darkness.
extended families, Inuit and Inuvialuit were
Spirituality
nomadic people who survived primarily by
hunting marine mammals and gathering. As in many other Indigenous cultures, the
Circle was one of the underpinnings of ancient
People of the Arctic were fully aware of
belief systems. It represented the cyclical
the urgency of their struggle for physical
aspects of birth, life and death, as well as
survival.They understood the absolute need
seasonal cycles marking changes in lifestyle,
for cooperation and sharing in order to
food, social activities and ceremonies.
endure the harsh Arctic environment.
Cooperation and sharing remain the Inuit Elder Angaangaq describes this
foundation of an Inuit social ethic Elders call concept as “the Circle that Has No
“Inuit law” (Kulchyski et. al., 1999). Beginning and No Ending to Which We
All Belong.”
Preserving emotional stability and balance
within the camps were essential to maintaining Prior to contact, spiritual practice was
cooperation, as conflict and disruption used up based on shamanism. Shamans could be either
precious energies needed for survival. male or female and held powerful and
respected positions in community life.
Inuit and Inuvialuit were adept at finding
creative ways to overcome interpersonal
13
Shamans were believed to possess into a powder (this was considered best
healing powers, as well as the ability to for preventing bleeding).
influence or change nature.Visions, songs and • Infections were opened to let the pus
medicines helped shamans to induce out, then treated with geese or seal fat to
pregnancy, restore mental health, overcome keep it from drying out.
illness or injury and guide animals to the
hunters. • Cataracts were removed by inserting
human lice or warble fly larvae into the
As with many other Indigenous cultures, eye. (Larvae are now used to clean
the Inuit and Inuvialuit worldview was one in infected wounds in many modern
which all living things were in unity; hospitals.) Another treatment was to
therefore, humans, the land, animals and apply a powder made of cooked bones to
plants were considered equal in terms of the eye; this stuck to the cataract and
respect and consideration. was then removed with the cataract
intact.
Traditional Diet
• Treatment of Ear Infections,
The traditional Inuit diet consisted primarily
Fevers and Fractured Bones was the
of sea and land mammals, such as whale, seal,
same as today, applying hot or cold
and polar bear, as well as berries. (Caribou
compresses and setting bones in splints
were not introduced to the Arctic until the
or slings.
twentieth century.) Meat, preferred fresh and
uncooked, was always eaten communally. Family Life
Today, traditional Inuit food is known as
country food. Family life in the Arctic was
characterized by the fluidity of the
Traditional Medicine relationships among children and adults in
the camps. Children held a very special place
Centuries of accumulated knowledge
in Inuit life and in the hearts of all people of
allowed Inuit to survive and live long lives
the camps, not just the birth parents.
without modern doctors, longer than any
Disciplining, teaching and guiding children’s
other Indigenous people. Inuit used
development was a responsibility shared by
medicines derived from plants and animals to
all.
prevent and heal from illness and injury.
This fluidity is also evident in long-held
Types of medicines and methods for
Inuit adoption practices. Customary adoption,
using them varied widely with regional
which is still practiced today, is a traditional
differences in plant and animal life. Some
custom in which children are accepted into
examples include:
the homes of adoptive parents to be raised.
• Cuts were treated by applying a powdery
The reasons for such adoptions vary
plant to the wound before it was
widely. It may be because the adoptive
bandaged with a thin layer of caribou
couple is unable to have children or because
skin; or sometimes a whole leaf of
the birth parents are unwilling or unable to
chewing tobacco was applied or arctic
care for the child.
hare droppings that had been crushed
14
Whatever the reason, the child knows Roles of Men and Women
her or his biological parents and family and is
Survival in the Arctic required the skills
encouraged to develop a sense of
and cooperation of everyone in the camps.
connectedness to them while clearly also
Women developed skills in preparing seal and
belonging with the adoptive family. caribou skins for clothing to suit even the
Inuit and Inuvialuit do not use terms such harshest Arctic weather conditions.
as “give-up” or “give-away” to describe their They prepared the food and, along with
relationship with children. There is no stigma the men, fished, dried the fish and constructed
attached to adoption and all references are the camp dwellings.Women were also the
from the perspective of choosing, wanting and keepers of the Qulliq, an oil lamp that was the
welcoming children. only source of light and heat throughout the
Their love of children is reflected in long winters.
Aqausig, which means loving babies and Along with Elders, women were the
creating a special song for each infant out of decision-makers of the household, influential in
that love. resolving disputes and maintaining
relationships.
The Role of Elders
The most essential skills of the men were
Elders were held in great respect and planning and carrying out the dangerous
authority.They intervened when there was hunting expeditions for large game, such as
trouble, provided guidance to members of the seal, whale, caribou and polar bear.
camps and determined what action would be Both women and men were actively
taken when community laws were broken. involved in child-rearing as parents,
People with extensive knowledge of the grandparents, uncles, aunties and foster
land were also considered Elders.They taught parents, teaching the children of the camps
young people respect for animals, the land and respect for Inuit laws crucial to their survival.
the importance of sharing. Inuit expansive notion of “family” is
reflected in the language.The word
qatangutgiit refers to immediate or close
“We were told to help Elders, to love them, to go to family relations based on blood ties.
Elders with problems because they wanted us to be
good people. We were told to obey and listen to The word ilagiit refers to the “outer
adults and we were told to love orphans. We were family” of extended relatives that can
told not to fight, not to lie, and not to steal. This is sometimes overlap with qatangutgiit.
what we were told.”
Children were also bonded to adults
(Elder Rachael Uyarasuk through tuqlluraniq—a namesake. Inuit
as cited in Kulchyski et. al., 1999:260) believed naming a child after someone who
has recently died would allow the spirit of that
person to live on in the child.
For thousands of years, Inuit cultural and
family life centred on community feasts and
15
the sharing of food, drum dancing, throat- • the kayak, designed by Inuit, has become
singing and games of dexterity and skill. one of the most popular ways of enjoying
water travel and sport worldwide;
Sustained Contact with Europeans • snow goggles were fashioned from bone,
The quest for a northwest passage first antler and ivory to reduce blinding snow
motivated Europeans to explore the Arctic glare during hunts; and
regions. One of the earliest accounts of • Inuit art inspired by the animals, people
European contact with the Inuit are the and spirits of the Arctic is known and
journals of Martin Frobisher who made three loved by collectors worldwide.
expeditions to the Arctic in 1576, 1577 and
1578 (Morrison and Wilson, 1995). Explanation of terms
The arrival of whalers in the Arctic in the Inuit: is plural and means “the people;” the
mid-1700s marked the beginning of economic singular is Inuk.
relationships between Inuit and Europeans. By
1800, whaling boats pervaded the North and, Inuktitut and Inuvialuktun: are the
by the early 1900s, intense whaling had languages of the Inuit and Inuvialuit,
severely reduced the stocks. respectively, including many dialects.
Following the whalers came traders, Inuksuk: singular, meaning “like a person,”
missionaries (Anglican from rural England and refers to stones piled to resemble a human
Roman Catholic from France and Belgium) and and is used as markers or forms of
the North-West Mounted Police. Until the communication. Plural is Inuksuit.
1950s, however, Inuit still retained control over Eskimo: a Chipewyan word meaning “eaters
their own decision-making and remained of raw meat” that many contemporary Inuit
largely autonomous. find insulting and unacceptable.
Discovery of rich mineral deposits and Qallunaat: the name Inuit use to describe
the Cold War’s demand for strategic NATO people who are not Inuit.
air bases in the 1950s sparked a new interest
Ulu: the half-moon shaped woman’s knife
in the North that would change Inuit cultural
used for cutting meat and preparing hides.
and political life dramatically.
Country Food: the food of the North, such
This interest marked the onset of forced
as Arctic char, caribou, muktuk, seal, whale and
relocation, during which the Canadian
bannock. Inuit love this food raw and fresh or
government forcibly removed Inuit from
frozen, or made into roasts and stews.
ancestral homes and hunting territories to
centralized, government-built settlements.This Amauti: a woman’s parka with a large hood
dis-connection from ancestral lands caused for carrying a child on her back.
grief that is still felt by many Inuit today. Qulliq: a long, narrow, flat lamp, generally
carved of soapstone with a wick made from
Contributions of the Inuit cotton or moss that can only be picked at
Inuit ingenuity and creativity continue to certain times of the year. The fuel it burns is
enrich contemporary life. Some examples are: oil from the fat of any animal, such as caribou,
seal, whale or polar bear. For many centuries,
16
the qulliq was the only source of heat, light from residential schools (although for a time,
and cooking for Inuit. some schools served raw foods to the
Syllabics: there are two written forms of children as a “special treat”). Children were
Inuktitut and Inuvialuktun, one based on taught that the foods fed to them by their
syllabics and the other based on Roman parents were dangerous to health and
orthography.These written forms of the uncivilized. Needless to say, this caused a strain
language were introduced by missionaries and on relationships when the children returned
are still in use today. home (King, 1996).
Today, Inuit Survivors of residential
Inuit and Residential Schools5 schools speak of their terror as children
Inuit were the last Aboriginal people in during first plane flights to these schools, of
Canada to be affected by the residential their loss of a sense of family and feeling of
school system. Even though Inuit had being loved, the loss of language, the
indicated their preference for federal day humiliation they suffered at being forced to
schools where the children could remain perform demeaning acts and the pain of
under the cultural influence of their families, physical and sexual abuse.
the Canadian government opened four
Cultural Reclamation
residential schools:Yellowknife Residential
School Hostel in 1958, Inuvik Residential Forced changes in housing, diet and
School in 1959, Churchill Residential School education imposed by the Canadian
in 1964 and in Chesterfield Inlet in 1955 government proved disastrously unhealthy for
(King, 1996). the Inuit. A population that had endured for
tens of thousands of years without addictions,
“In 1955, less than 15 percent of the Inuit
substance abuse or serious health problems,
school-age population was in attendance”
such as tuberculosis, began spiralling into
(King, 1996:74). By 1964, due to “vigorous”
tragedy.
government policy, this had increased to 75
per cent and overcrowding was becoming a In 1971, Inuit Tapirisat of Canada (ITC)
problem (King, 1996). It is estimated that, of was formed to work on behalf of Inuit social,
the total 105,000 to 107,000 individuals who economic and political development. Through
attended residential schools, 5 per cent were ITC, cultural reclamation emphasized
Inuit (DIAND, 1998). protection of language and restoration of
hunting as the bases of Inuit society. (With the
Inuit children attending these schools
creation of Nunavut, the name was changed to
experienced a dramatic change in both diet
Inuit Tapiriit Kanatami (ITK).)
and dress.The purpose was to acculturate
them to middle-class Canadian standards that In 1984, Pauktuutit, the National Inuit
failed to take into account conditions of life in Women’s Association, was founded to address
the Arctic (King, 1996). social, economic and political issues of
importance to women and to restore the role
To wean the children away from raw
of women in all spheres of cultural and
meat, the traditional Inuit diet was banned
political life.
5
See also Section II: Residential Schools.
17
Some of the issues of concern being individuals, a concern for Inuit collective well-
addressed by the Inuit in Canada are: being and a willingness to share. Inuktitut is
• 60 per cent of Inuit are under age 25; still spoken in all Inuit communities and is the
language used in radio and television programs
• 50 per cent are unemployed; that originate in the North.
• 6 per cent live in southern Canada; Whether in northern communities or the
• the rate of suicide is the worst in the urban Inuit communities of the South,
world: the Inuit suicide rate in Canada is traditional Inuit country food, games, drum
211 per 100,000 vs. the rest of Canada at dancing and throat-singing remain the central
14 per 100,000; focus at community celebrations.
• sexual assault in the North is 4 to 5 times
higher than the rest of Canada; the highest
risk group is children age 7 to 18 years;
• the Inuit have lower life expectancies,
higher infant mortality rates and higher
rates of death by accident and violence
than the rest of the population in Canada;
and
• by the year 2016, the Inuit population is
expected to reach 60,300 (Health Canada,
1993).
Inuit today
There are four Inuit regions of the
Canadian Arctic, each with its own “Regional
Association” and separate land claim
agreement.These regions are: Labrador with an
Inuit population of 4,500; Nunavik, population
of 8,000; Nunavut, population 23,000; and
Inuvialuit with a population of 5,000.6
The creation of the new territory of
Nunavut on April 1, 1999, marked a historic
milestone in the history of Inuit in Canada. Its
new legislative assembly, cabinet and court are
responsible for governing an area comprising
20 per cent of Canada.
The hallmarks of Inuit tradition and
culture remain to this day: respect for
6
See the Inuit Tapirisat Kanatami (ITK) website for further information.
18
First Nations
Prior to European contact, many the Christians for men and women concerning
significant and distinctive nations co-existed in sexuality and “chastity” were considered
the Americas. In what is now Canada, there coercive and unacceptable.
are six major cultural regions: the Woodland Two essential values or laws expressed
First Nations in the east, the Iroquois First and modeled in family and community life
Nations of southeastern Ontario and Quebec, were non-interference and sharing. Because
the Plains First Nations of the prairies, the sharing was considered a law, the hoarding of
Plateau First Nations, the Pacific Coast First possessions or wealth was considered anti-
Nations and the First Nations of the social behaviour. Whether through potlatches
Mackenzie and the Yukon River basins. or give-aways, a family’s wealth was indicated
The economic base was primarily fishing, by the value of the gifts bestowed on others.
hunting and agriculture. Goods found at burial The European notion of discipline for
sites, such as conch shells from the Gulf of children was virtually non-existent in
Mexico, copper work from the Southwest and Indigenous cultures. Children learned proper
ground slate from the Maritimes, show there behaviour by modeling adults or experiencing
was also an extensive trading network the consequences of their misbehaviour. The
throughout the continent. (Such expansive steadfast refusal of parents to spare the rod or
trading practices later enabled the First spoil the child later became one excuse for the
Nations to become competitive, efficient Church to remove children from their families
trading partners with the Europeans.) and communities in order to civilize them.
Family Life Gender and Sexuality

Most Indigenous cultures were matrilineal Studies of 200 Indigenous languages show
with descent traced on the female side of the 168 have a concept of more than two genders,
family. Clans were comprised of extended with some having words to describe as many
families descended from a common female as 8 different genders. In some Indigenous
ancestor. They generally consisted of a cultures, men who were like women and
woman, the Clan mother, and her daughters women who were like men were especially
or a group of sisters, together with their respected for the uniqueness of the gifts they
husbands and children. contributed to community life. Such
The bonds uniting couples were individuals, called “berdaches” by Europeans
completely different from European customs (known today by some as Two-Spirited7
of matrimony and divorce. Couples partnered people), served important roles as
and unpartnered easily, with no other matchmakers, teachers, counsellors, medicine
consideration than consent of the two people people, pipe carriers, visionaries and seers. In
involved. the Crow tradition, a gay or transgendered
The double standards later introduced by man cut the centre pole for the Sun Dance.
7
Two-Spirited is a modern term created by Aboriginal gays, lesbians and transgendered people. It refers to both female and male
characteristics being present within one person.
19
Every member nation of the League had a
A Case Study: Indigenous Governance
council composed of delegates called sachems,
Aboriginal people possess the chosen by the women of that nation.
accumulated wisdom of many centuries of
Each nation governed its own territory
nation building. One of the earliest known
and had its own council to decide issues of
governance systems created to manage the
public policy. These councils exercised
complex affairs of many nations is the union of
jurisdiction over the internal concerns of that
the Haudenosaunee (meaning People of the
one nation only. In this respect, they exercised
Longhouse).
powers somewhat like the individual
This union marked the first time in world governments of the colonies.
history that several mighty nations had joined
In addition to individual councils for each
together without sacrificing the sovereignty of
separate nation, the sachems together formed
any individual member.
the Grand Council of the League.
Over a thousand years ago in early 1,000
In this Council, all fifty sachems of the five
AD, the great leaders, Ayonwatha and the man
(and later six) nations sat together to discuss
known as The Peace Maker8 founded the
issues of common concern and manage
Haudenosaunee. Also called League of the
internal and external affairs. Within the Grand
Iroquois or Iroquois Confederacy, it created
Council, each sachem had equal authority and
its own Constitution called the
privileges. Individual power was wholly vested
Kaianerekowa or Great Law of Peace.
in each person’s speaking skills, gifts of
The Wampum Belt, created to symbolize persuasion and ability to represent the people.
the Constitution, is the oldest of its kind in
When the Europeans arrived in America,
North America and possibly the world.
the Iroquois League constituted the most
The design of the Wampum Belt elaborate and significant rights-based political
illustrates the principles of Friendship, Law, confederation in the world.
Peace, Security and Shelter under which the
The Iroquois model of political alliance
five nations that comprised the League united
and governance became a template later used,
with one another.
in some instances word for word, by the
The principal nations of the Iroquois founders of the American Constitution, some
League were: the Mohawk, Onondaga, Seneca, of whom had visited the chiefs to learn about
Oneida and Cayuga and their union endured the Constitution. 9
for many centuries. (The Tuscarora were later
incorporated into the League when it became The Role of Women in the League
evident to them the extent to which
Europeans jeopardized their future.) Together, Women had an important and central
they controlled territory stretching from what role in all Indigenous cultures. Within the
became New England to the Mississippi River. Iroquois League, this role included the power
8
According to Mohawk Elder Paul Skanks, the name of The Peace Maker is never mentioned except in the most sacred of
ceremonies.
9
Thomas Paine and Benjamin Franklin visited the Iroquois chiefs and borrowed much from their Constitution. For example, the
oral preface to the Iroquois Constitution begins, “We the people” as does the written preamble to the American Constitution.
20
to choose, as well as to de-horn (or impeach) Another important political innovation
a chief. borrowed from the First Nations was the
If the conduct of any sachem or chief caucus. Caucus was a formal mechanism
appeared improper to the people or if he was designed to prevent political issues from
unable to inspire their confidence, the women becoming too divisive or combative within a
of his clan had the authority to de-horn and larger group.
expel him by official action.They would then Potentially troublesome issues were
choose a new chief to replace him. delegated to a smaller, closed group called a
Women were also owners of the caucus for full discussion by members.
Longhouses and agricultural lands, responsible Representatives of the caucus then
for decision-making and other aspects of returned to the larger council with the results
family and community life. of their deliberations. (The caucus has since
Men were generally the providers and become a mainstay of both American and
defenders who carried out the decisions of Canadian political systems.)
the women. However, as noted previously, the
concept of gender was fluid as were gender
“I like to think of Indigenous leadership in terms of
roles. the relationship between the drummers, singers,
and dancers at a pow-wow. The drummers and
Shared Leadership and Authority singers give voice to the heartbeat of the earth, and
the dancers move to the sound, giving life to their
In almost every North American tribe, personal visions and to those of their people. The
clan or nation, ultimate authority rested with drum prompts and paces. Drummers, singers, and
the group rather than individuals. Power was dancers act together to manifest tradition through
not centralized, compliance was not coerced the songs: all three groups are essential and
and decision-making required consensus. related, the role of each group being to respect and
represent the spirit of the creation in its own way,
The underlying principle of consensus according to its own special abilities.”
was that the best decisions arise out of a
participatory process in which a diversity of (Alfred, 1999:91)
ideas and perspectives are taken into
consideration.
Legacy of the Iroquois League
Communication and consent were the
central tenets of good government. Leaders The Iroquois model of governance and its
were fully accountable to the people through concept of impeachment were worlds apart
transparent, collaborative decision-making from the European tradition, where monarchs,
processes. regardless of their competency, ruled by
“divine right” until death.
The system of women choosing male
chiefs ensured gender equity, respect and In creating a “new” independent
accountability to women, creating balance in government, the Americans categorically
family, community and political life. rejected this European model in favour of the
21
egalitarian principles of the Iroquoian model. mounds. This resulted in less soil lost to rain
(Although they apparently saw no reason to runoff that, in turn, stabilized the soil.
copy the Iroquois in granting women any European farmers in America adopted
political role.) 10 this practice, known as hilling, and followed it
Many aspects of the governance model from early colonial times until the 1930s.
conceived by the Iroquois were borrowed for (When the United States abandoned hilling in
the constitutions of both the United States favour of dense planting, erosion increased
and Canada, as well as for the United Nations dramatically. To this day, thousands of tons of
when it was created in 1945. quality topsoil float down the Mississippi River
The United Nations was first called the system annually.)
League of Nations. It was modeled after the Combining complementary crops and
Iroquois League, granting all members an equal planting in the “hilling” system protected
voice, no matter how small or large the against erosion, insects and harsh weather.
country they represented. Ironically, the
Recent scientific research has proven the
founders of this international body established
effectiveness of combining corn, squash and
its offices in New York, part of the ancestral
homelands stolen from the Iroquois. beans in reducing herbivory —the destruction
of plants by insects and other pests.
Agriculture Because cultivated plants attract
From the beginning of European contact, predatory insects that, in turn, prey upon
Indigenous people, skilled in agriculture, smaller pests, corn loss is reduced without use
willingly shared their ancient practices of of chemical insecticides.
biodiversity with the newcomers. Their Weed-like plants were also grown around
practical, yet innovative, approach to growing the edges of gardens, to attract pests away
and processing plants is now understood as from the crop plants. (Recent studies in
one of the keys to reversing ecological damage Mexico have shown traditional polyculture
in today’s commercial farming (Weatherford, increases corn yields by as much as 50 per
1991). cent over monoculture.)
Some of the best-known plants, originally
domesticated by Indigenous people, are corn, Traditional Medicines
potatoes and tobacco. From the time of first contact, the
Foremost of the ecologically-friendly Europeans recognized the skills of Indigenous
methods they developed was polyculture people in preparing, preserving and
farming — planting crops that are different, compounding medicines. Although European
but complementary, together on a small field medicine, at that time, had not yet progressed
or milpa. beyond alchemy, people of the Americas had
refined countless highly effective medicines
Rather than planting in neat rows to capable of producing both psychological and
allow cultivation, plants were placed in small physiological effects.
10
In addition to governance structure, the American Constitution also “borrowed” the guiding principles of the Great Law of Peace,
such as the Right of Freedom of Speech and the Right of Freedom of Religion/Culture of Happiness, Shelter and Protection.
22
Traditional healers used the roots of By 1820, when the first United States
trees and plants to produce drugs such as Pharmacopeia was published, it listed over
quinine and ipecac, a potent medicine that 200 drugs supplied by “Indians” that
cured otherwise lethal intestinal infections. continue to benefit modern medicine.
(Poison clinics throughout the world still use
this to induce vomiting, but it is most Spirituality
important in treating amoebic dysentery.) Balance and holism are the fundamental
A tonic made from evergreen bark and principles underlying the Native worldview
needles to cure scurvy would later save the and concept of spirituality.The circle, hoop, or
lives of many European sailors. wheel are one of the most sacred Native
spiritual symbols because they express a
The bark of the poplar or willow tree
unifying force in life.
was used to make a liquid for headaches and
other minor body pains. Centuries later, a coal The circle represents balance and
tar derivative was found to contain a similar completeness in the universe within a
active ingredient, salicin, which is now known framework of ongoing cyclical change and
as acetylsalicylic acid or aspirin. transformation.
A cathartic from the bark of the Rhamnus The Medicine Wheel is the symbol of
purshiana shrub was a commonly used how this principle applies in theology,
laxative. Because of its bitter taste, it was philosophy and psychology.
usually mixed with sugar or chocolate. Although many nations have developed
Traditional healers also developed different versions of the Medicine Wheel, all
medicines for the ailments of women. Blue or are based on the four directions and the four
black cohosh, a parasitic plant growing on the seasons or cycles of life.
roots of oak trees, was used as an At the centre of Medicine Wheel
antispasmodic to help reduce menstrual teachings is the concept of Bimaadiziwin or
cramps. Living in a Good Way.This concept
One of the most widely used skin teaches the importance of balance in oneself,
ointments in the world today is known as aspects of all four quadrants of the wheel
petroleum jelly. Traditional healers made (Kulchyski, et. al., 1999).
this salve from olefin hydrocarbons and
methane. Applied to human and animal skin, it
protected wounds, stimulated healing and kept Holism means awareness of and sensitivity to
the skin moist. (It was also used to lubricate the interconnectedness of all things: of people and
the moving parts of tools.) nature; of people, their kin and communities; and
within each person, the interconnectedness of
The proven value and usefulness of body, mind, heart and spirit.
Indigenous cures and medicines were
demonstrated in a series of publications in
early 1800, with such titles as The Indian
Doctor’s Dispensary.
23
The Third Direction is the West: the
Teachings of the Medicine Wheel
direction of Interdependence. The
Applied to the Four Developmental developmental task in this phase is to put the
Stages of Life11 skills that have been acquired and one’s own
The Medicine Wheel or Sacred Hoop special gifts into service for the benefit of
teaches that life is cyclical. Because everything family, community and nation.
occurs naturally in cycles, the potential for The Fourth Direction is the North:
transformation is inherent in all Creation. the direction of Generosity. This is the
Within this worldview, the circle connects direction of the Elders whose developmental
the spirits of all beings and things in a great, task, now that they know they belong and have
sacred whole. When connectedness to any learned and practiced many useful skills, is to
part of the whole is lost or interrupted, the give away their wisdom. This ensures the
sense of sacredness is also lost. As the sacred teachings continue into the next generations.
is the most fundamental of all connections, Disruption of the developmental tasks in
when it is lost, people will destroy others, the any of the four cycles can cause an imbalance
environment or themselves. resulting in a loss of connection to the sacred.
Applied to human development, the The role of traditional people, counsellors
Medicine Wheel teaches of four sequential life and Elders is to help individuals find their own
cycles, each with its own developmental task. A path to restoring balance by reawakening their
special ceremony is attached to each stage to connection to the sacred. Healing work is,
mark and celebrate the changing seasons of therefore, considered sacred work and
life from birth to old age and death. requiring special gifts, characteristics and skills.
The First Direction is the East: the
direction of childhood. The developmental
In this sense, traditional healing is a science,
task in this quadrant is to learn belonging.
an art, a philosophy and a way of life.
By watching and play-acting what adults
do, children learn the place of people and all
things in Creation, as well as their own place Contributions of the First Nations
at the heart of family and community life.
The modern world continues to benefit
The Second Direction is the South: enormously from the contributions of the
the direction of mastery. The developmental First Nation people. In addition to governance
task in this quadrant is learning new skills models and the medicines described earlier,
and behaviours. the following are just a few of many First
Children learn the mental, physical, Nation gifts to modern life:
emotional and spiritual aspects of a balanced • canoe, originally made of bark and pitch;
life by spending time on the land, hunting,
fishing, trapping, canoeing and kayaking; • toboggans, invented by the Mi’kmaq of
through storytelling, ancient legends and what is now Eastern Canada for hauling
through ceremonies. game, moving camp and traveling;
11
These teachings are from an undated taped lecture by Dr.Terry Tafoya, titled Values, Attitudes & Beliefs.
24
• snowshoes of many different types were In 1900, 48 per cent of First Nation
first invented by Aboriginal people; children between the ages of 6 and 15 were
• hundreds of pharmaceuticals derived enrolled in these schools (Dickason, 2002).
from original native remedies are still used According to the Indian Residential
widely in treating dysentery, cholera, upset Schools (IRS) Data Project (INAC, 1998), it is
stomach, diarrhea and scurvy; also, aspirin, estimated that 105,000 to 107,000 Aboriginal
petroleum jelly and cough syrup made individuals who had attended residential
from balsam and honey; schools were still alive in 1991. Of these, 80
• more than 100 species of plant per cent were status Indians, 6 per cent were
grown today were originally grown non-status Indians, 9 per cent were Métis and
by Indigenous people. Corn, squash 5 per cent were Inuit.
and potatoes are some of the best
known of these plants that are now grown
worldwide.The Huron cultivated 17
varieties of corn or maize and eight
varieties of squash. (Popcorn and corn
syrup have become favourite foods);
• wild rice is actually a cereal grain
mistakenly called rice by the Europeans
because of its rice-like shape. This was an
especially prized delicacy, often presented
as a gift or token of friendship;
• games, such as lacrosse and lawn darts,
originated with the First Nations;
• chewing gum, originally made from
spruce trees;
• ginger ale, originally a remedy for upset
stomach, is still widely used as a tonic as
well as a soft drink; and
• sunflowers were cultivated for the
nutritional value of the seeds.
First Nations and Residential Schools12

Residential schools were established in all
provinces and territories, except for Prince
Edward Island and New Brunswick, as a means
of assimilating “Indian” children into Canadian
society.
12
See also Section II: Residential Schools.
25
Post-Contact History
Emergence of the Métis
Although racial “mixing” began from the Their distinctiveness from both First Nations
time of first contact with Europeans, a distinct and European culture was marked.
Métis identity did not emerge until early in the When the Hudson’s Bay Trading Company
eighteenth century when the fur trade was defeated the Northwest Trading Company in
well established (Dickason, 2002). early 1800, it established a settlement at the
The word Métis comes from the Latin junction of the Red and Assiniboine rivers in
miscere, which means “to mix” and was used Manitoba to promote its interests in the fur
originally to describe offspring of Algonquin, trade.With Hudson’s Bay Company approval,
Ojibwe and Cree women, and the French and Métis joined this settlement, where they
Scottish fur traders. Other terms for these combined subsistence farming with bi-annual
biracial children included: country-born, Black buffalo hunting.
Scots, Bois brules and Half-breeds.
From the eastern coastal regions across The Art and Science of the Hunt
to Hudson’s Bay and the Great Lakes, English, Buffalo hunting was a dangerous and
Scottish and French crews of fishing, trading or complex undertaking that required a broad
exploring expeditions paired with Native range of skills and military-type precision
women. In what was then New France, both planning.
the Church and the Crown encouraged such
interaction as a way of bolstering the The hunts, held each year in late summer
French/Native population and strengthening and, again, in winter, were highly organized
French claims to the land. events involving men, women and children.The
distinctive, two-wheeled Red River carts were
With the expansion of the fur trade, designed by the Métis to haul the belongings
these men moved westward, intermarrying of the families, as well as meat and hides, to
with Cree and Ojibwe women. Gradually, the and from the location of the hunts.
coureurs de bois became of mixed heritage. By
mid-1800, a large population had congregated Before each hunt, a General Assembly
in the Great Lakes region. was held to select officers and ensure
everyone knew and agreed to abide by
With competition becoming fiercer established rules of order to ensure
between the Northwest Trading Company everyone’s safety.
based on the Pacific Coast and the Hudson’s
Bay Trading Company based in the interior, As a first step, the assembly chose ten
many French coureurs de bois moved even capitanes who, in turn, selected ten soldats
further westward to seek their fortune in the each, as well as ten guides from among
fur trade. hunters past their prime. The most skilled of
the capitanes became the leader of the hunt
Métis leader Louis Riel (1844 to 1885) whose role was styled after a combination of
estimated that, by mid-1800, one-quarter of “War Chief” and “le President.”
the Native population of the West was Métis.
26
Over the course of the hunt, each guide
Spirituality
and captain commanded for a day, ensuring
that for each ten-day cycle, all guides and Historically, many Métis of French and
captains had an opportunity to experience the Catholic ancestry expressed their spirituality
leader’s role. through strong ties to the Roman Catholic
faith. Although many also retained aspects of
An elaborate choreography of riders on
their First Nation spiritual traditions,
horseback and the sequential positioning of
Catholicism largely influenced social customs
coloured flags signalled progression of the
and controls. Métis communities routinely
hunt from one stage to the next.
sought guidance from their priest for
During the sighting phase, two soldiers marriage, divorce, family disputes, births,
always rode together.Whether they rode deaths and legal issues.
towards or away from each other indicated to
This familiarity with Roman Catholic
the others the presence of buffalo. At sighting,
customs would later bring comfort to Métis
the hunt flag flying above the cart of that day’s
children in residential schools who found
guide was lowered, signalling authority had
consolation in the religious teachings and
been passed from guide to hunt leader.
songs of their family and community life
Changing gaits and directions of the lead (Logan, n.d.).
horses, as well as riding and flag patterns for
the chase and cool down were all part of the
Resistance and Rebellion
visually stunning, complex choreography of the
buffalo hunt. (This choreography became the The most famous Métis leader was
prototype for what is now known as the Royal Cuthbert Grant (1793 to 1854), called “White
Canadian Mounted Police “Musical Ride.”) Ermine” by the Cree. In 1816, Grant led an
armed confrontation at a place called Seven
By the summer of 1840, the buffalo hunt
Oaks against settlers who had encroached on
consisted of over 1,200 Red River carts, 620
lands the Métis considered their own (Ens,
hunters, 650 women and 360 children (Ens,
1996).
1996).
The victory at Seven Oaks was a
Role of Women watershed event, generating a sense of unity
and nationalism among the Métis.
Women played a crucial economic role in
Later, in the Sault Ste. Marie area of
Métis culture. They produced clothing and
Ontario, property rights again sparked an
footwear for trade, tanned hides, trapped and
armed battle against prospectors in search of
traded furs, dressed furs for shipment, grew
copper who had overrun Métis lands. In 1849,
vegetables, fished, built smoking lodges;
armed resistance against these trespassers
smoked fish, as well as buffalo, for pemmican
resulted in some Métis names being included
and produced and sold large quantities of a
in the Robinson Treaties of 1850.
dried fish gelatin—isinglass.
The creation of the Dominion of Canada
in 1867 marked the transfer of lands
previously “owned” by the Hudson’s Bay
27
Trading Company. These lands now became increased in significance. By the mid-nineteenth
part of the new country under the authority century, Métis had become renowned
of a British lieutenant governor. lumberjacks and their expertise driving logs to
Louis Riel defied the authority of this market was much sought after.When timber
new government and established his own resources were depleted, new opportunities
provisional government in Manitoba to secure arose in the mining industry, where Métis
the economic and political interests of Métis continue to be employed in large numbers.
in the West.
Traditional Medicine
Negotiations between Riel’s government
and the Canadian government led to the Traditionally, the Métis lived in harmony
passing of the Manitoba Act in 1870 that, with nature and knowledge of the healing
among other things, reserved 1.4 million acres qualities of plants, roots, bark, flowers, fruits,
of land for the children of “half-breed heads of leaves, oils and seeds were passed from
families” (Ray, 1996:200). Later, the generation to generation. Medicinal teas,
government would evict Métis from these salves, poultices, liniments, preparations and
lands to create national parks and sell parcels foodstuffs were used to prevent and cure
of the land to speculators. illness and to treat injuries.
When the rights they had negotiated in
good faith through the Manitoba Act failed to The Metis and Residential Schools
materialize, the Métis launched the The Métis fell outside of the plans made
Saskatchewan Rebellion of 1885. by the Canadian government for people of the
The Métis were defeated on the First Nations, including educational provisions
battlefield at Batôche on May 12, 1885 and such as residential schools. Stripped of their
their leader, Louis Riel, was subsequently hung land, as well as hunting and trapping rights,
for treason. Although these events delayed the many Métis became increasingly impoverished.
quest for justice for almost half a century, the The close link between Métis and the
Métis refused to abandon their identity as a Roman Catholic Church, and the pressure to
distinct people or their vision of self- fill up the schools in order to receive more
government. government funding, prompted some bishops
The disappearance of the buffalo herds and priests to pressure the government to
due to over-killing created an economic crisis include Métis children in residential school
in western Canada. Métis in this region were policy.
starving, while continuing to struggle for their Initially, the government opposed this
rights to land and political representation. recommendation, though a policy was
eventually developed to admit Métis to these
Economy and Employment schools only when there were not enough
“Indian” students and where the Métis families
Although born of the fur trade, Métis
were living “in varying degrees, the Indian
existence was not bound to it and gradually
mode of life” (Logan, n.d.:18). Finally, in 1952,
other staples, such as timber and mining,
28
the provinces began paying for Métis students
Métis Today
to attend residential schools.
Métis is a completely distinct culture
Because Métis children were either
from First Nations and Inuit.This was formally
recorded as “half-breeds” or not recorded as
recognized in the 1982 Canadian Constitution,
enrolled at all, actual enrolment numbers are
which included Métis in the definition of
difficult to confirm. It is estimated that 18.8
“Aboriginal Peoples” (although Métis remain
per cent of the students in residential schools
excluded from all benefits under the Indian
were Alberta Métis, 15.7 per cent were
Act).
Manitoba Métis and 8.1 per cent were
Saskatchewan Métis.When combined with According to the 1991 Aboriginal Peoples
non-Status Indian records, the number increases Survey, the majority of Métis (99,00013 or 74
to 25 per cent in Alberta, revealing that one- per cent of the total population) live in the
quarter of the total population of residential Prairie provinces with the remaining 26 per
school students in Alberta were Métis. Overall, cent in Ontario, British Columbia and Quebec.
9.12 per cent of self-identified Métis in Canada Contemporary researchers describe
report attending residential schools (Daniels, difficulties of identifying Métis through
2003). historical records. Overwhelmingly, these
Three Alberta residential schools were records refer to Métis as half-breed or non-
located in areas with high Métis populations. Treaty (Daniels, 2003).
They were: Grouard-St. Bernard’s Indian The Métis National Council defines a
Residential School, Fort Vermillion-St. Henri Métis person14 as someone who:
Indian Residential School and Joussard-St.
Bruno Indian Residential School. • can trace their lineage back to the
traditional territory of the Métis Nation in
The school located in an area with the west central North America;
highest Métis population in Saskatchewan was
Qu’Appelle Indian Residential School and, in • is distinct from other Aboriginal peoples;
Manitoba, the Elkhorn Indian Residential and
School. • is accepted by the Métis Nation and self-
Although Métis children lived under the identifies as a Métis citizen.
same conditions as First Nations and Inuit in
residential schools and suffered the same Language and Cultural Symbols
intergenerational impacts, one aspect of their
experience was unique. In addition to the The mixed blood of the Métis is reflected
abuses and deprivations endured by other in the Michif language and cultural symbols
children, both First Nation and non-Aboriginal that are a synthesis of European and First
students and staff regarded the Métis as Nation traditions.
outsiders. Michif is a mixture of French nouns and
noun phrases tied to the Cree verb system.
Other First Nation languages, such as
13
The Métis National Council puts population figures much higher at approximately 350,000 for Canada as a whole.
14
Presently, each of the provincial Métis governments are in the process of creating an agreed-upon definition.
29
Assiniboine and Ojibwe, in addition to English • black, the dark period of repression and
phrases, contribute to the vocabulary. dispossession.
Cultural symbols of the Métis today
include the Métis flag, the Métis sash, the Red
River Cart and distinctive music and dance.
The Métis flag is the oldest Canadian
patriotic flag, predating Canada’s Maple Leaf
flag by 150 years. First used by Métis prior to
the Battle of Seven Oaks in 1816, the flag The Red River cart first made its
depicts a white infinity symbol horizontally appearance in early 1800, evolving over time
placed against a blue background, symbolizing from a small 3-wheel horse-drawn cart to a
an eternal, seamless interaction of two distinct much larger, many-spoked, 4-wheel vehicle by
cultures: that of the Europeans and that of the the turn of the century.
First Nations.
The sash is a finger woven, woollen belt Métis music is a fusion of Aboriginal and
approximately three metres long.Traditionally Celtic rhythms and songs expressed on the
made to tie a coat closed at the waist, it is fiddle. Although Scottish strathspeys, reels and
now worn ceremonially either over the hornpipes were mainstays, these were
shoulder or around the waist. gradually replaced by music written to express
the unique sentiments of Métis people.
The colours of the sash represent
historical aspects of Métis culture and The music is accompanied by dance, also
history:15 originating in the Scottish Highlands but
performed at a much faster rate, when Métis
• red symbolizes the blood that was shed families and communities gather at revaillon to
fighting for justice; celebrate.
• blue indicates depth of Métis spirit;
• green denotes the fertility of a great Contemporary Issues
nation; As Métis are under the jurisdiction of
• white represents the connection to the provincial governments that have not kept
Earth and Creator; Métis-specific data, and as the federal
government does not have a way of identifying
• yellow represents the potential for
and tracking Métis health or social trends, it is
prosperity; and
difficult to concisely describe the situation of
Métis using accurate statistics.
15
Thanks to Don Fiddler of the Métis Nation of Ontario for providing much of the information in this section.
30
Data from the Aboriginal Peoples Survey On July 1, 1990, the Métis settlements
(1991) highlights the following:16 and the Alberta government signed the Métis
• 17 per cent of the Métis population over Settlements Accord, establishing the only form of
age 15 have less than grade 9 education, legislated Métis government in Canada and
compared with 13.9 per cent of the providing a framework for negotiating land and
general population; self-government. Some highlights of this
accord include:
• 3.6 per cent of the Métis have a university
education, compared with 5.1 per cent of • 1.28 million acres of land were transferred
the First Nations and 11.4 per cent of the to the ownership of the Métis;
general population; • constitutional protection of lands was
• 65.3 per cent are employed; provided; and
• of those employed, the average income is • co-management agreement established

