Urban Aboriginal Health: Using individual and contextual approaches to better understand the health of Aboriginal populations living in Toronto
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INTRODUCTION: Canada’s Aboriginal population is growing at a faster rate than the rest of Canada. While Aboriginal health has improved in the last few decades, life expectancy of First Nations, Inuit and Métis continues to be lower compared to the rest of the Canadian population. Furthermore, current Aboriginal health research tends to focus on those living onreserves while more than half of the Aboriginal population currently resides in urban areas. Despite the importance of neighbourhood factors for understanding health in urban areas, the importance of neighbourhood characteristic for urban Aboriginal health has yet to be examined. OBJECTIVE: The objective of the research was, to determine both individual-level predictors and neighbourhood-level predictors of self-rated health and diagnosis of chronic conditions, amongst Aboriginal populations living in the City of Toronto; and to determine whether and how neighbourhood-level predictors influence individual-level predictors of self-rated health and diagnosis of a chronic conditions in Toronto neighbourhoods with Aboriginal populations living in them. METHODS: This study was a secondary analysis of two samples from the 2006 Aboriginal people Survey, consisting of 1080 and 500 Aboriginal individuals in the Toronto Census Metropolitan Area. A series of logistic regressions models were created to identify individual and neighbourhood predictors of “poor” self-rated health and having one or more diagnosed chronic condition(s). RESULTS: A best fitting model was derived from the individual-level variables to include the demographic variables age, gender and Aboriginal status; and the socio-economic variables average household income, education level and employment status. While neighbourhood-level variables had no significant influence in predicting either health outcome, there was some evidence to suggest influence over individual-level predictors. To further examine this relation, neighbourhoods were stratified based on income inequality, average household income and availability of Aboriginal specific services. This analysis yielded some different effects of individual-level variables for different neighbourhood types, suggesting that some effects of neighbourhood characteristics may interact with individual characteristics to influence health. CONCLUSION: While contextual factors have some effect on self-rated health, individual factors serve as stronger predictors of individual health. However, more neighbourhood level studies should be considered in order to better understand the growing urban Aboriginal population and potential ecological effects on health.