ABORIGINAL HEALTH

Objective: To inform health care workers about the health status of Ca nada's native people. Data sources: A MEDLINE search for articles publ ished from Jan. 1, 1989, to Nov. 31, 1995, with the use of subject hea dings ''Eskimos'' and ''Indians, North American,'' excluding specific subject headings related to genetics and history. Case reports were ex cluded. Material was also identified from a review of standard referen ces and bibliographies and from consultation with experts. Study selec tion: Review and research articles containing original data concerning epidemiologic aspects of native health. Studies of Canadian populatio ns were preferred, but population-based studies of US native peoples w ere included if limited Canadian information was available. Data extra ction: Information about target population, methods and conclusions wa s extracted from each study. Results: Mortality and morbidity rates ar e higher in the native population than in the general Canadian populat ion. The infant mortality rates averaged fur the years 1986 to 1990 we re 13.8 per 1000 live births among Indian infants, 16.3 per 1000 among Inuit infants, and only 7.3 per 1000 among all Canadian infants. Age- standardized all-cause mortality rates among residents of reserves ave raged for the years 1979 to 1983 were 561.0 per 100 000 population amo ng men and 334.6 per 100 000 among women, compared with 340.2 per 100 000 among all Canadian men and 173.4 per 100 000 among all Canadian wo men. Compared with the general Canadian population, specific native po pulations have an increased risk of death from alcoholism, homicide, s uicide and pneumonia. Of tile aboriginal population of Canada 15 years of age and older, 31% have been informed that they have a chronic hea lth problem. Diabetes mellitus affects 6% of aboriginal adults, compar ed with 2% of all Canadian adults. Social problems identified by abori ginal people as a concern in their community include substance abuse, suicide, unemployment and family violence. Subgroups of aboriginal peo ple are at a greater-than-normal risk of infectious diseases, injuries , respiratory diseases, nutritional problems (including obesity) and s ubstance abuse. Initial data suggest that, compared with the general p opulation, some subgroups of the native population have a lower incide nce of heart disease and certain types of cancer. However, knowledge a bout contributing factors to the health status of aboriginal people is limited, since the literature generally does not assess confounding f actors such as poverty. Conclusions: Canadian aboriginal people die ea rlier than their fellow Canadians, on average, and sustain a dispropor tionate share of the burden of physical disease and mental illness. Ho wever, few studies have assessed poverty as a confounding factor. Futu re research priorities in native health are best determined by native people themselves.