$16,853; between the province of Alberta and the
Métis for long-term management of
• the rate of unemployment is 20 per cent; resources.
and
After a decade of struggle, the efforts of
• of those employed, 60 per cent earn the Métis Nation of Ontario, on behalf of
$10,000 per year or less. Métis hunter Steve Powley, were successful. In
2003, a landmark decision of the Supreme
Cultural Reclamation Court of Canada affirmed the inherent hunting
rights of Métis as Aboriginal persons under the
The Métis have played an important role Constitution.
in the development of Canadian society and,
increasingly, their special status and rights are
being recognized at provincial and federal
levels.
The Métis National Council, established
in 1983, represents elected members from
provincial Métis organizations in the three
Prairie provinces, as well as Ontario and
British Columbia.The Métis Association of the
Northwest Territories is separate from the
national organization, and Métis in Quebec and
the Eastern provinces are generally
represented through First Nations political
bodies.
16
Source: Norris, Mary Jane, Don Kerr and François Nault (1995). Projections of the Aboriginal Identity Population in Canada,
1991-2016", research study prepared by Statistics Canada for RCAP. Found in Table 7.1 Comparison of Aboriginal Identity and
Non-Aboriginal Populations in Urban Off-Reserve Areas, 1991. In Royal Commission on Aboriginal Peoples (RCAP) (1996).
Volume 4: Perspectives and Realities. Ottawa, ON: Minister of Supply and Services Canada, p. 572.
31
Aboriginal People Today
According to the 2001 Census, over 1.3 • Siouan,
million people or 4.4 per cent of the Canadian • Tlingit,
population self-report Aboriginal ancestry.17 • Tsimshian and
However, as many researchers have • Wakashan.
noted, the accuracy of this data is seriously
undermined by the following factors: Challenges Facing Aboriginal People
• many reserves (also called First Nations) • Sixty per cent of the Aboriginal population
were incompletely enumerated in the Census; is under the age of 25 years;
• many “registered Indians” refuse to report • almost one-third of Aboriginal people over
and/or identify and/or participate in the the age of 15 years have a disability
enumeration process; (double the national rate);
• Aboriginal people make up a significant • the rate of diabetes is among the highest
portion of Canada’s homeless population, in the world—the risk of death from
which is not included in the enumeration; diabetes is 4 times higher for Aboriginal
and women and 2 times higher for men;
• many people of Inuit, Métis and First • there is a higher rate of injury and death
Nation descent do not self-identify. due to accident—4 times greater for
infants, 5 times greater for preschoolers
Taking these factors into account,
and 3 times greater for adolescents;
researchers estimate the total number of
Canadians of Aboriginal ancestry is likely • more than 50 per cent of Aboriginal
under-reported by anywhere from 60,000 to children live in poverty;
120,000. • infant mortality is double the national rate;
• the unemployment rate for Aboriginal
Language people is 3 times that of other Canadians;
There are over fifty distinct Indigenous • 26 per cent of Aboriginal adults have less
language groups in Canada today. The main than Grade 9 education. In older adults
ones are: aged 50 to 64 living off-reserve, 44 per
• Algonkian, cent have less than Grade 9; and
• Athapaskan, • 3 per cent of Aboriginal people have
• Inuit, completed a university degree compared
• Haidan, with 12 per cent of other Canadians.
• Iroquoian,
• Kutenaian,
• Salishan,
17
Aboriginal Peoples of Canada: A demographic profile, Statistics Canada.
32
Section II:
Section II
Residential Schools
Section II:
Residential Schools
The Following is a Chronology of Indian residential schools similar to the United
Residential School Policy in Canada:18 States model. He further recommends funding
The Aboriginal Healing Foundation off-reserve boarding schools to teach children
defines “residential school” as the “Residential the skills needed in the modern Canadian
School System in Canada attended by economy and advises the government to
Aboriginal students. It may include industrial consider boarding schools rather than day
schools, boarding schools, homes for students, schools. Residential schools, it was reasoned,
hostels, billets, residential schools, residential would be more successful because they could
schools with a majority of day students, or a completely remove children from their “evil
combination of any of the above” (Aboriginal surroundings” (Fournier and Crey, 1997:55).
Healing Foundation, 2001:5). Not only was it commonly believed at
1845: A government report to the legislative the time that the “savage” Indian needed to be
assembly of Upper Canada recommends “civilized,” but, in the opinion of many church
boarding schools be set up to educate Indian and government officials, the best way to do
children. this was to bring children completely under
the control and influence of the church-run
1847: The assistant superintendent of Indian boarding schools. At these schools, children
Affairs writes to Dr. Egerton Ryerson, could be fully indoctrinated in the ways of
Methodist head of education in Upper Canada, mainstream Canadian society (Fournier and
asking for suggestions in how to set up Indian Crey, 1997).
industrial schools. Ryerson suggests there be
a partnership between government and church 1892: The Government of Canada passes an
and that the schooling be of a religious nature. order-in-council regulating the operation of
Indian residential schools.The federal
1863: A Roman Catholic residential school is government and churches enter into a formal
established at St. Mary’s Mission in Mission, partnership to run a school system for Indian
British Columbia by Oblate Father Florimond children.
Gendre.
1892 to 1969: The partnership between the
1867: The British North America Act is enacted; government of Canada and the churches
Indian education becomes a federal lasted from 1892 until 1969.The Roman
responsibility; and Indian day schools are set Catholic Church, Church of England, United
up. Church and Presbyterian Church ran the
1879: Nicholas Flood Davin is commissioned schools that operated in all provinces except
by Prime Minister John A. Macdonald and sent New Brunswick, Newfoundland and Prince
to the United States to investigate and report Edward Island.
on Indian industrial training schools. Davin’s
report recommends the establishment of
18
For further information, see the Residential School Update published by the Assembly of First Nations Health Secretariat, 1998.
33
From 1969 to 1996, when the last
Third Phase: 1951 onward
school closed, the Government of Canada
assumed responsibility for the schools. Integration: Aboriginal children began to
be absorbed into mainstream schools and
Federal government policies concerning
residential schools increasingly came under
the education of Aboriginal children are
secular administration.
characterized by three distinct historical
phases (Assembly of First Nations, 1998). Programs and activities similar to those
provided in mainstream schools for Euro-
First Phase: Mid 1800s to 1910 Canadian children were emphasized.
Until 1910, the federal residential school 1990s: The last residential school, Akaitcho
policy was openly and aggressively assimilative. Hall in Yellowknife, Northwest Territories,
Residential school curricula primarily aimed to closes.
prepare First Nation children to join the 1992 to 1993: The Nuu-chah-nulth Tribal
“lower fringe of the dominant society” Council in British Columbia begins a research
(Dickason, 2002:315). study of the effects of residential schooling on
There were two basic strategies for their community.They identify a range of
furthering the goal of assimilation: physical, sexual and psychological abuses.
1. Isolating Aboriginal children from 1994: In November, the Royal Canadian

mainstream society as schoolteachers and Mounted Police review the research files of
missionaries taught them the skills to the Nuu-Chah-Nulth Tribal Council. As a
effectively function within it; and result, the “Native Residential Task Force” is
created with an investigative mandate to
2. Placing Aboriginal children among examine all Indian residential schools in British
European-Canadians to learn their Columbia operating between 1890 and 1984.
behaviours, customs and social graces. The Assembly of First Nations releases its
report on Residential Schools titled Breaking
Second Phase: 1910 to 1951 the Silence.
Segregation: Aboriginal children were 1995: Arthur Henry Plint, former supervisor
streamed into residential and day schools of the Alberni Indian Residential School (1948
designed to ‘civilize and christianize’ them in to 1953 and 1963 to 1968) pleads guilty to 16
accordance with Euro-Canadian values. The counts of indecent assault and is sentenced to
goal was for the children to return to their 11 years in prison.
home communities and, in turn, teach these 1996: The Report of the Royal Commission
same values to their families and communities. on Aboriginal Peoples is released in
During this phase, the government delegated November. It includes three recommendations
responsibility for daily operation of residential specific to residential schools. Foremost
schools to four major churches in Canada: among these is a call for a public inquiry on
Roman Catholic, Anglican, United and the effects of residential schools on
Presbyterian. generations of Aboriginal people. It also
34
recommends creating a national repository of person that may utilize techniques, including
residential school records. but not limited to, conditioning, mind control
1997: In late June, John Watson, British and torture.
Columbia’s highest-ranking Indian Affairs
official, is the first government of Canada “Some clients who use dissociative defences
representative to admit that residential extensively report experiences of extremely
schools were part of an assimilatory policy of disturbing events. Their trauma stories are of
the Canadian government. intentional cruelty, malevolent intent, multiple
perpetrators, abusive activities by groups of
1998: Gathering Strength, the Canadian people, and abuse that occurs in the context of
government’s response to the elaborate rituals with or without religious content.
recommendations of the Royal Commission Hearing these stories can stir strong feelings (and
on Aboriginal Peoples is released, announcing sometimes doubts) in the minds of the listeners.”
the creation of a one-time $350 million (Saakvitne, et. al., 2000:23)
healing fund to address the impacts of
residential school abuse.
Biderman’s Chart of Coercion identifies
In March of 1998, the Aboriginal Healing eight conditions or tactics of power and
Foundation is established.The vision of its control that, together, characterize ritualized
Board of Directors is: abuse (Russell, 1982):
1. Isolating victims by depriving them of their
“Our vision is one where those affected by the usual social supports and the ability to
legacy of physical abuse and sexual abuse resist, making them completely dependent
experienced in residential school have addressed upon the captor;
the effects of unresolved trauma in meaningful 2. Monopolizing the perception of victims by
terms, have broken the cycle of abuse, and have eliminating any stimuli not controlled by
enhanced their capacity as individuals, families, the captor and punishing non-compliance;
communities and nations to sustain their well being 3. Inducing debility and exhaustion in victims by
and that of future generations.”
weakening their mental and physical ability
(Aboriginal Healing Foundation, 2003:10) to resist;
4. Continual threats against victims to induce
anxiety, helplessness and compliance;
5. Granting occasional indulgences as positive
Abuse in Residential Schools motivation for compliance and to prevent
Increasingly, many Aboriginal therapists complete adjustment to deprivation;
and frontline workers describe the abuse that 6. Demonstrations of the omnipotence and
occurred at residential schools as ritual or power of the abuser by demonstrating the
“ritualized” abuse. futility of any resistance;
7. Degradation and humiliation, making the
Contemporary trauma literature defines costs of resistance more damaging than
ritualized abuse as repeated, systematic, compliance; and,
sadistic and humiliating trauma to the physical, 8. Enforcing trivial demands to ensure that
sexual, spiritual and/or emotional health of a total compliance becomes habitual.
35
Using these eight characteristics as a • if the nuns did not like a child, it further
framework, participants at an Eastern Ontario isolated that child;
retreat for Aboriginal frontline workers, • uniform clothing, haircuts and language
counsellors and Elders generated the following fostered feelings of anonymity; and
examples to illustrate the ritualized nature of
abuse in residential schools. • children who were assertive or showed
independence were a “pariah” to nuns
The examples described below are drawn and students.
from personal experiences of the participants
who attended residential or day schools or
from the stories told to them by family Examples of Monopolization of
members who attended these schools.19 Perception
• The priests, sisters and their spiritual
Examples of Isolation symbols became your foes—you had to
believe in their god;
• Children were taken away from family,
community, extended family, from spirit of • children were given continual messages of
place and familiar language, from the land POWER AND CONTROL and EVIL VS.
and their natural environment, and placed INNOCENCE: the abusers had the power
in a foreign environment; of either damnation or “saving the
savages;”
• children were separated by gender at the
schools; • authority was their god and the school
was their world;
• siblings were either sent to different
schools or separated within the same • there was continuous degrading or
institution; “shaming” of traditional/cultural ways, as
well as of individual children and their
• family contact through letters or visits
“heathen” families;
from family or siblings was forbidden;
• children forgot the concepts embedded in
• isolation rooms or solitary confinement
their own languages and religious practices;
were forms of punishment for children;
• there was mental, physical, spiritual and
• emotional needs of children were seen as
emotional suppression;
evidence of “sickness;”
• sexually abused children were made to
• some parents died while their children
pray after the abuse for the abusers “lost
were away at the schools and the
souls;”
children were not told or allowed to
return for the funeral ceremony; • children were taught everything about
native culture is wrong/bad (symbols,
• children were transported across far
songs, dances medicines, Elders, toys)—
distances;
only non-Indian culture is good;
• children were left alone to deal with
bullies or victimization;
19
Note: these examples were provided on flip charts; certain words are capitalized or put in quotations at the request of
participants.
36
• children were punished for individuality or • children endured years of emotional
self-expression: children were forced to deprivation—received no love or
believe the abusers’ version of right and comfort;
wrong; • talk, touch and interaction were
• children were made to look “not-Indian” forbidden—kids were put together who
by being scrubbed with iron brushes, dark could not speak a common language;
hair cut off and dressed in “white” clothes; • children endured years of sensory
• girls were made to feel ashamed of their deprivation;
maturing bodies through binding of • the environment was completely
breasts; regimented, time schedules were very
• children saw things that even a child knew structured; there was little free time and
were wrong, but were helpless to do no time to slow down or process what
anything about them; and was happening or form opinions;
• choices did not exist. • children were used in experimentation
with various diets to determine effects;
Examples of How Debility and Exhaustion • when children became ill, their form of
Were Induced in Children “health care” was to be put in isolation;
• Children lived in continual fear of • room checks were conducted during the
complete denial of rare privileges; night and early in the morning;
• children spent their whole childhood in • children were forced to bury the bodies
continual fear of further punishment and of other child residents who had died;
abuse; • all forms of ABUSE were perpetrated on
• children were deprived of food, sleep, children: sexual, physical, emotional and
warmth and other basic human spiritual abuse.
necessities as a form of punishment;
• children endured cold buildings and Examples of Threats Against Children
“disgusting” food; • If you tell anyone about the abuse:
• hard labour and religious regimes were - you will never see your family again,
hard on children, such as early morning - you will lose visitations/mail,
mass, standing or kneeling in corners or - you will not be fed,
on hard floors for hours; - you will be hurt even worse,
• children were used as “slave labour” and - you will die,
given adult-level chores, constantly - you will go to hell, and
working and cleaning to the point of - no one will believe you;
exhaustion; • children were threatened with torture
• children were stressed out; forced to for disobedience, such as having mouths
endure long hours of work and study scrubbed out with Ajax;
regardless of their state of health;
37
• children were threatened that if they did • even the manner in which the priests and
not do chores satisfactorily, they would nuns walked around was intimidating;
get even more or worse chores; • children were taught Aboriginal people
• children were threatened with further have no voice in anything and no choice
degradation, such as shaved heads or because whites are the best and natives
removal of clothing in front of peers; are the savages;
• children were threatened with losing day • the teachers have all the power and
trips; and control so they eat and dress better;
• the threat of punishment was constant. • children did the labour (i.e., knitting) and
the children’s work was sold, but no
Examples of Occasional Indulgences money went to the children;
• If everyone is good, there will be ice • everyone had to stand up when the
cream, fresh dairy products, sweets or a priest walked in the room;
trip to the movies; • priests and nuns were role models, so
• infrequent day trips for older students; the goals and dreams of some children
were to become clerics;
• there was a special meal at Christmas or
Easter; • no one could escape without
consequences and punishment; and
• some children were allowed to return
home in summer; • they (priests and nuns) could see
everything we did.
• during school inspection times, there was
good food, a homey atmosphere was
created and children were dressed up
Examples of Degradation
nice; • There was name-calling and put-down of
• children who were teachers’ “pets” kids, parents, culture and language;
received special privileges in front of • children were forced to wear dirty or
peers; soiled clothes as punishment;
• small gifts were given “by God;” • sick children were forced to eat their
• children got bread instead of dog biscuits; own vomit;
• children got sexual touching as • children were hit while eating;

“nurturing;” and • children were forced to crawl at the feet
• one day a year, there was a picnic. of nuns and priests;
• children were forced to wear diapers for
Demonstration of Omnipotence bed-wetting;
• There was blind obedience within a chain • children were taught women were below
of hierarchy—a pecking order; men in all things;
38
• the lighter-skinned kids got more positive Inuit, First Nations and Métis cultures
treatment; were considered, at best, irrelevant and, at
• children were physically beaten in front worst, uncivilized and savage. The practical
of the whole school, held down by the wisdom of their teachings and long-held
hands and feet with pants pulled down; customs, such as cooperation, sharing, balance
and and respect, were not recognized or
understood by Euro-Canadians. As a result,
• there was different food for children policies were created and implemented that
from what the nuns ate. had devastating long-term impacts on
Aboriginal people.
Examples of Enforcing Trivial Demands Policies, such as those in Canada that
• Every little thing had to be cleaned, i.e., supported the aggressive assimilation of
forced to clean the already clean toilets, Aboriginal children through residential
over and over again; schooling, are now characterized as examples
of ethnocide or as genocide.
• children were forced to follow rules for
genuflecting (to bend at the knee in a The Fourth Geneva Convention of the
servile gesture of respect), walking in United Nations (1948) describes genocide as
straight lines and protocols for follows.
addressing priests;
• children were forced to clean floors with
“...acts committed with the intent to destroy, in
a toothbrush as punishment; and
whole or in part, a national, ethnic, racial or
• there was continuous MILITANT religious group.”
SURVEILLANCE. (United Nations, 1948:1)
These multiple, ritualized forms of abuse
perpetrated against Aboriginal children over The convention bans a number of acts of genocide
including taking group members’ children away
many generations were made possible by
from them and giving them to members of another
convincing Aboriginal people the savagery of group.
their culture and their need to be civilized.
Reflections on Multiple Trauma Ethnocide is “the deliberate attempt to

eradicate the culture or way of life of a
Fully understanding the impacts of the people. Ethnocide depends on the use of
abuse suffered by Aboriginal children in political power to force a relatively powerless
residential schools by the adults responsible people to give up their CULTURE and is
for their care and education requires widening therefore characteristic of colonial or other
the lens and viewing this abuse within a larger situations where coercion can be applied”
context. Worldwide, the approach of (Barfield, 1997 cited in Legacy of Hope
colonizing countries to Aboriginal cultures was Foundation, 2003:18).
remarkably similar. Britain’s approach (and
later the Commonwealth of Canada) was no
exception.
39
Historical trauma is another contemporary having a history of child sexual abuse (Health
concept that helps put the long-term impacts Canada, 1993). A Save the Children Canada
of residential schooling into a larger context. report on Aboriginal children estimates 90 per
Historical trauma refers to traumatic cent of all child prostitutes in Canada are of
experiences that are cumulative over the life Aboriginal descent.
span of individuals, as well as across A 1990 survey of native treatment
generations. In one of her articles, Dr. Maria centres across Canada revealed that 80 to 95
Yellow Horse Brave Heart describes per cent of their clients were victims of sexual
“Intergenerational Trauma and Historical Grief abuse. According to this survey, employees of
in American Indians” as follows: these programs now see “alcohol and drug
addiction[s] ‘merely as symptoms’ with sexual
abuse as the underlying cause” (Fournier and
“Historical trauma [is] the collective emotional Crey, 1997:116).
and psychological injury both over the life span
and across generations resulting from a Many abusers shift the blame away from
cataclysmic history of genocide.” themselves, where it belongs, and place it on
the child, by telling the child the abuse is his or
(Ottenbacher, n.d.:2)
her own fault. Survivors often continue to
hold the distorted belief they are responsible
The urgent health and social problems of for the abuse perpetrated against them,
Aboriginal people in Canada are now believed causing feelings of extreme guilt and self-
to be directly related to multiple generations blame.
of children who were not only abused in
residential schools and disconnected from
“Recruiting the victim into a sense of responsibility
their families and communities, but were also for the abuse is often an important strategy that
taught to feel shame in their heritage, enables abuse to continue.”
language, customs and spiritual traditions.
(O’Leary, 1998:31)
Child Sexual Abuse: Facts to Consider20

For many years, the justice system of
“Many Survivors (estimates are as high as
North America enabled such abuse to
50%) do not remember the abuse until years
continue by fostering the (mis)perception that
after it has occurred” (Health Canada, 1993:2).
the complaints from children, especially of
Often, something in adulthood will trigger the
child sexual abuse, are invalid.
memory; many are never able to fully and
clearly recall the abuse. Writers exploring the origins of these
misperceptions (Brownmiller, 1975; Herman,
Numerous studies have underscored the
1997) refer to the defining text on courtroom
relationship between child sexual abuse and
procedure. The Treatise of Evidence of 1940 was
adolescent/adult prostitution with estimates
instrumental in creating and sustaining a
ranging from 76 to 90 per cent of prostitutes
climate of doubt about the credibility of
20
This information was taken from the fact sheet titled Adult Survivors of Child Sexual Abuse, National Clearing House on Family
Violence, 1993.
40
victims by making victim credibility a central The churches involved in residential
focus of courtroom procedure. schools have now all apologized for this
tragedy.The first to issue an apology was the
United Church of Canada in 1986, followed by
“Modern psychiatrists have amply studied the the Missionary Oblates of Mary Immaculate
behavior of errant young girls and women coming (Roman Catholic) in 1991, the Anglican
before the courts in all sorts of cases. Their Church in 1993 and the Presbyterian Church
psychic complexes are multifarious, distorted
in 1994. In 1997, the Canadian Conference of
partly by inherent defects, partly by diseased
derangements or abnormal instincts, partly by bad
Catholic Bishops issued a statement of regret,
social environment, partly by temporary which was echoed by Pope John Paul II in
physiological or emotional conditions. One form 2000.
taken by these complexes is that of contriving false One painful outcome of this history is
charges of sexual offenses by men.” that many Aboriginal individuals, families and
(Brownmiller, 1975:370) communities have learned these lessons well
and may use these tactics against each other
through lateral violence.
Summary Lateral violence is described as “the
shaming, humiliating, damaging, belittling and
This section is provided to foster sometimes violent behaviour directed toward
understanding, from an Aboriginal a member of a group by other members of
perspective, of the type of power and control the same group” (Middleton-Moz, 1999:116). It
tactics used against children at residential is seen most often in oppressed groups who
schools.The toxic mixture of physical and have been rendered helpless to fight back
sexual abuse, combined with racist cultural against a powerful oppressor and who
denigration and religious fundamentalism or eventually turn their anger against each other.
fanaticism, proved highly traumatic for
Aboriginal children who attended these The widespread lateral violence in many
schools, as well as for their descendants. Aboriginal families, communities and nations
today must be acknowledged and addressed as
Although there are remarkable part of any effective plan for long-term healing.
similarities in the types of abuse at residential Examples of lateral violence include gossip, put-
schools across Canada and although many of downs, competition, family feuds, family violence,
these abuses correspond with the eight elder abuse, violence against women, bloodism
techniques of coercion illustrated in this (see footnote #23 for definition) and gangs.
section, this is not to say that ritualized abuse
was intended. Although residential schools have now
disappeared from the Canadian landscape,
However, as the overview of other tactics of power and control against
assimilationist policy shows, the tactics of Aboriginal people have not.
disconnection and shaming were deliberately
undertaken to further the goal of civilizing the Aboriginal people in Canada continue to
savages. Such strategies are now understood as be trapped by social, political and economic
genocide or ethnogenocide. policies that promote dependency by
preventing self-determination.
41
Healing in a larger cultural context,
therefore, requires a commitment to fostering
social, political and economic conditions of re-
empowerment: a politics of healing.
42
Impacts of “Aggressive Assimilation” and
Traumatic Disconnection
The Indian Act and Residential Schooling: comfortless and, at worst, unremittingly cruel
The Long Shadow of Colonization and inhumane.
in Canada
Humiliation and Shame:Tools of
In Canada, Sections 113 to 122 of the
Indian Act legally removed the rights of “Aggressive Assimilation”
Aboriginal parents to their children, giving the To further the process of assimilation,
government total control over the children’s children were taught shame in their families
lives. and in spiritual traditions that had spanned
For over a century, under the authority of over thousands of years.To sever their ties to
Indian agents and enforced by the Royal their cultures, they were taught lies about the
Canadian Mounted Police (RCMP), Aboriginal history, character and spirituality of their
children were taken from their families and people.
incarcerated in residential schools.There was The relational theory of human
no recourse for the parents, families or development is particularly useful in
communities in this process. understanding the full scope of the impacts of
this aspect of residential schooling on
generations of Aboriginal families.
“The Indian Agent - we called him the overseer, Underscoring the centrality of connection
lived on the reserve. He went around and told in healthy human development, relational
parents which children had to go to school. And theory has gained increasing attention over
the priests arrived with their little black cars. This
the past decade.
older woman still stands out in my mind. She was
crying because her daughter Marie was getting The main premise of relational theory is
into the car. She tried to pull her back out of the that making and maintaining healthy
car and the RCMP took a hold [of] her and flung relationships is the foundation of the
her away from the car and she landed in the ditch development of a healthy sense of self and
and just lay [there] crying.” balanced well-being (Jordan et. al., 2000).
(Assembly of First Nations,
Just as food, water and air nurture the
1994: Executive Summary)
body, relationships and feelings of
connectedness nourish the heart, mind and
In both residential and day schools, Inuit, spirit. In this model of human development,
Métis and First Nation children were the deep yearning and movement toward
instructed in a foreign language and punished connection is seen as a central force in a
for using their own languages and customs. healthy life, while traumatic disconnection is
Unfamiliar foods, clothing and forms of understood as the source of most human
worship were forced upon them in settings suffering.
that were, at best, cold, institutional and
43
Although not all children were physically a breach between the generations that is still
or sexually abused at residential schools, felt today and is one of the underlying causes
traumatic disconnection from their families, of elder abuse and neglect.
communities, languages and cultures had far-
reaching, historical impacts. “Killing the Indian in the Child”
The purpose of residential schools was to
Disconnection and Its Impacts assimilate Inuit, Métis and First Nation children
into mainstream Canadian culture. To this end,
“When we cannot represent ourselves authentically isolating them from the influence of family and
in relationship, when our real experience is not community life was believed essential.
heard or responded to by the other person, then we But many schools went much further
must falsify, detach from, or suppress our response. than separation and isolation to what has been
Under such circumstances we learn that we cannot
called: “killing the Indian in the child” (Fournier
have an impact on other people in the relationships
and Crey, 1997:47). Understanding the full
that matter to us. A sense of isolation,
immobilization, self-blame, and relational meaning of this chilling concept is essential in
incompetence develops.” order to grasp the full scope of what is meant
by “disconnection” in the context of
(Jordan, 1999:1)
residential abuse.
According to Fournier and Crey: “Kill the
The right of Aboriginal families to create Indian in him and save the man” (1997:55) was
and sustain healthy, caring relationships based the watchword of Lieutenant Richard Henry
on mutual love and respect was denied under Pratt who established one of the first
the Indian Act legislation that made their residential schools for the government of the
children wards of the state. Mothers, fathers, United States in 1878.This model was
uncles, aunts and grandparents, deprived of a recommended to the Canadian government in
meaningful role in the lives of their children, a report from the minister of Indian Affairs in
suffered terribly—physically, emotionally, 1879 (Fournier and Crey, 1997).
mentally and spiritually—from this loss, as did
In the context of residential schooling,
the children.
“killing the Indian” meant dis-connecting
According to Dumont-Smith (2002), the children physically, emotionally, mentally and
major factors that contribute to elder abuse spiritually from their language, culture and
are: the personality traits of the abuser, their communities and also, but most painfully,
intergenerational violence, and degree of from their own sense of identity as being
dependency, stress and ageism. Indian.
Communities and Elders denied their role Physical dis-connection was achieved
in raising children through teaching and by removing children from loving families and
reaffirming language and customs and became, communities and forcing them to grow up in
over time, fragmented and conflictual. Loss of institutions among prejudiced strangers.
language to communicate between the
Mental dis-connection was achieved
generations and loss of cultural pride created
by forbidding children to use their own
44
languages or any familiar customs that may
have given them comfort.Without language, “One aspect of our relationship with Aboriginal
the key to the distinctive worldview of people over this period that requires particular
Aboriginal cultures was lost. attention is the Residential School system. This
Emotional dis-connection was system separated many children from their families
and communities and prevented them from
achieved by teaching children that the parents,
speaking their own languages and from learning
grandparents and Elders they so loved were
about their heritage and cultures. In the worst
savages, and their own bodies and racial cases, it left legacies of personal pain and distress
characteristics were sinful and dirty.21 that continue to reverberate in Aboriginal
Spiritual dis-connection was achieved communities to this day. Tragically, some children
by teaching children to adopt the new religion were the victims of physical and sexual abuse.”
or suffer God’s wrath eternally. (The Honourable Minister Jane Stewart, 1998:1-2)
Impact on Child Development

Frontline workers, counsellors and Elders
Children were also taught this would be at the five-day residential abuse retreat in
the fate of family members who stubbornly eastern Ontario reflected on the impacts of
refused to leave their savage beliefs and these losses personally, as well as on their
customs behind. families, communities and clients.
At the same time children were suffering
the impacts of traumatic disconnection, they Impacts of Residential Abuse and the
were faced with the developmental task of Aspect of the Intergenerational
forming primary attachments to caretakers Legacy Identified by Counsellors, Frontline
who were prejudiced at best and dangerous at Workers and Elders
worst. For many, in this context, traumatic
bonding became a way of surviving childhood The following are the observations and
in an unsafe, unpredictable environment. reflections of frontline workers at the
residential school abuse retreat in 2000.They
The profound loneliness and grief arising from have been transcribed from flip charts used
multi-layered dis-connections and accumulated during group exercises.
losses are directly linked to the most acute
Although retreat participants emphasized
problems facing Aboriginal families and
the uniqueness of each individual’s experience
communities today.The government of
based on factors, such as resilience, values and
Canada, in its Statement of Reconciliation issued
crisis or coping skills, there are many common
in 1998, acknowledged the legacy of pain
patterns.
caused by residential schooling.
21
A Fact Sheet detailing human violations endured by Aboriginal children is in Appendix A.
45
• using gifts and material things to soothe
Impacts on the Self
wounds in the family;
• Personal loss of culture, language,
• wishing that things had been done
traditional modes of spirituality, pride in
differently and deep feelings of remorse;
cultural origins resulting in lack of
positive self-identity and confidence; • the silence and shame of abuse in
residential school is repeated in the
• having to use a sense of humour to get
home; and
past trauma;
• family members direct lateral violence,
• little guidance or nurturing from family;
such as anger, jealousy, resentment and
• deep-rooted feelings of humiliation, gossip, against each other.
shame and abandonment leading to low
self-esteem; Impacts on Communities
• communication barriers, especially an • High rates of suicide and family violence;
inability to express affection; and
• addictive and self-destructive behaviours:
• ongoing triggers from sounds and smells; substance abuse, sexual abuse, sex trade,
• a belief system that denies the value and gambling or violence;
importance of women. • lack of traditional skills and role models;
• unhealthy living conditions;
Impacts on Families
• feelings of isolation within the
• Inconsistent or extreme expressions of
community;
love: to go from trying to give everything to
the children to an inability to give anything • ongoing power and control issues;
at all; • inability to face the levels of abuse and
• families where no nurturing or affection dysfunction within the community;
was present for generations; • racism, racial scaling—splits between
• discomfort expressing love for children in mixed/Métis and Status vs. “Non-Status;”
physical ways, especially hugs; • lack of self-sufficiency and sustainability;
• lack of communication within the family; • spiritual “splits” and factions between
• loss of bonding between siblings; Catholics, Protestants, Jehovah’s
Witnesses, Christians and those with
• children taken into custody by Children’s
traditional Aboriginal spiritual beliefs;
Aid Society;
• problems of reserves and settlements are
• inability to talk to our young children
transferred to urban communities, such
about our childhood because it involved
as family feuds, bloodism and violence;
so much abuse;
• a strong desire to reclaim cultural and
• emotional abuse and patterns of
spiritual identity; and
traumatic bonding;
46
• the community comes together during
Long-Term Impacts
crises but cannot sustain positive
energies at other times. Each individual’s experiences and
reactions are subjective and unique. Not all
Impacts on Clients children who attended residential schools
were physically or sexually abused there.
• Addictive and self-destructive behaviours:
alcohol, drugs, gambling, sex, choosing All, however, were impacted by long-term,
unhealthy partners, self-mutilation, separation during childhood from family,
prostitution; community, culture and language. Generations
of family and community members were also
• mental illness and emotional disorders; profoundly impacted.
• suicidal ideation and attempts at suicide; With more Survivors sharing their stories
• conflict with the law; and their descendants talking about the
intergenerational impacts, the full scope of the
• violence against women; tragedy becomes clearer:
• histories of inter-generational family • cultural denigration, humiliation and
violence, elder abuse, child abuse and shaming were standard practices in
histories of involvement with foster care residential schools.This deprived the
and Children’s Aid Society; children of self-esteem and, in many
• law education levels; cases, led to life-long feelings of self-
hatred and depression;
• unhealthy coping, social and life skills;
• Survivors report frequent sleep
• denial of impact of residential abuse and
disturbances and nightmares. Links have
intergenerational legacy;
been made between such symptoms and
• emotional numbness; the fact that children were often sexually
• anger towards authority figures; abused in their own beds;
• bitterness and lack of personal growth; • trust is a crucially important issue for
Aboriginal Survivors. Being betrayed by
• a sense that being Aboriginal is wrong; caretakers who threatened children with
• no sense of belonging to family or God’s wrath while abusing them, deprived
culture; and children of faith in a higher power to
protect and help them;
• fear of the past and fear that “opening
up” will lead to insanity. • the capacity for intimacy is severely
disrupted by the traumatic loss in
These examples underscore the multi-
childhood, of persons with whom
faceted emotional, mental, physical and
children are deeply connected. Fear of
spiritual impacts of traumatic disconnection
further loss can be so great it far
and how they are played out in personal,
outweighs the hope of sustaining intimate
family and community relationships today.
or loving relationships; and
47
• many Survivors experience ongoing • ongoing re-victimization (whether
trauma from flashbacks. Although this is through oppressive political and
the body’s way of signalling that healing is economic policy or systemic barriers),
needed, too many Survivors resort to • unresolved trauma of child abuse, and
substance abuse to numb these feelings
instead of using them to heal. • undiagnosed post traumatic stress
disorder (PTSD)
Chronic poverty, under-education and
ongoing prejudice are all part of the reality of are fully understood in terms of how they play
life for Aboriginal people in Canada today. Such out in the lives of Aboriginal people today.
living conditions and their attendant health and
social problems compound the long-term Moving Forward Toward Healing
impacts of historical, unresolved trauma.
Working effectively to heal the impacts of
residential school abuse requires a holistic,
Accumulated Grief and Loss solution-focused and sustained approach at all
Restoring health and balance within levels.
Aboriginal families and communities requires At the individual level: Survivors
an understanding of the impacts of need non-judgemental support in creating
accumulated grief and loss experienced over strategies of empowerment to overcome their
many generations. own traumas and transform negative coping
This includes the loss of: strategies into self-care.
• relationships with siblings, parents, Elders At the community level: Survivors
and extended family members; need to re-connect with peers who share
both an understanding of the past and hope
• language and other forms of for a new future.
communications;
At the political level: counsellors and
• spiritual and healing customs and frontline workers need to fully support the
traditions; individual and collective rights to justice and
• parenting and grandparenting skills; self-determination of Aboriginal clients,
• homelands and ancestral territories; communities and nations.
• hunting and fishing skills and other means At the service system level: Survivors
of promoting self-sufficiency; and need strong, vocal advocates within “the
system” who are knowledgeable about the
• cultural identity and pride. impacts of residential abuse and the potential
Accumulated losses underlie the for re-victimization, who themselves model a
unresolved, intergenerational grief, frustration healing path and who are committed to re-
and rage experienced in many Aboriginal empowering Aboriginal people.
families and communities today. Effective At the cultural level: Survivors need
healing can only happen when the multi-level to re-connect with history, culture and
impacts of: language through Elders, traditional people,
• accumulated historical losses, workshops, field trips and ceremonies.
48
Section III:
What is Trauma?
Section III
Section III:
What is Trauma?
Increasingly, psychological trauma is
Who Are Trauma Survivors?
understood as an affliction of the powerless.
During a traumatic event, the victim is made In the context of residential school abuse
completely helpless by an outside force. and forced relocation, there are Survivors
When this force is one of nature, it is called a who attended residential schools, as
natural disaster; when it is human-to-human, it well as their descendants who have
is called an atrocity.Traumatic events cause suffered the historical or
people to lose a sense of control, connection intergenerational impacts. All have
and meaning (Herman, 1997). The root word experienced the traumatic, accumulated losses
of trauma means “to wound.” of extended family, culture, language and
identity.
• Survivors are those adults who, as
Psychological trauma is a unique, individual
experience of an event or enduring conditions, in
children, suffered the trauma of forced
which: removal or relocation away from families,
home communities, languages and
• The ability to integrate our emotional traditional ways of life.
experience is overwhelmed, (i.e. our ability to
stay present, understand what is happening, • Survivors are those adults who, as
integrate the feelings, and make sense of the children, endured multiple
experience), or physical, emotional and sexual
• We experience (subjectively) a threat to life, abuse and/or neglect by caregivers
bodily integrity, or sanity. over many years of confinement in
(Saakvitne et. al., 2000:5)
• Survivors are the generations of
family and community members
whose children were seized from them,
Examples of Psychological Trauma depriving them of the love, joy and
Trauma can be a one-time event or a responsibility of raising their own children,
series of ongoing experiences over the life grandchildren, nieces and nephews.
span of an individual, as well as across • Survivors are the descendants who
generations. Examples include life-threatening have suffered the intergenerational
situations, such as: car accidents, fire, physical impacts of the abuse endured by their
violence, threats or fear of harm to, or loss of, parents and grandparents. Deprived of
one’s children or family members. It includes adults with any experience of parental
sexual abuse, separation from family and/or and family roles and responsibilities or
community, war, extreme poverty, deprivation sense of community belonging, their own
and chronic neglect, as well as racism, childhood abuse, trauma and multiple
genocide and other forms of oppression. losses were, in turn, unexpressed and
unresolved.
49
• Survivors are Aboriginal youth and They spoke of trying to escape the
adults who have been abuse by running away, being tracked down by
re-victimized many times through police, returned to school and brutally
brutal treatment aimed at controlling punished.
their dysfunctional behaviour, whether in They spoke of families and
prisons, in the streets, in psychiatric communities who were powerless to protect
wards, mental health facilities, hospitals, them.
addiction treatment centres or schools.
Inuit also spoke of their childhood
Because residential school abuse was terror during a first plane ride to schools far
directed against both boys and girls; Survivors away, of missing the tundra and familiar smells,
are of both genders and can be of any income foods, light and shadows of Arctic life; of
level, sexual orientation or level of ability. unexpected, intense grief during visits to long-
Although, at present, the greater number abandoned childhood camps; and of finding, in
of clients in trauma recovery programs are decades of overgrowth, relics of a lost
female, many Aboriginal men and boys also childhood life—cooking utensils, toys,
suffered childhood abuse and trauma. Under- buttons–all left behind in the abrupt departure
recognition and under-reporting of male of forced relocation.
childhood sexual abuse, as well as Western
socialization that teaches men and boys to Intergenerational Impacts of Residential
deny or avoid feelings, are barriers to trauma
recovery for Aboriginal men.
School Abuse
Many generations of Inuit, Métis and First
Nation children spent the greater part of their
Trauma in the Context of Residential
childhood in residential schools.The abuse and
Schools and Forced Relocation neglect they suffered while there left its mark
Many Survivors of residential schooling on their adult lives, as well as the lives of their
have broken the long silence about their descendants whose families have been
suffering and pain. Participants at a retreat for characterized by further abuse and neglect.
frontline workers spoke of the following As adults, many Survivors of residential
experiences: school abuse found themselves struggling
They spoke of witnessing the violence alone with the pain, rage and grief of
and cruelty inflicted on other children or unresolved trauma.Those who sought escape
younger brothers and sisters, and being through marriage or domestic partnerships
helpless to stop it. were often overwhelmed by the complex
They spoke of being taken from their demands of intimacy, parenting and family life,
families and communities by force, some for without previous experience of it or
ten months of the year and others for their preparation for its demands. Some were also
entire childhood. re-victimized by domestic violence or became,
themselves, the abusers of their partners,
They spoke of ongoing feelings of children or parents.
abandonment, loneliness and isolation.
50
Children who are abused by adults are
“Intergenerational or multi-generational trauma also given another clear message—not to
happens when the effects of trauma are not express their feelings about the abuse. As a
resolved in one generation. When trauma is result, traumatized children learn very early to
ignored and there is no support for dealing with it, survive repeated trauma through non-
the trauma will be passed from one generation to expressive coping mechanisms, such as denial
the next. What we learn to see as “normal” when or dissociation.
we are children, we pass on to our own children.
When a child or adult is prevented from
Children who learn that … or [sic] sexual abuse is releasing overwhelming feelings of rage, fear or
“normal”, and who have never dealt with the grief, those feelings are unresolved.The
feelings that come from this, may inflict physical
outcomes of unresolved psychological trauma
and sexual abuse on their own children.
are usually very severe. Some of the most
The unhealthy ways of behaving that people use to common outcomes reported by Aboriginal
protect themselves can be passed on to children, frontline workers are:
without them even knowing they are doing so. This
is the legacy of physical and sexual abuse in • substance abuse and/or addictions;
residential schools.” • suicide or other self-harming behaviours,
(Aboriginal Healing Foundation, 1999:A5) such as slashing, burning and cutting;
• dissociation, (inability to feel); and/or
Some residential school Survivors escaped • re-enactment through risk-taking or
into the military, but became further affected by abusive behaviours.
combat trauma or discriminatory treatment.
Unresolved trauma from residential
Others self-medicated their pain through
school abuse continues to impact individuals,
addictions or substance abuse. Gang and drug-
families, communities and nations and will do
related violence, homelessness and poverty
so until it can be expressed, validated and
began to grow.Those in conflict with the law
released in healthy, creative ways.
risked re-victimization through police brutality.22
What is Post Traumatic Stress

