Long-term trends in health status and determinants of health among the off-reserve Indigenous population in Canada, 1991–2012

The Indigenous population in Canada totals approximately 1.6 million individuals, representing about 5% of the total population. The off-reserve Indigenous population represents the fastest growing segment of the Indigenous population, with over 50% living in urban settings. Despite the size of the off-reserve population, research on the health of Indigenous peoples tends to remain focused on reserve-based populations. The purpose of this paper is to contribute to a better understanding of health and social determinants of health among off-reserve Indigenous peoples in Canada. Using data from the 1991 and 2012 Aboriginal Peoples Surveys this paper examines changes in health status and the social determinants of health over a 20-year time span. Results show a decline in health care use and self-reported health status in the period between 1991 and 2012. The results may be related to urbanization, aging, and increased prevalence of some chronic conditions. The findings may also be tied to barriers to achieving adequate off-reserve health care—jurisdictional disputes, disjointed program coverage, systemic racism, and a lack of equity-oriented health services. There remains a pressing need for Indigenous and non-Indigenous governments, researchers, and policymakers to build new relationships that bridge these gaps in health and access to timely care.