• 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 Métis in Ontario

 

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. A higher proportion of Métis people in Ontario smoked cigarettes than their non-Aboriginal counterparts. More Métis adults also exceeded cancer prevention guidelines for drinking alcohol (fewer than two drinks each day for males and less than one per day for females), especially Métis males. Most adult Ontarians, Métis and non-Aboriginal, consumed fewer than the recommended five daily servings of non-starchy vegetables and fruit. A high prevalence of obesity existed among Métis adults and many were not getting enough physical activity. In general, Métis with lower compared to higher income and education had higher prevalence of these modifiable risk factors, while very little variation was observed by region of the province (north vs. south).

These findings have strong implications for greater risk and burden of cancer among the Métis people of Ontario compared to the general population of Ontario. As with the general population, Métis living in more socio-economically disadvantaged conditions are more likely to experience higher rates of modifiable risk factors, and will be more adversely affected by the future burden of cancer.

More information on cancer risk among the Métis people of Ontario is available in the recently published report developed collaboratively by the Métis Nation of Ontario and Cancer Care Ontario, Cancer in the Métis People of Ontario: Risk Factors and Screening Behaviours.

Who are the Métis Peoples of Ontario?

Métis are one of three groups 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.”

The genesis of the Métis culture and nation dates back to the 1600s when early European settlers first came into contact with local First Nations communities. Early unions between these predominantly male fur-trading European settlers and local First Nations women led to the emergence of a new and highly distinctive Aboriginal people with a unique identity and consciousness. Distinct Métis settlements began to appear throughout what was then called “the Northwest” and subsequently spread throughout what is now defined as Ontario, as Métis settlements sprung up along the rivers and watersheds surrounding the Great Lakes and to the northwest of the province. Historical Métis communities were closely connected through the highly mobile fur-trade network, seasonal rounds, extensive kinship connections, and a collective identity characterized by a common culture, language and unique way of life that was influenced by a complex blend of traditions from both sides of the Atlantic. These strong family connections and the unique Métis way of life that characterized these original Métis settlements form the foundation of the Métis nation we know today and remain strongly evident in contemporary Métis life.

In 2011, 451,795 Canadians self-identified as Métis1. Métis currently comprise almost one-third of the over 1.4 million Aboriginal people in Canada. The Métis population is one of the fastest-growing populations in Canada, having nearly doubled in size between 1996 and 20062. This rapid growth is largely due to changes in peoples’ reporting of identity to Métis between Census years—a phenomenon known as “ethnic mobility”3. The Métis population of Canada is relatively young, with a median age of 31 years compared to 41 years among non-Aboriginal Canadians3. The majority (85%) of Métis people live in either the Western provinces or in Ontario. Ontario has the second-largest number of Métis, with 86,015 people, or 19% of all Métis living in Canada3. In 2006, about two-thirds (nearly 70%) of the Métis population in Canada lived in urban areas, slightly less than the non-Aboriginal population (81%). However, it is important to note that Métis people living in urban areas are twice as likely as their urban non-Aboriginal counterparts to reside in smaller urban centres with populations of fewer than 100,000 residents (41% vs. 20%)4.

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
  • vegetable and fruit intake
  • excess body weight (being overweight or obese)
  • physical inactivity
Percentage of Métis adults who smoked daily or occasionally, by geography (aged 20+), education and income (aged 25+), Ontario
Percentage of Métis and non-Aboriginal adults (aged 20+) who smoked daily or occasionally, by year, Ontario, 2007-2014 combined
Percentage of non-smoking Métis and non-Aboriginal teens (aged 12-19) and adults (aged 20+) exposed to second-hand smoke, by location, Ontario, 2007–2014 combined
Percentage of Métis and non-Aboriginal adults (aged 19+) drinking alcohol in excess of cancer prevention guidelines, by sex, Ontario, 2007-2014 combined
Percentage of Métis adults eating vegetables and fruit less than five times a day, by geography (aged 20+), education and income (aged 25+), Ontario, 2007-2014 combined
Percentage of Métis and non-Aboriginal adolescents (aged 12¬-17) and adults (aged 18+) who were obese, Ontario, 2007-2014 combined
// index

Figure 7. Percentage of Métis adults who were obese, by geography (age 18+), education and income (aged 25+), Ontario, 2007-2014 combined

Percentage of Métis adults who were obese, by geography (age 18+), education and income (aged 25+), Ontario, 2007-2014 combined

Figure 8. Percentage of Métis adults (aged 20+) who were physically inactive, by geography, education and income, Ontario, 2007-2014 combined

Percentage of Métis adults (aged 20+) who were physically inactive, by geography, education and income, Ontario, 2007-2014 combined
// index

Métis: what do the results show?

Current Smoking

  • Cigarette smoking was similar across the different regions of Ontario among Métis adults (40.5% in Northern Ontario and 34.1% in Southern Ontario). A higher prevalence of cigarette smoking was seen among Métis adults with lower levels of educational attainment (57% for less than secondary education vs. 29% for post-secondary graduates) and lower household incomes (58% for lowest income quintile vs. 20% for highest income quintile) (Figure 1).
  • The percentage of Métis adults who smoked cigarettes showed a pattern of decline from 2007 to 2014, however, this decrease was not significant (Figure 2).

Second-hand Smoke

  • Non-smoking Métis adults were significantly more likely to be exposed to second-hand smoke in their private space (home or vehicle) than non-smoking non-Aboriginal adults (15% and 8.3%, respectively). The prevalence of exposure to second-hand smoke in one’s home or vehicle was also significantly higher for Métis teens (37%) relative to non-Aboriginal teens (17%). No significant differences were seen in public second-hand smoke exposure between Métis and non-Aboriginal adults or teens (Figure 3).