Impacts of Unresolved Trauma
Disorder?
The seeds of lifelong mistrust and fear
are planted when children are harmed and According to the Diagnostic and Statistical
betrayed by the people they must depend Manual, 4th Edition (DSM-IV-TR), published by
upon for protection and care. the American Psychiatric Association (2000),
post traumatic stress disorder (PTSD) is
Because abused children are frequently diagnosed as follows:
told by the abusive parent or caregiver the
abuse is for your own good, the stage is set for A. The person has been exposed to a
self-blame and self-hatred. traumatic event in which both of the
following were present:
22
In Saskatchewan, a criminal investigation is underway regarding reports of police taking inebriated Aboriginal men to the
outskirts of town in the bitter cold of winter, where they then froze to death.
51
1. The person experienced, witnessed or symbolize or resemble an aspect of
was confronted with an event or the traumatic event.
events that involved “actual or C. Persistent avoidance of stimuli associated
threatened death or serious injury, or with the trauma and numbing of general
a threat to the physical integrity of self responsiveness (not present before the
or others.” trauma), as indicated by three (or more)
2. The person’s response involved of the following:
intense fear, helplessness or horror. 1. Efforts to avoid thoughts, feelings or
Note: In children, this may be conversations associated with the
expressed instead by “disorganized or trauma.
agitated behaviour.”
2. Efforts to avoid activities, places or
B. The traumatic event is persistently re- people that arouse recollections of the
experienced in one (or more) of the trauma.
following ways:
3. Inability to recall an important aspect
1. Recurrent and intrusive distressing of the trauma.
recollections of the event, including
images, thoughts or perceptions. 4. Markedly diminished interest or
Note: In young children, repetitive participation in significant activities.
play may occur in which themes or 5. Feeling of detachment or
aspects of the trauma are expressed. estrangement from others.
2. Recurrent distressing dreams of the 6. Restricted range of affect (e.g., unable
event. Note: In children, there may be to have loving feelings).
frightening dreams without
recognizable content. 7. Sense of a foreshortened future (e.g.,
does not expect to have a career,
3. Acting or feeling as if the traumatic marriage, children or a normal life
event were recurring (includes a sense span).
of reliving the experience, illusions,
hallucinations and dissociative D. Persistent symptoms of increased arousal
flashback episodes, including those that (not present before the trauma), as
occur on awakening or when indicated by two (or more) of the
intoxicated). Note: In young children, following:
trauma-specific re-enactment may 1. Difficulty falling or staying asleep.
occur.
2. Irritability or outbursts of anger.
4. Intense psychological distress at
3. Difficulty concentrating.
exposure to internal or external cues
that symbolize or resemble an aspect 4. Hypervigilance.
of the traumatic event. 5. Exaggerated startle response.
5. Physiological reactivity on exposure to E. Duration of the disturbance (symptoms
internal or external cues that in criteria B, C and D) is more than one
month.
52
F. The disturbance causes clinically • greater perception of threat, danger,
significant distress or impairment in horror or fear; and
social, occupational or other important • a social environment that promotes shame,
areas of functioning. guilt, stigma or self-hatred.
Hallmarks of PTSD Defence or Coping Mechanisms

Repeated re-living of the traumatic event When a child or adult is traumatized, the
through dreams, hallucinations or flashbacks is mind and body provide ways of adapting to the
one of the hallmarks of PTSD. Sensory stimuli, situation.The following are some descriptions
such as sights, sounds, smells or tastes of coping or defence mechanisms
associated with the event, become triggers for developed from decades of research in the field
these flashbacks. of trauma and recovery (Frontline Workers,
Persons suffering from PTSD learn to 2000).
maintain a constant state of vigilance to avoid Readers are cautioned that these
anything that may cause a flashback. They may descriptions have been formulated by, and for,
use addictions to numb themselves from non-Aboriginal people from a contemporary,
sensory stimulation that could trigger recall of Western approach to health. As such, they
the initial trauma. may not reflect the worldview or cultural
PTSD is marked by complex biological beliefs of Aboriginal people.
changes, as well as severe psychological Coping or defence mechanisms are
symptoms, often occurring in combination, understood as survival strategies that enable
such as depression or mental illness and victims of trauma not merely to survive, but to
substance abuse. live in an otherwise almost “normal” way.
PTSD impacts every part of a survivor’s Such strategies may have helped victims
life, including mental, physical, emotional and survive the initial traumatic event or may be
spiritual aspects. used in the present to help numb painful
memories.They may also be used to control
What Other Factors Are Associated With repressed feelings that, if released, would
the Development of PTSD? overwhelm and devastate the survivor.
Research shows PTSD is more likely to It is the role of the counsellor to help
develop in persons whose subjective individuals and families identify which coping
experience of the trauma includes the strategies are healthy and working well for
following: them, and those that are part of the problem
and a barrier to healing.
• greater magnitude, intensity,
unpredictability, uncontrollability, betrayal Suppression
or helplessness; Suppression is consciously and deliberately
pushing memories/feelings of an event out of
• sexual as apposed to non-sexual
one’s thoughts, refusing to let anything around
victimization;
53
it surface. For example: I will not think about example, the sick feeling while walking up
this right now, I have moved on with my life, stairs may be the only shard of memory left
therefore there is no problem. from the trauma of sexual abuse that occurred
Repression in the bedroom. Repression and dissociation
Repression is the unconscious “forgetting” can become habitual.
of painful or unacceptable memories and Displacement or Diversion
feelings.This type of defence mechanism This refers to moving one’s attention
requires cues or triggers to resurface the away from a traumatic event by focusing on
memory. In a national survey of psychologists, something else, such as details of the room,
23.9 per cent reported being victims of child sounds or clothing. Other forms of diversion
sexual abuse; of those, 40 per cent reported a include spiritual imagery, inventing imaginary
period of forgetting (Feldman-Summers and beings or other parts of the self, or focusing
Pope, 1994). on foods or treats.
A Caution About Suppression and Repression: Splitting
The first Aboriginal psychiatrist in Canada, Splitting occurs when an individual cuts
Clare Brant (1990), suggests repression is a off or splits from the part of the self that is in
key attribute of Indigenous cultural training. pain.This separated part is then viewed as the
Emotional restraint (especially repression of bad, needy, angry or hopeless part of the self.
anger) is a foundational ethic considered Splitting into separate parts helps retain a
essential to self-control. sense that the main part of the self can still be
Discouraging expression of strong or healthy.
violent feelings against others promotes Denial and/or Minimizing
cooperation in small, close-knit communities When an experience is too painful to
bound by survival needs.When understood in deal with, we can deny there is a problem,
the larger framework of social customs that insisting: “that never happened” or “it did not
permit feelings to be expressed non-verbally, happen to everyone at residential school, therefore
through dance, art and ceremony, this type of it probably did not happen to me (or to you).”
repression is not inherently harmful. Denial also occurs when the traumatic
Dissociation event and its impacts are minimized; for
Dissociation is sometimes referred to as example: “It wasn’t that bad; after all I got a good
a trance-state. It refers to the ability to put education.” Denial can work at individual, family
oneself outside of the pain of what is and community levels and there can be an
happening by disconnecting feelings from active, aggressive quality to denial.
thoughts. Car accident victims, for example, Denying and minimizing are also essential
report feeling distanced from the event, as if strategies in maintaining addictions. Addicted
they were outsiders observing it. Survivors who are always on the verge of a
Repression and dissociation often work in healing breakthrough are able to sustain both
tandem because of the way memory shatters the addiction and the illusion of recovery by
during trauma. A child who dissociates during minimizing and/or denying the seriousness of
a traumatic event retains only very foggy or the amount they consume.
shard-like memories of the actual event. For
54
A Word of Caution About Denial Projection
From an Aboriginal perspective, there are This refers to an unconscious tendency to
two important aspects of denial as a culturally- attack in others what we most fear in
based norm. In the context of colonization, ourselves, insisting: “It’s not my problem; it’s your
Indigenous people could not be open and problem.” People who cannot face their own
transparent to those in authority regarding memories of victimization may lash out at the
their experiences and feelings for obvious victim mentality of those who are trying to
reasons. Denial is inherent in any relationship heal; or, people who repress their own
involving misuse of power, such as that attraction to members of the same sex,
between the colonizer and the colonized. sometimes direct their confusion and hostility
The ability to deny and/or minimize toward gays, lesbians and/or transgendered
feelings of discomfort, fear, frustration or people.
impatience is also a learned and valued hunting Transference23
skill. This refers to redirecting unresolved
Projective Identification childhood feelings and desires onto a new
This term refers to unconsciously putting object; for example, clients falling in love with
one’s own unresolved feelings onto someone or idealizing their counsellor or other
else, such as a child, spouse or boss. For authority figure who then becomes a
example, a mother with unexpressed feelings substitute for a loving, caring and trustworthy
of being dirty due to child sexual abuse may parental figure.
project those unresolved feelings onto her Sexualized transference is especially
daughter through obsessive attention to common where there has been prolonged
cleanliness or by calling her a dirty little girl. childhood sexual abuse (Herman, 1997). As
Object Relations many Survivors of residential school abuse
This refers to unintentionally transferring were abused sexually throughout their entire
unresolved feelings, emotions or desires onto childhood, often by multiple perpetrators, and
a substitute person, for example, treating a may have come to believe their primary value
child, spouse or boss as the abusive parent. is through their sexuality.The ability to
sexually attract becomes, paradoxically, a
Stopping Mechanism litmus test for evidence of caring, as well as of
This refers to cutting off those feelings or corruption.
bodily functions associated with the trauma,
such as orgasm, the capacity to be surprised, Survivors may also idealize their
bodily or bathroom functions, hunger or eating counsellors and develop extremely unrealistic
certain foods. expectations of the counsellor’s role as a
protector or rescuer.When the counsellor,
Intellectualizing helper or Elder fails to live up to this role, the
This refers to trauma Survivors who Survivor who feels betrayed and abandoned
emphasize explanations or analysis in order to once again may react by transferring the rage,
understand at a rational or intellectual level, so formerly directed at the abuser, onto the
they can avoid addressing their pain at a counsellor.
feeling or emotional level.
23
For information about countertransference in this context, see Section 5 of this manual.
55
In situations where the counsellor or in order to focus only on survival. That is why,
helper is non-Aboriginal, characteristics of the during trauma, the brain puts the body into a
white abusers may also be transferred. As a flight, fight or freeze fear response. (The
result, the Survivor may accuse the counsellor information in this section is from a lecture
of acting like the white residential school the author attended in Boston on April 29,
abuser or of racism. 2000 through the Harvard Medical School
On the other hand, Aboriginal Department of Continuing Education,
counsellors, helpers or Elders who fail to meet delivered by Amy E. Banks, M.D.)
idealized expectations may be accused of Under normal conditions of life, the brain
acting like an apple: red on the outside but white functions through an even, balanced flow of
on the inside. chemicals and message processing systems.
Traumatic Bonding But in response to a traumatic event, the brain
When a strong attachment is formed to massively increases production of adrenalin for
someone who is unsafe in an attempt to gain greater strength and endurance.This, in turn,
safety or to survive, it is called traumatic increases the heart rate and blood pressure,
bonding. Examples include hostages who come causing hyperarousal of the nervous system.
to care for or join up with their kidnappers or When the traumatic event and the
children who learn to see the world through danger have passed, the brain then returns to
the eyes of the abusive parent. normal functioning once again.
However, if traumatic events are re-
Trauma and Resilience experienced repeatedly over time, the brain
According to Aboriginal frontline loses its ability to regulate its own chemistry.
workers, some coping strategies used to Repeated flooding of adrenalin will eventually
survive early trauma, such as sexual and temporarily deplete the supply.The brain then
physical abuse, can become valuable strengths. tries to compensate by alternating patterns of
Determination, hard work, looking out for over-stimulation and depletion.
others, a sense of humour and the ability to When the brain is flooded with adrenalin,
handle crisis situations have enabled many the body enters a state of hyper-arousal,
Aboriginal Survivors of abuse to help re- anxiety and fear. In this state, Survivors may
empower their families and communities. react to seemingly harmless situations as if re-
A shared understanding of residential traumatized, appearing terrified of the people
school abuse and its impacts can help or places around them. On the other hand,
counsellors and Survivors work together to when adrenalin is depleted, Survivors may feel
transform negative coping strategies into emotionally shut down with no interest or
strengths. energy to react or reach out to others.
The Biology of Trauma

People who are in danger need to
mobilize themselves for strenuous action, so
they are able to dismiss hunger, fatigue or pain,
56
This explains why some traumatized Instead of amnesia, the person
people feel and act as if their nervous systems experiences hyper-amnesia, an abnormally vivid
are completely disconnected from the present or complete recall of memory.This is often
situation. As brain activity fluctuates, their seen in victims of car accidents who re-
feelings alternate between numbness and panic experience the crash over and over again until
or sheer terror. they develop coping mechanisms that help
The brain/body changes associated with them recover.
PTSD also cause hyper-arousal of the nervous
system, creating symptoms such as increased
Repeated Incidents of Trauma
startle reflex and sleep disturbances. Traumatic events that are repeated over
time can result in more frequent dissociation;
Impact of Trauma on Memory therefore, greater memory fragmentation.
Many adults, who experienced repeated
According to Dr. Banks, the fight, flight or traumatic incidents as children, are often unable
freeze fear response dramatically alters to consciously recall their early years at all.
function in two areas of the brain, the
hippocampus and the amygdala. Because these Aboriginal children in residential schools
areas of the brain are where memory is were subjected to daily, ongoing racially-based
processed and integrated, there can be humiliation and shaming. As well, many suffered
distortion in how information is processed. cruel physical punishments and/or sexual
abuse and were also forced to witness the
This means that, during a traumatic event, abuse and malicious humiliation of other
memory can be shattered like broken glass, children. As a result, many adult Survivors of
with some pieces being stored in the body residential schools suffer from undiagnosed
(referred to as body memories), while others PTSD compounded by ongoing re-
are stored as shards or glimpses of visual victimization as adults.
imagery, scents or sensations.
The fragmentation of memory occurring What Are Triggers, Flashbacks and
at the same time that emotion is separated Flooding?
from memory due to dissociation, explains
why many trauma Survivors can only recall PTSD is marked by episodes of repeated
bits and pieces of the experience. In place of reliving of the trauma through intrusive
memory, they may experience bouts of memories or flashbacks. During a flashback,
intense, overwhelming emotion without any Survivors re-experience the feeling of
clear image attached to explain the feelings. the abuse as if it were occurring at
that moment. Typically, flashbacks are set
off by stimulation of the senses, such as
Single Incidents of Trauma particular sounds, sights, smells, tastes or
When a person has been traumatized, touch.These stimuli are known as triggers.
there can be an over-indulgence of memory The terror of these experiences creates
that keeps images or sensations coming back excessive fear and avoidance of any stimuli
or intruding. that might evoke a flashback. Sometimes
57
Survivors become so totally engulfed by the For example, Survivors may be drawn to
terror of reliving a traumatic event, they relationships with people who appear very
become utterly cut off from the present. This strong and overly protective, not realizing that
is referred to as flooding. these can also be warning signs for
Dr. Banks’ research on flooding suggests possessiveness, jealousy and control. As a
it is a neuropsychological event, during which result, many Survivors find themselves trapped
brain chemistry is completely overwhelmed by in repeating patterns of disrespectful or
the fight, flight or freeze fear response. violent relationships as adults.
Flashbacks and flooding are frightening Lateral Violence

experiences, both for Survivors and those Issues of protection and risk are ongoing
around them. According to frontline workers, hot buttons for Aboriginal Survivors of
identifying the triggers that cause flashbacks childhood abuse that are sometimes played
and building a base of inner strength, in order out as lateral violence in Aboriginal families and
to confront the memories, is the first step communities. Lateral violence is defined as
toward re-empowerment and recovery. “the shaming, humiliating, damaging, belittling
and sometimes violent behaviour directed
Outcomes of Unresolved Trauma toward a member of a group by other
members of the same group” (Middleton-Moz,
Inability to Assess Risk 1999:116). It is a learned behaviour that allows
Like anyone else, Survivors of childhood oppressed and vulnerable people to feel more
trauma long for safe, intimate connections powerful by turning their anger against each
with others. However, when children are other. Symptoms of lateral violence include
abused by their caretakers, the lessons they gossip, put-downs, competition, family feuds,
learn about trust and safety, protection and religious wars, gang wars and bloodism24
risk, and truth and lies are contradictory and (Middleton-Moz, 1999).
confusing. Re-Enactments
Some Survivors of childhood abuse find
themselves unknowingly re-enacting some
“In addition to caretaker abuse, children in
aspect of the trauma in a disguised form as
residential schools were also subject to religious
adults.
abuse where “God’s love” was used as a
justification for their abuse and misery. “ Re-enactment can occur through high-
risk, dare-devil behaviours, such as:
(Participant at Retreat for Frontline Workers)
• playing chicken on the highway;
• slashing, burning or cutting;
According to frontline workers, this • starvation;
confusion, compounded by the urgency of the • unsafe or rough sex;
instinctual drive for safety and protection, can • picking fights;
cause Survivors to mistake the characteristics • criminal behaviours that risk being
of an abuser for those of a caretaker. “captured” and spending time in jail; and
24
According to Middleton-Moz, “Bloodism” refers to rejecting or accepting someone based on skin colour or the amount of full-
blooded vs. mixed-blood ancestry.
58
• relationships that repeat the harm, Survivors with such fears become skilled
whether from or against others. at undermining authority25 and intimacy as a
For some Survivors, compulsive control survival mechanism.
of food intake or addictions is another way of As a result, many Survivors experience
regaining power and control over one’s body difficulties in the formal, hierarchal education
and feelings; control that was denied due to system and employment systems (above and
the abuse. beyond systemic and attitudinal barriers
In the context of residential school abuse, imposed by prejudice).
where Survivors recall never having enough to In personal relationships, adult Survivors
eat as children, hoarding, hiding and/or of traumatic disconnection in childhood tend
bingeing on food are common in adulthood. to develop disruptive relational patterns, such
Regardless of how trauma is re-enacted, as:
whether through memories, nightmares, risk- • ending relationships just as the newness
taking or repeating the abuse, re-enactment wears off and closeness begins;
carries all of the emotional intensity of the • not allowing relationships to progress
initial event. Because trauma is characterized beyond certain limits of closeness; or
by feelings of overwhelming helplessness, the
ability to control re-enactment of a traumatic • ending relationships on an extremely
event evokes exhilarating feelings of power negative or conflictual note.
and triumph. In her book Children of Trauma, Middleton-
The compulsive need to re-enact trauma Moz (1989) suggests leaving relationships before
can be understood as an unhealthy and they get left is a pattern of re-enactment that
dangerous coping strategy. Simply asking or allows Survivors to lessen their fears of
expecting Survivors to stop such behaviour is intimacy and loss by regaining a sense of
not an effective counselling technique. power and control over abandonment.
Re-enacting behaviours can only be Domestic Violence
resolved when the Survivor is able to develop Over the past century, domestic violence
a new understanding of them and achieve has become an epidemic in Aboriginal
feelings of personal power and triumph communities across Canada.This abuse takes
through other, more healthy means. many forms, including physical, emotional and
Fears of Authority and Intimacy sexual, as well as neglect of children, spouses
and/or elders. As with the widespread
People who have learned as children that domestic violence in the non-Aboriginal
those in authority will harm them, fail to population, the most violent offenders are
protect them from harm or abandon them, male. A recent AHF report on Aboriginal
often develop a deep-seated fear of both domestic violence reveals the following
authority figures and intimate relationships. situation (Bopp, Bopp and Lane, 2003).
25
This is not to deny the role of authority figures in perpetuating racism and inequality and the need to find ways to remove the
authority of such persons.
59
Spousal Violence psychological and financial (including neglect
• 25 per cent of Aboriginal women and 13 and abandonment).
per cent of Aboriginal men report According to her report, the lack of
experiencing violence from a current or research and information in the area of elder
previous partner over the past five years; abuse in both Aboriginal and mainstream
• 49 per cent of the women reported society makes it impossible to state with
physical injury, 23 per cent received certainty the full extent of this problem.
medical attention for the injuries and 39 However, she cites surveys in the general
per cent feared for their lives; population that indicate the following:
• 37 per cent of Aboriginal women and 30 • in a sample survey, 25 per cent of violent
per cent of Aboriginal men reported acts responded to by police involved an
emotional abuse during the same older person; and
period; and • 4 per cent of seniors who responded to
• 57 per cent of the women who a national survey in 1989 indicated they
experienced abuse reported their had experienced some form of abuse.
children had witnessed it (Canadian With Aboriginal seniors accounting for
Centre for Justice Statistics, 2001 cited 8.3 per cent of the total Aboriginal population
in Bopp, Bopp and Lane, 2003:26). and much higher rates of violence in the
Child Abuse Aboriginal population, Dumont-Smith (2002)
• “An estimated 45 per cent to 70 per suggests Aboriginal elders experience abuse at
cent of children living in abusive a rate that is at least comparable to, but likely
situations are likely to be physically or higher than, the general population.
sexually abused” (Bodnarchuk, 1999 cited Mental Illness
in Bopp, Bopp and Lane, 2003:43). Depression and suicide are problems of
• “Children living with an abused mother epidemic proportion in the Aboriginal
are 12 to 14 times at greater risk of population. An annual report from the Ontario
being abused by their mother’s partner” Aboriginal Healing and Wellness Strategy
(McCloskey, Figuerdo and Koss, 1995 (2003) and a report from the Department of
cited in Bopp, Bopp and Lane, 2003:43). Indian Affairs and Northern Development
(2003) show the following:
• The ratio of Aboriginal to non-Aboriginal
children in care of a Children’s Aid • comparisons in potential years of life lost
Society is 7 to 1 (National Association of by mental illness as a cause of death in
Friendship Centres, 1999). the Aboriginal vs. non-Aboriginal
population is 142 vs. 60, respectively;
Elder Abuse26 • the rate of suicide among Canadian Inuit
Dumont-Smith (2002), categorizes elder is the worst in the world: 211 per
abuse as: domestic elder abuse; institutional 100,000 vs. 14 per 100,000 for the rest of
abuse; and self-neglect or abuse. The most Canada;
common types of abuse are physical,
26
In this context, the term “elder” refers to Aboriginal seniors vs. Elders who are cultural or spiritual guides.
60
• depression is three times more ceremonies in hospitals or by provincial
prominent in Aboriginal youth than in the registries who refuse to acknowledge the legal
older generations; and validity of Inuit customary adoption.
• depression is the second most common Aboriginal frontline workers believe that
diagnosis reported by physicians at a shared understanding of the conditions that
Aboriginal Health Access Centres in cause re-victimization will help ensure
Ontario (research conducted over a strategies are created to prevent this.They
three- month period from April to June maintain Survivors of residential abuse are re-
2003 by the Aboriginal Healing and victimized in any situation where:
Wellness Strategy; n=3,401 clients). • the full scope of their suffering as
children is denied or minimized;
Re-victimization • they are blamed for the abuse;

• they are not believed;
From the perspective of frontline workers
who participated in the residential school abuse • they are believed but not credible enough;
retreat, “re-victimization” refers to and
conditions or circumstances, whether intended • their cultural or language needs are not
or unintended, that replicate in whole or in part understood and taken into account.
the original abuse. It includes any situation in
Survivors of residential school abuse at a
which Survivors of historical trauma experience
retreat in eastern Ontario provided the
overwhelming loss of control resulting in
following examples of re-victimization from
feelings of disempowerment, disconnection or
their own experiences:
pain (including institutional indifference to their
pain or suffering). • Any institutional environment or
setting that replicates the long, echoing
Just as Aboriginal children suffered abuse
hallways, closed doors and sterile,
at residential schools that were supposedly
dormitory settings of residential schools,
there to educate them, many Survivors have
such as hospital psychiatric wards and
suffered further abuse from counselling and
some homeless shelters.
psychiatric services instead of healing.
• An “institutionalized” cultural
Survivors of residential abuse are
environment where rules are inflexible,
especially vulnerable to re-victimization due to
appear arbitrary and seem to sacrifice
ongoing marginalization and discrimination
emotional and spiritual health in the
against Aboriginal people.
name of time, efficiency and the bottom
Evidence of this marginalization is the line such as hospital emergency
level of social and political tolerance for departments or social welfare agencies.
continued injustices against Aboriginal people,
• Restraining practices in psychiatric
whether by police at Ipperwash, Ontario or
or police facilities meant to protect
Burnt Church, New Brunswick, or by health
people from self-harm, such as physically
care professionals who disallow smudging
61
wrestling them to the ground, pinning Crown in order to allow the government full
their arms and/or using straitjackets, control over assimilation through schooling. In
replicate aversive restraints against many cases where families resisted sending
children in residential schools. their children to these schools, police
• Any situation in which the underlying intervened by forcibly removing the children
assumption is that non-Aboriginal from their parents.
culture or knowledge holds the Further encounters between many of
answer to the “problems” of these Aboriginal children and police occurred
Aboriginal people, whether in trauma when they ran away from the schools to
recovery, child protection, addictions escape the abuse, only to be hunted down,
recovery, HIV prevention, violence captured and returned to the schools by
prevention and intervention or criminal police. In later years, police also assisted
justice. Children’s Aid Societies in removing children
• Any situation in which human from their parents.
rights, basic necessities or The historical role of police in the lives of
opportunities that benefit other Aboriginal people and the mutual mistrust
Canadians are denied or inaccessible to generated by it has contributed to the
Aboriginal people. following situations:
• Any situation of prejudice due to • The chances of a 16-year-old Aboriginal
Aboriginal culture, sexual orientation, boy will be imprisoned at least once by
level of ability, gender, education level, the age of 25 are 70 per cent;
income or criminal record. • The rate of incarceration of Aboriginal
Without full awareness of the conditions men is 11 times the rate of non-
associated with re-victimization, frontline Aboriginal men.
workers and counsellors risk compounding • The rate of incarceration of Aboriginal
the pain of Aboriginal clients instead of women is 250 times the rate of non-
assisting them. 27 Aboriginal women (although Aboriginal
In terms of re-victimization, the women comprise only 3 per cent of the
relationship between police and Aboriginal population of Canada, they represent 30
people requires special attention and per cent of the total population of
sensitivity. Historically, this relationship has federally sentenced women).
been characterized by deep-seated fear and • Aboriginal women are 14 per cent less
mistrust on both sides. likely to be released into the community
In the context of residential school abuse, on conditional release than non-
both the Royal Canadian Mounted Police and Aboriginal women.
provincial police services enforced policies • The failure of police to act appropriately
that, in effect, denied Aboriginal people the to protect Aboriginal people was
right to family life. Under Indian Act legislation, illustrated by the brutal murder in early
Native children were made legal wards of the
27
A “Checklist to Prevent Re-victimization” created by counsellors and frontline workers is appended.
62
2000 of two Métis women in Winnipeg,
whose repeated calls for help to police
were dismissed.
• Over 500 Aboriginal women in Canada
have disappeared in a 20-year period,
approximately 50 from Vancouver’s
downtown eastside. No serious police
investigations were undertaken to find
out what had happened to these women
(NWAC, 2004b).
• Thirty-two Aboriginal women have gone
missing along Highway 16 between Prince
Rupert and Prince George BC, now
referred to as the Highway of Tears.
Between 1988 and 1995, five young
Aboriginal women went missing along
this stretch of highway. Despite protests
by Aboriginal communities, neither the
police nor the media took their
disappearances seriously.Then, in June of
2002, another young woman went
missing whose disappearance immediately
sparked media attention and government
action. How did this case differ from the
others? She was the first non-Aboriginal
woman to disappear from the Highway of
Tears (NWAC, 2004a).
63
Section IV:
Healing is Sacred: Stories,
Dreams, Dance,
Drum & Ceremony
Section IV
Section IV:
Healing is Sacred: Stories, Dreams, Dance,
Drum & Ceremony
The previous sections of this manual
outline an Aboriginal approach to
Circle Theory and Process
understanding trauma in the context of Indigenous people worldwide use the
residential school abuse and its structure of the circle for council meetings,
intergenerational impacts.This section spiritual ceremonies, healing, sharing and
provides a brief overview of Aboriginal cultural teaching.
beliefs and practices that restore and maintain The circle is holistic in that everyone has
physical, mental, emotional and spiritual an equal opportunity to participate and each
health.28 voice is valued and respected; what one
In Aboriginal cultures, individual health individual shares in the circle is equally as
and healing is integral to a balanced family and important as any other.
community life. In this context, healing is a In many Indigenous cultures, silence
group process involving all those who are indicates respect; therefore, full participation
impacted by an individual’s dis-ease, whether requires an understanding of both oral and
of the mind, body, heart or spirit. aural functions.
The Elders teach that, if a problem is due When a person shares in the circle, there
to ignorance, meaning the person lacks the is no interruption. Non-interference and the
knowledge or skills required for balanced value of holistic listening are paramount.
relationships or a balanced life, the situation According to Inuit Elder Meeka Arnakaq,
requires teachings. If the person possesses the holistic listening means to actively and with
knowledge and skills, but the problem persists, empathy listen with the heart, the mind, the
the situation requires healing. body and the spirit.
Through Elders, traditional healers and
cultural teachers, these beliefs and customs
live on whether in remote, rural or urban “ Everyone has their time to speak, even children
Aboriginal communities. were asked for their opinions. Listening was a
major characteristic in the Native society.
Everyone honoured the speaker because they
“Traditional teachings have always included wanted to have the same attention when they
behaviour modification, cognitive therapy and spoke.”
narrative therapy. Our children learned through (Seneca Elder Twylah Hurd Nitsch
the stories of the Elders, making the connections cited in Kulchyski et. al., 1999:73)
from the stories to their own life journeys.”
(Frontline Worker Retreat Participant, 2000)
28
For further information, contact the Aboriginal cultural centre nearest you.
65
spirit of the universe. For many First Nations,
Healing Circles “the words that come before all else”29 are
When used in healing, the function of the important ritual openings for gatherings of
circle is to re-connect individuals with the people. Once everyone has been smudged, an
parts of themselves that have been injured and Elder or traditional person may offer up an
to connect with others through a process of expression of thankfulness and hope for the
voluntary, personal, mutual disclosure. gifts of Creation, affirming for those within the
Sharing circles allow everyone to actively Circle their shared commitment to speaking in
participate as teachers as well as learners; to a good way. For Inuit, openings and closings can
be healed as well as to heal.The most sacred also take the form of drumming and/or song.
teachings are those that arise out of the
collective insights of those who fully Sacred Items
participate in the circle in a good way. Traditional people and Elders often use
sacred objects, such as an eagle feather or
Smudging talking stick, to guide the circle process. The
Smudging is a sacred ritual using smoke sacred object may be passed from person to
from burning medicine such as sage, person around the circle or placed in the
sweetgrass, cedar or tobacco, to cleanse centre of the circle to be picked up by the
people, places, food and objects. next person wishing to speak. Some examples
of other sacred objects used in ceremonies
When used to cleanse people, a smudge are the drum, pipe, drumstick and rattle.
is usually led by an Elder or traditional healer
who may have a helper or may engage one of
the participants to assist. Smudging is used to Sacred Medicines
dispel negative energy, creating an opening for The most sacred of medicines_tobacco,
positive healing energy. sage, sweetgrass and cedar_are used in
Depending on the preference of the Elder traditional ceremonies and for healing, as well
or traditional healer, elements such as fire and as in everyday life.Tobacco is offered to
water may be placed in the centre of the express thanks or to ask for help in a good or
circle to help participants stay focused. respectful way. Like the three other sacred
medicines, it is also used in ceremonies and
Once everyone has smudged, the burning teachings to cleanse, purify, calm and protect.
medicine may be placed in the centre of the
circle. Fire in the centre of a circle symbolically
connects participants to their inner sacred fire.
Dreams
Dreams occupy an important place in
Prayer/Giving Thanks Aboriginal customs. It is believed that dreams
provide significant information about our past
Prayer is a ritual reminder of our most as well as our future, including warnings of
deeply held principles and convictions and is impending misfortune or needs that must be
one way of communicating with the creative fulfilled to promote healing.
29
Mohawk Elder Paul Skanks and Ojibwe educator Sally Gaikexheyongai speak of these teachings.
66
On a community level, dreams guide the
planning of feasts, the choreography of dances,
Lighting of the Qulliq
the message of songs, the design of costume
and regalia and the rules of games. A qulliq is a boat-shaped soapstone lamp
When used in healing, dream imagery that burns oil and cotton as fuel for its flame.
provides insights about each person’s life path For millennia, Inuit used the oil of sea
and the spirit guides who are there to help on mammals, such as whale or seal and a cotton-
that journey. like material harvested from plants as a wick.
The flame and warmth of the qulliq were the
only source of light during the dark months of
Sweat Lodge Ceremony northern winters. Although, for convenience,
For many Aboriginal people, the the materials have changed to cooking oil and
foundational remedy for maintaining and cotton, the Lighting of the Qulliq has become
restoring health is the cleansing and purification an important ceremony for contemporary
ceremony known as the sweat or smoke lodge. Inuit. It is lit at the start of most community
Sweats are conducted in sacred lodges, events to symbolically reconnect Inuit of today
constructed in a traditional dome shape with life in the past and to honour the spirit
representing the womb of Mother Earth. and wisdom of the ancestors.
During the sweat ceremony, the vapours
of medicines, such as cedar, and steam restore Dance
strength and promote healing by cleansing the In Inuit, Métis and First Nation cultures,
body, mind, heart and spirit. dance is a form of non-verbal expression that
defines and strengthens at a personal level,
Other Ceremonies while also honouring connections with
community. Drum dancing is a central feature
Ceremony is used the world over to mark of Inuit gatherings and ceremonies; Métis jigs
important life and community transitions. Some are performed at “revaillons” and dance is a
Aboriginal people believe ceremonies have the central feature of First Nation pow wows and
power to strengthen the body’s ability to fight Sunrise ceremonies. Each dance carries its
disease and the ability of the mind and heart to own unique meaning expressed through the
move from suffering to joy. dancing style and song, as well as design of the
Aboriginal cultures are rich with clothing worn for it. For First Nations, dance is
ceremonies designed to build strength, restore also a way of honouring people who are ill or
balance and promote healing. These include, have passed on.
but are not limited to, seasonal celebrations,
such as the Sundance, Strawberry festival and Vision Quest
Green Corn festival, as well as Medicine
Walks, Feasts, Give-Aways and Potlatches, The vision quest is a highly personal
Welcoming ceremonies for Newborns, ceremony and an integral part of the process
Naming ceremonies and Death ceremonies. of self-reflection and self-understanding. In
67
many cultures, vision quests are an important
developmental ritual for both boys and girls at
Art
adolescence.Thereafter, it is part of a lifelong In oral cultures, art is the primary means
process of learning, balance and growth. through which ideas, emotions, hopes and
dreams are communicated. In Inuit, Métis and
Fasting First Nation cultures, the colour and design of
masks, beadwork, quilts and other crafts is
Fasting usually takes place each spring and carefully chosen to express a specific meaning
fall to help seek new direction in life by or purpose.
shedding old or negative energy and
replenishing positive energy. Fasting may take Artistic expression is an important, non-
place in the woods, a fasting lodge or on a verbal method of communication, and many
vision quest. Aboriginal arts and crafts are created in a
group setting. As such, art has an important
role in healing through relationship and
Silence community building. Art inspired by vision
Whether for communications or in quests is also considered an integral part of
healing, silence is a traditional skill highly balanced mental, emotional, physical and
respected, especially among Inuit who have the spiritual well-being.
longest pause times of any other culture.
According to some Aboriginal counsellors and Humour and Play
group facilitators, speaking too much or too
quickly may undermine trust.While silence is Humour and play for both adults and
considered a form of healing in itself, it also children was integral to good physical, mental,
affirms the value and importance of non-verbal emotional and spiritual health, especially during
forms of communication. the long winter months of confinement. One
example is an Inuit game where one person
tries to make the others laugh, while remaining
Seven Sacred Gifts or Teachings completely impassive. Other games include
A fundamental belief underlying most lacrosse, lawn darts (played with shucked
Aboriginal spirituality is that everyone was green corn) and high kicking.
given gifts from the Creator at birth to use as
medicine for the mind, body, heart and spirit. Storytelling
These sacred gifts are: Respect, Humility,
Compassion, Honesty, Truth, Wisdom Traditional stories are a lens through
and Love. which Aboriginal people recall and honour the
past, understand the present and envision the
Each gift comes with a teaching that future.They are the primary method for
offers direction and guidance in finding balance teaching children the complexities of an
and purpose in life by: Indigenous philosophy or worldview.
• accepting who we are, Anishinaabe people distinguish between two
• understanding our responsibilities, and types of stories or legends: tabatacamowin are
• doing as we ought to with the best of
our abilities.
68
anecdotes or narratives about exceptional The role of physical exertion in restoring
experiences, while atiso’kanak are the sacred mental health is also gaining new attention.
stories of the ancestors. Researchers at Duke University Medical
Center in North Carolina found that
The Widsom of Traditional Healing exercising three times per week for four
months was just as effective as one of the
As the modern world struggles with popular anti-depressant medication Zoloft; and
increasingly complex health problems, such as after another six months, there was less
cancer, AIDS and mental illness, greater likelihood of relapse.This study also concluded
attention is being focused on “alternative” that physical exercise is more potent than a
healing methods. Some contemporary healing pill because people felt a greater sense of
practices that borrow from traditional achievement, a sense of being in control and of
Aboriginal teachings and customs include the mastering something (Mautz, 2001).
following.
2. Art and Dance Therapy:
Note: In his lectures, Mac Saulis, Mi’kmaq
Professor of Social Work at Carleton New forms of so-called alternative
University, describes the difference between therapies, such as art and dance therapy, are
Western and Aboriginal perspectives on now accepted in the mainstream health
teaching: “Teachings are the wisdom that system as legitimate, non-verbal strategies for
arise out of the collective insights of other expressing repressed emotions.
people, not the singular insights of one person, 3. Relationships and Connectedness:
although one person can enhance the wisdom
There is increasing recognition that
of the collective.”
healthy, growth-fostering relationships are the
1. Holism: fundamental human requirement for a healthy
The importance of a holistic approach to life.The therapeutic relationship has become
health is becoming more common, and most an important model for helping Survivors
self-help books now offer a range of healing move away from unhealthy patterns of
strategies encompassing physical, mental, interaction to relations based on trust,
emotional and spiritual aspects.They also empowerment and mutual respect.
emphasize the key roles of family and 4. Dream Therapy:
community supports in fighting disease.
Dream management is a popular
Recent cancer research has proven the contemporary strategy for furthering self-
effectiveness of positive healing imagery in awareness, as well as trauma recovery,
promoting healing, as well as managing the especially for Survivors experiencing post
emotional, mental and spiritual distress traumatic nightmares as a symptom of PTSD.
induced by a major illness. Using strategies Imagery from nightmares is now understood
that help the mind to heal the body and the as the brain’s way of processing repressed or
body to heal the mind are now considered dissociated memories; therefore, accessing and
crucially important complementary therapies understanding dream imagery can be a key to
to chemotherapy and radiation. recovery.
69
Traditional Midwives know the
Traditional Healers Today traditional teachings for bringing new life into
The De dwa da dehs nye>s Aboriginal the world and the ceremonies required. They
Health Centre in Ontario has produced the work with the woman during pregnancy,
following guide for traditional healers: labour, childbirth and, for a period of time,
Medicine People consider themselves after pregnancy.
channels or mediums in healing work. They Who is an Elder?
diagnose and treat a full range of spiritual,
The Aboriginal Healing Foundation
mental, emotional and physical problems using
describes an Elder as: “someone who is
the pipe, drum, rattles and other sacred
considered exceptionally wise in the ways of
objects.Treatment plans can include:
their culture and the teachings of the Great
ceremonies, such as sweat lodges or fasting;
Spirit.They are recognized for their wisdom,
offerings; feasts; and traditional plant
their stability, their humour and their ability to
medicines.
know what is appropriate in a particular
Elders have knowledge of traditional situation.The community looks to them for
teachings and model living in a Good Way. guidance and sound judgement.They are caring
They transmit the teachings and values in and are known to share the fruits of their
sweat lodge and other ceremonies, teaching labours and experience with others in the
and healing circles, and individual or group community” (Aboriginal Healing Foundation,
consultations and/or counselling sessions. 2001:4).
Herbalists know the traditional uses of Aboriginal services and communities rely
a variety of medicinal plants. They often work on the proven wisdom and cultural knowledge
in conjunction with medicine people, seers or of Elders for guidance. Examples of what one
medical doctors. Aboriginal health service considers essential
Traditional Teachers may be “Elders qualities in an Elder are as follows:
in Training” who know the traditional 1. disciplined and committed to a lifetime of
teachings and are committed to sharing this learning;
knowledge for the good of the people. They
2. knows traditional teachings and is
may conduct ceremonies and will work in
committed to helping people within this
conjunction with medicine people.
framework;
Seers are able to look into the past and
3. physically, emotionally, mentally and
future of a person to identify problems that
spiritually healthy;
need attention. They may suggest ceremonies
to be carried out or refer to a medicine 4. born with, or seeks, the gift of healing in
person or medical practitioner. apprenticeship with a traditional healer;
Ceremonialists are people who do 5. walks his or her talk, i.e., lives a healthy
certain types of ceremonies on request and lifestyle within the parameters of
know the songs and protocols for conducting traditional values;
the ceremonies. 6. provides help when asked, although may
not provide this help immediately;
70
7. able to bring traditional values and life • are holistic;
ways into contemporary urban life and • include a central role for Elders and
living in a practical way; traditional people;
8. treats his or her family, spouse, children, • use the structure of the circle and
parents, Elders and other traditional outdoor physical settings; and
healers in a respectful and caring manner;
• include traditional teachings and
9. is a positive role model for Aboriginal medicines, storytelling and ceremony.
people;
In the process of revitalizing traditional
10. able to teach and correct behaviour with customs, some Aboriginal people and
kindness and respect without humiliating communities choose spiritual beliefs and
the individual; teachings that predate the arrival of Christian
11. always hopeful of people and able to see religions.
the goodness in people; Others choose to integrate their
12. does not use alcohol or drugs or engage traditional customs and beliefs with
in other destructive addictive behaviour; Christianity. Personal choice in these matters
13. does not set a fee for their healing should be the central guiding principle.
service or request gifts in payment; Note: The wisdom and teachings of
14. knows the medicines and ceremonies; Elders and Traditional Teachers visiting or living
and in Ottawa contributed to this section,
including: Dr.Terry Tafoya, Dr. Mac Saulis, Jim
15. evidence of his or her success exists Albert, Irene Lindsay, Angaangaq, Reepa Evic-
among the people and the communities. Carleton and Paul Skanks.
The Continued Relevance of a

