Inequalities in Health between First Nations Adults Living Off-Reserve and Non-Indigenous Adults in Canada: A Decomposition Analysis

Using the sub-sample of First Nations adults from the 2017 Aboriginal Peoples Survey and non-Indigenous adults from the 2017 Canadian Community Health Survey (N = 35,390), we examined inequalities in self-reported general and mental health, diagnosed asthma, and diagnosed diabetes between non-Indigenous people and First Nations adults living off-reserve in Canada. The Blinder–Oaxaca approach was used to decompose the inequalities of each health outcome into the differences in characteristics and differences in returns. We found that First Nations adults experienced health outcomes 5–10 percent worse than those of non-Indigenous populations, with non–Status First Nations adults reporting poorer health than Status First Nations adults, with the exception of diabetes. Our findings also revealed that observable characteristics accounted for 20–45 percent of the inequalities in general health, mental health, and diabetes. Socio-economic factors, such as employment status, income, and educational attainment, explained 10–25 percent of the differences in self-rated general health, mental health, and diagnosed diabetes for both Status and non–Status First Nations peoples compared with the non-Indigenous population. Although we were unable to assess other critical pathways through which various aspects of colonialism continue to affect First Nations peoples, our findings suggest that improving the socio-economic status of off-reserve First Nations peoples could potentially narrow the health inequalities between them and the non-Indigenous population in Canada.