• 2,300 women
    women were determined to be at high risk for breast cancer by the High Risk Screening Program in Ontario in 2015
  • 86%
    of cancer patients saw a registered dietitian at a regional cancer centre within 14 days of referral in 2016
  • 71%
    of stage III colon cancer patients received chemotherapy within 60 days of after surgery in 2014
  • 86%
    of all cancer surgery patients received their consult within the recommended wait time in 2016, and 87% received their surgery within the recommend wait time
  • Over 43,000
    patients were discussed at comprehensive multidisciplinary cancer conferences (MCCs) in fiscal year 2016/2017
  • About 13%
    of patients who undergo lung, prostate and colorectal surgery have an unplanned hospital visit following surgery
  • 79%
    of breast cancer patients had a guideline-recommended mammogram in the first follow-up year
  • 74%
    of colorectal cancer patients diagnosed in 2013 had a surveillance colonoscopy within 18 months of surgery
  • Over 100
    patient and family advisors, who vary by their type of cancer and experiences, represent diverse regions and work with Cancer Care Ontario to ensure a person-centred cancer system
  • 383,023
    unique patients were screened for symptom severity using Your Symptoms Matter – General Symptoms (YSM-General) in 2016
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Modifiable Risk Factors in Inuit in Ontario and Other Regions in Canada

 

Key findings

Commercial tobacco use, exposure to second-hand smoke, alcohol consumption, excess body weight, poor diet and physical inactivity are modifiable risk factors associated with a number of different cancers. Inuit living in Nunangat (Inuit traditional homeland across Arctic regions in Canada) and outside Nunangat were more likely to smoke cigarettes, or be exposed to second-hand smoke in the home, compared to non-Aboriginal Ontarians. Inuit women living in Nunangat were more likely to have 5 or more drinks on one occasion 2 to 3 times per month compared to non-Aboriginal women in Ontario. Prevalence of obesity was higher among Inuit women living in and outside Nunangat compared to non-Aboriginal Ontarians. Fewer Inuit live in food-secure households, irrespective of geography, which has implications for issues in diet quality of Inuit, as it relates to food access and affordability.

More information on cancer risk among Inuit living in Ontario and in other regions of Canada is available in the forthcoming report developed collaboratively by Tungasuvvingat Inuit and Cancer Care Ontario, Cancer Risk Factors and Screening among Inuit in Ontario and other regions of Canada. This report will be available on the Cancer Care Ontario and Tungasuvvingat Inuit websites in Summer 2017.

Who are Inuit in Ontario and other regions in Canada?

Inuit are recognized by Canada’s Constitution Act of 1982 as “the Aboriginal peoples of Canada,” who are explicitly defined as “the Indian [now referred to as “First Nations”], Inuit, and Métis peoples.”

Inuit in Ontario constitute a small but fast-growing population. In 2011, 3,360 Inuit were living in Ontario1. Compared to the Canadian population, the age structure of the Inuit population is also quite young, with more than half (58%) under 25 years of age. Rapid Inuit population growth and the corresponding young age structure are demographic trends that are expected well into the future. The Inuit population in Ontario continues to grow through high fertility rates and migration away from the Inuit Nunangat ("the place where Inuit live"). Inuit Nunangat is made up of four regions: Inuvialuit Settlement Region (including parts of Northwest Territories and Yukon), Nunavut, Nunavik (Northern Quebec) and Nunatsiavut (Labrador)3. In 2011, about three-quarters (73%) of Inuit in Canada lived in Inuit Nunangat. The remaining 27% lived outside Inuit Nunangat, up from 22% in 2006 and 17% in 19962.

Inuit move to southern cities, such as Ottawa, for many reasons. Some come for work, post-secondary education or housing, and many Inuit are living in Ontario due to long-term medical treatment—treatment that is not available in Inuit Nunangat. Most Inuit communities lack access to specialized medical care3. The 2006 Aboriginal Peoples Survey found that Inuit were significantly less likely to have had contact with a medical doctor during the previous year than non-Aboriginal Canadians4. Inuit living in the Qikiqtaaluk (Baffin) region of Nunavut primarily travel south to Ottawa for medical treatment via Iqaluit (Figure 1), while those living in the Kivalliq Region (Western region of Hudson Bay) are transferred to Winnipeg and those in the Kitikmeot Region go to Edmonton (via Yellowknife). Inuit in need of complex medical care living in Nunavik or Nunatsiavut travel to Montreal or St John’s, respectively. Due to limited options for post-secondary education in Inuit Nunangat, 50% of Inuit with post-secondary credentials (and 85% of those with a university degree) reported having to relocate for their education5.