Culture-Based Approach to Healing
Although colonization interrupted the
passing along of traditional teachings and
practices, Indigenous people worldwide are
now making significant strides toward
reclaiming and revitalizing them.
Non-Aboriginal counsellors and
therapists must be open to seek guidance
from respected Aboriginal Elders and
traditional people and to refer Aboriginal
clients to culturally-based services, as needed.
By definition, culturally-based approaches
to healing:
71
Healing From Trauma
When psychological trauma is The eagle soars higher and higher by
understood as an affliction of the powerless, the spiralling upwards in ever-widening circles.This
importance of a holistic healing model that pattern of flight teaches that healing also
promotes empowerment at individual, family progresses cyclically, each new stage offering
and community levels is clear. deeper insights as preparation for the next.
Addressing historical and intergenerational
impacts of residential school abuse means re- Steps on a Healing Journey
viewing and assessing individual healing needs
within the larger picture of the healing needs of 1. Restoring a Holistic Life
families, communities and nations. The Medicine Wheel teaches that all
Culture-based healing strategies are aspects of life are cyclical; therefore,
creative and multi-dimensional, ranging from transformation is a natural part of all life.This
crisis intervention and prevention to addictions means, regardless of circumstance, everyone is
recovery, and cultural reclamation (including capable of change. Healing is said to begin at
reclaiming positive, pre-contact parenting). the point a commitment is made to leave an
old way of life behind and begin a new path
The Elders teach that all healing is spiritual aimed at restoring physical, mental, emotional
in the sense that honouring the spirit within and spiritual balance.
each person, regardless of their circumstances,
will naturally promote a movement toward 2. A Commitment to Safety and
balance and health. From an Aboriginal
Respect
perspective, healing is understood as a deeply
spiritual journey. For frontline workers, the first
The vision of the Medicine Wheel healing responsibility in trauma recovery is promoting
model, is reconnecting with our own inner safety in the healing process.
healing force/spirit that will restore: In an Aboriginal context, this means
• trust in others and ourselves; creating trust through a non-
• trust in the potential for ourselves and judgemental attitude and an approach to
others to change; support that aligns with the unique needs,
• trust in our ability to help ourselves and pace and realities of each individual.
our community; The Grandmother/Elder for the eastern
• a belief that we are worthy of love and Ontario frontline worker retreat, who is also a
kindness; and residential school Survivor, believes the most
• a belief that we are capable of showing destructive aspect of abuse is its cumulative
love and kindness to others in healthy impacts over the long-term. She believes the
ways. relentless, seemingly small, daily acts of
In the Aboriginal worldview, healing is a humiliation endured by children over the
lifelong process following the same spiralling course of their entire childhood is what has
pattern as an eagle in flight. been most difficult to heal.
72
She suggests healing must follow this Because they were taught as children that
same cumulative process in reverse, by what happened to them was their own fault
providing ongoing, relentless, seemingly small and they deserved the abuse, many lost the
acts of respect, loving kindness and support. ability to trust and count on themselves or
As trust is established through such other people. Because no action they could
means, clients, who are at risk of harm to take changed or influenced the situation to
themselves or others due to violence, their advantage, their sense of hopelessness
attempted suicide, slashing or substance abuse, grew, over time, into cynicism and despair.
may begin to work in partnership with their The following are some of the “Best
counsellors. Creating individual safety plans Practices” shared by frontline workers that
that minimize the level of future risk, while promote physical, emotional, mental and
ensuring clients are not re-victimized should spiritual empowerment of Aboriginal clients.
be a collaborative process. Physical Empowerment is restored in
The complexity of risk assessment and healthy ways through:
safety planning will vary with the severity of • breathing and rest/relaxation techniques;
trauma symptoms and level of risk associated • exercise, such as walking or games, or
with the coping strategies being used. sports of physical skill and endurance;
The key to safety is building a trusting • hunting or being on the land;
relationship between counsellor and client/ • Sweat Lodge ceremonies;
Survivor that grounds the client to hope. • therapeutic dance;
• healthy diet and nutrition;
• drinking lots of good water;
“Learning to trust is a crucially important first • support to manage addictions; and
step in restoring faith in one’s self and in other • traditional or modern medicine that
people.” reduces reactivity and hyperarousal.
(Frontline Worker Retreat Participant, 2000)
Mental Empowerment is restored in
healthy ways through:
• traditional teachings;
3. Re-Empower by Restoring Control • cognitive strategies, such as identifying
Unresolved trauma causes Survivors to symptoms and triggers and using daily
feel unsafe physically, emotionally, mentally and logs or diaries to chart them;
spiritually, even when circumstances no longer • dream interpretation and vision quests;
pose a threat. • creating innovative safety plans to reduce
risk and prevent re-victimization;
They feel unsafe in their own bodies; they • making a story, map or narrative to
fear the intensity and lack of control over illustrate the larger picture of the
their own emotions; they feel unsafe in Survivor’s life in the past, present and
relationships with others; and they feel future; and
disconnected from their inner spirit, as well as • visualizing new and more hopeful
from a higher creative power. outcomes of challenges in the Survivor’s
life.
73
One of the basic tasks in mental system that lacks personal contact. More often
empowerment is to create a sense of than not, people in urgent need encounter
partnership based on mutual respect between impersonal voice mail and endless recorded
the counsellor and/or helper and the trauma dialling options when they telephone for
survivor. assistance.
Healing partnerships are based on the Providing practical help accessing the system
belief that, by sharing their knowledge, or explaining complicated forms, such as for
survivors and healers generate new insights income tax, health care, housing or financial
into the impacts of trauma, healing and assistance, is more important in de-escalating
restoring balance. clients’ feelings of frustration and helplessness.
Another form of empowerment is However, such practical help must be
bringing the issue of residential school abuse combined with strategies that alert policy
into the public domain. Counsellors and makers and the general public about the impacts
clients, who are ready, can participate in of systems barriers and economic policy on
educational activities to increase awareness of people in pain.Advocacy is the only way of
past injustice and restore a sense of balance in effecting systems and policy improvements that
Aboriginal and non-Aboriginal relations. will prevent further suffering.
Emotional Empowerment is restored Spiritual Empowerment is restored in
in healthy ways through: healthy ways through any opportunity to re-
• non-judgemental support; connect with the life force or power of
• anger release and anger management Creation through:
techniques; • meditation or prayer and giving thanks;
• creative dream or art therapies; • participation in ceremonies;
• strengthening of informal support • consultations with respected Elders
systems with extended family, and/or and/or traditional people;
peers, and the Aboriginal community, • storytelling and legends;
including family members in healing plans; • chanting, singing or drum-dancing;
• restoring pride in Aboriginal identity, • healing circles;
history and culture; and • workshops for drum-making, wood or
• ongoing affirmations of the person’s stone carving, beading and craft-making;
unique gifts, strengths and worth. and
In the context of residential school • hunting or spending time on the land.30
trauma Survivors, it also means providing both
practical assistance and political 4. Remembering, Honouring and
advocacy to address social and economic Releasing
conditions, such as poverty and prejudice, that
Once steps are taken to ensure safety
cause continued suffering.
and to empower through personal control, the
For example, one of the features of trauma recovery work can begin. Counsellors
modern life is, paradoxically, a human service
30
Being on the land means peace, no distractions, disruptions or other intruding responsibilities. Most Aboriginal people consider
the relationship between people and the land sacred.
74
and helpers experienced in trauma recovery
Some Examples of Healing Strategies Used
refer to this as developing a gentle relationship
with the triggers that recall the traumatic in Métis Programs
event through flashbacks, nightmares or • Teaching and valuing the traditional skills
flooding. This means helping Survivors of men by being on the land hunting,
understand: fishing and cooking;
• what triggers are all about; • gathering medicines, such as sweetgrass;
• what to expect; • healing circles, smudging, drumming, and
• how to identify them; and sharing traditional Métis food;
• culturally-based strategies for managing, • culture camps for youth where they learn
overcoming and releasing them. traditional Métis music and dances, old-
time games and storytelling, as well as
As Survivors begin to understand and family and community values; and
honour the role of their triggers, they • leather and craft workshops for men, as
overcome their fears and are able to use them well as hockey nights at the counselling
in new ways as tools for the trauma recovery centre and quilting workshops for women.
process.
The better triggers are understood, Some Examples of Healing Strategies Used
the less power they have over the
in Inuit Programs
Survivor. According to frontline workers,
self-capacity in managing the symptoms of The central focus of Inuit healing
trauma is a cornerstone of recovery. strategies is to re-create a context in which
people work together for a better future for
the community, just as their ancestors did
Best Practices for Healing Strategies in the
living together in small camps. Building trust
Context of Residential School Abuse and cooperation through informal settings and
Specific to Métis and Inuit approaches is believed to work best for Inuit.
In 2004, the Aboriginal Healing • Culture camps: building igloos and making
Foundation convened gatherings for project traditional clothing;
staff of AHF-funded healing programs across • being out on the land;
Canada.The following strategies were • emoting powerfully in non-verbal ways,
described by project staff as especially effective such as screaming;
in promoting recovery from residential school • helping men understand their anger and
abuse and its intergenerational impacts. (Notes violence are triggers or symptoms of
of the AHF Project Gatherings, March 8th - unresolved trauma;
10th, 2004 in Winnipeg and in Iqaluit, March 16 • honouring ceremonies for men and
- 17th, 2004.) Note:These activities are often women to apologize to each other and
complementary strategies to family, group affirm each other’s value and worth;
and/or individual counselling. • feasts with traditional Inuit country food;
and
• Elder teaching.
75
Checklist to Prevent Re-Victimization
Frontline workers and helpers, including √ Counsellors must walk their talk:
traditional people, developed the following counsellors can take clients only as far as
checklist as a tool to help prevent re- they have gone on their own healing
victimization. (These guidelines apply from journeys and do not abuse substances
intake through to follow-up and/or referral.)31 when you counsel clients on relapse
√ Offer unconditional compassion and prevention, for example.
support within a safe, confidential √ Fostering a confidential, safe and calming
environment. atmosphere creates comfort for clients;
√ Understand holistic needs: provide focus on internal, as well as physical,
resources for clients that are culturally safety; and a healing-centred space and
appropriate and support all aspects of physical comfort is crucial for recovery.
well-being: mental, physical, spiritual and √ Active listening, positive feedback and
emotional. attention to body language are crucial
√ Understand and model the Seven aspects of helping clients feel safe.
Teachings with clients and co-workers: √ Never try to force a client back from a
love, trust, courage, honesty, bravery, flashback or dissociated state: in a soft
respect and honour. voice talk to the client about what you
√ Use a client-centred approach: the client see and hear; and allow time for re-
directs the healing journey, not the grounding before talking about what
counsellor; move at the client’s pace happened, how it felt back then and how
trusting them to know their needs; and it feels today.
respect their choices. √ Set healthy boundaries with clients:
√ It is important that clients do not have to inappropriate relationships are dis-
repeat the details of their traumatic empowering for clients and unethical for
experiences over and over again; counsellors.
becoming more aware of feelings and √ Minimize power imbalances between
coping strategies leads to positive change client and counsellor.
more readily than reinterpreting past √ Counsellors do not tell clients what to
factual events. do, make judgements or have
√ Use appropriate terms and proper expectations: clients must be empowered
names, i.e., calling a client “sweetheart” or to find their own answers, make their
“honey” may trigger a memory of sexual own decisions and take control over
abuse: use language the client can relate their own lives; and the counsellor or
to and understand; and do not use helper’s role is to facilitate this process.
language based in theory or jargon.
31
Contributors in developing this checklist: staff from Minwaashin Lodge, Pauktuutit Inuit Women’s Association, Ottawa Rape
Crisis Centre and the author.
76
√ Respect diversity: understand different √ Ask clients who self-harm to help identify
cultures and faiths, know your own roots. creative ways of minimizing risk that do
Assumptions and stereotypes based on not re-victimize themselves or others.
gender, race, culture, sexuality, age and/or √ Each organization and counsellor should
physical and mental ability serve to have a formal process for client safety to
further dis-empower and re-victimize assess triggers and create strategies that
clients and diminish the helper’s will prevent use of harmful forms of
effectiveness. intervention, such as physical restraint.
√ Each client is an individual: although √ Every organization should have a Code of
patterns exist, it is important to Ethics that all staff sign and agree to
recognize the unique resilience of each respect. (The Seven Teachings can be
individual client; and one person’s used as a guide.)
experience is never rated as more or less
traumatic than an others. √ Every organization should re-view its
service environment through new eyes to
√ Exposing clients to controlling, punitive assess whether, from an Aboriginal
or threatening attitudes or behaviours, perspective, it is a place of hope and
even in a joking a way, is a form of re- belonging, (i.e., whether Inuit, Métis and
victimizing them. First Nation people are represented,
√ Screen/educate referral services about respected and welcomed there).
attitudes or practices that may either √ Healing work is sacred work: clients
trigger or re-victimize Aboriginal clients. deserve counsellors and frontline
√ Openly discuss the counsellor’s obligation workers who honour their own healing
to report suspicions of child paths and can model self-care and
abuse/neglect or danger to self and/or respect of the body, mind, heart and
others. spirit.
77
Other Ways to Prevent Re-Victimization
78
“Just” Therapy
A team of Maori, Samoan and Pakeha32 In the Just Therapy model, new meanings
therapists from New Zealand have developed or interpretations re-place a person’s clinical
a reflective approach to therapy that symptoms within a broader social and political
underscores the role of historical, social and context. Instead of experiencing overwhelming
economic factors in perpetuating ongoing feelings of failure or helplessness, this
sicknesses of Indigenous people. approach encourages people to identify
Just Therapy takes into account the aspects of the problem that are beyond
impacts of colonization, marginalization and themselves.
poverty, as well as social, political and Understanding the social and political
economic inequities between men and women context of people’s pain reduces feelings of
due to gender discrimination. self-blame and guilt that are often roadblocks
to moving forward.This empowers people,
when they are ready, to join with others in
“Therapy can be a vehicle for addressing some of advocating for social change and ending
the injustices that occur in a society. It could be injustice.
argued that in choosing not to address these
issues in therapy, therapists may be inadvertently Therapists who are unaware of, or who
replicating, maintaining, and even furthering deny, avoid or minimize, the impacts of social
existing injustices. A “Just Therapy” is one that and historical injustice, risk perpetuating the
takes into account the gender, cultural, social and self-blame of clients. Rather than empowering
economic context of the persons seeking help. It is the clients, this may foster greater dependency.
our view that therapists have a responsibility to
find appropriate ways of addressing these issues, From a Just Therapy perspective, the
and developing approaches that are centrally benchmark of a service provider’s
concerned with the often forgotten issues of commitment to social justice is the extent to
fairness and equity. Such therapy reflects themes which its programming reflects themes of
of liberation that lead to self determining outcomes liberation, empowerment and cultural self-
of resolution and hope.” determination.
(Waldegrave, 1990:5, emphasis added)
Counselling Skills that Promote
As do many other Indigenous cultures, Empowerment
the people of New Zealand view the process In order to work effectively with
of therapy as sacred. Stories of pain and Aboriginal trauma Survivors in the context of
suffering are considered gifts that are worthy of residential school abuse and its
honour. intergenerational impacts, frontline workers
By listening respectfully and facilitating suggest the following list of skills are essential:
the search for new meanings, resolution and 1. Communication Skills, especially the
hope, therapists honour the pain of their ability to listen with empathy and without
clients. judgement, as well as a basic
32
An Indigenous term for New Zealanders of European origin.
79
understanding of First Nations, Inuit and 8. A Willingness to Refer and bridge
Métis cultural differences in Aboriginal clients to services run by and
communication (such as, pause times, the for Aboriginal people. Regardless of the
healing aspect of silence and variations in level of training and cultural skills, or the
refusal protocols). good intentions of non-Aboriginal
2. Crisis Management Skills, including counsellors, Aboriginal clients need the
risk assessment training (for self-harm, opportunity to interact and learn from
such as cutting, eating disorders or harm Aboriginal counsellors, Elders and
to or from others) and suicide traditional people who model a healthy
prevention. lifestyle.
3. Safety Planning Skills and proven Hope for a New Future

experience developing individual goal Aboriginal people have long been calling
monitoring plans in partnership with for services and service providers that respect
clients. and reflect their unique cultural perspectives,
4. Case Management Skills, especially values, beliefs and customs.
knowing how to mobilize community Many Aboriginal service providers are
resources effectively, to ensure a full committed to helping mainstream service
spectrum of culturally sensitive legal, providers develop a better understanding of
health, therapeutic, financial and an Aboriginal worldview, as well as the
educational supports. diversity of cultural beliefs and practices.
5. Interpersonal Skills, especially those By increasing cultural knowledge and
that promote mutual respect and a understanding, the dignity and honour of
collaborative approach between Aboriginal people and the wisdom and
counsellor and client, such as personal transformative power of their ancient
warmth, patience, flexibility and humour. teachings is upheld.
6. Understanding of Trauma in the The information in this section is
context of colonization and its impacts; presented in hope of generating discussion
knowledge of culture-based strategies to between Aboriginal and non-Aboriginal service
prevent re-victimization and manage providers about ways to promote healing
triggers effectively; and knowledge of how within a framework of social justice.
to access such supports for referral
purposes.
7. Culture-Based Knowledge and
Demonstrated Respect for the rich
history and diversity of Aboriginal people,
the impacts of assimilationist policies and
the courage, strength and tenacity that
have enabled Aboriginal people to survive
and thrive.
80
Working With Clients to Promote Safety
and Prevent Re-Victimization
Cultural accountability and prevention of Unconditional compassion, moving slowly

re-victimization were recurring themes at the and softly, and staying centred and strong
2000 retreat for Aboriginal frontline workers outside of the client’s chaos, all help to build
and Elders. In the view of those who trust in the relationship. Only when trust has
contributed to this manual, there are several been achieved can the counsellor/helper and
important aspects of cultural accountability client begin to explore issues of safety and risk
crucial to trauma recovery in the context of management.
residential abuse.
Helping to Prepare Clients for the Criminal
They include:
Justice System
• the capacity to communicate respect in Survivors who are thinking about using
ways that have meaning for Inuit, Métis the courts to seek reparation for residential
and First Nation people; school abuse need practical information about
• a non-judgemental attitude; the legal system and their options, as well as
• warmth and flexibility vs. rigidity or emotional support through this process.
institutional indifference;
• empathy; and People who have not been involved with
• a tolerance for ambiguity. the criminal justice system are often surprised
by the acrimony and injustice they encounter
Effective communication skills (both when they do become involved. Survivors
verbal and non-verbal) and sensitivity to the need to be aware the Western criminal justice
needs, values, aspirations and ways of system is based on an adversarial approach to
Aboriginal people are essential. winning and losing; therefore, the role of the
Because trust-building is so crucial as a defence is to discredit and disprove their
first step in healing, counsellors and frontline testimony. Many Survivors report feeling
workers must understand the importance of humiliated, shamed and re-victimized by their
building relationships slowly and informally, in experience within this justice system.
incremental stages. Survivors need to be prepared for the
Direct or personal questions are rarely sense of powerlessness they might feel in this
asked at the onset of a counselling process. Telling one’s story of trauma over
relationship. Before any explicit question is and over again, especially to unsympathetic
asked and before the issue of abuse is even listeners, requires great courage and resilience.
addressed, the counsellor must foster an Survivors may need help to identify a range of
atmosphere of safety and hope. supports before, during and after legal
procedures.
Once the counsellor understands the
client’s basic reason for seeking help and has a
sense of his or her unique conversational
pace, more probing questions can be posed.
81
each stage is crucial to involving clients and
Helping to Prepare Clients for the
their friends and family in the healing process.
Psychiatric Intervention and/or
As well, families and Survivors need
Institutionalization
specific information, such as who to telephone
Even though the rate of suicide is
in an emergency and what the process will be
significantly higher in the Aboriginal
from that point on, what to expect from
population, there are, at present, no culturally-
assessment, intake and hospitalization
based psychiatric facilities available. As a
procedures, what the timelines might be and
result, many clients are unintentionally re-
how they can best support their loved ones
victimized in the process of seeking help.
throughout the process.
Re-victimization in this context can take
many forms: a rigid, institutional setting with
Helping to Prepare Addicted or Solvent-
many rules replicates the institutional
indifference of the residential school Abusing Clients for Detoxification
environment. Aboriginal frontline workers and
Procedures used by psychiatric personnel counsellors have been strong advocates for
to subdue clients, such as forcible restraint and culturally-based addictions and detoxification
solitary confinement, evoke memories of force services. If culturally-specific services are not
and restraints used against children who tried available in your area, the following general
to escape from the residential schools. guidelines are suggested33 to help bridge
Aboriginal clients to mainstream services:
Frontline workers and counsellors must
work in partnership with psychiatric services DOs
to create new procedures that do not re- √ Do ensure the client is fully aware of the
victimize Survivors.The clients, especially those process to which they are agreeing by
who are unsafe due to aggression as a result informing yourself about all aspects of
of solvent abuse or psychotic episodes, must the service; tour the facility, talk to the
be partners in developing these procedures. staff, and create formal, interagency case
This empowers Survivors to take a more management and follow-up mechanisms.
proactive role in managing their own healing.
√ Do your best to convey to the client that
Family members or friends of Survivors it is safe and you are trustworthy.
who are experiencing the impacts of their
destructive behaviours also need practical √ Do your best to assess the needs of the
information and ongoing support. Many client vs. your own needs or the agency’s
Aboriginal friends and family members report needs; include, as many as possible, the
being ignored and feeling helpless in the resources at your disposal in client
course of accessing psychiatric services for evaluation and planning.
their loved ones. √ Do continue to provide emotional and
Information about the stages of practical supports to the client as
depression, suicide ideation or addiction needed.
withdrawal and the characteristics that define
33
Provided by the Addictions Case Manager for the Wabano Centre for Aboriginal Health, Ottawa, ON.
82
√ Do show you value the client’s humanity,
Preparing for Detoxification
remembering we are all the same people.
Detoxification is required when the
√ Do instill a sense of pride in the clients
person is experiencing severe physical
as they continue their healing work in
sickness, such as convulsions, profuse sweating,
partnership with you and staff of the
vomiting (dry heaves), tremors and/or
detox/treatment centres.
hallucinations. For clients in this condition and
DON’Ts depending on the available services in your
√ Don’t ever put a client below you in area, the following are presented as general
esteem or worth. procedural steps:
√ Don’t enable a client with money or 1. Contact a medical practitioner, such as a

material objects. community nurse or family physician, for
assistance.
√ Don’t pass on to other workers or
agencies your responsibility to a client; 2. If a medical practitioner is not available,
foster a team approach that includes the contact the nearest detox centre or
client and shared responsibility for hospital; in many rural communities,
outcomes. hospitals provide this service.
√ Don’t assume you know best what the 3. Make the client as comfortable as
client’s needs are. possible under the circumstances, by
providing limited amounts of water,
√ Don’t do everything for the client; mainly for rinsing; try to discourage too
provide practical support and assistance, much intake and provide a cold compress
but promote skills that build self-reliance and rest in a quiet, dimly-lit room.
and encourage interdependence and
mutual help. 4. Ensure the client is near a toilet facility
or provide an appropriate container for
Frontline workers and counsellors, who vomiting.
are new to working with addicted or
substance-abusing clients, need to make 5. Do not provide any medication, such as
themselves aware of the differences between aspirin, Pepto-Bismol or Gravol, without
detoxification centres and drug/alcohol professional guidance.
treatment centres. 6. Remain calm and reassure that everything
will be okay.
7. Relay all pertinent information to the
detox centre or hospital and any person
who will be in contact with the client. At
this time, include any information specific
to cultural needs, such as smudging or
access to Elders, while in the detox
centre.
83
8. Make arrangements for travel to the 3. Schedule a time and safe place with your
detox centre or hospital. client to assess treatment needs.
9. If the client agrees by signing a release of 4. Considering your contacts and the
information agreement, contact a trusted services you have identified as being the
friend or family member of the client to most appropriate for your clients, present
inform them of her or his whereabouts a range of treatment options for the
and plans. client to consider.
10. Request information about joint case 5. Schedule another appointment in a safe
management options and follow-up place to fill out the application and/or
concerning client outcomes. referral forms with the client.
11. Provide a written report to your 6. Ensure all application forms are
supervisor detailing the steps you have COMPLETE. Incomplete application
taken, as well as the contact people’s forms will delay services for your client.
names, roles and telephone numbers. 7. Should your client or staff of the centre
have questions or concerns, try to make
Preparing for Addiction Treatment Centre
sure your client is always part of the
Application discussion.This way everyone concerned
The following guidelines may be beneficial is clear about what is being stated and
to counsellors or frontline workers who are there is less chance of miscommunication
new to their position or have not fully or misunderstanding.
accompanied a client through the treatment 8. Make sure the decision of the client to
process.They are offered as general guidelines enter the treatment service is based on
only and should be adjusted based on full and informed consent.
individual needs and available services.
9. Ensure all articles a client will need while
1. Obtain copies of the Canadian Directory of in treatment are available; most centres
Substance Abuse Services and the Directory provide a list of what to bring or not to
of the National Native Alcohol and Drug bring.
Abuse Program (NNADAP); these
directories provide an overview of 10. Once you have received confirmation of
individual and group treatment options, as acceptance, inform your client
well as criteria for entrance and immediately so preparations to enter may
restrictions. begin.
2. To the best of your ability, identify the 11. Arrange for travel and/or
services in your area you believe will be accommodation as required.
most beneficial to your clients; contact 12. During any waiting period, begin weekly
these services and ask for copies of their counselling sessions with your client
application forms to have on hand.Take and/or inform them of other options,
this opportunity to introduce yourself such as Alcoholic’s Anonymous, men’s or
and to talk about your position and the women’s talking circles, cultural events,
needs of your clients. workshops, etc.
84
13. Once the client is in treatment and with 5. Reclaiming a nation-to-nation relationship
the client’s written consent, contact the in political life.
family to see if any assistance is required; Cultural reclamation as a healing strategy
be prepared to offer options and bridge helps transform the pain of disconnection and
family members to appropriate services humiliation into pride, honour and strength.
for women, children or seniors.
Aboriginal organizations have a
14. Make contact with the treatment centre responsibility to ensure the spiritual teachers
on a weekly basis for updates on your and guides they recommend are safe for
client’s progress. Ask for a role in case Survivors.The increasing use of “traditional
management and coordination, as well as medicines” or drugs to induce visions, as well
follow-up plans to reduce the likelihood as openly discriminatory attitudes toward gay
of relapse. and lesbian people among some traditional
15. Review all of the client’s goal plans and healers and Elders are considered forms of re-
identify areas where you can best provide victimization.
support and those areas where the client The following guidelines were developed
will benefit most from referral to another by the Wabano Centre for Aboriginal Health
service. (2000) in Ottawa to protect clients from re-
16. Celebrate the client’s courage and victimization:
commitment to a healing path. 1. Each organization should have a Code of
Helping to Prepare Clients for Linkage to Ethics specifically for Elders and
Elders and/or Traditional Healers traditional people.
Cultural reclamation through linkage to 2. A thorough screening and reference
cultural supports is a foundational principle of check (including police check) should be
accountability in effective healing work with conducted for each Elder or traditional
Aboriginal people. healer brought into the organization as a
resource for clients.
What Cultural Reclamation Means 3. Elders and traditional people should be
1. Reclaiming cultural pride and the identity screened for sensitivity to client needs
that was stolen from individuals, families and should have extensive experience
and nations. with residential school Survivors.
2. Revitalizing the wisdom of traditional 4. A helper should be provided to assist and

teachings, customs and practices. be present at all times to ensure the
safety of clients, as well as Elders and
3. Respecting and honouring the roles of all: traditional people.The helper should also
women, men, children, Elders and gay and be knowledgeable about safety
lesbian people; ensuring a place of precautions relating to Survivors.
belonging for all.
4. Reclaiming ceremony and celebrations of
our survival.
85
5. In a holistic healing model, Elders and
traditional people are part of a larger
team or Circle of Care that includes
therapists, family members, friends, and/or
other Elders with whom the client feels
safe and comfortable. (These individuals
should be available as back-up, in case of
an emergency.)
The following are key questions for non-

