Lower Indigenous Lifespans Demand a National Response

A few months ago, I attended six funerals in a single month. Not one of those funerals was for someone who had reached the life expectancy of the average Canadian, which is around 82 years.

This is the reality for many of us as First Nations peoples.

Ongoing colonialism, racism across all sectors and lasting impacts of the Indian Residential Schools (which I refer to as institutions of genocide), the potlatch ban, the removal of our children from their families through the Sixties Scoop and other government actions have disrupted our culture and undermined our traditional ways of knowing, being and living.

First Nations people continue to experience poorer health outcomes and shorter life expectancies than other Canadians.

The 2024 health indicator report from B.C.’s First Nations Health Authority and Office of the Provincial Health Officer highlighted staggering gaps in health equity and access.

Consider that between 2019 and 2021 the life expectancy for First Nations people decreased by about six years in B.C., much more than that of non-Indigenous people. Similarly in 2023 the average life expectancy for First Nations people in Alberta was almost two decades less than non-First Nations residents.

Life expectancy is widely considered one of the clearest measures of societal well-being because it reflects the conditions that allow people to live long, healthy lives. Health care plays an important role, but it is only part of the picture. The persistence of lower life expectancy among First Nations communities suggests that closing the gap will require looking beyond health care and addressing the social determinants of health, including housing, food security, education, mental health supports, economic opportunity, access to care in remote communities and Indigenous-led approaches.

Australia and New Zealand illustrate both progress and complexity in addressing Indigenous health inequities. Despite gains in life expectancy among Aboriginal, Torres Strait Islander and Māori populations, both countries have found that lasting progress on closing the broader life expectancy gap depends on addressing social and structural determinants of health as well as supporting Indigenous self-determination to enable reclaiming of ancient wellness practices.

To take back control of health care for First Nations and address the social determinants of health, B.C. First Nations created a model that is unique in Canada and is one of only a few in the world: the First Nations Health Governance Structure, which includes the First Nations Health Council as its advocacy arm.

The Transformative Change Accord, an agreement between the First Nations Health Council and the governments of Canada and B.C., was signed in 2005 and led to the creation of a new health authority for First Nations. The accord’s purpose was to close “the social and economic gap between First Nations and other British Columbians over the next 10 years,” targeting four priorities: health, education, housing and economic opportunities.

That 10-year timeline has long expired and our life expectancy has only gotten worse. We need Canada and B.C. to be active partners alongside us in addressing these pervasive disparities.

A social determinants-focused approach to improving health and greater access to culturally safe care works. Recent discussions in Vancouver around overdose prevention services have only highlighted the importance of ensuring people have access to co-ordinated support that addresses complex health and social needs. Unfortunately, the B.C. government recently announced that a proposed overdose prevention site would not proceed following public pressure even though overdose prevention services are part of a broader continuum of care that helps prevent harm and connect people to additional support.

Last year my community Hot Springs Cove and four other Nuu-chah-nulth Nations opened the ʔuukʷinkpanač (ook-wink-panach) West Coast Primary Care Initiative, which provides traditional wellness and nursing appointments to community members on Vancouver Island’s west coast. This allows First Nations patients to more easily access culturally safe and appropriate primary care close to home. This type of holistic perspective is inherent to the First Nations worldview and holds promise for improving health outcomes and thus life expectancy for all Canadians.

Like all Canadians, First Nations people deserve to live long, healthy, supported lives.

Closing the life expectancy gap will require more than ad hoc solutions. It will require long-term commitments to addressing the social determinants of health, including First Nations-led health care, culturally safe services, addiction and mental health supports, housing, economic opportunity and equitable access to care in rural and remote communities.

The solutions exist.

The question is whether Canada is willing to treat First Nations life expectancy as a national priority.