What are modifiable risk factors?

Modifiable risk factors are behaviours and exposures that can lower or raise a person’s risk of cancer and that can, in theory, be changed.

The specific modifiable risk factors in this section include the following:

  • cigarette smoking
  • second-hand smoke exposure
  • alcohol consumption
  • excess body weight (being overweight or obese)

A system-level measure of healthy eating was also included:

  • proportion of people living in a food-secure household

Percentage of Inuit and non-Aboriginal adults (age 20 and older) who smoked cigarettes daily or occasionally
Percentage of Inuit adults in Canada and non-Aboriginal adults in Ontario (age 20 and older) who smoked cigarettes daily or occasionally, by sex
Percentage of Inuit non-smokers in Canada and non-Aboriginal non-smokers in Ontario (age 15 and older) exposed to second-hand smoke in the home
Percentage of Inuit adults in Canada and non-Aboriginal adults in Ontario (age 19 and older) who abstained from alcohol in the previous 12 months, by sex
Percentage of Inuit adults in Canada and non-Aboriginal adults in Ontario who had excess body weight (obese and overweight combined)
Percentage of Inuit in Canada and non-Aboriginal Ontarians (age 16 and older) living in food-secure households
// index

What do the results show?

Cigarette Smoking

  • In Ontario, roughly 34% of Inuit adults smoked cigarettes, compared to 23% of non-Aboriginal adults. This difference was not statistically significant (Figure 1). The estimated percentage of Inuit in Ontario who smoke is similar to that of all Inuit outside Nunangat (3%).
  • The prevalence of cigarette smoking was highest among Inuit living in Nunangat (Figure 2), where about three-quarters of Inuit adults reported smoking cigarettes daily or occasionally (73% of Inuit men and 74% of Inuit women). Cigarette smoking was significantly more common in Inuit men and women living in Nunangat than Inuit living outside Nunangat or non-Aboriginal Ontarians.
  • A significantly higher proportion of Inuit women living outside Nunangat (41%) than non-Aboriginal Ontario women (18%) smoked cigarettes daily or occasionally. Among men, roughly 33% of Inuit living outside Nunangat smoked cigarettes, compared to 27% of non-Aboriginal men in Ontario.

Second-hand Smoke

  • The proportion of non-smoking Inuit living in and outside Nunangat exposed to second-hand smoke in the home (28% and 19%) was significantly higher than the proportion of non-Aboriginal non-smoking Ontarians exposed to second-hand smoke in the home (7%) (Figure 3).

Alcohol Consumption

  • Similar proportions of Inuit men living outside Nunangat (26%), Inuit men living in Nunangat (20%) and non-Aboriginal men living in Ontario (21%) reported binge drinking (i.e. having 5 or more alcoholic drinks on one occasion at least 2 to 3 times a month) in the past year (Figure 4).
  • The proportion of binge drinking was the same in Inuit women living in and outside Nunangat (13%). Binge drinking was significantly more common in Inuit women living in Nunangat than in non-Aboriginal women in Ontario.

Excess Body Weight

  • The proportion of Inuit women inside (28%) and outside Nunangat (30%) who were obese was nearly twice that of non-Aboriginal women living in Ontario (17%) (Figure 5). About 20% of Inuit men living in Nunangat and 24% of men living outside Nunangat were obese, compared to 16% of non-Aboriginal men in Ontario. These differences among men were not statistically significant.
  • Being overweight was about as common in Inuit women living outside Nunangat as it was in Inuit women living inside Nunangat and in non-Aboriginal women in Ontario (Figure 5). A lower proportion of Inuit men living inside Nunangat (28%) were overweight than non-Aboriginal men in Ontario (38%).
  • A higher proportion of Inuit women living in Ontario (60%) had excess body weight—that is, were overweight or obese—than non-Aboriginal women living in Ontario (41%) (Figure 5). Inuit men in Ontario (49%) had about the same prevalence of excess body weight as non-Aboriginal men (55%).

Food Security

  • A significantly lower proportion of Inuit living in and outside Nunangat reported that their household was food secure than non-Aboriginal Ontarians (Figure 6).
  • A significantly lower percentage of Inuit living in Ontario lived in food-secure households (67%) compared to non-Aboriginal Ontarians (94%) (Figure 6).