Aboriginal counsellors and frontline workers
underlying all strategies to promote client
safety:
√ Are you as informed as you need to be
about Inuit, Métis and First Nations
cultural issues, in order to be an effective
counsellor/frontline worker for Aboriginal
clients?
√ Who else should be included in building a
strong network of support for Aboriginal
clients?
√ Are you willing to work cooperatively
and with mutual respect with Elders,
traditional people and staff of Aboriginal
services in your area?
86
Section V:
Impacts of Trauma
on Workers
Section V
Section V:
Impacts of Trauma on Workers
Working on the front lines of trauma response to the personal histories,
recovery has profound impacts on the experiences, worldviews, belief systems and
physical, mental, emotional, and spiritual life of feelings of their clients.
counsellors and frontline workers. Counsellors typically react to clients on
In the context of residential school abuse the following levels:
and its intergenerational impacts, most • an emotional or feeling level;
Aboriginal frontline workers and counsellors
have been personally touched by this tragedy. • a mental or thought level; and
Three areas requiring special attention in • through physical sensations.
terms of impacts of this work relate to
countertransference, burn-out and vicarious The type of reaction, whether
or secondary trauma. Aboriginal counsellors comfortable or uncomfortable, reflects how a
and frontline workers should have a basic client has affected the counsellor in the
understanding of these impacts, so that context of the counsellor’s own personality
effective strategies for self-care can be and past experience. Sometimes, a client’s
incorporated into their work. personality or personal story may trigger
unresolved, deep-rooted issues from the
counsellor’s past.
Understanding and Working With
Countertransference signals the presence
Countertransference
of such issues on the part of the counsellor
Countertransference refers to a that are playing out in the counsellor and
counsellor responding to a client’s Survivor relationship.
transference by accepting it at face value,
In the context of residential school abuse,
rather than understanding it as part of a
most Aboriginal counsellors, helpers and
natural process of healing, trust-building and
Elders are themselves impacted by it, whether
growth.
as Survivors or through its intergenerational
According to the authors of a training impacts.
curriculum for working with survivors of
As a defence against their own
childhood abuse, countertransference is the
unresolved feelings of helplessness or
term used to describe the counsellor’s
hopelessness, they may assume the role of
responses and reactions to clients.
rescuers, seeing themselves as the only people
Countertransference is a normal part of the
who truly understand Survivors. Severe
dynamics of every client and counsellor
boundary violations, such as sexual
relationship (Saakvitne et. al., 2000).
relationships, are often rationalized on the
Counsellors bring their own personal basis of the Survivor’s desperate need for
histories, experiences, worldviews, belief rescue and the counsellor’s equally desperate
systems and feelings into each counselling need to rescue as a form of self-validation
relationship. From these, they shape a (Herman, 1997).
87
Both transference and countertransference
also need to be understood in the context of “the easy part is recognizing the courage and skills
Western popular culture, which sexualizes of Survivors and the wisdom of their culture. The
figures of power and authority. hard part is reconciling that we are part of the
Other forms of countertransference white system that created residential schools, a
system that still carries racist ideas.”
include over-identification due to unresolved
grief, anger or bystander guilt. Counsellors
may begin to identify with the Survivor’s Dr. Saxe suggests there is a need for non-
helplessness or rage to the point they begin to Aboriginal counsellors to be humble, while
fear the client, becoming deferential to the recognizing their knowledge and experience is
anger or placating it. relevant. (From conversations between Dr.
This may result in the counsellor Saxe and the author, 2004.)
becoming sceptical of, or minimizing, the Part of good counselling is being mindful
Survivor’s story, feeling increasingly inadequate of one’s own internal reactions and responses
or even becoming unable to enjoy the to others, and understanding where they come
pleasures of her or his own life. from, what they mean and being able to
Re-enactment of victim/perpetrator roles contain those reactions and responses.
in the counselling relationship through Defence mechanisms or triggers on the
transference and countertransference can part of the counsellor are signals of
become extremely complex. Ongoing political countertransference.
and social tensions between Aboriginal and
non-Aboriginal people in the larger society Countertransference becomes a problem
may add to this complexity and each may when it interferes with the counsellor’s ability
come to feel a victim of the other. to understand the client, empathize with the
client and/or respond appropriately to the
Countertransference can lead counsellors client’s needs.
to feel helpless and hopeless in their abilities
and skills.They may question their capability to In the context of the legacy of residential
work with Survivors and, if non-Aboriginal, school abuse and the intergenerational
may even question their right to be doing this impacts, non-Aboriginal counsellors with
work. unresolved feelings of guilt might initially react
by denying or minimizing an Aboriginal client’s
As a result, non-Aboriginal counsellors experience.
may think they have no role in healing for
Survivors of residential school abuse; however Aboriginal counsellors with unresolved
well-intentioned, they are imposing themselves trauma related to abuse in their own personal,
just as residential schools were imposed on family or community histories might react by
Aboriginal people. projecting personal feelings of rage, grief or
helplessness onto clients with similar stories.
According to Dr. Brenda Saxe of the
Centre for Treatment of Sexual Abuse and Any strong reactions toward a client,
Childhood Trauma, for non-Aboriginal whether positive or negative, indicate a
therapists: potential problem with countertransference.
88
As transference and countertransference Physical stress may arise from modern
are inevitable, counsellors must ensure safety technology: too much time in front of the
in the relationship through ground rules and glare of computer monitors, too many
boundaries, as well as through personal telephones ringing, badly designed work
support systems for themselves and stations or office chairs; from lack of time for
opportunities for intercultural collaboration. breaks/rest; or from bad air or bad water in
All counselling organizations should have the workplace. Emotional stress may arise
procedures in place for counsellors and from trying to balance the demands of work
frontline workers to debrief and problem- and family life, or from the urgency of the
solve issues of countertransference with a needs of clients or from the sheer amount of
qualified supervisor, Elder or peers. It is paperwork required. Spiritual stress may
suggested that therapists seek support arise from: feelings of dis-connection to one’s
through their own therapist. inner self or to Creation; or from lack of time
to take part in customs, traditions or
ceremonies that are spiritually grounding.
Understanding Burn-Out
When workplace stress is not
Aboriginal counsellors and frontline acknowledged or validated, and the feelings
workers work in a service environment where around it are unexpressed, it generates still
the urgency of client and community needs far more stress.
outweigh the resources to meet them. This
environment, as well as the nature of trauma By the time impacts begin to manifest as
recovery work, puts volunteers and staff at symptoms, burn-out may be quite advanced.
high risk for burn-out.
Symptoms of Burn-Out
“Burn-out” is described by the
psychotherapist Herbert J. Freudenberger who • Tired, even with adequate sleep;
coined the term as: “a state of fatigue or • dissatisfied with the work;
frustration brought about by devotion to a • feeling sad for no apparent reason;
cause, way of life, or relationship that failed to • forgetfulness;
produce the expected reward” (1981:13). • irritability;
• avoidance of people;
Using this definition, burn-out results not • difficulty communicating;
from overwork, but from the gap between • sick more often;
effort and reward. Over the past two decades, • conflictual;
the meaning of the term has been broadened • difficulty concentrating; and
to include chronic fatigue from the continuous • mood swings.
stress of the modern workplace and fast-
paced way of life. It is crucially important that crisis
intervention and trauma recovery service
According to Aboriginal frontline providers recognize their responsibility to
workers, stressors take many forms. Mental prevent occupational stress and burn-out.
stress may come from too many things to do
or to keep track of in too few hours; or from Clients in trauma recovery deserve
many sudden changes in the workplace. healthy, balanced frontline workers able to
impart a sense of balance, energy and spirit.
89
Frontline workers and counsellors, whose
expertise and compassion help inspire clients “As victims describe the horrifying details of their
to renewed hope, deserve to be treated with trauma, parallel states of fear, grief, helplessness,
respect, not driven to exhaustion. and disgust can be evoked in the therapist.”
Self-care is a way of protecting the (Blair and Ramones, 1996:26)
mental, emotional, physical and spiritual well-
being of counsellors and frontline workers,
while burn-out is destructive and unbalancing. Vicarious or secondary trauma mirrors
the impacts of traumatic events experienced
Service providers who have not yet
directly by victims.Vicarious trauma impacts all
developed formal strategies to prevent burn-
areas of a counsellor’s life by touching the very
out should take this opportunity, in
core of an individual’s belief system and
partnership with their frontline workers, to
disrupting meaning, connections, identity and
develop prevention plans. Such plans should
worldview. Damage from vicarious
include supervision processes for ongoing
traumatization worsens over time and can be
monitoring of work and caseloads, as well as
permanent.
opportunities for fun, laughter and relaxation
throughout the workday. Coping mechanisms for vicarious trauma
are the same as those for trauma survivors,
including numbing through alcohol or drugs,
Understanding Vicarious Trauma
denial, dissociation, withdrawing from
Vicarious or secondary trauma are terms relationships and so on. Aboriginal frontline
used to describe the emotional, mental, workers developed the following list of
physical and spiritual effects on counsellors symptoms that, from their experience, may
and frontline workers of hearing and indicate vicarious trauma.
visualizing the traumatic stories of their clients
(Saakvitne et. al., 2000).
Symptoms of Vicarious Trauma
Counselling and healing work requires a
willingness and ability to be open, respectful, Physical Symptoms:
compassionate and empathetic to clients. • Sleep disturbances, nightmares;
Many people are drawn to this work • eating disorders, loss of appetite;
because of a deep belief in social justice and a • nausea or sickness;
personal desire to foster social change. • sweating or chills;
However, these beliefs, combined with a • dizziness;
greater capacity for empathy, increase one’s • chest pains; and
vulnerability to vicarious trauma.Vicarious • difficulty breathing, forgetting to breathe.
trauma is a normal human response to hearing Mental Symptoms:
about or witnessing such suffering.
• Memory lapses, forgetting;
• difficulty making decisions;
• confusion;
• difficulty concentrating;
90
• flashbacks, repeatedly visualizing the approach.This worldview presents some
traumatic event; serious limitations, the most important having
• too many thoughts at once, mind is to do with perceived impacts of vicarious
racing; and trauma. For example, in their paper
• suicidal thoughts. Understanding Vicarious Traumatization, Blair and
Emotional Symptoms: Ramones suggest the following:
• Crying;
• feelings of inexplicable grief or loss; “...therapists may become prone to intrusive
• helplessness; thoughts and disturbing dreams in response to these
• anger; stories, or may become unable to control anger at
• fear; perpetrators or become hypercritical of the system
that “allows” abuse and victimization to continue.”
• irritability;
• feeling overwhelmed; (Blair and Ramones, 1996:26, emphasis added)
• guilt;
• hopelessness;
• nervous or anxious; and From an Aboriginal perspective, being
• depression. “hypercritical” of a system that allows abuse
and victimization to continue is an important
Spiritual Symptoms: aspect of healing in the context of
• Loss of meaning; colonization and residential school abuse.
• loss of hope for the future;
• loss of faith in humanity; and Resource People:
• loss of a sense of connection to self, to
significant others and to all Creation. Elders and traditional healers are available
for consultation through Aboriginal counselling
Frontline workers and counsellors, as well or health centres, friendship centres or
as the service organizations that employ them, organizations.
should have a thorough understanding of
vicarious trauma. There are now many Aboriginal healers in
North America who specialize in trauma
Without this understanding, workplace recovery training for frontline workers, such
problems are too easily attributed to personality as Dr.Terry Tafoya, Shirley Turcotte, Jane
differences or difficult people instead of impacts Middleton-Moz and David Asetoyer. For more
of the work.This only compounds the level of information, use Internet searches and/or
stress for people already in difficulty. Much sick contact Aboriginal services in your area. Look
leave and workplace conflict is directly linked to for Aboriginal healing programs specializing in
unrecognized, untreated vicarious trauma. trauma recovery from residential school abuse
and its intergenerational impacts.
A Word of Caution About Contemporary
Theories of Vicarious Trauma
Most of the material about vicarious
trauma is the work of non-Aboriginal
therapists schooled in a modern,Western
91
Strategies for Self-Care
The Chinese symbol for “crisis”
Self-Care Suggestions from Frontline
integrates elements of two other symbols: the
one for “danger” and the one for Workers and Counsellors
“opportunity.” The question underlying all • Remember to love and to grow.
crises should be: Where is the opportunity to
• Connect with other organizations and
learn and grow stronger in this situation?
share the work.
Aboriginal frontline workers and Elders have
contributed their ideas for this section of the • Sustain a commitment to empowering
manual. Inuit, Métis and First Nation people.
Strategies to prevent burn-out and • Grow and develop personally and
vicarious trauma are similar to those for professionally in working for Aboriginal
empowering trauma survivors. The first step people.
is making a commitment to a holistic, balanced • Take any learning from this manual you
life at both individual and organizational levels. feel is positive back to your organizations
The second step is accepting that workers are and communities.
not to blame, nor are they “crazy” or in the
wrong line of work. The third step is to Using the Medicine Wheel as a guide,
learn, use and share effective, culturally- Aboriginal frontline workers and Elders
based strategies to promote self-care. created a sample organizational and personal
self-care plan at the end of this section.
Commitment to “Working in a
Good Way”
The following practices are widely used
by Aboriginal frontline workers, counsellors
and Elders and are presented here to illustrate
a culture-based, holistic and balanced approach
to trauma work.
Self-Care Suggestions from Elders

• Use the smudge daily to purify thoughts,
words and actions.
• Continue to strengthen the circle that
has no beginning and no ending to which
we all belong by ensuring everyone is
welcomed into the circle and has a
valued role in healing.
92
In Closing...
The final words in this manual are a
reminder from the Addictions Case Manager
at the Wabano Centre for Aboriginal Health
that Aboriginal people have all that is needed
right now to meet the challenges.
“Today our nations are struggling to regain their

strength which once was found in our cultural
teachings and worldview. We knew that life would
be a hardship at times on this physical path;
however, we also knew that everything that we
would need to face these hardships were placed
upon Mother Earth and that she would provide
medicine, food, clothing, shelter and teachings on
how one should act and behave within Creation.
Our cultural histories cannot be honoured or
praised if we as a people stand silently by and
allow our own teachings of kindness, sharing,
strength, and honesty to be violated. Our past
Grandfathers and Grandmothers would not allow
for any of their people to go without; this was
unheard of amongst our people. We were taught to
share life, even if it meant that we had to go
without for a time. We would offer our last piece of
bread or meat or flour to someone who had none.
We need to remind all of our people that we should
never allow even one of us to suffer upon our
provider, Mother Earth.”
93
Example of an
Organizational Self-Care Plan
From an Aboriginal Perspective
Heart Mind
Include policy for Provide sweat lodges;
spiritual and mental health systems for debriefing and
leave days; a “buddy” system support; encourage openness
to encourage looking out for so workers express feelings
each other and promote safety and thoughts; provide ongoing
(safety encompasses all 4 aspects); supervision with trauma specialists;
and also provide sweat lodges, a good ongoing professional development
place to cry, good places with cultural healers and teachers.
to tell stories, to laugh and
tease with each other.
Body Spirit
Massages for staff; sweat lodges; Sweat lodges;
energy work and treats; time-out seasonal ceremonies;
for stretching and yoga; lunch hour buildings and/or offices smudged
walking and Medicine Walks; each day; arts and crafts workshops,
a water dispenser and healthy, staff retreats in the woods;
traditional food served at and drumming,
staff retreats; and throat-singing to
country food replenish spiritual
for Inuit. energy.
94
Example of a
Personal Self-Care Plan
From an Aboriginal Perspective
Heart Mind
Laugh, cry, sing Listening to stories
Talking/sharing for teachings
Laugh and tease each other – Compare notes on Teachings
Laugh at myself/humour Be open to change and to love.
Exchange energy with trees – Actively listen with an open mind
Balance a heavy heart with the Know there is something to be learned
pure energy of trees each day, everyone is my teacher
Show love to family/friends Humour
Personal healing, ongoing caring, Listening to soothing music
sharing, hugs, not being afraid to Reading
say ‘I love you’ … Talk with friends, interact with others
Care, share and love lots! Healing circles,Visualization
Treat everybody equal and with respect
Interaction
Body Spirit
Dance Ceremony, Prayer, Medication
Sex Medicines – our own Love!
Massage Laugh at myself
Sweat Lodge Drum and sign
Physical activity/exercise Re-connect the Spirit to Earth,Water
Cedar Baths Grounding Ceremony on Mother Earth,
Eating well & getting enough rest Mountains – camping – hiking
Knowing who I am for today Let go of guilt
Listening to my body Smudging before and after work
Knowing my limits Smudge after each client
Keep the Mind, Body
Looking good everyday
and Spirit clear
Bath, clean clothes Think positive thoughts
Lunch – feast – love at all times
Walking, fresh air Hunting
& exercise Peace
95
Appendix A
Appendix A:
Fact Sheets
Appendix A
A1
Inuit Culture and History
1 Centuries of accumulated knowledge
Some facts to consider
allowed Inuit to survive without modern
The Canadian Constitution defines Inuit
doctors longer than any other Indigenous
as one of the three Aboriginal peoples in
people. Inuit used medicines derived from
Canada along with First Nations and Métis.
plants and animals to prevent and heal from
The word Inuit means the people.The singular
illnesses and injuries.
is Inuk, meaning a person.
The traditional Inuit diet consists of sea
Within Canada, Inuit are distinct
and land mammals, such as whale, seal, polar
Aboriginal people who inhabit vast areas of
bear and caribou. Food was often preferred
the Arctic. Inuvialuit live in the Western Arctic
uncooked and was always eaten communally.
and speak Inuvialuktun. Inuit live primarily in
Nunavut, the Northwest Territories and An ancient Inuit custom still practiced in
northern Labrador and Quebec. Inuktitut is the North is customary adoption, which assures
the language of over 85 per cent of the Inuit families who want children but are unable to
population in Canada. have them are able to adopt. Parents willing
to share a child with such families are sure of
Inuit and Inuvialuit maintain distinct
a welcoming home and continued contact with
dialects, histories and cultural traditions that
their birth child. Customary adoption ensures
span thousands of years.
all children are loved and cared for by sharing
Approximately 56,000 Inuit and Inuvialuit the responsibilities and joys of parenting.
live in 53 small communities scattered
throughout the far North. Although these Contact with Europeans
communities are separated by great distances The quest for the Northwest Passage
and connected primarily by plane or radio, first motivated Europeans to explore the
Inuit are an extraordinarily close-linked Arctic regions. Earliest written accounts are
people. the 1576 journals of Martin Frobisher, who
Inuit in Canada are part of a larger described Inuit as “peaceable,” though not all
circumpolar Inuit community of approximately subsequent contacts were as friendly
250,000 people from regions in Russia, Alaska (Morrison and Wilson, 1995).
and Greenland, making Inuit the largest The first exploitable Arctic resource for
landholders of any tribe on earth. The Inuit Europeans was whales; by the 1800s, their
Circumpolar Conference (ICC) represents whaling boats pervaded the North.
Inuit at the United Nations.
Following the whalers came traders,
The hallmarks of Inuit tradition and missionaries (Anglican from rural England and
culture are: respect for individuals, a Roman Catholic from France and Belgium) and
concern for Inuit collective well-being and a the North-West Mounted Police. During this
willingness to share. time, Inuit still retained control over their own
1
Morrison, B. and C.Wilson (1995). Native Peoples: The Canadian Experience.Toronto: McClelland and Stewart.
A3
decision-making and remained largely schools, the loss of family and absence of love,
autonomous. and the strangeness of the new language and
This changed suddenly by the 1950s with food. Many also describe the humiliation of
the discovery of rich mineral deposits and the being forced to perform demeaning acts and
Cold War’s demand for strategic NATO air the trauma of physical and sexual abuse.
bases.
Cultural Reclamation
Impact on Inuit In 1971, Inuit Tapirisat of Canada (ITC)
New interest in the North ushered in a was created to promote social, economic and
period of forced relocation, during which Inuit political development, including protection of
were removed from their ancestral homes and the Inuktitut language and the restoration of
hunting territories to centralized, government- the hunt. After the opening of Nunavut, its
created settlements. This disconnection from name changed to Inuit Tapiriit Kanatami (ITK).
their lands caused a grief that is still felt In 1984, Pauktuutit, National Inuit
among many Inuit today. Women’s Association, was founded to address
The Inuit traditional way of life changed issues of importance to women and restore
dramatically in the settlements. Traditional women’s role in cultural life.
systems of justice, education, health, spirituality As a result of the Nunavut Land Claim
and the role of Elders were replaced with Settlement, the new territorial Government of
non-Inuit institutions and laws. Nunavut officially opened on April 1, 1999. Its
Government-imposed housing and diet Legislative Assembly, Cabinet and Court are
proved disastrously unhealthy for Inuit. A responsible for governing an area comprising
population that had survived for thousands of 2.2 million square kilometres (20 per cent of
years without addictions, substance abuse or Canada).
diseases, such as tuberculosis, began spiraling
Inuit Today
into tragedy.
• 60 per cent of the Inuit in Canada are
Residential Schools under age 25;
Many Inuit children were taken far from • by the year 2016, the Inuit population is
their homes to four schools established by the expected to reach 60,300;
Canadian government and the churches: the • 6 per cent of Inuit live in southern
Yellowknife Residential School, Inuvik Canada;
Residential School, Churchill Residential
School and Chesterfield Inlet Residential • 50 per cent of the Inuit in Canada are
School (King, 1996). unemployed;
At these schools, Inuit children • sexual assault in the North is 4 to 5
experienced sudden and dramatic changes in times higher than in the rest of Canada
diet, dress, language and environment. with the highest risk group being children
aged 7 to 18;
Survivors today speak of their terror as
children during first plane flights to the
A4
• the rate of suicide among the Inuit in
Canada is the worst in the world: 211
per 100,000 vs. 14 per 100,000 in the
rest of Canada; and
• Inuit also have lower life expectancies,
higher infant mortality rates and higher
rates of death by accident and violence
than the rest of the population in Canada
(Health Canada, 2000).
An Inuit Health Policy Forum has been
organized to address the above issues.
Special thanks to Angaangaq, Reepa Evic-Carleton
and Tracey Brown for guidance on this Fact Sheet.
A5
Milestones in First Nations History
Many non-Aboriginal Canadians are society.
unaware of the true history of First Peoples In 1874, Indians were required to be
and their long struggle for equality and justice. “registered” in anticipation of the Indian Act.
Although in 1763, King George R. III issued a
Royal Proclamation affirming Native people In 1876, the Indian Act was passed,
had not ceded their rights and title to the detailing the Canadian government’s system
land.This proclamation, like the treaties to for controlling and assimilating First Peoples.
follow, was never respected in spirit or intent During subsequent years, amendments to this
by those in power. act reinforced this imposing system.
Highlights of this Act

“And whereas it is just and reasonable and • Native people were forbidden from
essential to Our Interest, and the Security of Our leaving or travelling off their reserves
Colonies, that the several Nations or Tribes of without written permission on a pass
Indians with whom We are connected, and who live card signed by an Indian agent.
under Our Protection should not be molested or
disturbed in the Possession of such Parts of Our • Native women who married non-Native
Dominions and Territories as, not having been men were denied their status rights, as
ceded to, or purchased by Us, are reserved to them were their children, while non-Native
as their Hunting Grounds.” women, who married Native men, and
(RCAP, 1996 cited in INAC, 2004) their children received full status rights.
The great Shawnee Chief Tecumseh was

born about 1768. Although he lost his life in
battle, his vision of a unified Indian
Confederation uniting all tribes lived on.
Today,Tecumseh is recognized by historians
and honoured by Native people for his role in
advancing Native history, identity and culture
in Canada.
In 1867, the British North America Act gave
jurisdiction over Indians and lands reserved
for the Indians to the federal government.
This was followed in 1869 by the
Enfranchisement Act, which asked Native people
to give up their special status in exchange for
Canadian citizenship rights as a way of
integrating them into the new “Canadian”
A7
• Traditional, sacred ceremonies were soil using only hand implements would help
criminalized; anyone caught practicing him to “evolve from hunter to peasant and
them was liable to imprisonment. only then, to modern man.”
From 1900 to 1927, some First Nations
began organizing politically to raise money for
Every Indian or other person who engages in, or
assists in celebrating or encourages either directly lawsuits against these injustices.The Canadian
or indirectly another to celebrate, any Indian government responded by making it illegal to
festival, dance or other ceremony, goods or raise money or contribute funds for political
articles, of any sort forms a part, or is a feature, purposes, including land claims.
whether such gift of money, goods or articles takes
place before, at, or after the celebration of the The Long Struggle for Justice
same, and every Indian or other person who
engages or assists in any celebration or dance of In 1960, the Canadian Bill of Rights
which the wounding or mutilation of the dead or granted Indian Suffrage, giving Indians, for the
living body of any human being or animal forms a first time, the right to vote in a
part or is a feature, is guilty of an indictable federal election.
offence and is liable to imprisonment for a term not In 1968, status and treaty groups
exceeding six months and not less than two
achieved Tecumseh’s vision by forming the
months; but nothing in this section shall be
construed to prevent the holding of any National Indian Brotherhood “uniting all Indian
agricultural show or exhibition or the giving or groups into one” as a lobbying mechanism for
prizes for exhibits thereat. treaty and human rights.
Statutes of Canada, [S.C.] 1895, c. 35, s. 6; S.C. In 1969, the Canadian government
1906, c. 81, s. 149 released its White Paper on Indian Policy, calling
for the complete assimilation of First Nation
People into Canadian society by eliminating
• It was illegal for Natives to kill any of their special status.The National Indian
their own livestock for sale off the Brotherhood successfully lobbied parliament
reserve. and the public to defeat the White Paper.
• Rules from inheritance rights to details of In 1974, the Native Women’s Association of
what crops could or could not be Canada was founded to enhance, promote and
planted, to whom they could be sold and foster the social, economic, cultural and
for what price were imposed and political well-being of First Nations and Métis
enforced by Indian agents. Similar laws women.
were passed restricting commercial
In 1981, the United Nations found
fishing sales to just one outlet.
Canada and the Indian Act in violation of
international law, due to the discriminatory
In 1888, legislation was passed to treatment of Indian women and the status law.
prevent Native people from taking out loans
for farm machinery.The reason given by
Hayter Reed, deputy commissioner of Indian
Affairs, was that forcing the Indian to work the
A8
The Canada Act, proclaimed in 1982, In 1997, the Supreme Court of Canada
included a provision for Aboriginal rights, as made another landmark decision in the land
well as a recommendation to resolve claim of the Gitksan and Wet’suwet’en peoples
discrimination against Aboriginal women. Also, in British Columbia.This decision “affirms
the National Indian Brotherhood changed its Aboriginal title exists at law and cannot be
name to the Assembly of First Nations. sold, surrendered or relinquished without the
In 1985, Bill C-31 ended a century of consent of the First Nations.”
discrimination against Native women who For further information, see:
marry non-Native men by restoring status a) Assembly of First Nations: http://www.afn.ca
b) Native Women’s Association of Canada: www.nwac-hq.org
rights to them and their children. c) Congress of Aboriginal Peoples: www.abo-peoples.
To satisfy male leaders of Native bands
who had lobbied against Bill C-31, bands were
allowed by the government to develop their
own membership codes and determine who
can reside within their territories.
In 1990, a ruling by the Supreme Court of
Canada signalled a new era in the relationship
between the Canadian government and
Aboriginal people. In Sparrow v.The Queen, the
court decreed that the Crown must honour
its obligations by respecting treaty and
Aboriginal rights.
Also, from July to September 1990, the
standoff between Mohawks and the Quebec
police and Canadian military at Kanesatake
(Oka) created headlines around the world.
This situation drew attention to 300 years of
unresolved conflicts and escalating tension
between the government and Aboriginal
people.
In 1991, the Assembly of First Nations
successfully negotiated an amendment to the
Constitution Act to protect treaty rights and
ensure Aboriginal people are involved in any
further attempts to change or revise sections
of the Constitution Act affecting them.
Also in 1991, a Royal Commission on
Aboriginal Peoples was created to find ways of
improving relations between the government
and Canada’s First People.
A9
The Métis in Canada
Métis are defined by the Constitution Act, Eastern mixed-blood people were also
1982 as one of the three distinct Aboriginal becoming a political force in the Ontario
people in Canada, along with Inuit and First Great Lakes region. Even before the Riel
Nations. Rebellion, an uprising occurred near Sault Ste.
The word Métis comes from the Latin Marie in 1849.The issue at stake was property
miscere, which means to mix and was used rights because Aboriginal lands had been
originally to describe offspring of Algonquin, overrun by prospectors in search of copper.
Ojibwe and Cree women and the French and Armed resistance resulted in the inclusion of
Scottish fur traders. Other terms for these Métis names in the Treaty of 1850.
biracial children were Country-born, Black Although born of the fur trade, Métis
Scots, Bois brules, and Half-breeds. In what was existence was not bound to it and other
then called New France, both the Church and occupations, such as timber and mining,
Crown encouraged the bolstering of the became increasing significant.They were
French-Aboriginal population to strengthen especially known for their skill as buffalo
French claims to the land. hunters, whose intricate choreography of the
hunt was both an art and a science. (The
Emergence of the Métis Musical Ride of the Royal Canadian Mounted
A distinct mixed-blood population began Police derives from it.)
to emerge, who were neither European nor
Native. Intermarriage among their own kind
The Métis Today
began to produce a separate linguistic and The Métis National Council estimates
cultural community by the early 1800s. there are approximately 350,000 Métis in
Because of their active involvement in the fur Canada as a whole (Dickason, 2002).
trade, their population grew and their culture The Métis flag is the oldest Canadian
strengthened over time. patriotic flag, predating Canada’s Maple Leaf by
One of the great Métis leaders was 150 years. First used by Métis prior to the
Cuthbert Grant (1793 to 1854), who the Cree Battle of Seven Oaks, the flag depicts a white
called “Wapeston:White Ermine.” In 1816, infinity symbol horizontally placed over a blue
Grant led an armed confrontation at Seven background symbolizing an eternal, seamless
Oaks against settlers who had encroached on interaction of two distinct cultures of the
Métis lands.Their victory was a watershed in Europeans and of the First Nations.
creating a sense of unity and nationalism
among Métis people in the West.
The Red River Rebellion of 1870 and the
Riel Rebellion of 1885 made Gabriel Dumont
and Louis Riel cultural and political heroes in
the long struggle of the Métis for recognition
as a distinct people.
A11
Although the Métis population is • Métis music is a fusion of Aboriginal and
comprised of citizens from all across Canada, Celtic rhythms expressed on the fiddle.
there is no nationally agreed-upon definition of The music is accompanied by dances that
the term. also originate from the Highlands, but the
The current definition adopted by the Métis jigs are performed at a much faster
Métis National Council is: a person who rate.
self-identifies as Métis, can trace Residential Schooling
their lineage back to the territory of
Because Métis children were either
the Métis Nation in West Central
recorded as “half-breeds” or not recorded at
North America, is distinct from
all, enrolment estimates are difficult to
other Aboriginal Peoples and is
confirm. Overall, 9.12 per cent of self-
accepted by the Métis Nation.
identified Métis in Canada report attending
Métis in other parts of Canada dispute residential schools.
this definition and have created a website to
Métis Survivors of these schools describe
air these differences called “The Other Métis”
being treated as outsiders, experiencing
(www.othermetis.net).
racism and castigation by Aboriginal, as well as
For legal purposes, the Supreme Court white, schoolmates. Many also experienced the
has defined Métis as those who can identify physical abuse, sexual abuse and neglect
themselves as a member of a Métis community associated with the Aboriginal residential
and have proof of an ancestral connection to school system.
the community.
The language of the Métis is Michif, a Cultural Reclamation
mixture of French nouns and noun phrases The Métis have played an important role
tied to the Cree verb system. According to the in the development of Canadian society and,
report of the Royal Commission on Aboriginal increasingly, their special status and rights are
Peoples, help is needed to save the Michif being recognized due to persistent efforts of
language from extinction. their political bodies.The Métis National
Council, established in 1983, represents
Other Métis Cultural Symbols elected members from provincial Métis
• The well-known Métis sash, a finger- organizations in the three Prairie provinces, as
woven woolen belt about three metres well as Ontario and British Columbia.The
long that was traditionally made to tie a Métis Association of the Northwest Territories
coat closed at the waist, but is now worn is separate from the national organization.
ceremonially either over the shoulder or
around the waist. Recent Victories
On July 1, 1989, the Métis Settlements
Accord was signed by the Alberta government,
establishing the only form of legislated Métis
government in Canada and providing a
framework for negotiating land and self-
government. Under this accord, 1.2 million
A12
acres of land were transferred to the
ownership of the Métis, making Alberta the
only province or territory in Canada where
Métis have a land base.
For the past decade, the Métis Nation of
Ontario has been heavily involved in the legal
defense of the Powley family from Sault Ste.
Marie charged with hunting moose without a
licence.The Ontario Supreme Court affirmed
their Aboriginal right to hunt as Métis under
section 35 of the Constitution Act of Canada and
the Supreme Court upheld this right in 2003.
For more information, contact the following by
telephone or through their websites:
Métis National Council (613) 232-3216
Métis National Council of Women (613)
567-4287.
Sources for this Fact Sheet:

