What is the comparative health status and associated risk factors for the Métis? A population-based study in Manitoba, Canada.

BACKGROUND: Métis are descendants of early 17th century relationships between North American Indians and Europeans. This study's objectives were: (1) to compare the health status of the Métis people to all other residents of Manitoba, Canada; and (2) to analyze factors in predicting the likelihood of diabetes and related lower limb amputation. METHODS: Using de-identified administrative databases plus the Métis Population Database housed at the Manitoba Centre for Health Policy, age/sex-adjusted rates of mortality and disease were calculated for Métis (n = 73,016) and all other Manitobans (n = 1,104,672). Diseases included: hypertension, arthritis, diabetes, ischemic heart disease (age 19+); osteoporosis (age 50+); acute myocardial infarction (AMI) and stroke (age 40+); total respiratory morbidity (TRM, all ages). Using logistic regression, predictors of diabetes (2004/05-2006/07) and diabetes-related lower-limb amputations (2002/03-2006/07) were analyzed. RESULTS: Disease rates were higher for Métis compared to all others: premature mortality before age 75 (4.0 vs. 3.3 per 1000, p < .001); total mortality (9.7 vs. 8.4 per 1000, p < .001); injury mortality (0.58 vs. 0.51 per 1000, p < .03); Potential Years of Life Lost (64.6 vs. 54.6 per 1000, p < .001); all-cause 5-year mortality for people with diabetes (20.8% vs. 18.6%, p < .02); hypertension (27.9% vs. 24.8%, p < .001); arthritis (24.2% vs. 19.9%, p < .001), TRM (13.6% vs. 10.6%, p < .001); diabetes (11.8% vs. 8.8%, p < .001); diabetes-related lower limb amputation (24.1 vs. 16.2 per 1000, p < .001); ischemic heart disease (12.2% vs. 8.7%, p < .001); osteoporosis (12.2% vs. 12.3%, NS), dialysis initiation (0.46% vs. 0.34%, p < .001); AMI (5.4 vs. 4.3 per 1000, p < .001); stroke (3.6 vs. 2.9 per 1000, p < .001). Controlling for geography, age, sex, income, continuity of care and comorbidities, Métis were more likely to have diabetes (aOR = 1.29, 95% CI 1.25-1.34), but not diabetes-related lower limb amputation (aOR = 1.13, 95% CI 0.90-1.40, NS). Continuity of care was associated with decreased risk of amputation both provincially (aOR = 0.71, 95% CI 0.62-0.81) and for Métis alone (aOR = 0.62, 95% CI 0.40-0.96). CONCLUSION: Despite universal healthcare, Métis' illness and mortality rates are mostly higher. Although elevated diabetes risk persists for the Métis even after adjusting for sociodemographic, healthcare and comorbidity variables, the risk of amputation for Métis appears more related to healthcare access rather than ethnicity.

Identifying indigenous peoples for health research in a global context: a review of perspectives and challenges.

OBJECTIVES: Identifying Indigenous Peoples globally is complex and contested despite there being an estimated 370 million living in 70 countries. The specific context and use of locally relevant and clear definitions or characterizations of Indigenous Peoples is important for recognizing unique health risks Indigenous Peoples face, for understanding local Indigenous health aspirations and for reflecting on the need for culturally disaggregated data to plan meaningful research and health improvement programs. This paper explores perspectives on defining Indigenous Peoples and reflects on challenges in identifying Indigenous Peoples. METHODS: Literature reviews and Internet searches were conducted, and some key experts were consulted. RESULTS: Pragmatic and political definitions by international institutions, including the United Nations, are presented as well as characterizations of Indigenous Peoples by governments and academic researchers. Assertions that Indigenous Peoples have about definitions of indigeneity are often related to maintenance of cultural integrity and sustainability of lifestyles. Described here are existing definitions and interests served by defining (or leaving undefined) such definitions, why there is no unified definition and implications of "too restrictive" a definition. Selected indigenous identities and dynamics are presented for North America, the Arctic, Australia and New Zealand, Latin America and the Caribbean, Asia and Africa. CONCLUSIONS: While health researchers need to understand the Indigenous Peoples with whom they work, ultimately, indigenous groups themselves best define how they wish to be viewed and identified for research purposes.

Framework for Aboriginal-guided decolonizing research involving Métis and First Nations persons with diabetes.

This paper documents the process of implementing an Aboriginal-guided research approach to examining the lived experiences of Métis and First Nations peoples with diabetes in Winnipeg, Manitoba, Canada. A newly developed Aboriginal-oriented process framework for decolonizing research includes, in order of application, the six processes of rationalizing, enabling, facilitating, experiencing, accepting, and enacting decolonizing research. We review the key methodological elements of our research as a basis for discussing this decolonizing process framework that challenges traditional western ways of doing research, and requires the reformulation of underlying assumptions and methods. Aboriginal-grounded decolonizing research processes have implications for health researchers and health service providers who work with Indigenous peoples worldwide and are particularly useful for developing culturally grounded, community-based health promotion programs for Indigenous peoples suffering from health-related problems, including diabetes.

Health and well-being for Métis women in Manitoba.

BACKGROUND: Continuing compromised Aboriginal health status and increasing opportunity for new Aboriginal health surveys require that Aboriginal understandings of health and well-being be documented. This research begins exploration of whether the Aboriginal Life Promotion Framework may increase culturally pertinent planning, collection and analysis of health survey data. METHODS: A quasi-phenomenological tradition of enquiry was employed to gain understanding of the lived experience of participants. Data were collected through focus groups utilizing a 'talking circle' methodology. A participatory research approach involved three large Aboriginal organizations. RESULTS: Conceptions of health and of well-being are different entities for these Métis women. Health was most often more reflective of physical issues. Well-being was much broader, holistic and inclusive of the dimensions of spiritual, emotional, physical and mental/intellectual aspects of living, consistent with the first circle of the Aboriginal Life Promotion Framework. CONCLUSIONS: The implications of this study should be important to health providers, and policy developers regardless of sector. Métis women in this study show significant strengths in the spiritual, emotional and intellectual/mental aspects of life, areas that could be incorporated into health promotion approaches. Physical health was focussed on ensuring a healthy diet and exercise, yet most adult women in the study experienced stress around goals that are seen as relatively unattainable. The data produced in this study should be utilized to develop and test survey questions that can be applied to a larger portion of the Métis population. The Aboriginal Life Promotion Framework is useful as an organizing tool for systematically exploring elements of living.

Conceptions and dimensions of health and well-being for Métis women in Manitoba.

Because of the continuing poor health status of Aboriginal populations in Canada, along with increasing opportunity for Aboriginal designed health surveys, it is argued that policies and programs, and the research from which they are derived, should be more solidly grounded within Aboriginal understandings of health and well-being. Survey research for Aboriginal populations usually draws on questions developed by and for mainstream Canadians. This paper stems from the author's master's thesis study that elicited adult and elder Métis women's description of 'what constitutes health' and 'what constitutes well-being'. Outlined are descriptions of Métis women's Conceptions of Health and Conceptions of Well-being, as well as Dimensions of Well-Being that should be included in health survey research.