Why is this important to Ontarians?

Healthier behaviour reduces cancer risk

  • Very little is currently known about cancer risk and burden among Inuit living outside of Nunangat. Therefore, information about the prevalence of cancer risk factors offers perhaps the best approach for determining where cancer prevention resources can be directed most effectively in order to reduce the future burden of cancer and other chronic diseases.
  • With their current high rates of cigarette smoking, Inuit both in and outside Nunangat are expected to experience a substantial future burden of tobacco-related chronic disease; therefore, strategies, policies and programs to reduce smoking should be a priority. Smoking cessation interventions should consider the many factors that influence the high smoking prevalence among Inuit from a holistic perspective. In 2015, Inuit Tapirit Kanatami published a report entitled Social Determinants of Inuit Health in Canada6. The analysis found that high-risk behaviours, such as tobacco misuse, are indicators of deeper social and economic issues linked to the legacy of colonialism.

Healthy eating behaviours are influenced by economic resources for obtaining sufficient and nutritious food

  • Food insecurity is associated with inadequate nutrition and eating too few servings of vegetables and fruit6. The Aboriginal Peoples Survey does not include any direct measures of vegetable and fruit intake (e.g. number of servings eaten per day); therefore, food security was used as a measure of a healthy diet due to its relationship with nutrition more broadly. Levels of food security also speak to the issues of food access and affordability facing Inuit communities, particularly in Inuit Nunangat.
  • The low prevalence of food security among Inuit communities in Nunangat, outside Nunangat and in Ontario specifically, suggest that Inuit face more difficulty in accessing and affording food than non-Aboriginal people in Ontario, which has implications for inadequate nutrition.

What is happening in Ontario?

Tungasuvvingat Inuit

  • Tungasuvvingat Inuit (TI) works closely with a wide range of government and other partners at the municipal, provincial and federal levels—including Cancer Care Ontario and university-based researchers—to build the evidence and knowledge base required to support better health outcomes for the Inuit of Ontario.
  • Working with partners, TI hosts regular community events and health promotion and disease prevention workshops (primarily in Ottawa) to promote Inuit health and reduce the risk of chronic diseases and conditions in Inuit families. Workshop topics include smoking cessation, healthy cooking and nutrition, diabetes awareness and prevention, and mental health and wellness.
  • TI holds weekly program activities involving community health and well-being. These initiatives include the following:
    • The Family Well-Being Program delivers prevention-focused, culturally-responsive supports to promote healthy communities by supporting families to heal from the effects of intergenerational trauma, reduce violence, and address the over-representation of Indigenous children and youth in child welfare and youth justice systems.
    • The Housing Support Program assists Inuit in transitioning to an urban setting and aims to prevent homelessness in Ottawa’s rapidly growing Inuit community.
    • The Housing First Program is a housing-based case management program that serves clients who are chronically or episodically homeless and who are at different stages of housing stability.
    • The Youth in Transition Program provides supports to help young people currently involved in and soon-to-be leaving the care of Children’s Aid Society. TI’s YIT Worker helps youth to connect with educational, employment, housing, life skills, mental health and other supports in their communities, and supports them in navigating the transition from care to adulthood.
    • Men’s Group provides a safe and abstinent environment in which men can participate in talking circles, board-game nights, movie nights and cultural activities, such as carving or drum-making.
    • Women’s Healing Circle provides a safe and abstinent environment, including healthy meals, talking circles and cultural activities.
  • Inuit Blanket Toss: Community members gather around the blanket, grabbing, pulling and holding tight to the blanket. The blanket and supporters will catch the individual in the air, no matter how high an individual is falling from, or how many times they are tossed in the air. Like the blanket toss, TI supports will “catch” anyone who is in need of support. The integration of all the TI programs is the cornerstone of their community of services.

Cancer Care Ontario

  • The Aboriginal Cancer Strategy III (ACS III), released by Cancer Care Ontario in 2015, aims to help cancer control stakeholders in Ontario jointly develop, fund and implement Aboriginal cancer control policies and programs that improve the performance of the cancer system for Aboriginal peoples in a way that honours the Aboriginal Path of Well-being.
  • The Aboriginal Tobacco Program at Cancer Care Ontario addresses the high prevalence of non-traditional tobacco use and second-hand smoke exposure in First Nations, Inuit and Métis communities through culturally appropriate awareness and education initiatives that support capacity-building with (and in) these communities in order to address commercial tobacco prevention, cessation and protection.
  • Cancer Care Ontario’s newly released report, Path to Prevention: Recommendations for Addressing Chronic Disease in First Nation, Inuit and Métis, outlines evidence-based policy recommendations to guide decision-making related to chronic disease prevention policy for First Nations, Inuit and Métis. The report focuses on the 4 major risk/protective factors for chronic disease: commercial tobacco use, alcohol consumption, physical activity and healthy eating. While the recommendations are aimed at the Government of Ontario, their implementation will involve full participation by First Nations, Inuit and Métis partners, as well as collaboration with a range of organizations.