Dickason, Olive (2002) Canada’s First Nations: A History of
Founding Peoples From Earliest Times, 2nd Edition. Don Mills,
ON: Oxford University Press.
Also, thanks to Don Fiddler of the Métis Nation of Ontario
and Duane Morriseau of the Métis National Council.
A13
Gay and Lesbian Issues
The terms gay, lesbian, transgendered and Indigenous languages are an
bisexual are modern words used to describe important key to understanding pre-contact
people based on sexual orientation or beliefs about sexuality and gender.
preference.Traditionally, however, Indigenous According to respected American Indian
cultures did not define a person’s identity by psychologist and educator Dr.Terry Tafoya, a
sexuality or gender. Gender roles, as well as study of 200 Indigenous languages reveals that
sexual behaviours, could be flexible and fluid. 168 have a concept of more than two
Acceptance of the differences in people was genders; with some having words to describe
central to a widely-held spiritual belief that as many as eight different genders.
each person has been granted unique and
sacred gifts from the Creator. Anthropologists have identified eighty-
eight Native societies with specific references
Today, the term Two-Spirited has to homosexuality (Anderson, 2000).
become the culturally appropriate way many
gay, lesbian, transgendered or bisexual Métis
and First Nation people choose to describe “American Indians believe that each person is
themselves, although it is not a term often called on to play a part in the natural course of
used by Inuit.The term Two-Spirited is meant to events. Those who are very different, not-men and
convey an identity that goes beyond sexual not-women for example, must have a special
behaviour or gender roles, emphasizing instead spiritual calling, based on the fact that they are
the balancing of both male and female called on to be different from others in the tribe
energies within one person. 1 The “Two- and that they have special qualities and
characteristics that differ significantly from others
Spirited” community is encouraging both the
in the community.”
Aboriginal communities and mainstream
society to accept it. (Brown, 1997:10)
Pre-Contact History
For centuries, people now known as gays, Because men were foremost in the
lesbians, transgendered or bisexual had special concerns of the Europeans, historical accounts
and important roles in Aboriginal community refer more often to gay men in the Americas.
and cultural life as matchmakers, teachers, European explorers referred to homosexual
counsellors, medicine people, pipe carriers and Native men as “bardache” or “bourgre,” terms
visionaries or seers.They had formal roles in that denoted their sexual roles as either
many seasonal and special ceremonies; for passive or active (Williams, 1992).
example, in Crow and Lakota traditions, a gay
man cuts the centre pole for the Sun Dance
ceremony (Williams, 1992; Allen, 1992; Brown,
1997).
1
In the Algonquin language, the term for lesbian is Pana-be-kwe, meaning one who carries the spirit of a woman and the spirit of a
fish.
A15
Impacts of Colonization Isolation and loneliness place gay youth at
higher risk for suicide than heterosexual
The first Europeans had no tolerance for
youth. Fearful of living openly, many gays and
a flexible, Indigenous concept of sexuality and
lesbians leave their communities for urban
gender. The presence of openly accepted
centres only to find they do not feel at home
homosexuality went against their deeply-held
among non-Aboriginal gay communities due to
religious beliefs.
cultural differences.
Gays and lesbians, as well as traditional
Like the silencing of residential school
spiritual leaders and women, were devalued by
abuse, silencing the voices of gays and lesbians
patriarchal Europeans because of the power
only increases their vulnerability to unsafe sex
and status they held within their Aboriginal
practices, addictions and depression.
communities (Allen, 1992).
The term homophobia refers to an
“Colonization means the loss not only of
irrational fear of, or aversion to, gay, lesbian,
language and the power of self-government
transgendered and bisexual people. For
but also of ritual status of all women and
example:
those males labeled ‘deviant’ by the white
Christian colonizers” (Allen, 1992:196). As a • not saying anything when jokes are
result of colonization, the long-held traditions told that make fun of, or humiliate, gays
respecting the special gifts of gays and lesbians, and lesbians;
as well as their important ceremonial roles, • avoiding public displays of affection or
were largely forgotten. friendship toward friends or family who
are gay for fear of being identified with
them;
“We honoured two-spirited people because they
brought gifts to our communities that were very • being disgusted by public displays of
important. And all of a sudden the Christians affection between gays and lesbians, while
came along and said, ‘Oh you can’t do that. That is accepting those same affectionate
a sin against God’.” behaviours from heterosexuals; and
Helen Thundercloud (cited in Anderson, 2000:91) • gay bashing and violence, whether
through physical, mental or emotional
abuse or exclusion.
Later, under the church-led residential
school system, Aboriginal children were taught
Resistance and Reclamation
to feel ashamed of their culture, as well as
guilt and shame about their bodies and Aboriginal gays and lesbians are
sexuality. For many children, this shame was organizing to resist all forms of homophobia
compounded by the trauma of physical and and reclaim a respected place in the cultural
sexual abuse.The impacts of shame and life of their communities. Across Canada,
unresolved trauma are seen today in a there are many organizations and groups that
reluctance to speak openly about issues of educate and promote understanding of both
sexuality and sexual orientation; leading, in historical and modern issues.
turn, to greater isolation.
A16
Respected Aboriginal authors, educators
and traditional teachers, such as Sylvia
Maracle, Suzy Goodleaf,Terry Tafoya, Paula
Gunn Allen, Kim Anderson, Lester Brown, Lee
Maracle and Beth Brant, have taken leadership
roles in changing attitudes and promoting
equality for gays and lesbians and Two-Spirited
people.
Two-Spirited People of the First
Nations is a Toronto-based organization that
works to bridge the gaps between Aboriginal
culture and alternative sexuality.They also host
an annual national conference to encourage
ongoing dialogue and to celebrate the survival
of this important aspect of Indigenous
cultures.
In urban centres across the country, there
are many Aboriginal gay and lesbian support
groups, and most colleges and universities now
include Aboriginal issues in their PRIDE or
GBLT2 information and resource centres.
Sources for this Fact Sheet:
Anderson, Kim (2000). Recognition of Being: Reconstructing
Native Womanhood.Toronto, ON: Second Story Press.
Williams,Walter L. (1992).The Spirit and the Flesh: Sexual
Diversity In American Indian Culture. Boston, MA: Beacon
Press.
Allen, Paula Gunn (1992).The Sacred Hoop: Recovering the
Feminine in American Indian Traditions. Boston, MA: Beacon
Press.
Brown, Lester (ed.) (1997).Two Spirit People: American Indian
Lesbian Women and Gay Men. New York, NY: Harrington Park
Press.
Other sources include information from an oral presentation
by Dr.Terry Tafoya in Ottawa at the “Returning to the Circle”
conference hosted by Minwaashin Lodge in 2001 and a
conversation with Sylvia Maracle in 2004.
An Internet search of “two-spirited” also provides many
written, community and on-line resources.
2
An acronym for gay, lesbian, transgendered or bisexual.
A17
Residential School History:
A Legacy of Shame
In 1892, the Canadian government began
a policy of “aggressive assimilation,” under “Pre-contact systems of communal ownership were
which Aboriginal children were taken to dismantled and in their place the male head of the
residential schools to remove them from the family was given ownership of everything. This
“uncivilizing influences” of Aboriginal family rendered women dependent on the men, made
and community life. divorce more complicated, and ultimately stripped
women of economic freedom.”
During the century in which they
operated, one-third of Aboriginal (Anderson, 2000:84)
children in Canada spent most of their
childhood in these schools. The impact
of this tragically ill-conceived policy continues Chronological History
to reverberate today in Aboriginal families,
communities and nations. 1879: Sir John A. Macdonald’s government
creates church-run boarding schools to
Colonization is a term that describes assimilate Aboriginal children into white
the process of taking control over and culture.
assimilating Aboriginal people through formal
government policies. From an Aboriginal 1884: Bowing to pressure from churches,
perspective, it refers to the theft of ancestral Ottawa passes an amendment to the Indian Act
homelands and resources, as well as attempts making attendance for Native children aged 7
to destroy Indigenous languages and cultures. to 15 years mandatory at the schools.
Colonization and the Indian Act also 1907: The Montreal Star reports 42 per
dispossessed Aboriginal women from their cent of children attending residential
traditional leadership roles, creating a serious schools die, “a situation disgraceful to the
imbalance in Aboriginal society that still country” (cited in Fournier and Crey,
accords Aboriginal men greater political, social 1997:49).
and economic influence than Aboriginal 1947: The United Church requests residential
women. schools be shut down in favour of non-
While Aboriginal women represent half of denominational day schools, citing harm to
the total on-reserve population, less than 10 children in being separated from their families.
per cent of chiefs are women. Over the next two decades, residential
schools begin to close down.
1960 to 1969:The federal government
assumes full management of the 60 remaining
schools from the churches that, by now, house
extremely troubled Aboriginal youth. New
child protection legislation is created with
A19
provincial Children’s Aid Societies as new 2000:The number of individual plaintiffs in
partners in the continued forced removal of residential lawsuits reaches 6,324; churches
Aboriginal children. This period has come to begin to publicly voice fears of bankruptcy.
be known as the 60s Scoop where Aboriginal
children were fostered and/or adopted into Who Ran the Schools?
white families. Residential schools were a joint government of
1973: A new federal policy gives control of Canada and church initiative.The churches
Native education to the bands and tribal involved were: Roman Catholic, Anglican,
councils. United and Presbyterian.
1986: The United Church is the first church
Healing and Reconciliation
in Canada to apologize to its Aboriginal
congregations. Since the Aboriginal Healing Foundation
was established, programs have been created
1989: The first residential school lawsuit is
in every province and territory to address the
filed in British Columbia.
legacy of abuse in residential schools, including
1990: Phil Fontaine, Grand Chief of the its intergenerational impacts.
Assembly of First Nations and leader of the
Assembly of Manitoba Chiefs, discloses publicly
The courage of residential school Survivors to
that he was sexually and physically abused at
heal themselves, their families and their
residential school.
communities is a source of inspiration.
1990s: The last residential school closes in They are living embodiments of the strength,
Yellowknife, Northwest Territories. beauty and resilience of Inuit, Métis and First
The Royal Commission on Aboriginal Peoples Nation peoples who are transforming the pain
releases its report including findings and of the past into hope for a new future.
recommendations related to residential
schools.
1997: The Canadian Conference of Catholic
Bishops expresses regret for the pain and
suffering of children in residential schools.
1998: Indian Affairs Minister Jane Stewart
issues a Statement of Reconciliation that includes
a commitment to support healing for the
abuse in residential schools and establishes a
one-time $350 million healing fund for
Survivors.
The Aboriginal Healing Foundation is created
as an Aboriginal-run, not-for-profit corporation
that is independent of government to manage
the healing fund.
A20
Human Rights Violations and the Abuse of
Aboriginal Children in Residential Schools
Residential schools are defined as the However, many Aboriginal children
“Residential School system in Canada attended endured more than the trauma of separation
by Aboriginal students; it may include industrial and loss.Tragically, many also suffered the pain
schools, boarding schools, homes for students, of physical and sexual abuse. The following are
hostels, billets, residential schools, residential types of abuse described by Survivors of these
schools with a majority of day students, or a schools.1
combination of any of the above” (Aboriginal
Physical and Sexual Abuse
Healing Foundation, 2001:5).
• Sexual assault, including forced oral-
From 1892 to 1996, approximately 130
genital, masturbatory or sexual
residential schools operated across Canada
intercourse between men or women in
under a joint initiative of the federal
authority and the girls and boys in their
government and Christian churches.
care.
A common belief at the time was that the
• Sexual touching and fondling of children
savage Indian needed to be civilized. In the
by men or women in authority; private
opinion of church and government officials, the
pseudo-official inspections of children’s
best way to do this was to bring Aboriginal
genitalia.
children completely under their control and
influence. At residential schools, away from • Arranging or inducing abortions in female
their families and communities, Aboriginal children impregnated by men in authority.
children could be fully immersed in the ways • Severe punishments and torture when
of mainstream Canadian society. children would speak their own language,
By the 1960s, many thousands of such as needles stuck in the tongue,
Aboriginal children had been forcibly removed mouths washed out with lye soap and
from their parents, extended families and beatings.
communities and placed in sterile institutions • Beating children to the point of
among unfamiliar people, customs and unconsciousness, drawing blood and/or
languages. After two to three generations of breaking or fracturing bones; and inflicting
families had experienced this traumatic serious permanent or semi-permanent
disconnection and loss, any sense of trust or injuries, such as deafness, permanent limp
feeling of belonging to family, community and or chronic pain.
culture had been broken.
• Beating naked or partially naked children
before their fellow students and/or other
institutional officials.
1
The majority of this information has been retrieved from Chrisjohn, R. and S. Young (1997:32-33). The Circle Game. Penticton,
BC:Theytus Books Ltd.
A21
• Using electrical shock devices on • Child labour: children received little or
physically restrained children; burning, no education as they had to cook, clean
scalding or starving children as and mend to provide church income.
punishment; and forcing sick children to
eat their own vomit.
Religious and Spiritual Abuse
• Abusing the Christian religion and church
• Exposing children to the elements as authority to control, humiliate and
punishment, sometimes to the point of dominate children.
inducing life-threatening conditions, such
as frostbite and pneumonia. • Mocking, belittling and prohibiting
Aboriginal spiritual beliefs as evil and
• Withholding medical attention from savage.
children suffering the effects of physical
abuse or illness, sometimes to the point The intergenerational impacts of traumatic
of causing death. disconnection and multiple abuses suffered by
Psychological and Emotional Aboriginal children still reverberates
in Aboriginal communities
Abuse across Canada.
• Publicly shaming Aboriginal people as
“savage” and “doomed to hell,” and In 1998, the Canadian government
teaching children to reject and even announced Gathering Strength - Canada’s
despise their parents, Elders and Aboriginal Action Plan. Gathering Strength
communities. included a Statement of Reconciliation and the
government’s commitment to healing the
• Shaving the heads of children as a form of
negative impacts caused by the physical and
punishment or humiliation.
sexual abuse of children at residential schools.
• Isolating children by locking them in
The Aboriginal Healing Foundation (AHF)
closets or basements, as punishment.
was created to administer a one-time $350
• Undermining relationships between million healing fund. According to the AHF:
parents and children by withholding their
gifts and letters.
“Our vision is one where those affected by the
• Not allowing children to express fears or legacy of physical abuse and sexual abuse
seek help; using police to track down experienced in residential school have addressed
children who ran away and return them the effects of unresolved trauma in meaningful
to even greater punishment. terms, have broken the cycle of abuse, and have
enhanced their capacity as individuals, families,
Living Conditions communities and nations to sustain their well being
and that of future generations.”
• Nutritional deprivation; food unfit for
human consumption or not compatible (Aboriginal Healing Foundation, 2003:10)
with Aboriginal regional diet.
A22
Vicarious Trauma
Vicarious means indirect or through the believe life can be meaningful and
experience of others. beautiful.
Vicarious trauma refers to the short and • Troubled, fearful or self-critical: feelings of
long-term impacts of working with irritability; and increasing difficulties in
victims/survivors of trauma and the painful, relationships with others.
disruptive effect this can have on the frontline • Reduced sense of commitment and
worker or counsellor. 1 motivation for the work: increasing knee-
jerk reactions and intolerance or feelings
Characteristics
of numbness and disconnection toward
Vicarious trauma refers to strong coworkers or clients.
reactions that may emerge during or after
• Changes in appetite, increasing fatigue
sessions with clients, as well as the coping
and/or swollen glands.
strategies or defenses to protect against those
feelings. • Physical illness or depression.
Reactions of grief, rage or despair can • High staff turnover and/or rates of
intensify over time as counsellors repeatedly absence due to sick days; and escalating
hear the clients’ stories of suffering and pain. workplace conflicts that increase costs to
the organization.
Compounding Factors
The scale of suffering witnessed by
frontline workers can intensify vicarious
trauma. Its impacts may also be compounded
by the frustration of too few resources to
meet the urgency of client needs.
Symptoms
• Intrusive imagery and thoughts:
repeatedly visualizing the traumatic
events described by clients.
• Sleep disturbances: unable to quiet the
mind and/or stop thinking about client’s
problems.
• Personal beliefs begin to change:
increasing loss of faith and inability to
1
This term was first used by McCann and Peralman (1990) in Vicarious Traumatization: A framework for understanding the
psychological effects of working with victims. Journal of Traumatic Stress 3:131-149.
A23
Prevention Strategies For Aboriginal
Counsellors and Frontline Workers
Take space and time away from Take the time to look special
frontline work and the constant demands of each day in whatever way has meaning for
crisis intervention to help keep balance and you.
perspective. Also, find ways to create that Keep your spirit strong: pray or
sacred, quiet space internally through daily meditate, go on a vision quest, talk to an Elder,
ritual or meditation. smudge with medicines (sage, cedar or
Be aware of holistic personal sweetgrass), take cedar baths and attend Sweat
self-care needs: ensure balanced health by Lodge ceremonies or fast for cleansing and de-
attending to all aspects of your well-being stressing.
(spiritual, emotional, mental and physical). Trust in and make time for the
Express feelings verbally and people in your life: your coworkers, family
non-verbally. Receive and give hugs, laugh, and network of friends. Do not be afraid to
cry, talk, share, dance and sing. say: I need your support just now. Start a “buddy”
Listen to your body and get system at work with a daily check-in and use
enough rest and replenishment: eat staff team debriefings to rebalance after an
good nutritious food, drink pure water and get especially stressful time.
physically active. Dance, drum, have a massage, Set common sense limitations: say
take a walk, quilt or bead. “no” to clients or coworkers and balance their
Be open to change. Look at the needs with what you are able to provide.
world through different eyes: see every Speak your mind from your heart.
situation as an opportunity to learn and grow. Keep a journal or life map and/or
Read, attend healing circles, meditate or listen get support from peers and Elders who
to beautiful music. Connect with nature and know the pressures of trauma work.
the beauty and sacredness of life.
Aboriginal frontline workers at a healing retreat in
Trust in yourself and your own eastern Ontario, July 2000, created these prevention
resilience. Remind yourself of your many strategies.
unique strengths and gifts.
A25
Signs and Symptoms of PTSD
Post traumatic stress disorder or • Selective amnesia: memories of the past
PTSD first emerged as a clinical are fragmented or missing.
diagnosis following the return of • Loss of interest, flat feeling, restricted
Vietnam veterans to the United range of feelings or emotions.
States and Canada. Understanding
the impacts of combat trauma • Reluctance or inability to commit to
helped further an understanding of anyone or anything.
trauma in general. • Sense of being without a future: many
Due to the increased survivors feel certain they will die early in
understanding of trauma, it is now life.
clear that all survivors of
interpersonal violence and abuse Physiological Hyperarousal
share common symptoms. The • Jumpy; exaggerated startle responses.
characteristics of PTSD are as
follows.1 • Manic, compulsive or obsessive
behaviours and/or frenetic activity.
Intrusion/Re-Experiencing • Sleep disturbances (either too much
• Intrusive imagery, recurrent dreams, sleep or insomnia).
flashbacks or hallucinations. • Inability to relax; hypervigilant, constantly
• “Flooding” of emotions/fear. scanning the environment for danger.
• Dissociation : tuning out or “not being all • Sensation seeking and/or risk-taking
there.” behaviours.
• Compulsive behavioural re-enactment

(for example, self-harm by cutting). This information was developed by Aboriginal frontline
workers at a healing retreat in eastern Ontario.
Constriction/Avoidance/
Numbing
• Phobia or acute distress in response to
sensory cues that trigger memories of
the event.
• Inability to face feelings or memories,
“numbing” out with alcohol or drugs.
• Detachment, isolation or withdrawal from
family, friends and community.
1
Adapted from Desk Reference to the Diagnostic Criteria from DSM-IV,TR (2000) American Psychiatric Association.
A27
A Model for Holistic Healing
• addiction recovery; and
• medications (traditional or medical) to
reduce reactivity and hyperarousal.
Mental Healing Strategies:
• cognitive strategies, such as using diaries
or logs, to identify and chart symptoms
of PTSD;
Medicine Wheel teachings provide a • dream interpretations and vision quests;
useful framework for working with survivors and
of childhood abuse or other trauma.
• creating new life stories, maps or
The vision of these teachings is that all narratives.
healing is spiritual in the sense that honouring
the spirit within generates a movement Emotional Healing Strategies:
toward balance and health. • anger release/management;
Honouring and reconnecting with the • non-verbal expression through art and
inner spirit will restore: craft making, quilting, carving, song and
dance;
• trust in self and others;
• talking and sharing circles;
• trust in the potential for oneself and
others to change; • restoring cultural pride and identity; and
• trust in the ability to help oneself, one’s • affirming each person’s unique gifts,
family and communities; strengths and worth.
• belief in being worthy of love and Spiritual Healing Strategies:

kindness; and • meditation, prayer and giving thanks;
• belief in being capable of showing love • burning medicines or the Quilliq;
and kindness to others.
• participating in ceremonies or sweats;
Physical Healing Strategies: and
• breathing and relaxation techniques; • guidance from Elders and traditional
• exercise: walking, sports or games of skill teachers.
and endurance;
• hunting and camping: being on the land; This information was developed by Aboriginal frontline
workers at a healing retreat in eastern Ontario.
• healthy diet and nutrition (country food
for Inuit); community feasts;
A29
Appendix B
Appendix B:
Aboriginal Healing Models
Appendix B
B1
Aboriginal Healing Models
1. Turtle Model of Hollow Water

Process
First Nation, Manitoba
1. Disclosure takes place with a
2. “Just Therapy” Model of New coordinated team of justice members,
Zealand child protection services, community
3. Intergenerational Trauma mental health services and a community
Recovery Model, Ottawa representative, such as an Elder. An initial
investigation is carried out and the
The Turtle Model of Hollow victim’s story is recorded. Reliable and
trusted people are available to the victim
Water First Nation to ensure safety and support throughout
A diverse team from surrounding Métis the process.
and First Nation communities initially began an 2. Establishing Safety occurs when the
assessment of approaches for responding to abuser is confronted and charged,
sexual abuse in the First Nation community of following a determination that the abuse
Hollow Water, Manitoba. Community members has taken place beyond a reasonable
felt that the non-Aboriginal legal system is not doubt.The abuser has two choices:
effective in addressing Aboriginal cases of sexual
abuse for some of the following reasons: • to plead guilty and be sentenced to
probation requiring full cooperation
• Many sexual abuse cases could not be with the healing process; or
brought before the court for lack of
evidence. • to be referred to the courts with
incarceration as the probable
• Many victims would not testify because of outcome.
stigma and lack of support.
3. Confronting the Offender if the
• Incarceration only perpetuated conflict abuser agrees to undertake the healing
with the law as perpetrators often re- process, the team asks the court for a
offended. minimum of four months to assess the
Community awareness and education was authenticity of the commitment. He or
initiated in order to ensure victims would feel she then begins a three to five-year
safe enough to disclose sexual abuse on a journey that concludes with restitution
community level.A two-year training program and reconciliation between the abuser
covered topics such as cultural awareness, and the victim, the victim’s family and the
alcohol and drug awareness, team building, whole community. A series of healing
networking, suicide intervention, family circles are carried out for steps 4 to 10
counselling, communication skills and sexuality. as follows:
Integral to the work of the assessment team 4. Supporting the Spouse/Parent
was a process for separate circles where team
members could discuss their own sexual abuse.
B3
5. Supporting the accountable and fosters healing for all
Families/Community affected by the unacceptable behaviour.
6. Meeting the Assessment Team 12. Components of phases 12 and 13,
7. Circles With the Abuser Sentencing Review and Cleansing
Ceremony, respectively:
8. Circles With the Victim
• Healing contracts for perpetrators.
9. Preparing the Victim’s Family
• Provision of a wide range of
10. Preparing the Abuser’s Family supportive services for the families
and friends of the victims and
A healing circle brings the abuser through offenders.
a process of self-reflection and self-
discovery to take responsibility for the • One-on-one counselling and
actions and for how these actions have assessment by a psychologist,
affected others. In addition to the circle, a additional counselling from traditional
psychologist provides support and teachers and community Elders.
assessment of the abuser’s commitment • Sharing circles and sweat lodges with
to restitution and personal healing. wider community participation.
The next circle brings the abuser’s • A final cleansing ceremony with
nuclear family together to talk about the participation of the community to
offence and to work through their provide closure.
reactions and response to the crime.
Other circles repeat this process with • A male psychologist facilitates the
the family of origin, such as parents, adult male sex offenders group using a
grandparents, aunts and uncles. cognitive/behavioural model.
The circles for the family and his or her • Other groups: Boys & Girls Group,
family follow the same method.Victim Women Survivors and Young Women
and family are provided with the Survivors.
supportive services they need from the • Case conferencing is used as a
team and wider community. A non- monitoring process where progress is
punitive approach is fostered that helps assessed and further interventions are
victims take steps toward their own planned in consultation with a
healing, as well as confronting the abusers psychologist.
in a non-punitive way.
Team Building
11. Sentencing Circle is where the
abuser must disclose to the whole The team building that took place at
community and discuss the steps already Hollow Water First Nation throughout the
taken on his or her healing journey. Once development of the model had major impact
an abuser completes all of these steps, on frontline intervention in Aboriginal
the goal is a full commitment to a healing agencies.These team-building steps are
process.The process holds all abusers described below:
B4
1. Breaking all the separate chains of explore better ways to coordinate services,
confidentiality that kept workers from develop a common vision and generate renewed
sharing information and from being commitment to personal healing.
manipulated by dysfunctional clients. For further information on the Hollow
2. Designing common training for all issues Water Model, see The Four Circles of Hollow
they faced as a team, rather than Water (1997), Aboriginal Peoples Collection
continuing with conflicting strategies from and Solicitor General of Canada.
separate fields of expertise.
3. Requiring outside professionals to learn “Just Therapy” New Zealand
about and support a holistic team Model: Social Justice and
approach, as well as to share their own
Family Therapy
skills openly with team members, before
permitting them to play an active role in The Just Therapy approach was developed
the community. over eleven years of organizational evolution
within the Family Centre in Lower Hutt, New
4. Committing the time and resources for
Zealand, and a community-based family
continued team and individual healing so
therapy agency.This diverse community is
members have strength enough to
comprised of Aboriginal Polynesians (Maori
maintain a safe place for others, as well as
and Samoan) and Europeans (Pakeha).
for themselves.
There are many parallels between the
Outcomes cultures and socio-economic conditions of
Polynesians in that region and Aboriginal
• Greater coordination of services through
people in Canada. Just Therapy grew out of the
partnerships with justice, health and
belief that therapy can be practiced just as
traditional service providers.
effectively by people with community
• High level of training and community experience and cultural knowledge as by those
building leading up to implementation of with professional and academic training.
the model.
Its meaning is just how it sounds: “Just”
• Improved system for addressing sexual Therapy, which reflects a philosophy that
abuse. Offenders’ rate of incarceration breaks down and demystifies therapy and
and re-offence are reduced. therapists through practice incorporating
Valdie Seymour was one of the therapists simplicity, justice and spirituality.
who initiated the development of the The Just Therapy approach is rooted in a
community healing process in Hollow Water. He belief that therapeutic work requires a
facilitated a two-day workshop at the Wabano political, as well as a clinical, response.The
Centre for Aboriginal Health in Ottawa on therapy incorporates social change by
March 6th and 7th, 2000.There were twenty-four approaching the underlying causes of family
Aboriginal and non-Aboriginal participants from problems from the perspective of how
agencies in the Ottawa, Ontario, area who colonization, gender, culture, class, poverty and
attended.As a result of sharing this model with spirituality impact on the Aboriginal and non-
Ottawa workers, Unity Council was created to Aboriginal communities in the region.
B5
Process associate directly with impacts of
unemployment, poverty and injustice.
The centre became involved with
Aboriginal community members and employed • A family therapist may work on
them to focus on issues affecting their own emergency housing, community
people.This led to an exploration of culturally organizing and housing policy projects in
appropriate ways of bringing resources and a community development role meant to
therapy to Aboriginal people in the broader promote a holistic understanding of the
region. needs of clients living in substandard
conditions.
In addition to client services, the agency
created a structure that put Maori, Samoan • Aboriginal staff work with members of
and European therapists at the centre of their cultural community. Each cultural
planning and providing not just family therapy, “section” of the agency has an equal
but also community development and share of male and female staff to ensure
advocacy around poverty, unemployment, gender balance and equity.
housing, sexism and racism.
Outcomes
The social justice orientation is reflected
in the Family Centre’s personnel policy as • More Aboriginal clients now access the
follows: Family Centre’s services.
• All workers at the agency, from therapists • Priorities of marginalized members of the
to receptionists, make the same salary. community get greater attention and
understanding.
• At all levels, therapists work within a
framework that takes into account • Power imbalances between client and
impacts of New Zealand’s socio-economic therapist are reduced.
policy on its citizens. • Increased accessibility and greater
• Therapy includes naming the struggle empowerment for clients.
against injustice, creating an equitable • A greater number of clients of the
partnership between Aboriginal and non- Centre have learned to re-interpret their
Aboriginal clients and therapists, and personal stories positively and to
addressing issues of marginalization and participate in communal and social action
the increasing poverty of people on low that will change the conditions of their
incomes. lives for the better.
• Increasing understanding among workers • Enhanced roles of therapists and Centre
of the structures and actions that oppress staff in community development work
and destroy equality in relationships on and increased community building
both the macro level (social structures) through work exchanges, advocacy
and the micro level (family) is emphasized. activities and political lobbying.
• Therapists found many symptoms of
“sickness” among their clients that they
B6
• The social justice approach ensures that The pilot program began with twelve urban
those most in need receive therapy and Aboriginal grandmothers who were residential
resources in a manner that addresses school Survivors. All have since become active
their daily experience of inequality. leaders in the urban community of Ottawa as
teachers and healers.
Recommendations
This model draws on the Flying on Your
1. Therapists must consider the broader Own program of Alkali Lake, British Columbia,
social issues underlying a client’s as well as information from the Focusing
“problems” and ask whether these Institute of Winnipeg, Manitoba and New York,
“sicknesses” are not symptoms of New York.The model is culturally transferable
poverty, unemployment, racism, sexism from Aboriginal to non-Aboriginal groups, and
and barriers to education. is appropriate for men as well as women.
2. Incorporate diverse community members
and cultures on staff and as policy
Process
partners.This enhances the potential for Programming begins with a detailed
broader social change and introduces intake interview that can take from one to
new systems of knowledge that enrich an two hours to complete. Applicants are
agency. provided with support and information during
3. Conduct staff field trips or work this process.The intake questionnaire is
exchanges in other types of services, such designed to identify feelings, past experiences,
as housing, so workers and therapists past family dynamics and current problems the
gain a deeper understanding of the socio- applicant would most like to work on to begin
economic and political realities in which healing.
their clients live. Program participants number from 10 to
4. Identify political responses, as well as 20 per session with a staff team of 5 to 10
clinical responses, that promote providing support. During the five-day healing
empowerment of clients. retreat, the staff members create a safe place
for participants to work through their issues
5. Consider adopting the centre’s policy of of unresolved trauma in an atmosphere of
a 5-day retreat every 6 months for staff trust.
reflection and goal-setting.This gives
workers an opportunity to re-fuel, Over the five days, the facilitator and
team-build, reflect on best practices and healers move participants through a series of
develop more creative programming. individual and group exercises that provide
detailed information about the mental,
Residential and Intergenerational emotional, physical and spiritual impacts of
trauma and post traumatic stress disorder
Trauma Recovery Model, Ottawa
(PTSD) in the context of residential school
The Residential and Intergenerational abuse.
Trauma Recovery model was first introduced to
the Ottawa area by the Aboriginal Women’s
Support Centre (Minwaashin Lodge) in 1998.
B7
Participants learn trauma recovery and • Individual counselling, weekly healing
self-management tools to use long after the circles and a 1-day workshop complete
workshop and aftercare have ended. Some the program. Participants are encouraged
features of this model are as follows: to continue using the services of the
• The level of involvement is high: intensive Aboriginal Women’s Support Centre
intake procedures; a 5-day workshop (Minwaashin Lodge) upon completion of
commitment; and continued group and their aftercare.
individual aftercare sessions with a
Outcomes
therapist.
• A deeper understanding of the residential
• Upon intake, a confidentiality agreement
school experience and its
is signed, in order to maintain the
intergenerational impacts among
integrity of the program and protect
participants and the Aboriginal
participants.
communities of Ottawa.
• The workshop/retreat team is trained
• Demonstrated growth in personal ability
over a 3-month period and all are
to self-manage healing, increased self-
graduates of the workshop and aftercare
esteem and self-confidence, and increased
program who have demonstrated their
involvement in the Aboriginal community
commitment to healing on mental,
by participants.
emotional, physical and spiritual levels.
• Increased access to services offered in
• The workshop/retreat is held in a
the region’s mainstream, as well as
secluded, safe country setting where the
Aboriginal, agencies.
usual, everyday distractions for
participants and staff are not present. • Reduced feelings of isolation,
disconnection and loss among
• Focusing therapy is used to help
participants and the wider community of
participants identify themselves as equal
their friends and families.
parts in mind, body, heart and spirit.
• Transfer of knowledge and experience, as
• Participants learn ways to attune to
many graduates of the program return as
feelings in their bodies, how to “clear
volunteers or peer supporters for
space” within themselves, how to cope
Survivors and others impacted by the
with flashbacks and how to identify and
intergenerational legacy of residential
self-manage triggers.
school abuse.
• Spiritual and traditional healing methods
• Many graduates have adopted healthier
are integrated through music as a healing
lifestyles and entered or re-entered the
tool throughout workshop activities.
workforce or further education. Several
• A client-centred approach ensures each have become counsellors or are in
program is customized to suit the unique professional training.
needs of the individuals in each group.
B8
• Many of the grandmothers have become
Elders and teachers in the urban
Aboriginal community, strengthening the
community and reclaiming their sacred
roles.
Recommendations
This program is recommended for the
following:
• First Nations, Inuit and Métis women and
men carrying multifaceted,
intergenerational trauma from residential
school abuse, resettlement, forced
adoption, sexual abuse, family violence
and/or substance abuse.
• Men and women of non-Aboriginal
ancestry willing to participate in a healing
program based on Aboriginal spirituality.
• Any person who has experienced trauma,
has symptoms of PTSD and is ready to
begin a path toward self-empowerment
and healing.
B9
Appendix C:
Annotated Bibliography
Appendix C
Appendix C
C1
Annotated Bibliography
BOOKS
Bopp, Judie, Michael Bopp, Lee Presents the universally held Aboriginal concepts and teachings
Brown and Phil Lane (1984).The from Indigenous societies throughout North America. The
Sacred Tree. Lethbridge, AB: Four Medicine Wheel teachings are used to explain human potential
Worlds Development Press. and development within an Aboriginal worldview.
Brant, Clare C., M.D. (1996). A Discusses issues from an Aboriginal perspective including
Collection of Chapters, Lectures, psycho/social dynamics of family violence; violence in the
Workshops and Thoughts, available native population; anger management/spousal assault; symptom
from the Native Mental Health patterns of alcoholism; depression; suicide; child rearing
Association of Canada, Chilliwack, practices; verbal/non-verbal communication; ethics and rules of
BC. behaviour; self-esteem.
Chrisjohn, Roland D. and Sherry L. From the report on residential schooling submitted by the
Young (1997).The Circle Game: authors to the Royal Commission on Aboriginal Peoples.The
Shadows and Substance in the authors argue that media accounts of residential school are
Indian Residential School ambiguous and misinform the public.The book offers an
Experience in Canada. Penticton, alternative account of Canada’s operation of residential
BC:Theytus Books Ltd. schools in a broader context, as well as guidelines for
undertaking personal, community or provincial-national
research in the area of residential schooling.
Dickason, Olive Patricia (2002). Written by a Métis academic using an interdisciplinary
Canada’s First Nations: A History approach, this important book charts the richly complex
of Founding Peoples from Earliest history of Canada’s first peoples. Includes recent events, such
Times, 2nd Ed. Don Mills, ON: as land claims settlements and the findings of the Royal
Oxford University Press. Commission on Aboriginal Peoples, as well as the peopling of
the Americas and the significance of Inuit, Métis and First
Nation cultures within Canada’s national character.
Fournier, Suzanne and Ernie Crey Using powerful personal accounts, this book underscores how
(1997). Stolen From Our Embrace: systemic racism and ignorance among non-Aboriginal “child
The Abduction of First Nations welfare” authorities led to the devastation of Aboriginal
Children and the Restoration of families, communities and nations in Canada; captures the
Aboriginal Communities. urgency of the struggle against unjust systems, as well as the
Vancouver, BC: Douglas & restorative power of healing journeys already underway in
McIntyre. Aboriginal communities.
Holt, Jacqueline D. (1993). How A handbook about project self-evaluation for First Nation and
About . . . Evaluation: A Handbook Inuit communities providing child development and mental
About Project Self Evaluation for health programs in their communities.
First Nations and Inuit
Communities. Ottawa, ON: Health
Canada.
C3
Kuptana, Rosemarie (1991). No Explores the issue of child sexual abuse from an Inuit
More Secrets: Acknowledging the perspective. Describes the signs/symptoms, impacts and coping
Problem of Child Sexual Abuse in mechanisms for survival, as well as strategies for helping the
Inuit Communities:The First Step sexually abused child disclose.There are tips on assisting the
Towards Healing (English Version). victim of child sexual abuse by listening, communicating and
Ottawa, ON: Pauktuutit Inuit being supportive; and also provides a perspective on healing
Women’s Association Canada. and treatment issues in Inuit communities. Available in
Inuktitut syllabics, Inuktitut orthography and Inu orthography.
Levan, Mary Beth (1996). Courage, This manual is a guide for helping male survivors of sexual
Wisdom and Love, First Nations abuse in their healing process. The dynamics and impacts of
and Inuit Men Healing from child sexual abuse are described, as well as the healing process
Childhood Sexual Abuse, A Guide for men and the importance of healing relationships. It also
for Caregivers. Ottawa, ON: describes the role of the counsellor working with adult male
Medical Services Branch, Health survivors based on personal stories of survivors. Included in
Canada. the manual is information about legislation specific to child
sexual abuse and symptoms of adult men who have been
abused as children.
MacLeod, Flora and Brenda Dafoe This handbook is a step-by-step guide for planning and
(1994). Family Violence: Awareness carrying out a one-hour introductory session on family
Information for People in the violence. Although designed for use in the workplace, it
Workplace - A Guide for Use by applies equally well in other settings; includes basic information
People Interested in Meeting on family violence.
Together to Discuss Family
Violence Issues. Ottawa, ON:
National Clearinghouse on Family
Violence.
McTimoney, David (1993). A This resource kit presents a framework for understanding and
Resource Guide for Family responding to family violence in Aboriginal communities. It
Violence Issues for Aboriginal describes the connection between individuals, communities
Communities. Ottawa, ON: and the environment and answers common questions about
National Clearinghouse on Family family violence. Examples of how this approach can be applied
Violence. to strategies for healing, such as mobilizing community
participation, prevention activities, public education, policy
making, crisis intervention and professional training, are
provided. National resource centres and Indian Child and
Family Services Agencies across Canada are listed.
Rose, Elizabeth (1995). A Return to This workbook is a tool for growth based on identifying
Wholeness: A Resource Guide for personal strengths and inner resources in relation to recovery
Personal Growth. Fairbanks, AK: and prevention, self-care and self-esteem, as well as an
Fairbanks Native Association. overview of families in trauma.
Federation of Saskatchewan Indian A handbook intended to support the work of caregivers
Nations (1994). Expanding the providing crisis intervention for First Nation individuals,
Circle of Healing: A Handbook for families and communities. Provides exercises and activities for
Caregivers in First Nations planning and building a healing network.
Communities. Saskatoon, SK:
Health and Social Development
Commission, Federation of
Saskatchewan Indian Nations.
C4
Nechi Institute (1987). Guidelines An information guide based on the story of the O’Chiese First
for Community Sobriety - Nation community’s commitment and journey to sobriety. It
O’Chiese Information Package. describes the vision, organization of the team, as well as how
Edmonton, AB: Nechi Institute on to expand the team using Medicine Wheel teachings, in order
Alcohol and Drug Education. to bring balance to the team and community. The guide
concludes with a step-by-step account of actions taken by the
Band Council to end alcoholism through treatment, rebuilding,
training and sober-fun.
National Association of Treatment This handbook was developed as a learning tool for
Directors (1989). In The Spirit of counsellors working with Aboriginal families affected by
Family: Native Alcohol & Drug alcoholism using a family-centred approach to treating
Counselor’s Family Systems chemical dependency. It focuses on family systems theory in
Treatment Intervention Handbook. treatment intervention, extending it beyond contemporary
Edmonton, AB: National clinical approaches to the problem of addictions. A holistic
Association of Treatment approach is used to discuss the impact of addictions on the
Directors. individual, the family and the community.
National Native Association of This handbook was developed specifically to help Aboriginal
Treatment Directors (1992).The alcohol and drug treatment counsellors deal with sexual abuse
Right To Be Special: Native Alcohol disclosures within their centres. It is designed as a tool to
and Drug Counselor’s Handbook enhance the existing skills of Aboriginal alcohol and drug
For Working with Sexual Abuse counsellors. Safety issues, establishing a treatment program for
Disclosure. Edmonton, AB: National survivors, referral and reporting procedures and strategies for
Native Association of Treatment linking with the community are outlined.
Directors.
Health Canada (1995). Our Healing A brief overview of suicide prevention, including myths and
Journey Begins with facts about suicide, suicide rates among Aboriginal people,
Understanding: A Guide on Suicide reasons for attempting suicide, early warning signs, what to do
Prevention for Community in a crisis and effective intervention approaches; and provides
Helpers. Ottawa, ON: Health a short discussion on therapeutic drama and the role of Elders
Canada and the Ontario Ministry and traditional teachings.
of Health.
Health Canada (1993). Prevention For people working to improve the health of First Nation
Framework for First Nations people and their communities; and designed to stop
Communities. Ottawa, ON: Medical dependency before it occurs.
Services Branch, Health and
Welfare Canada.
Clairmont, Don and Rick Linden This bibliography lists written materials: books, monographs,
(1998). Developing and Evaluating reports, articles and papers of interest to policy-makers who
Justice Projects in Aboriginal are concerned with justice issues and projects in Aboriginal
Communities: A Review of the communities in Canada.
Literature. Ottawa, ON: Aboriginal
Corrections Policy Unit, Solicitor
General Canada.
C5
Bopp, Judie and Michael Bopp This ground-breaking manual was developed to assist frontline
(1998). At the Time of Disclosure: workers deal more effectively with issues around sexual abuse
A Manual for Front-Line Workers disclosures. The document provides the reader with a
Dealing with Sexual Abuse historical context of abuse and a definition of abuse; how to
Disclosures in Aboriginal facilitate and investigate sexual abuse disclosures; issues and
Communities. Ottawa, ON: needs at the time of disclosure; and how to restore balance
Aboriginal Corrections Policy Unit, and plan for the post-disclosure process.
Solicitor General Canada.
Bopp, Judie and Michael Bopp This manual provides an overview of the abuse in Aboriginal
(1997). Responding to Sexual communities. It also contains helpful information on how to
Abuse: Developing a Community- develop programs and build community teams. Intervention
based Sexual Abuse Response strategies for working with sexual offenders, their victims and
Team in Aboriginal Communities. families are described.
Ottawa, ON: Aboriginal
Corrections Policy Unit, Solicitor
General Canada.
Linden, Rick and Don Clairmont Includes chapters on restorative justice; describes justice
(1998). Making It Work: Planning & problems and needs; how to develop and carry out an action
Evaluating Community Corrections plan; and how to monitor and evaluate your healing program.
& Healing Projects in Aboriginal
Communities - Aboriginal Peoples
Collection. Ottawa, ON: Solicitor
General of Canada.
Linklater, Clive (1991) Follow-Up Research and development project exploring needs and issues
and After-Care Manual, National of Aboriginal people after leaving alcohol treatment centres;
Native Alcohol and Drug Abuse and designed as a tool by practitioners in the field of
Program (NNADAP). Ottawa, addictions.
ON: Health Canada.
Middleton-Moz, Jane (1994). “From A training manual for Aboriginal American children of
Nightmare to Vision”: A Training Alcoholics to help heal the wounds of chemical dependency in
Manual for Native American Aboriginal communities. Presents overview of adult children
Children of Alcoholics. Colorado of alcoholics, individual and family issues, how to start up
Springs, CO: National Association ACOA groups, etc.
for Native American Children of
Alcoholics (ACOA).
Saakvitne, Karen, Sarah Gamble, This manual for therapists and counsellors provides a
Laurie Anne Pearlman and Beth thorough understanding of trauma and its impacts and a
Tabor Lev (2000). Risking comprehensive treatment approach from a client-centred,
Connection: A Training Curriculum holistic perspective. From the perspective of understanding
for Working With Survivors of trauma, this is one of the most useful manuals reviewed as it
Childhood Abuse.Towson, MD: includes detailed information on the impacts of doing trauma
Abuse Sidran Press. work on counsellors and frontline workers, as well as
strategies for self-care.
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Saxe, Brenda J. (1993). From Victim Describes a group treatment model for female incest survivors
To Survivor: A Group Treatment developed by the Family Service Centre of Ottawa-Carleton.
Model for Women Survivors of Presents guidelines for group structure and format,
Incest. Ottawa, ON: University of participation criteria and assessment review, steps in facilitating
Ottawa and Family Service Centre each session of the twenty-week program, including process
of Ottawa-Carleton. guidelines, structured activities, reflection and discussion, journal
work and handouts. Five modules cover: coping, conflict, anger,
intimacy and self-injury; and also includes a format for two
information sessions with partners, friends and family members
of group participants.
Solicitor General of Canada This manual describes an approach to community healing based
(1993). Community Holistic Circle on traditional values of individuals, family, community, the nation
Healing - Aboriginal Peoples and strengthening the circle. It promotes balance by empowering
Collection. Ottawa, ON: Solicitor individuals, families and the community to deal productively and, in
General of Canada. a healing way, with the problem of sexual abuse.
Solicitor General of Canada This manual describes the Community Holistic Circle Healing
(1997).The Four Circles of Hollow process developed to heal sexual abuse in the small community
Water - Aboriginal Peoples of Hollow Water; and discusses why the Canadian justice
Collection. Ottawa, ON: Solicitor system is not appropriate for problems of Aboriginal people.
General of Canada.
Mnjikaning First Nation (1996). This manual arose from this community’s desire to address the
Biidaaban - The Mnjikaning issue of sexual abuse through a holistic community-based
Community Healing Model.Training design, fusing traditional Aboriginal and modern therapeutic
Guidelines and Resource Material. methods of healing. It aligns with the principles and procedures
Rama, ON: Mnjikaning First Nation. developed for the Hollow Water Circle Healing model. A core
group of sixteen persons who received training for thirteen full
days prepared the manual.
CATALOGUES - DIRECTORIES
Legacy of Hope Foundation (2003). This catalogue documents a photographic exhibit of the same
Where Are The Children? Healing name, which was launched at the National Archives of Canada
the Legacy of the Residential in 2003. Depicting many, never before seen photographs, it
Schools. Ottawa, ON: Legacy of provides a painful and poignant visual account of the
Hope Foundation, Aboriginal government and churches’ misguided attempts to forcibly
Healing Foundation, National assimilate Aboriginal children.
Archives of Canada and National
Library of Canada.
National Clearinghouse on Family An up-to-date guide to Canadian videos about family violence.
Violence (2000). Preventing Family Titles in this catalogue are listed alphabetically under four
Violence: A catalogue of Canadian subject headings: Child Abuse, Child Sexual Abuse,Women
videos on family violence for the Abuse and Abuse of Older Adults. Information on how to
genernal public and for obtain videos from the National Film Board of Canada and a
professionals working in the field, list of public libraries and other organizations across Canada
11th Edition. Ottawa, ON: National that lend titles from this collection is available.
Clearinghouse on Family Violence,
National Film Board of Canada and
the Government of Canada.
C7
National Clearinghouse on Family An updated version that contains the latest research findings
Violence (2003). Publications and information on all aspects of violence prevention,
Catalogue. Ottawa, ON: Health protection and treatment. You can obtain a catalogue and
Canada. order documents free of charge by calling 1-888-267-1233.
National Clearinghouse on Family This directory provides a listing of 400 Canadian programs
Violence (2002). Combining Voices: available to adult survivors of sexual abuse. The directory is
A Directory of Services for Adult organized alphabetically and includes detailed information on
Survivors of Child Sexual Abuse. the sponsoring organization, hours of service, client services
Ottawa, ON: Minister of Public and cost. Intended audience: service providers and survivors.
Works and Government Services
Canada.
Health Canada (2002).Treatment Provides basic information on all Aboriginal treatment centers
Centre Directory: National Native funded by NNADAP and includes the eight national youth
Alcohol and Drug Abuse Program solvent abuse treatment programs. The centres are listed by
(NNADAP) and National Youth regions and by type of centre (i.e., solvent abuse treatment,
Solvent Abuse Program. Ottawa, inpatient/outpatient, family treatment, youth treatment).
ON: Health Canada.
Connors, Edward and Maurice This chapter contrasts the worldviews of Euro-Western
Oates (1997).The Emergence of Judeo-Christian societies and North American tribal societies;
Sexual Abuse Treatment Models and emphasizes the role of acculturation in disconnection
Within First Nations Communities. from the traditional beliefs and values that had once guided
In Wolfe, David, Robert McMahon healthy human development. The author describes how sexual
and Ray Peters (eds.), Child Abuse: abuse programs have evolved over the past 15 years and the
New Directions in Treatment and extent to which they operate from a traditional perspective.
Prevention Across the Lifespan. A description of the sexual abuse treatment model that
Thousand Oaks, CA; London, UK; formed the basis for the development of the Hollow Water
New Dehli, India: Sage. model is provided.
FACT SHEETS, HANDOUTS, ARTICLES AND JOURNALS

Native Healing Program Helps Describes briefly the history behind the development of the
Abusers.The Globe and Mail, April community holistic circle healing model of Hollow Water,
1995. Manitoba and its relationship to the justice system.
Native Social Work Journal: Articles in this issue include:
Nishnaabe Kinoomaadwin • Mooka’Am (A New Dawn);
Naadmaadwin (Native Teaching and • Cross-Addictions of Gambling, Alcohol and Drugs in
Helping),Volume 1, Number 1, Aboriginal Communities;
Laurentian University Press, May • Northern Student Education Initiative;
1997. • Kinship Care: A Community Alternative to Foster
Care;
• Mino-Yaa-Daa: An Urban Community Based Approach;
• Aboriginal Communities and Social Science Research:
Voyeurism in Transition; and
• Bringing Home Payahtakenemowin (Peace of Mind):
Creating Self-governing Community Services.
C8
Native Social Work Journal: Articles in this issue include:
Nishnaabe Kinoomaadwin • The Circle of Healing;
Naadmaadwin (Native Teaching and • Aboriginal Students Speak About Acceptance, Sharing,
Helping),Volume 2, Number 1, Awareness and Support: A Participatory Approach to
Laurentian University Press, April Change at a University and Community College;
1999. • Trauma and Healing in Aboriginal Families and
Communities;
• Seeking Minopimatasiwin (The Good Life): An Aboriginal
Approach to Social Work Practice;
• The Learning Circle as a Research Method:The Trickster
and Windigo in Research;
• Location and Knowledge-Building: Exploring the Fit of
Western Social Work with Traditional Knowledge; and
• Long Term Evaluation of the Health Transfer Initiative: Major
Findings.
Assembly of First Nations (1999).
First Nations Health Bulletin: Special
Children’s Issue. Ottawa, ON:
Assembly of First Nations Health
Secretariat.
OTHER RESOURCES
Chartrand, Larry N. (2002). Métis This important review contains an annotated bibliography of
Residential School Participation: A published and unpublished materials and resources on Métis
Literature Review (Draft). Ottawa, residential school history and experiences, as well as a brief
ON: Aboriginal Healing Foundation. synthesis of materials researched and provided to the
Aboriginal Healing Foundation.
Government of Canada (1997). Based on 178 days of public hearings, visits to 96 communities
Gathering Strength -- Canada’s and its own research and consultations, this royal commission
Aboriginal Action Plan, Government report documents sexual and physical abuses at residential
of Canada, 5 Volumes. Ottawa, ON: schools and concludes that the policy direction of assimilation
Minister of Public Works and was wrong and destructive. It also describes conditions of life
Government Services Canada. for Inuit, Métis and First Nation people in Canada and
highlights urgent issues, such as infant mortality rates, youth
suicide, unemployment and poverty. The plan calls for a
renewed relationship between Indigenous nations and
Canadian society, including funds to promote healing from the
effects of residential school abuse and its intergenerational
impacts.
Bopp, Judie, Michael Bopp and Phil Building on fifteen years of contributions to the field of
Lane Jr. (2003). Aboriginal Domestic Aboriginal family violence, this report describes the scope of
Violence in Canada. Ottawa, ON: the problem, its root causes and enabling factors, external
Aboriginal Healing Foundation. influences and constraining factors, as well as responses from
Aboriginal communities and government programs to date. A
comprehensive framework for intervention is proposed that
addresses both root causes and enabling factors.
C9
Corrado, Dr. Raymond R. and Dr. This research report examines the abuse, mental health and
Irwin M. Cohen (2003). Mental health profiles in a sample of 127 Aboriginal Survivors of the
Health Profiles for a Sample of residential school system who have undergone a clinical
British Columbia’s Aboriginal assessment. Findings show 100 per cent of the case files
Survivors of the Canadian reporting sexual abuse and 90 per cent reporting physical
Residential School System. Ottawa, abuse during residential school attendance. Impacts of the
ON: Aboriginal Healing Foundation. abuse show rates of conviction for assault and sexual assault,
as well as rates of mental disorders: 64.2 per cent diagnosed
with post traumatic stress disorder; 26.3 per cent with
substance abuse disorder; and 21.1 per cent with major
depression, while only 4.3 per cent mentioned the new, yet
unofficial, clinical category of “residential school syndrome” —
a sub-type of PTSD that focuses on intense feelings of fear and
anger and the tendency to abuse alcohol and drugs.
Daniels, Judy D. (2003). Ancestral An Alberta Métis perspective of the impact of residential
Pain: Métis Memories of Residential schools and the federal government’s assimilatory policies on
School Project. Edmonton, AB: Métis today; and includes a brief definition of who are the
Métis Nation of Alberta. Métis, an overview of Métis history and education,
descriptions of Alberta residential schools and impacts on
Métis children, families and communities.
Dion Stout, Madeline and Gregory This report provides a critical analysis of the literature on
Kipling (2003). Aboriginal People, resilience in the context of the experiences and social
Resilience and the Residential conditions of Aboriginal Survivors of residential schools in
School Legacy. Ottawa, ON: Canada.Traditions and beliefs derived from the wisdom of
Aboriginal Healing Foundation. Aboriginal cultures are described as resilience enhancement
interventions that should be integrated into existing
approaches to community healing.
Dumont-Smith, Claudette (2002). This article examines the issue of elder abuse from an
Aboriginal Elder Abuse in Canada. Aboriginal perspective, including categories of abuse,
Ottawa, ON: Aboriginal Healing contributing factors and a demographic profile of the elder
Foundation. Aboriginal population in Canada.The literature review draws
upon national and international information on elder abuse
from major national Aboriginal organizations, university and
government libraries, as well as Internet and contacts from
countries with Indigenous populations.
Ellerby, Lawrence A. and Rev. This evaluation report provides an overview of the role of
Jonathan H. Ellerby (1998). Elders in sex offender treatment programs and includes an
Understanding and Evaluating the Elder perspective on traditional healing and approaches to
Role of Elders and Traditional treatment.The importance of a cooperative working
Healing in Sex Offender Treatment relationship between Elders and clinicians is underscored in
for Aboriginal Offenders. Ottawa, evaluating healing gains, needs, successes, strengths and
ON: Solicitor General of Canada. challenges of these programs.
Krawll, Marcia B. (1994). This report attempts to develop a common understanding of
Understanding the role of healing in healing for both Aboriginal and non-Aboriginal people. It
Aboriginal communities. Ottawa, provides a working definition of healing, describes healing
ON: Solicitor General of Canada. approaches and recommends government roles and strategies
in supporting healing programs.
C10
Logan,Tricia (n.d.).The Lost Drawing on oral information from Métis who attended or
Generations:The Silent Métis of the were impacted by residential schools, this report provides a
Residential School System. Interim much-needed focus on the experience and impacts from a
Report 2001, unpublished. Métis perspective. Although Métis children lived under the
Winnipeg, MB: Southwest Region of same conditions and rules as First Nation children in these
Manitoba Métis. schools, their experience was unique in that they were
considered “outsiders” by other children, as well as by staff.
Mathews, Frederick (1995). This paper introduces some of the research findings, issues,
Combining Voices: Supporting Paths concepts and controversies pertaining to programming for
of Healing in Adult Female and Male adult female and male survivors of sexual abuse. It provides a
Survivors of Sexual Abuse. Ottawa, brief summary of current thinking in this field and attempts to
ON: National Clearinghouse on honor similarities, as well as differences, in female and male
Family Violence, Health Canada. survivors’ experiences; and includes extensive references,
suggested resources and bibliographies useful to female as well
as male survivors.
Assembly of First Nations (1996). Published before the official apology and creation of the
National Residential Schools Aboriginal Healing Foundation, this report discusses the
Review. Project Final Report: challenges of Survivors in the courts and attempts to have
National Lobbying Committee on their experiences recognized and addressed by the
Residential Schools (draft). Ottawa, government.
ON: Assembly of First Nations.
Law Commission of Canada (2000). Interpretation of child abuse in institutions from a legal
Restoring Dignity: Responding to framework; and includes overview of residential school
Child Abuse in Canadian Survivors experiences and recommendations for systemic
Institutions. Ottawa, ON: Minister of changes to prevent further abuse.
Public Works and Government
Services.
King, David (1996).The History of This thesis is a significant contribution to historical
the Federal Residential Schools for documentation of the federal government’s record regarding
the Inuit, Located in Chesterfield Inuit education and northern residential schools from 1955 to
Inlet,Yellowknife, Inuvik and 1970 (when responsibility for education in the North was
Churchill, 1955-1970. Peterborough, transferred to the new government of the Northwest
ON:Trent University, unpublished Territories). It also provides a detailed description of
thesis. accommodation, curriculum, extra-curricular activities,
language, diet and clothing in these schools. Excerpts of
interviews are appended that provide first person accounts of
life in the schools from the perspective of former Inuit
students.
Nechi Institute and KAS This is an in-depth study of twenty Aboriginal people in
Corporation Limited (1994). serious conflict with the law, who served time but eventually
Healing, Spirit and Recovery: Factors turned their lives around. Getting in touch with one’s
Associated with Successful spirituality was identified as the key to recovery by all
Integration. Ottawa, ON: Solicitor participants.
General of Canada.
C11
Assembly of First Nations (1994). This important report describes residential school impacts and
Breaking the Silence, An Interpretive healing from a historical perspective and provides an overview
Study of Residential School Impact of how policies affected the education of First Nation children.
and Healing as illustrated by the The personal experiences of direct Survivors of residential
stories of First Nations individuals. schools are detailed through interview sessions. Trauma
Ottawa, ON: Assembly of First theory is used to illustrate the impacts of the experience on
Nations. children emotionally, mentally, physically and spiritually. Coping
strategies and healing paths of Survivors illustrate four phases
of a healing process including: recognizing, remembering,
resolving and reconnecting. It also includes the role of family
and community in healing.
Antone, B. and D. Hill (1990). Explores the role of traditional healing in the broader health
Traditional healing: Helping our and well-being of Aboriginal communities and nations.
people lift their burdens. London,
ON:Tribal Sovereign Associates.
Connors, Dr. Ed. (1999, September). A brief summary of the changing role of spirituality in the lives
The role of spirituality in wellness of First Nation peoples and how Native thinking has shifted
or how well we can see the whole since contact with Europeans. The article discusses the
will determine how well we are and emergence of a new paradigm of healing based on a holistic
how well we can be. Paper worldview; and also details changes in conceptual frameworks
presented at the meeting of the of Euro-western sciences from a linear reductionistic model to
Native Mental Health Association of an environmental paradigm.
Canada, Saskatoon, SK.
Hodgson, Maggie (1991). Impact of Explores the multifaceted effects of residential schooling on
Residential Schools and Other Root Aboriginal people, such as suicide, family violence, alcohol and
Causes of Poor Mental Health. drug abuse.
Edmonton, AB: Nechi Research and
Health Promotions Institute.
VIDEOS and CD-ROMS

Aboriginal Healing Foundation In this video, Survivors and their descendants present deeply
(2003).Where are the Children? personal accounts of daily life, routines and rules in residential
Healing the Legacy of the schools, the impacts of the abuse they suffered there, both
Residential Schools. Ottawa, ON: personally and intergenerationally, as well as their coping skills
Aboriginal Healing Foundation. and strategies for healing.
Cariboo Tribal Council (1992). This documentary recorded events of the First Canadian
Beyond The Shadows. West Conference on Residential Schools in Vancouver, British
Vancouver, BC: Gryphon Columbia. It chronicles the testimonials of individuals who
Productions, Ltd., 28:20 minutes. attended residential schools and its devastating effects. It
describes how First Nation communities must heal the
multigenerational grief passed onto each new generation of
children through unresolved rage and abuse.
C12
Tafoya,Terry (2001). Keynote Terry Tafoya, a Taos Pueblo and Warm Springs Indian is a
Address.Training Workshop on trained traditional Native American storyteller and clinical
Values, Attitudes and Beliefs, psychologist. His presentation interweaves traditional legends
February 8, 2001. Ottawa, ON: and contemporary psychology to powerfully illustrate elements
Shared Realities Working Group. of healing; how verbal and non-verbal cultural communication
differences can enhance or impede service delivery; and how
commonly used approaches to substance abuse may re-enforce
the very behaviours therapists are hoping to help change.
Law Commission of Canada (2000). Describes the stories of people who suffered abuse as children
Just Children: Survivors of in institutions across Canada; and also introduces a discussion
Institutional Abuse Tell Their of how to meet the healing needs of survivors.
Stories. Ottawa, ON: Law
Commission of Canada, 24 minutes.
C13
References
References
References
Aboriginal Healing and Wellness Strategy (2003). Annual Report 2002-2003. Toronto, ON: Aboriginal
Healing and Wellness Strategy.
Aboriginal Healing Foundation (1999). Aboriginal Healing Foundation Program Handbook, 2nd Edition.
Ottawa, ON: Aboriginal Healing Foundation.
_____ (2001). Aboriginal Healing Foundation Program Handbook, 3rd Edition. Ottawa, ON: Aboriginal
Healing Foundation.
_____ (2003). Aboriginal Healing Foundation Annual Report - 2003. Ottawa, ON: Aboriginal Healing
Foundation.
_____ (2004). The Future of the Residential School Healing Movement, March 2004 - A Discussion Paper.
Ottawa, ON: Aboriginal Healing Foundation.
Alfred, Taiaiake (1999). Peace, Power, Righteousness: An Indigenous Manifesto. Don Mills, ON: Oxford
University Press.
Allen, Paula Gunn (1992). The Sacred Hoop: Recovering the Feminine in American Indian Traditions.
Boston, MA: Beacon Press.
American Psychiatric Association (2000). Diagnostic and Statistical Manual, 4th Edition (DSM-IV-TR).
Washington, DC: American Psychiatric Association.
Anderson, Kim (2000). Recognition of Being: Reconstructing Native Womanhood. Toronto, ON: Second
Story Press.
Archibald, Linda and Mary Crnkovich (2000). Inuit Rights in the City: A Guide to Understanding the Rights
of Inuit Living in the Ottawa Area. Ottawa, ON: Tungasuvvingat Inuit.
Assembly of First Nations (1994). Breaking the Silence: An interpretative study of residential school impact
and healing as illustrated by the stories of First Nation individuals. Ottawa, ON: Assembly of First Nations.
Banks, Dr. Amy E. (2000). The Neurobiology of Traumatic Disconnection. Boston, MA: Harvard Medical
School’s Department of Continuing Education.
Blair, D. Thomas and Valerie A. Ramones (1996). Understanding Vicarious Traumatization. Journal of
Psychosocial Nursing and Mental Health Services 34(11): 24-30.
Bopp, J., M. Bopp and P. Lane (2003) Aboriginal Domestic Violence in Canada. Ottawa, ON: Aboriginal
Healing Foundation.
Brant, Clare C. (1990). Native Ethics and Rules of Behaviour. Canadian Journal of Psychiatry 35:534-539.
Brown, Lester (ed.) (1997). Two Spirit People: American Indian Lesbian Women and Gay Men. New York,
NY: Harrington Park Press.
Brownmiller, Susan (1975). Against our Will: Men, Women and Rape. New York, NY: Simon and Schuster.
Chrisjohn, R. and S. Young (1997). The Circle Game. Penticton, BC: Theytus Books Ltd.
Daniels, Judy (2003). Ancestral Pain: Métis Memories of Residential School Project. Edmonton, AB: Métis
Nation of Alberta, unpublished.
Demos, John (1994). The Unredeemed Captive: A Family Story From Early America. New York, NY:
Vintage Books.
Department of Indian Affairs and Northern Development (DIAND) (1998). Indian Residential Schools (IRS)
Data Project. Ottawa, ON: Department of Indian Affairs and Northern Development, unpublished.
References-1
_____ (2003). Basic Departmental Data 2002. Ottawa, ON: Department of Indian Affairs and Northern
Development.
Dickason, Olive Patricia (2002). Canada’s First Nations: A History of Founding Peoples From Earliest
Times, 3rd edition. Don Mills, ON: Oxford University Press.
Dumont-Smith, Claudette (2002). Aboriginal Elder Abuse in Canada. Ottawa, ON: Aboriginal Healing
Foundation.
Ens, Gerhard J. (1996). Homeland to hinterland: the changing worlds of the Red River Metis in the
nineteenth century. Toronto, ON: University of Toronto Press.
Feldman-Summers, S. and K. S. Pope (1994). The experience of “forgetting” childhood abuse: A national
survey of psychologists. Journal of Consulting and Clinical Psychology 62: 636-639.
Fournier, Suzanne and Ernie Crey (1997). Stolen from our Embrace: The Abduction of First Nations
Children and the Restoration of Aboriginal Communities. Vancouver, BC: Douglas & McIntyre Ltd.
Freudenberger, Herbert J. (1981). Burn-Out: the High Cost of High Achievement. Toronto, ON: Bantam
Books.
Health Canada (1993). Adult Survivors of Child Sexual Abuse. Retrieved 8 June 2004 from:
www.hc-sc.gc.ca/hppb/familyviolence/pdfs/ adsurcxa.pdf
Health Canada (2000). Inuit health status in Canada. Retrieved from:
http://www.hc-sc.gc.ca/english/media/releases/2000/2000_20ebk2
Herman, Judith (1997). Trauma and Recovery: The Aftermath of Violence From Domestic Abuse to Political
Terror. New York, NY: Basic Books.
Indian and Northern Affairs Canada (2004). Report of the Royal Commission on Aboriginal Peoples,
Volume 1 - Looking Forward Looking Back, Part One - The Relationship in Historical Perspective, Chapter
5 - Stage Two: Contact and Co-operation. Retrieved from: http:///www.aincinac.gc.ca/ch/rcap/sg/sg11_e.html
Jordan, Judith (1999). Toward Connection and Competence. Wellesley, MA: Stone Center, Wellesley
College.
Jordan, Judith V., Maryellen Handel, Margarita Alvarez and Robin Cook-Nobles (2000). Applications of the
Relational Model to Time-Limited Therapy. Work in Progress 87:1-2.
King, David (1996). The History of the Federal Residential Schools for the Inuit, Located in Chesterfield
Inlet, Yellowknife, Inuvik and Churchill, 1955-1970. Peterborough, ON: Trent University, unpublished
thesis.
Kulchyski, Peter, Don McCaskill and David Newhouse (1999). In the Words of Elders: Aboriginal Cultures
in Transition. Toronto, ON: University of Toronto Press.
Legacy of Hope Foundation (2003). Where Are The Children? Healing the Legacy of the Residential
Schools. Ottawa, ON: Legacy of Hope Foundation.
Logan, Tricia (n.d.). Lost Generations: The Silent Métis of the Residential School System, Interim Report.
Winnipeg, MB: Southwest Region of Manitoba Métis, unpublished.
Lovelace, Wicasta and Christie Rice (1999). The Malleus Maleficarum. Windhaven Network, Inc. Retrieved
2 June 2004 from: www.malleusmaleficarum.org/downloads/MalleusAcrobat.pdf
Mautz, Hong (2001). Exercise Can Help Clinically Depressed.
Retrieved from: http://www.mult-sclerosis.org/ news/Jan2001/ExerciseGoodforDepression.html
McCann, L. and L. Peralman (1990). Vicarious Traumatization: A framework for understanding the
psychological effects of working with victims. Journal of Traumatic Stress 3: 131-149.
References-2
Middleton-Moz, Jane (1989). Children of Trauma: Rediscovering your discarded self. Deerfield Beach, FL:
Health Communications Inc.
_____ (1999). Boiling Point: The High Cost of Unhealthy Anger to Individuals and Society. Deerfield Beach,
FL: Health Communications Inc.
Miller, J.R. (1996). Shingwauk’s Vision: A History of Native Residential Schools. Toronto, ON: University of
Toronto Press Incorporated.
Minor, Kit (1992). Issumatuq: Learning from the Traditional Helping Wisdom of the Canadian Inuit. Halifax,
NS: Fernwood Publishing.
Morrison, B. and C. Wilson (eds.) (1995). Native Peoples: The Canadian Experience, 2nd Ed. Toronto, ON:
McClelland and Stewart Inc.
Native Women’s Association of Canada (NWAC) (2004a). Sisters in Spirit: Stories. Ottawa, ON: Native
Women’s Association of Canada. Retrieved 4 May 2004 from: http://generalsynod.anglican.ca/
ministries/committees/acip/sistersinspirit/stories.html
_____ (2004b). Sisters in Spirit: Background and Information. Ottawa, ON: Native Women’s Association of
Canada. Retrieved 4 May 2004 from: http://generlsynod.anglican.ca/ministries/ committees/acip/
sistersinspirit/background.html
O’Leary, Patrick (1998). Liberation from self-blame: Working with men who have experienced childhood
sexual abuse. In: Some thoughtful considerations in relation to working on issues of violence and abuse.
Dulwich Centre Journal 4: 24-40.
Pauktuutit Inuit Women’s Association (1991). The Inuit way: A guide to Inuit culture. Ottawa, ON: Pauktuutit
Inuit Women’s Association and National Library.
Pearce, Roy Harvey (1988). Savagism and Civilization: A Study of the Indian and the American Mind.
Berkeley, CA: University of California Press.
Ray, Arthur J. (1996). I Have Lived Here Since The World Began: An Illustrated History of Canada’s Native
People. Toronto, ON: Lester Publishing Ltd.
Russell, Diana E.H. (1982). Rape in Marriage. New York, NY: Macmillan.
Saakvitne, Karen W., Sarah Gamble, Laurie Anne Pearlman and Beth Tabor Lev (2000). Risking Connection:
A Training Curriculum for Working With Survivors of Childhood Abuse. Lutherville, MD: Sidran Press.
Statutes of Canada, [S.C.] (1895). An Act further to amend The Indian Act, 1895, c. 35, s. 6; S.C. 1906, c. 81,
s. 149.
Stewart, The Honourable Jane (1998). Statement of Reconciliation. Hull, QC: Indian and Northern Affairs
Canada. Retrieved 3 May 2004 from: http://www.ainc-inac.gc.ca/gs/rec_e.html
Tafoya, Terry (2001). Keynote Address. Training Workshop on Values, Attitudes and Beliefs, February 8,
2001. Ottawa, ON: Shared Realities Working Group.
United Nations (1948). Convention against Genocide. Retrieved on 5 July 2004 from
http://www.hrweb.org/legal/undocs.html
Waldegrave, Charles (1990). Just Therapy. Dulwich Centre Newsletter, No. 1. Lower Hutt, N.Z.: Dulwich
Centre Publications.
Weatherford, Jack (1991) Native Roots: How the Indians Enriched America. New York, NY: Fawcett
Columbine.
Williams, Walter L. (1992). The Spirit and the Flesh: Sexual Diversity In American Indian Culture. Boston,
MA: Beacon Press.
References-3
75 Albert Street, Suite 801, Ottawa, Ontario K1P 5E7
Phone: (613) 237-4441
Toll-free: (888) 725-8886
Fax: (613) 237-4442
E-mail: programs@ahf.ca
Website: www.ahf.ca
Helping Aboriginal people heal themselves

This is Exhibit “G” referred to in the Affidavit of Grand Chief

10/4/2018 Ontario school board hires first superintendent of Indigenous education, reconciliation | CBC News
CBC
AUDIO
Ontario school board hires first superintendent of Indigenous

education, reconciliation
    
New supervisor ovesees language, culture, land-based programs and implements Truth &
Reconciliation report
Cathy Alex · CBC News · Posted: Jun 18, 2018 1:20 PM ET | Last Updated: June 18
Sean Monteith, director of education for the Keewatin Patricia District School Board, says he's excited and
hopeful about the board's decision to hire a superintendent of Indigenous education and reconciliation.
(KPDSB)
Reaching out for help, and starting the process of 'setting things right'... Sean Montheith of he Keewatin
Patricia District School Board is hiring a Superintendent of Indigenous Education and Reconciliation. 8:22
https://www.cbc.ca/news/canada/thunder-bay/kpdsb-indigenous-education-reconciliation-1.4710795 1/3
A public school board in northwestern Ontario is hiring a superintendent of Indigenous

education and reconciliation, a position believed to be the first of its kind in Canada.
The Keewatin Patricia District School Board (KPDSB) serves approximately 5,000 kindergarten
to Grade 12 students, with an additional 1,000 adult alternative learning students.
With over half of all those students — 54 per cent — now voluntarily self-identifying as being of
Indigenous ancestry, this new superintendent position is urgently needed, says Sean Monteith,
the board's director of education.
'We have a lot of work to do'
"We have a lot of work to do with this population to make things right," said Monteith. "I don't
think we're going to wait for someone else to do it for us. I think we're going to get involved
and roll up our sleeves because there is a lot of reconciliation that needs to take place."
The successful candidate will have many duties including overseeing language, culture and
land-based programs, embedding the histories of Treaties 3, 5 and 9 into the curriculum,
supervising the Four Directions graduation coach program, and implementing the
recommendations of the Truth and Reconciliation Commission report.
New northwestern Ontario support program boosts graduation rates for

Indigenous students
One of the key aims of the position is to help the school board close the gap in graduation and
success rates between Indigenous students and their non-Indigenous peers.
"I wonder sometimes if people know what that means," said Monteith. "Closing the gap in my
board ... is more than ... just a statement. It is blood, sweat and tears, sometimes literal even."
Helping Indigenous students achieve their potential is also a highly collaborative process, said
Monteith, who noted the board consulted extensively with a number of tribal councils inside
and outside Ontario, elders and officials with a variety of Indigenous organizations, including
the Nishnawbe Aski Nation, to draft the job description for this new position.
The board isn't just talking the talk. We're

walking the walk.
- Sean Monteith
"This person will not be successful without all of us working together, and working together in
a coherent, integrated way, so we had lots of input, lots of management and I'm excited about
it and I'm hopeful too."
The board covers a vast geographic area, serving the communities of Kenora, Dryden, Red
Lake, Sioux Lookout, Pickle Lake, Upsala, Savant Lake, Ear Falls, and Ignace with a system of 23
elementary and secondary schools, two board offices, and several alternative learning sites.
"The Keewatin Patricia District School Board is genuinely interested in closing gaps and we're
going to do whatever it is we have to do to address that and I really hope that people in both
non-First Nation communities and in First Nation communities see that the board isn't just
talking the talk. We're walking the walk."
Applications are being accepted until June 29, 2018.
You can hear the full interview with Sean Monteith on CBC's Superior Morning here.
©2018 CBC/Radio-Canada. All rights reserved.
Visitez Radio-Canada.ca
This is Exhibit “H” referred to in the Affidavit of Grand Chief

RESEARCH AND PRACTICE
Factors Associated With the Sexual Behavior of

Canadian Aboriginal Young People and Their
Implications for Health Promotion
Karen M. Devries, PhD, Caroline J. Free, PhD, MBChB, Linda Morison, MSc, and Elizabeth Saewyc, PhD
There are over 5 million people of indigenous

Objectives. We examined factors associated with having ever had sex, having
ancestry in Canada and the United States1,2 and
more than 1 lifetime sexual partner, and condom nonuse at last incident of
more than 1000 recognized First Nations and
sexual intercourse among Canadian Aboriginal young people.
Tribal governments.3,4 Indigenous young peo- Methods. We conducted a secondary analysis of data from the 2003 British
ple in both countries bear a disproportionate Columbia Adolescent Health Survey, a cross-sectional survey of young people in
burden of sexually transmitted infections grades 7 through 12.
(STIs). For example, in Canada Aboriginal Results. Of 1140 young Aboriginal men, 34% had ever had sex; of these, 63%
young people aged 15 through 19 years are 7 had had more than 1 sexual partner, and 21% had not used a condom at their last
times more likely to be diagnosed with chla- incident of sexual intercourse. Of 1336 young Aboriginal women, 35% had ever
mydia than are non-Aboriginal young people.5 had sex; of these, 56% had had more than 1 sexual partner, and 41% had not
Aboriginal people of all ages are 7 times more used a condom at their last incident of sexual intercourse. Frequent substance
use, having been sexually abused, and having lived on a land reservation were
likely to be diagnosed with HIV than the
strongly associated with sexual behavior outcomes. Feeling connected to family
general population.5 Among American Indians
was strongly associated with increased condom use.
and Alaska Natives aged 15 through 24 years
Conclusions. Sexual behavior change interventions for Aboriginal young
in the United States, incidences of gonorrhea people must move beyond the individual and incorporate interpersonal and
and chlamydia are proportionately higher than structural dimensions. Interventions to reduce substance use and sexual abuse
they are among any other ethnic/racial group and promote feelings of family connectedness in this population should be
except for African Americans.6 Adolescent explored. Young people living on land reserves need special attention. (Am J
pregnancy is also more common among in- Public Health. 2009;99:855–862. doi:10.2105/AJPH.2007.132597)
digenous than among nonindigenous young
women.7,8 number of sexual partners among young peo- individual level, to allow for life history and
Changing sexual behavior is an important ple13 but was confined to 1 tribal area. In individual behaviors; and a situational level,
strategy for preventing STIs and unwanted Canada, there has been 1 large study of adults which includes factors occurring at the time of
pregnancy.9 Behaviors that can reduce the risk on 11 land reservations in Ontario14 but no a sexual encounter.
of STI and pregnancy include delaying sexual studies of young people. Other studies are The structural and historical context is es-
debut, limiting the number of partners, and small and have produced inconsistent results.15 pecially important to consider in relation to
using condoms; addressing all 3 is important In our study, we examined factors associated current health outcomes for Aboriginal young
for a comprehensive behavioral approach.10 with having ever had sex, having had more people.17 The destruction of traditional ways of
Knowing which factors are associated with than 1 sexual partner, and not having used life and social reorganization resulting from
these behaviors among Aboriginal young peo- a condom at last incident of sexual intercourse colonization as well as the abuse and trauma
ple is necessary to design maximally effective among Canadian Aboriginal young people. We suffered by residential or boarding school
prevention programs for this group. included factors known to be important pre- attendees have profoundly influenced indige-
Most studies of factors associated with po- dictors of sexual behavior in other populations nous communities.17 We considered 2 varia-
tentially risky sexual behavior, however, do not as well as variables unique to indigenous young bles related to the broader social context: living
focus on indigenous populations. Extant people. We sought to determine which fac- on-reserve and cultural traditions. Living on-
larger studies that focus on indigenous young tors were the strongest predictors of sexual reserve is associated with low income levels
people have been conducted in the United behavior. and high risk of some diseases18,19; we hy-
States. One such study used late 1980s data We selected factors according to an ecolog- pothesized it would be positively associated
from selected sites and examined the factors ical perspective16 that outlines different levels with our behavioral outcomes. Qualitative
associated with having ever had sex.11 Another of influence on health outcomes. Our model work has shown that some Aboriginal young
used 1998 and 2001 data from Minnesota included a structural level, consisting of vari- people perceive pregnancy and fertility as
American Indian young people and examined ables related to the broader social environment; traditionally valued in their communities and
factors associated with having ever had sex.12 an interpersonal level, where influences come that some young people desire pregnancy in
A third US study examined condom use and from the community, school, and family; an the context of serious relationships.20 We
May 2009, Vol 99, No. 5 | American Journal of Public Health Devries et al. | Peer Reviewed | Research and Practice | 855
hypothesized that, compared with those with encounter would be positively associated with Participants
less cultural knowledge, young people who had our outcomes. We also considered use of Only participants who identified themselves
more cultural knowledge would be less likely to contraception methods other than condoms at as Aboriginal were included in the analyses.
have ever had sex and to have a lower number a particular sexual encounter as a risk factor for Participants were considered Aboriginal if
of partners, but also less likely to have higher condom nonuse because pregnancy prevention they selected ‘‘Aboriginal/First Nations’’ in re-
levels of condom nonuse. is the primary goal of condom use for many sponse to the question, ‘‘What is your back-
At the interpersonal level, volunteering is adolescents.42 ground?’’; if they specified a particular First
associated with lack of sexual experience We tested our hypotheses using a data set Nation or other Aboriginal group in the ‘‘Other:
among American Indian adolescents12 and with representative of young people attending please specify’’ category; or if they answered
safer sexual behavior among other popula- grades 7 through 12 in British Columbia, yes to the question, ‘‘Are you Aboriginal/First
tions21–23; hence, we hypothesized that helping Canada. Nations?’’ Having ever had sex was defined
in the community would be negatively associ- as a positive response to the question, ‘‘Have
ated with our outcomes. METHODS you ever had sex?’’ and not indicating else-
Feelings of connection to family and school where in the survey that they had never had
may both provide an effective buffer to stress- We performed secondary analyses with data sex. Only those who had ever had sex were
ful life events and encourage higher educa- from the 2003 British Columbia Adolescent included in the condom use and partner
tional aspirations, which are both associated Health Survey (BCAHS 2003). The BCAHS is analyses.
with lower STI and pregnancy risk.24–26 Some a cross-sectional survey administered every 5
research has demonstrated that poor parent– to 6 years to young people enrolled in grades 7 Measures
adolescent communication and a lack of pa- through 12 in the province of British Columbia. The sexual behavior outcomes were mea-
rental supervision are associated with poten- Full details of the sampling scheme are avail- sured using binary variables and consisted of
tially risky sexual behavior outcomes in diverse able elsewhere.43 Briefly, the province is strat- the following: ever having sexual intercourse
groups.27–29 We hypothesized that increased ified by the administrative areas of the British (vs never), having more than 1 lifetime sexual
family and school connectedness would be Columbia Ministry of Health and then by partner (vs only 1), and not having used
negatively associated with our behavioral out- grade. A random sample of classrooms is in- a condom at last incident of sexual intercourse
comes. Similarly, peer attitudes can be an vited to participate in each stratum. Permission (vs using a condom). Exposure measures are
important predictor of young people’s for each classroom to participate is granted described in Table 1. We examined 12 expo-
behavior because of social identity develop- from school districts, which are the adminis- sure variables in relation to having ever had
ment during adolescence.30 We hypothesized trative units of the British Columbia Ministry of sex, 13 for having more than 1 sexual partner,
that, similar to nonindigenous young people, Education and fit within the administrative and 14 for condom use at last incident of
negative peer perceptions of pregnancy areas of the Ministry of Health. For the 2003 sexual intercourse (Table 3). We hypothesized
would be negatively associated with our cycle, 45 of 59 school districts in British age in years a priori to be a confounder and
outcomes.30 Columbia participated, involving 40 040 eligi- included it in all multivariate models. We
Individual history of sexual abuse has a clear ble students in 1557 classrooms. Informed computed individual scores for family and
association with subsequent sexual risk in the consent was sought either from parents school connectedness by summing item scores
general population31–35 and among American (with student assent) or students (with parental and dividing by the number of items com-
Indian adolescents.12,36 The causal mechanism notification) depending on school district pleted. Cronbach a in the sample used here
for the effects of abuse on behavior remains requirements. Selected participants returned for family connectedness was 0.86 (both
unclear but may involve negative mental 30 884 questionnaires, yielding an overall re- genders) and for school connectedness was
health sequelae,37 diminished self-efficacy and sponse rate of 76% among students in partici- 0.80 among young men and 0.81 among
sexual negotiation skills, and an increased de- pating districts. The main reason for nonre- young women. Because there is no univer-
sire to conceive because of fertility concerns.38 sponse was absenteeism on the day of the sally accepted definition of problematic sub-
We hypothesized that experience of sexual survey (12%). stance use levels, we generated a score by
abuse would be positively associated with our computing mean frequency of lifetime sub-
behavioral outcomes. Ethical Consultation and Approval stance use for each participant. We computed
Research has produced conflicting results on No formal community ethical review was the median of individual scores and
the relation between the use of various sub- available, so we held initial discussions with classified all Aboriginal young people as
stances and sexual health outcomes. Alcohol Aboriginal community health promotion above (‘‘high’’) or below (‘‘low’’) the
and marijuana use have been associated with workers to ensure analyses would be con- median.
sexual behaviors in various populations, al- ducted in an ethical and sensitive way. All
though evidence on causality is equivocal.39–41 agreed that the information would be useful for Statistical Analyses
In this study, we hypothesized that substance program development, which we took as com- The BCAHS 2003 provides weights to
use both over the lifetime and during a sexual munity approval for the project. correct for the differing probability of selection
856 | Research and Practice | Peer Reviewed | Devries et al. American Journal of Public Health | May 2009, Vol 99, No. 5
TABLE 1—Measurement of Exposures: Aboriginal Adolescent Health Survey, British Columbia, 2003
Factor Variable Measurement
Age What is your age in years? Continuous