Other organizations and collaborations—Ontario and the rest of Canada

  • Formed in 2016, the Champlain Inuit Service Providers Relationship Table (CISPRT) comprises representatives from Inuit health service providers working in the Champlain health region in Ontario, members of the Champlain Regional Cancer Program, as well as representatives from Cancer Care Ontario’s Aboriginal Cancer Control Unit. The purpose of the CISPRT is to provide guidance and direction to the Champlain Regional Cancer Program and Cancer Care Ontario for the continued development, implementation and evaluation of the Champlain Regional Aboriginal Cancer Plan and the Aboriginal Cancer Strategy III. Furthermore, CISPRT also provides a forum for discussing Inuit-specific initiatives regarding the implementation of Path to Prevention.
  • Inuit Tapiriit Kanatami (ITK) is the national representational organization advancing the rights and interests of Inuit in Canada. ITK carries out research, advocacy, public outreach and education on the issues affecting Inuit.
  • Pauktuutit is the national representative organization of Inuit women in Canada, and has partnered with Canadian Cancer Society to develop cancer information resources, called Inuusinni Aqqusaaqtara – My Journey, that were designed to provide Inuit patients and caregivers as well as health care professionals plain language information in English and five dialects of Inuktitut.
  • The Ontario Federation of Indigenous Friendship Centres, with funding from the MOHLTC, coordinates the Urban Aboriginal Healthy Living Program, which provides support to the urban First Nations, Inuit and Métis communities in the areas of nutrition, physical activity and smoking cessation.
  • The MOHLTC supports a number of initiatives designed to address the specific health needs of First Nations, Inuit and Métis people, including the Northern Fruit and Vegetable Program, which provides no-cost fresh fruit and vegetables alongside healthy eating and physical activity education for school-aged children in northern Ontario.
  • Aboriginal Health Access Centres are community-based health centres that provide primary care, cultural support and health promotion programs to First Nations, Inuit and Métis communities at 10 sites across Ontario.

View Notes

  1. [1] Statistics Canada. Aboriginal Peoples in Canada: First Nations people, Métis and Inuit: National Household Survey, 2011 [Internet]. Ottawa: Statistics Canada; 2013 [cited 2016 Oct 7]. Available from: http://www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-011-x/99-011-x2011001-eng.cfm
  2. [1] Statistics Canada. Aboriginal Peoples in Canada in 2006: Inuit, Métis and First Nations, 2006 Census: Aboriginal Peoples, 2006 Census [Internet]. Ottawa: Statistics Canada; 2008 [cited 2016 Oct 7]. Available from: http://www12.statcan.ca/census-recensement/2006/as-sa/97-558/pdf/97-558-XIE2006001.pdf
  3. [1] Inuit Tapiriit Kanatami. Social Determinants of Inuit Health in Canada [Internet]. Ottawa: Inuit Tapiriit Kanatami; 2014 [cited 2016 Oct 7]. Available from: https://www.itk.ca/wp-content/uploads/2016/07/ITK_Social_Determinants_Report.pdf
  4. [1] Statistics Canada. Aboriginal Peoples Survey, 2006: Inuit Health and Social Conditions [Internet]. Ottawa: Statistics Canada; 2013 [cited 2016 Oct 7]. Available from: http://www.statcan.gc.ca/pub/89-637-x/89-637-x2008001-eng.htm
  5. [1] Indigenous and Northern Affairs Canada. Aboriginal Peoples Survey 2012: Gender Differences in Inuit Education and Employment [Internet]. Ottawa: Government of Canada; 2015 [cited 2016 Nov 4]. Available from: https://www.aadnc-aandc.gc.ca/eng/1422283951935/1422284231303.
  6. [1] Kirkpatrick SI, Tarasuk V. Food Insecurity Is Associated with Nutrient Inadequacies among Canadian Adults and Adolescents. J Nutr. 2008;138(3):604-612.