Cultural knowledge How much have you learned about culture from your family? Some or a lot/none
How much have you learned about culture from your school? Some or a lot/none
How much have you learned about culture from your community? Some or a lot/none
Reserve Have you ever lived on a reserve? Ever/never
Community involvement In the past 12 months, did you help others without pay by helping in your community? Yes/no
In the past 12 months, did you help others without pay by helping neighbors or relatives? Yes/no
School connectedness 7 items, each on 5-point scales, e.g., How much do you feel that your teachers care about you? Continuous
Peer attitudes toward pregnancy Would your peers be angry if you were involved in a pregnancy? Yes/no
Family connectedness 11 items, each on 3-point scales, e.g., How close do you feel to your mother? Continuous
Sexual abuse 2 items, Have you ever been forced to have sexual intercourse? Have you ever been sexually abused? Yes (for selecting either)/no
Lifetime substance use Lifetime frequency of using alcohol, marijuana, cocaine, hallucinogens, mushrooms, inhalants, amphetamines, High/low
heroin, an injected illegal drug, steroids without a doctor’s permission, prescription pills without a
doctor’s consent
Noncondom contraceptive use at the last Last time you had sexual intercourse, what method(s) did you or your partner use to prevent pregnancy? Yes (for selecting any in list)/no
incident of sexual intercourse Birth control pills, Depo Provera, diaphragm/contraceptive sponge, withdrawal, emergency contraception
Substance use at last incident of Did you drink alcohol or use drugs before you had sexual intercourse the last time? Yes/no
sexual intercourse
across survey strata. We conducted all analyses RESULTS a noncondom method of contraception at last
using Stata,44 incorporating both weights and incident of sexual intercourse.
the complex clustered sampling scheme of the There were 2476 students (8.1% of the
survey. We conducted analyses separately by total sample) who self-identified as Aboriginal. Factors Associated With Having
gender. Of these students, 1140 (46.0%) were male Ever Had Sex
We computed descriptive statistics and used and 1336 (54.0%) were female. Of the 1140 For both young men and young women, the
logistic regression to calculate unadjusted odds young men, 33.7% have ever had sex. Of unadjusted analyses showed increasing odds of
ratios (ORs) for each association. Multivariate those, 63.3% have had more than 1 sexual having ever had sex among those of an older
logistic models were fitted using backward partner, and 21.4% did not use a condom at age, a higher level of substance use, and having
elimination to determine independent predic- last incident of sexual intercourse. Of the lived on a reserve. Table 3 shows ORs with
tors for each outcome. For this procedure, all 1336 young women, 34.8% have ever had 95% confidence intervals (CIs) and P values for
variables were entered, and at each stage the sex. Of those, 56.1% have had more than all unadjusted associations. Increased family
one with the largest P value was removed until 1 sexual partner, and 40.5% did not use and school connectedness were associated with
all remaining variables contributed signifi- a condom at last incident of sexual lower odds of having ever had sex. For young
cantly (P < .05) to the model. intercourse. women but not young men, the odds of
We excluded respondents with missing The mean age of young women (Table 2) having ever had sex were lower if they per-
data on exposure variables from analyses that was 14.8 years (range, 12–20), and 26.9% had ceived that their peers would react angrily to
used those items. For young women, missing at lived on a reserve. Among young women who a pregnancy. Table 4 shows adjusted ORs from
least 1 other response was associated with have ever had sex, 40.2% reported sexual the multivariate model with 95% CIs and P
having lived on a reserve (P = .02) and learning abuse. Substances were used by 34.9% the last values. The multivariate analyses showed that
about culture from the community (P = .05). time they had sex, and 30.6% used a non- after adjustment, older age, a high level of
For young men, missing at least 1 other re- condom method of contraception at last in- substance use, and living on a reserve were still
sponse was associated with helping neighbors cident of sexual intercourse. associated with higher odds of having ever had
(P = .05) and learning about culture from the For young men (Table 2), the mean age was sex for young men. For young women, adjusted
community (P = .05). Having ever had sex, 14.8 years (range, 12–20), and 29.4% had analyses showed that school connectedness
using condoms, and having had more than lived on a reserve. Among those who have ever was associated with lower odds of having ever
1 sexual partner were not related to missing had sex, 10.1% reported sexual abuse, 33.8% had sex. However, peer attitudes and family
data on exposure variables (P > .05 in each had used substances at last incident of sexual connectedness were no longer significant
case). intercourse, and 13.8% reported that they used (Table 4).
family connectedness and lower likelihood of

TABLE 2—Distribution of Exposure Variables: Aboriginal Adolescent Health Survey, British condom nonuse became apparent.
Columbia, 2003
Young Women Young Men DISCUSSION

Total No. % or Mean Total No. % or Mean
The strongest and most consistent factors
All Aboriginal young people associated with the sexual behavior of Aborig-
Age, y 1336 14.8a 1140 14.7a inal young people in our study were using
£ 14 46.0 48.5 substances more frequently than peers, expe-
15–16 34.9 30.2 rience of sexual abuse, and ever having lived
‡ 17 19.1 21.3 on a reserve. Feeling connected to family was
Where learned about culture strongly related to increased likelihood of
Family 1171 76.4 990 69.9 condom use in both genders.
School 1166 77.5 991 68.0 In addition to having strong relations with
Community 1167 55.4 983 48.7 sexual behavior, both substance use and having
Ever lived on a reserve 1163 26.9 974 29.4 been sexually abused are more common among
Helped in community in the past year 1254 35.4 1057 22.4 Aboriginal versus non-Aboriginal young people
Helped neighbors in the past year 1269 69.0 1062 59.2 in British Columbia.45 Therefore, it is impera-
School connectedness (range, 1–5) 1326 3.53a 1123 3.54a tive that these variables are addressed when
Peers would be angry you were involved in a pregnancy 1289 74.8 1075 54.8 planning interventions for this group. Our
Family connectedness (range, 1–3) 1327 2.38a 1123 2.50a findings highlight the importance of sexual
Higher lifetime substance use 1303 27.2 1098 22.6 health promotion efforts for young people
Aboriginal young people who have had sexual intercourse living on a reserve and indicate that behavior
Ever been sexually abused or forced to have sexual intercourse 437 40.2 346 10.1 change interventions need to move beyond the
Used other contraception at last act of sexual intercourse 436 30.6 354 13.8 individual and address interpersonal, social,
Used substance at last act of sexual intercourse 440 34.9 350 33.8 and structural factors.
Note. Analyses are based on weighted data and are adjusted for survey design. Total number of all Aboriginal young people in
each analysis varied because of missing data. Total number of sexually experienced young women was 445; total number of Findings From Other Studies
sexually experienced young men was 360. The associations observed here between
a
Mean value.
sexual behavior and frequency of substance
use, having been sexually abused, and family
Factors Associated With Having More Factors Associated With Condom Nonuse connectedness are broadly consistent with
Than 1 Lifetime Sexual Partner at Last Incident of Sexual Intercourse findings from other populations, although they
For young women, the unadjusted analyses Table 3 shows that among young women, appear to be especially important for Aborigi-
show that increased school connectedness and the odds of condom nonuse increased with nal young people. A Minnesota study found
helping in the community were associated increasing age, having ever lived on a reserve, that American Indian adolescents who use
with having had only 1 partner. Having been learning about culture from the community, substances at high levels are more likely to
sexually abused, learning about culture and using another method of contraception. have had sex.12 A San Francisco study found
from the community, and higher levels of There was some suggestion that family con- that sexual abuse among the general popula-
substance use were associated with having nectedness was associated with a lower likeli- tion was associated with subsequent low levels
had more than 1 partner (Table 3). These hood of condom nonuse (P = .079). After ad- of condom use and with having had more than
associations remained in the adjusted an- justment, these associations remained, and the 1 partner.31 Among a national sample of US
alyses (Table 4). association between family connectedness and adolescents, feeling connected to family was an
The unadjusted analyses for young men condom use strengthened (Table 4). important predictor of having had sex.26
showed that older age and higher levels of The unadjusted analyses show that, among Our findings regarding the importance of
substance use were associated with an in- young men, having learned about culture from living on a reserve contrast with the results of
creased likelihood of having had more than 1 school was associated with decreased odds of a US study that found status of having lived on
sexual partner, whereas school connectedness condom nonuse. Having been sexually abused a reserve did not predict sexual behavior.13
was associated with a decreased likelihood and use (by self or partner) of another form of There are at least 2 plausible reasons for our
(Table 3). After adjustment, there was no contraception was associated with an increase observed association—reserves tend to be
longer any association between school in the odds of condom nonuse (Table 3). In located in more rural areas46 and those living
connectedness and number of sexual partners the multivariate model, these associations on a reserve have lower incomes19—both of
(Table 4). remained, and an association between more which are independently associated with sexual
TABLE 3—Unadjusted Associations Between Exposure Variables and Ever Having Had Sex, Having
More Than 1 Lifetime Sexual Partner, and Not Using a Condom at Last Sexual Intercourse: Aboriginal
Adolescent Health Survey, British Columbia, 2003
Young Women Young Men

Ever Had Sexual Intercourse > 1 Lifetime Partner No Condom at Last Act of Ever Had Sexual Intercourse > 1 Lifetime Partner No Condom at Last Act of
(n = 1336) (n = 444) Sexual Intercourse (n = 440) (n = 1140) (n = 358) Sexual Intercourse (n = 351)
OR (95% CI) P OR (95% CI) P OR (95% CI) P OR (95% CI) P OR (95% CI) P OR (95% CI) P
a a a a a a
Age, y 1.76 (1.58, 1.95) <.001 1.14 (0.98, 1.34) .097 1.40 (1.17, 1.67) <.001 1.67 (1.51, 1.85) <.001 1.17 (0.99, 1.38) .058 1.06 (0.86, 1.30) .592
Learned about culture 1.05 (0.72, 1.53) .786 1.79 (0.98, 3.28) .057 1.00 (0.54, 1.82) .990 1.04 (0.69, 1.56) .849 0.80 (0.40, 1.59) .518 0.93 (0.50, 1.72) .812
from family, yesb
from school, yesb
May 2009, Vol 99, No. 5 | American Journal of Public Health

from community, yesb
Ever lived on a reserve, yesb 1.60 (1.11, 2.30) .011 2.16 (1.29, 3.62) .003 2.09 (1.24, 3.55) .006 1.79 (1.24, 2.60) .002 1.19 (0.65, 2.16) .572 1.32 (0.69, 2.55) .400
Helped in community, 0.98 (0.69, 1.40) .926 0.45 (0.26, .79) .005 1.07 (0.60, 1.89) .826 1.26 (0.84, 1.89) .268 1.30 (0.65, 2.61) .463 0.69 (0.34, 1.38) .288
past year, yesb
Helped neighbors, 0.75 (0.54, 1.04) .085 0.95 (0.57, 1.59) .857 1.02 (0.60, 1.73) .94 0.93 (0.65, 1.34) .695 1.16 (0.62, 2.18) .634 0.94 (0.50, 1.75) .844
past year, yesb
School connectedness 0.72a (0.60, .87) .001 0.68a (0.48, 0.96) .029 1.06a (0.71, 1.60) .761 0.78a (0.64, .96) .014 0.67a (0.48, 0.94) .021 1.05a (0.70, 1.59) .805
(range 1–5), high
Peers would be angry if 0.58 (0.41, 0.82) .002 1.00 (0.61, 1.64) .986 0.69 (0.42, 1.12) .129 1.05 (0.75, 1.48) .758 0.91 (0.51, 1.61) .749 1.18 (0.68, 2.07) .550
became pregnant, yesb
Family connectedness 0.55a (0.41, 0.72) <.001 0.62a (0.36, 1.06) .079 0.66a (0.39, 1.12) .122 0.53a (0.38, .76) <.001 0.90a (0.51, 1.59) .727 0.65a (0.37, 1.16) .148
(range 1–3), high

Lifetime substance 7.11 (5.02, 10.09) <.001 4.78 (2.88, 7.95) <.001 1.31 (0.77, 2.25) .321 13.40 (8.94, 20.08) <.001 2.38 (1.32, 4.29) .004 1.41 (0.74, 2.67) .297
use, highc
Ever been sexually ... ... 1.91 (1.18, 3.09) .009 1.29 (0.79, 2.12) .313 ... ... 1.33 (0.52, 3.43) .554 5.16 (2.40, 11.10) <.001
abused, yesb
Other contraception at ... ... ... ... 60.11 (16.54, 218.47) <.001 ... ... ... ... 27.28 (12.95, 57.44) <.001
last act of sexual
intercourse, yesb
Substance use at last act ... ... ... ... 0.99 (0.56, 1.71) .958 ... ... ... ... 1.38 (0.77, 2.48) .280
of sexual intercourse, yesb
Note. OR = odds ratio; CI = confidence interval. Analyses were based on weighted data and were adjusted for survey design. Range refers to the number of participants in each analysis, which vary slightly because of missing data: for young
women who had ever had sex, the range was 1163 to 1336; for young women with more than 1 lifetime partner, the range was 387 to 444; for young women who did not use a condom at sexual intercourse, the range was 385 to 440; for
young men who have ever had sexual intercourse, the range was 974 to 1140; for young men with more than 1 lifetime partner, the range was 317 to 358; for young men who did not use a condom at last sexual intercourse, the range was
310 to 351.
a
OR should be interpreted as increase in odds of outcome for every unit increase in exposure score.
b
The referent category was ‘‘No.’’
c
The referent category was ‘‘Low.’’
Devries et al. | Peer Reviewed | Research and Practice | 859

‘‘community’’ may have both positive and

TABLE 4—Adjusted Associations Between Exposures and Having More Than 1 Lifetime negative effects on sexual behavior.
Partner and Not Using a Condom at Last Sexual Intercourse: Aboriginal Adolescent Health Although school connectedness is associated
Survey, British Columbia, 2003 with positive sexual health outcomes in other
Exposure Variable AORa (95% CI) P populations of young people26 and with never
having had sex among American Indian young
Young women people,12 it was of less importance for Canadian
Ever had sexual intercourse (n = 1131) Aboriginal young people after adjusting for
Increasing age (years) 1.68b (1.49, 1.89) < .001 other factors. Here, only among young women
Higher lifetime substance use 4.02 (2.62, 6.16) < .001 was increased school connectedness related to
Ever lived on a reserve 1.59 (1.05, 2.42) .029 never having had sex. Other research has
Higher school connectedness (range, 1–5) 0.74b (0.56, 0.97) .030 shown that Aboriginal young people are gen-
Had more than 1 sex partner (n = 351) erally less connected to school45 than are their
Increasing age (years) 1.24b (1.02, 1.52) .030 non-Aboriginal peers and that they leave
Higher lifetime substance use 6.12 (3.54, 10.59) < .001 school earlier.48 The lack of observed associa-
Ever been sexually abused or forced to have sexual intercourse 1.95 (1.11, 3.44) .021 tion may reflect a general lack of relevance of
Learned about culture from school 0.48 (0.24, 0.95) .035 the school environment among Aboriginal
Learned about culture from community 2.14 (1.17, 3.93) .014 young people. Similarly, peer attitudes toward
Helped in community, past year 0.32 (0.17, 0.63) .001 pregnancy were unrelated to outcomes after
Condom nonuse at last act of sexual intercourse (n = 378) adjusting for other factors. Cultural knowledge
Increasing age (years) 1.51b (1.10, 2.07) .011 variables did not have a consistent relation with
Ever lived on a reserve 7.80 (3.25, 18.73) < .001 sexual behavior and produced results both
Higher family connectedness (range, 1–3) 0.43b (0.19, 0.99) .048 supporting and contradicting our hypotheses.
Learned about culture from family 0.37 (0.16, 0.86) .021
Contraceptive use 101.34 (30.05, 341.73) < .001 Strengths and Limitations
Young men Our population-based, probability survey of
Ever had sexual intercourse (n = 858) young people’s health behaviors is unique in
Increasing age (years) 1.51b (1.35, 1.69) < .001 Canada and had a larger sample of Aboriginal
Higher lifetime substance use 9.98 (6.13, 16.24) < .001 respondents than other sexual behavior re-
Ever lived on a reserve 1.88 (1.19, 2.99) .007 search.15 We were able to include both young
Had more than 1 sex partner (n = 297) people who live on a reserve and those who
Increasing age (years) 1.09b (0.92, 1.28) .324 live off a reserve, unlike many other surveys.
Higher lifetime substance use 2.22 (1.24, 3.97) .007 However, this includes a diverse set of peoples
Condom nonuse at last act of sexual intercourse (n = 334) with distinct cultures and experiences of colo-
Increasing age (years) 0.97b (0.75, 1.27) .849 nization in a wide variety of geographic loca-
Higher family connectedness (range, 1–3) 0.48b (0.26, 0.91) .023 tions. Variation among different Aboriginal
Used noncondom contraception at last act of sexual intercourse 39.66 (16.48, 95.46) < .001 groups may influence the relative importance
Ever been sexually abused or forced to have sexual intercourse 4.52 (1.69, 12.09) .003 of the associations presented here; however,
Note. AOR = adjusted odds ratio; CI = confidence interval. Analyses are based on weighted data and are adjusted for survey we could not explore this possibility because
design. more-detailed information on Aboriginal heri-
a
Adjusted for all other variables in the model. tage was not available. However, many associ-
b
AOR should be interpreted as increase in odds of outcome for every unit increase in exposure score.
ations observed in this study are also important
for young people from other populations, in-
dicating that at least some factors are important
behavior. Unfortunately, it was not possible to Young women who helped in their commu- across ethnic groups. Similar to other school-
establish the independent effects of those fac- nities in the past year were less likely to have based surveys, young people who were absent
tors because they were not measured in the had multiple sexual partners; otherwise, com- from school and were unable to participate in
survey. Also, half of the young people who had munity factors were not predictive of sexual our survey are likely to be at higher risk;
ever lived on a reserve were not living on one behavior. At least 1 study has found that different factors may better predict sexual
at the time of the survey and therefore had volunteering can be positively or negatively behavior among them. Our analysis is also
moved at least once. This may indicate family related to sexual risk, depending on the type limited by the use of self-reported data; but in
instability in some cases, which is related to of organization.21 Participation in different most sexual behavior research, there is no
sexual behavior.47 aspects of what young people define as their ‘‘gold standard’’ against which to measure this.
Implications for Health Promotion and ‘‘cultural knowledge’’ as measured here did not Human Participation Protocol
Research have a clear relation with outcomes, other This study was approved by the London School of
Hygiene and Tropical Medicine and the University of
The strong relations observed between sex- concepts such as ‘‘cultural continuity’’ are re- British Columbia’s ethical review boards.
ual behavior and substance use, experience of lated to health outcomes50 and may have more
sexual abuse, and feeling unconnected to fam- predictive value. Further work is needed to References
ily point to the need for integration of programs clarify the mechanisms by which sexual vic- 1. Population Division US Census Bureau. Table 4:
and services for this population. Given the high timization and substance use are related to Annual estimates of the population by age and sex of
American Indian and Alaska Native alone or in combi-
prevalence of both alcohol use and experience sexual behavior. Sexual behavior interventions nation for the United States: April 1, 2000 to July 1,
of sexual abuse among Canadian Aboriginal should consider including elements from suc- 2004. Washington, DC: US Census Bureau. Available at:
young people,45 programs that address these cessful substance use and sexual abuse pre- http://www.census.gov/popest/national/asrh/NC-
EST2004-asrh.html. Accessed April 3, 2006. NC-
factors may have a large impact on sexual vention interventions. EST2004-04-IAC.
behavior and STI incidence in this group. Also,
2. Statistics Canada. Population reporting an Aborigi-
those in substance use or sexual abuse treatment Conclusions nal identity, by age group, by province and territory
programs and those who have been in contact Interventions to reduce sexual behaviors (2001 Census) 2005-01-26. Available at: http://
www40.statcan.ca/l01/cst01/demo40a.htm?sdi=
with child protective services may benefit from associated with increased risk of STI and un-
aboriginal%20population. Accessed April 3, 2006.
increased sexual health promotion efforts. wanted pregnancy among Aboriginal young
3. Department of Indian and Northern Affairs Canada.
Several strong predictors of sexual health people should be carried out in conjunction First nations profiles. 1997. Available at: http://
behaviors for Aboriginal young people are with programs aimed at addressing substance sdiprod2.inac.gc.ca/FNProfiles/FNProfiles_List.asp.
beyond individual control, underlining the use and sexual abuse. These programs need to Accessed April 3, 2006.
need for higher-order prevention efforts. Re- be geared especially to young people living on- 4. Bureau of Indian Affairs. Bureau of Indian Affairs
main page. Available at: http://www.doi.gov/bureau-
serve communities may be among the best reserve. Including elements that promote feel- indian-affairs.html. Accessed April 3, 2006.
places to create successful community-level ings of family connectedness should be ex-
5. Health Canada. A Statistical Profile on the Health of
interventions. Further research is needed to plored. Several key correlates of behavior are First Nations in Canada for the Year 2000. Ottawa,
understand why the behavior of on versus off beyond individual control, suggesting that Ontario: Health Canada, Health Information and Analy-
sis Division; 2004.
reserve young people differs; however, in the a combination of individual- and social-level
6. Centers for Disease Control and Prevention. STDs in
interim, there is an obvious need to consider interventions are needed to produce behavior
racial and ethnic minorities. June 28, 2004. Available at:
increasing sexual risk reduction support to on- change for Aboriginal young people. j http://www.cdc.gov/std/stats/minorities.htm#headline.
reserve young people. Qualitative work shows Accessed September 29, 2004.
that young people perceive that adult alcohol 7. British Columbia Provincial Health Officer. The
use in their communities influences their own About the Authors Health and Well-being of Aboriginal People in British
At the time of the study, Karen M. Devries was a PhD Columbia. Victoria: British Columbia Ministry of Health
alcohol use.20 Addressing substance use at the student at the London School of Hygiene and Tropical Planning; 2002.
community level may encourage young people Medicine, London, England. Caroline J. Free and Linda
8. National Center for Health Statistics. Health, United
to alter their behavior and reduce their sexual Morison were also with the London School of Hygiene and
States, 2006 with Chartbook on Trends in the Health of
Tropical Medicine, London. Elizabeth Saewyc was with the
risk. Community leaders have already estab- Americans. Available at: http://www.cdc.gov/nchs/data/
McCreary Centre Society Vancouver, British Columbia, and
hus/hus06.pdf#004. Accessed April 8, 2008.
lished various initiatives that address the spe- the University of British Columbia, Vancouver.
Requests for reprints should be sent to Karen Devries, 9. Shain RN, Perdue ST, Piper JM. Behaviors changed
cific needs of indigenous young people (e.g., as
Health Policy Unit, London School of Hygiene and Tropical by intervention are associated with reduced STD re-
shown in Prentice49). At the policy level, those Medicine, Keppel St, WC1E 7HT London, UK (e-mail: currence: the importance of context in measurement. Sex
serving Aboriginal young people can advocate karen.devries@lshtm.ac.uk). Transm Dis. 2002;29:520–529.
funding and evaluation of these efforts. This article was accepted February 16, 2008. 10. Wellings K, Collumbien M, Slaymakers E, et al.
Importantly, most young people participat- Sexual behaviour in context: a global perspective. Lancet.
2006;368:1706–1728.
ing in this study felt ‘‘somewhat’’ or ‘‘very’’ Contributors
K. M. Devries conceptualized, designed, and conducted 11. Blum RW, Harmon B, Harris L, Bergeisen L,
connected to their family, illustrating that many Resnick MD. American Indian-Alaska Native youth
all analyses and wrote the article. C. J. Free supervised
Canadian Aboriginal families have successfully the design of the present analyses. L. Morison provided health. JAMA. 1992;267:1637–1644.
maintained relationships that contribute to input into the design and statistical advice about the 12. Hellerstadt WL, Peterson-Hickey M, Rhodes KL,
healthy child development. Future research analyses. E. Saewyc provided input into the design and Garwick A. Environmental, social and personal correlates
conduct of the analyses. All authors commented critically of having ever had sex among American Indian youths.
should explore which aspects of family and revised the article. Am J Public Health. 2006;96:2228–2234.
communication and relationships promote feel-
13. Mitchell CM, Kaufman CE. Structure of HIV
ings of connection in these Aboriginal families. knowledge, attitudes, and behaviors among American
Acknowledgments
Interventions for young people who feel un- K. Devries was supported by an Overseas Research
Indian young adults. AIDS Education & Prevention.
2002;14:401–418.
connected to their families should explore Student Award and a Canadian Institutes of Health
incorporating these elements. Similarly, in- Research Doctoral Research Award during this research. 14. Calzavara LM, Burchell AN, Myers T, Bullock SL,
She gratefully acknowledges the McCreary Centre Soci- Escobar M, Cockerill R. Condom use among Aboriginal
corporation of cultural factors into interven- ety for the use of BCAHS 2003 data and the mentorship people in Ontario, Canada. Int J STD AIDS. 1998;9:272–
tions should be further researched. Although of Deborah Schwartz during her PhD studies. 279.
15. Devries KM, Free CF, Jategaonker N. Factors related in women: a retrospective cohort study. Fam Plann 48. BC Ministry of Education. Aboriginal Report—How
to condom use among Aboriginal people: a systematic Perspect. 2001;33:206–211. Are We Doing? Public Schools Only. Victoria: British
review. Can J Public Health. 2007;98:48–54. Columbia Ministry of Education; 2005.
32. Hillis SD, Anda RF, Felitti VJ, Nordenberg D,
16. Bronfenbrennner U. The Ecology of Human De- Marchbanks PA. Adverse childhood experiences and 49. Prentice T. HIV Prevention: Messages for Canadian
velopment: Experiments by Nature and Design. Cambridge, sexually transmitted diseases in men and women: a ret- Aboriginal Youth. Ottawa, Ontario: Canadian Aboriginal
MA: Harvard University Press; 1979. rospective study. Pediatrics. 2000;106:e11–e18. AIDS Network; 2004.
17. Walters KL, Simoni JM. Reconceptualizing native 33. Holmes WC, Slap GB. Sexual abuse of boys: 50. Chandler MJ, Lalonde CE. Cultural continuity as
women’s health: an ‘‘indigenist’’ stress-coping model. Am definition, prevalence, correlates, sequelae, and manage- a hedge against suicide in Canada’s First Nations. Trans-
J Public Health. 2002;92:520–524. ment. JAMA. 1998;280:1855–1862. cult Psychiatry. 1998;35:193–211.
18. Health Canada. Diabetes among Aboriginal (First 34. Saewyc EM, Magee LL, Pettingell SE. Teenage
Nations, Inuit and Métis) People in Canada: The Evidence. pregnancy and associated risk behaviors among sexually
Ottawa, Ontario: Health Canada; 2001. abused adolescents. Perspect Sex Reprod Health.
2004;36:98–105.
19. Statistics Canada. 1996 Census: sources of income,
earnings and total income, and family income. Ottawa, 35. Saewyc EM, Skay CL, Richens K, Reis E, Poon C,
Ontario: Statistics Canada; 1998. Murphy A. Sexual orientation, sexual abuse, and HIV-risk
behaviors among adolescents in the Pacific Northwest.
20. Devries K. Condom Use and Sexual Health Among
Am J Public Health. 2006;96:1104–1110.
Canadian Aboriginal Adolescents. London, England: De-
partment of Epidemiology and Population Health, Lon- 36. Saewyc EM, Skay CL, Bearinger LH, Blum RW,
don School of Hygiene and Tropical Medicine, University Resnick MD. Sexual orientation, sexual behaviors, and
of London; 2007. pregnancy among American Indian adolescents. J Adolesc
Health. 1998;23:238–247.
21. Campbell C, Williams B, Gilgen D. Is social capital
a useful conceptual tool for exploring community level 37. Orcutt HK, Cooper ML, Garcia M. Use of sexual
influences on HIV infection? An exploratory case study intercourse to reduce negative affect as a prospective
from South Africa. AIDS Care. 2002;14:41–54. mediator of sexual revictimization. J Trauma Stress.
2005;18:729–739.
22. Crosby RA, DiClemente RJ, Wingood GM, Har-
rington K, Davies SL, Malow R. Participation by African- 38. Rainey DY, Stevens-Simon C, Kaplan D. Are
American adolescent females in social organizations: adolescents who report prior sexual abuse at higher
associations with HIV-protective behaviors. Ethn Dis. risk for pregnancy? Child Abuse Negl. 1995;19:
2002;12:186–192. 1283–1288.
23. Page RM, Hammermeister J, Scanlan A, Gilbert L. Is 39. Liau A, Diclemente RJ, Wingood GM, et al. Associ-
school sports participation a protective factor against ations between biologically confirmed marijuana use and
adolescent health risk behaviors? J Health Educ. 1998; laboratory-confirmed sexually transmitted diseases
29:186–192. among African American adolescent females. Sex Transm
Dis. 2002;29:387–390.
24. Perrino T, Gonzalez-Soldevilla A, Pantin H, Sza-
pocznik J. The role of families in adolescent HIV pre- 40. Cooper ML. Alcohol use and risky sexual behavior
vention: a review. Clin Child Fam Psychol Rev. 2000; among college students and youth: evaluating the evi-
3:81–96. dence. J Stud Alcohol Suppl. 2002;14:101–117.
25. Bonell C, Allen E, Strange V, Copas A, Stephen- 41. Halpern-Felsher BL, Millstein SG, Ellen JM. Re-
son JM, Johnson A. The effect of dislike of school on lationship of alcohol use and risky sexual behavior:
risk of teenage pregnancy: testing of hypotheses using a review and analysis of findings. J Adolesc Health.
longitudinal data from a randomised trial of sex edu- 1996;19:331–336.
cation. J Epidemiol Community Health. 2005;59:
42. Bearinger LH, Resnick MD. Dual method use in
223–230.
adolescents: a review and framework for research on use
26. Resnick MD, Bearman PS, Blum RW, et al. Pro- of STD and pregnancy protection. J Adolesc Health.
tecting adolescents from harm. Findings from the Na- 2003;32:340–349.
tional Longitudinal Study on Adolescent Health. JAMA.
43. Green R. Methodology: Survey Methodology for the
1997;278:823–832.
2003 AHS III. Vancouver, British Columbia: McCreary
27. DiClemente RJ, Wingood GM, Crosby R, Cobb BK, Centre Society; 2003.
Harrington K, Davies SL. Parent-adolescent communi-
44. Stata, Version 9.0. College Station, TX: StataCorp
cation and sexual risk behaviors among African
LP; 2004.
American adolescent females. J Pediatr. 2001;139:
407–412. 45. van der Woerd KA, Dixon BL, McDiarmid T,
Chittenden M, Murphy A, The McCreary Centre Society.
28. DiClemente RJ, Wingood GM, Crosby R, et al.
Raven’s Children II: Aboriginal Youth Health in BC.
Parental monitoring: association with adolescents’ risk
Vancouver, British Columbia: The McCreary Centre
behaviors. Pediatrics. 2001;107:1363–1368.
Society; 2005.
29. Stanton B, Li X, Pack R, Cottrell L, Harris C, Burns
46. Crosby RA, Yarber W, DiClemente RJ, Wingood
JM. Longitudinal influence of perceptions of peer and
GM, Meyerson B. HIV-associated histories, perceptions,
parental factors on African American adolescent risk
and practices among low-income African-American
involvement. J Urban Health. 2002;79:536–548.
women: does rural residence matter? Am J Public Health.
30. Taylor SE, Repetti RL, Seeman T. What is an 2002;92:655–659.
unhealthy environment and how does it get under the
47. Santelli JS, Lowry R, Brener ND, Robin L. The
skin? Annu Rev Health Psychol. 1997;48:411–447.
association of sexual behaviors with socioeconomic sta-
31. Hillis SD, Anda RF, Felitti VJ, Marchbanks PA. tus, family structure, and race/ethnicity among US
Adverse childhood experiences and sexual risk behaviors adolescents. Am J Public Health. 2000;90:1582–1588.
Court File No. 554/18
The Elementary Teachers’ Federation of Ontario et al. and Her Majesty the Queen as Represented by the Minister of
Education
Applicants Respondents
ONTARIO
SUPERIOR COURT OF JUSTICE
DIVISIONAL COURT
(Proceedings Commenced at Toronto)
AFFIDAVIT OF
OGICHIDAA FRANCIS KAVANAUGH
(Sworn October___, 2018)
GOLDBLATT PARTNERS LLP

20 Dundas Street West, Suite 1039
Toronto, ON M5G 2C2
Tel: 416-977-6070
Fax: 416-591-7333
Howard Goldblatt (LSO 15964M)
hgoldblatt@goldblattpartners.com
Adriel Weaver (LSO 54173P)
aweaver@goldblattpartners.com
Daniel Sheppard (LSO 59074H)
dsheppard@goldblattpartners.com
Kiran Kang (LSO 70023C)
kkang@goldblattpartners.com
Lawyers for the Applicants

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THE ELEMENTARY TEACHERS’ FEDERATION OF ONTARIO and CINDY

HER MAJESTY THE QUEEN IN RIGHT OF ONTARIO AS REPRESENTED BY THE

AFFIDAVIT OF GRAND CHIEF OGICHIDAA FRANCIS KAVANAUGH

I, Ogichidaa Francis Kavanaugh, of Noatkagemwanning First Nation, in the Province of Ontario,

MAKE OATH AND SAY AS FOLLOWS:

I am 67 years old; I am a father and a grandfather.

of that information, and affirm that I verily believe it to be true.

Grand Council Treaty #3

on reserve and off reserve.

6. First Nation communities in Canada are vulnerable populations as a result of historical

speech,” (2015) Globe and Mail, attached hereto as Exhibit A.

on healing, we continue to disproportionately suffer from difficulties accessing higher levels of

violence, and poorer physical and mental health indicators.

schools. There is well-documented intergenerational trauma, which describes the cumulative

literature and studies of Indigenous communities.

copy of the “Bombay Article” is attached hereto as Exhibit C.

Information Governance Committee “First Nations Regional Longitudinal Health Survey” is

attached hereto as Exhibit D.

Intergenerational trauma also includes compromised parenting skills

disadvantage as a result of historic trauma.

17. Academic studies suggest that:

them into their adult lives.” (Exhibit D, p. 136);

c. “the intergenerational effects of residential schools include communication barriers and a

lack of communication between family members” (Aboriginal Healing Foundation, “Reclaiming

Connections: Understanding Residential School Trauma Among Aboriginal People, A resource

Manual” (2005), attached hereto as Exhibit F).

school board hires first superintendent of Indigenous education, reconciliation,” (2018)

Ontario’s sexual-education curriculum, a robust and fact-based elementary school curriculum is

Journal of Public Health, attached hereto as Exhibit H, at p. 857).

were unable to achieve a grade 9 education (see Exhibit F hereto).

(Exhibit B, vol. V, p. 62).

helping to mitigate vulnerability of our community, including our children, as well as to

ameliorate the effects of intergenerational trauma.

a. of the significant vulnerability they have as a result of intergenerational trauma;

c. school, and elementary school in particular, is a critical aspect of educating

SWORN before me at the City of Toronto, in

Commissioner for Taking Affidavits (or as may be)

Remarks of the Rt. Hon. Beverley McLachlin, P.C.

Chief Justice of Canada

At the Aga Khan Museum

May 28, 2015

Tolerance: the willingness to allow the

The second approach is to adopt an attitude of tolerance – a willingness to live with

TOLERANCE: THE PHILOSOPHICAL AND HISTORICAL CONTEXT

Tolerance requires that we behave with dignity

Canada rightly prides itself on its evolutionary

Bruker v. Marcovitz, 2007 SCC 54 at para. 1.

It is built on successive waves of immigration – a tradition it maintains to this day. We

THE LIMITS ON TOLERANCE

R. v. Big M Drug Mart Ltd., [1985] 1 S.C.R. 295.

R. v. Keegstra, [1990] 3 S.C.R. 697.

R. v. N.S., 2012 SCC 72, [2012] 3 S.C.R. 726.

MAINTAINING A TOLERANT SOCIETY

ACCEPTANCE OF THE HUMAN DIGNITY OF EACH PERSON

The idea of human dignity finds expression in

R. v. Morgentaler, [1988] 1 S.C.R. 30 at 166.

BVefGe 45, 187 at 229 (1997).

INCLUSIVE INSTITUTIONS AND CULTURAL HABITS

We need independent educational institutions, he stated. On this front, it is reassuring

Maclean’s, May 25, 2015, p.5

As societies come to think in pluralistic ways, I

Commissioner for Taking Affidavits (or as may be)

The Final Report of the