Alcohol Consumption

  • Métis men were significantly more likely than non-Aboriginal men to exceed the cancer prevention guideline of no more than two alcoholic drinks per day (15% compared to 10%, respectively). A similar proportion of Métis and non-Aboriginal women exceeded the cancer prevention guideline (Figure 4).

Inadequate Vegetable and Fruit Consumption

  • The proportion of Métis eating fewer than five servings of vegetables and fruit daily was similar for Métis adults living in Northern and Southern Ontario (68% and 70%, respectively). Métis adults who have graduated from a post-secondary program were significantly less likely than their peers with lower levels of education to eat fewer than five servings of vegetables and fruit daily (59% of post-secondary graduates vs. 77% of those attaining less than secondary education). Across quintiles of incomes, Métis who have the lowest levels of incomes were the most likely to eat an inadequate number of vegetables and fruit (80% for lowest income quintile vs. 58% for highest income quintile) (Figure 5).

Overweight and Obesity

  • The prevalence of obesity was high for both Métis and non-Aboriginal teens (8.0% and 4.6%, respectively) (Figure 6).
  • The prevalence of obesity among Métis adults living in Southern and Northern Ontario was similar (25% and 24%, respectively). The proportion of obese Métis adults was also high across levels of educational attainment and household incomes (ranging from 23% to 33% and 20% to 34%, respectively) (Figure 7).

Physical Inactivity

  • Métis adults with lower levels of education appeared to be more physically inactive than Métis adults with higher levels of education, although not significantly (58% for those attaining less than secondary education vs. 40% for post-secondary graduates). The pattern was less clear for physical inactivity by income level, but overall, Métis adults earning in the lowest income quintile were more likely to be inactive than those earning in the highest income quintile (Figure 8).

Why is this important to Ontarians?

Healthier behaviour reduces cancer risk

  • Very little is currently known about cancer rates among the Métis people of Ontario. 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, Métis populations 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 historical role that tobacco has played in the Métis way of life over many hundreds of years.
  • So-called convenience foods that are higher in fat and lower in nutritional value are increasingly being integrated into modern Métis diets, partly because they are less expensive and partly because access to traditional foods from the land (such as wild game, fish, seasonal plants and bannock) has become more limited5. Evidence shows that while plant-based foods (such as non-starchy vegetables and fruit, or dietary fibre) have protective effects, red and processed meats and salted or salty foods increase cancer risk6.
  • Given the relatively high levels of obesity in Métis compared to non-Aboriginal Ontarians, an increased burden of cancers and other chronic diseases related to these factors may be anticipated. Obesity is a complex issue with multiple causes and contributors. While eating a diet rich in vegetables and fruits and participating in moderate-to-vigorous physical activity contribute to maintaining a normal body weight, these factors also confer independent health benefits for chronic disease and prevention of several types of cancer.
  • Physical activity improves overall health, decreases the risk of many chronic diseases and helps to maintain a healthy body weight. Studies show a dose-response relationship between physical activity and cancer risk; the higher the level of physical activity, the lower the risk7.
  • Socio-economic factors such as where we live, our level of education and income all contribute to our quality of life, which affects our health and well-being as a result8. Compared to their non-Aboriginal counterparts, Métis people completed less education with a higher proportion reported to have “no certificate, diploma or degree,” and earned lower median total incomes in 20119. These factors put Métis at greater risk for low socio-economic status and associated health consequences.
  • Geography is an important issue for the many Métis people living in smaller urban centres or rural environments in Ontario, where there are challenges in accessing prevention and treatment supports. Improving access to resources and services is critical to system-level interventions designed to reduce cancer risk and improve Métis health outcomes.

What is happening in Ontario?

Métis Nation of Ontario

  • The Métis Nation of Ontario (MNO) works closely with a wide range of government and other partners at the provincial and federal levels—including the Institute for Clinical Evaluative Sciences, Cancer Care Ontario and university-based researchers—to build the evidence and knowledge base required to support better health outcomes for the Métis people of Ontario.
  • The MNO offers healing and wellness programming and supports in more than 30 services centres located throughout the province. The aim of this programming is to foster better health and well-being and reduce health risk for Métis families across their lifespan.
  • Working collaboratively with Indigenous and other partners, the MNO hosts regular community events and culture-based health promotion and disease prevention workshops for MNO community members and clients. These targeted workshops aim to promote health and reduce the risk of cancer and other chronic diseases in the provincial Métis population, and all Indigenous clients who access MNO services and programs. Workshop topics include cancer screening and risk reduction, living with diabetes, and healthy cooking and nutrition practices grounded in the traditional Métis way of life.
  • In 2017-2018, MNO will be completing a province-wide survey of 20,000 MNO Citizens to identify priority health needs and access issues for Métis people in Ontario. The survey is assessing risk factors such as smoking behaviours and exposures to second-hand smoke in the home, among other determinants of health. Results will be used to inform intervention efforts going forward.

Cancer Care Ontario

  • The Aboriginal Cancer Strategy III (ACS III), which was released by Cancer Care Ontario in 2015, aims to help cancer control stakeholders in Ontario jointly develop, fund and implement First Nations, Inuit and Métis 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

  • 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. Statistics Canada. Aboriginal Peoples in Canada: First Nations people, Métis and Inuit: National Household Survey, 2011 [Internet]. Ottawa: Statistics Canada; 2013 [cited 2015 Mar 9]. Available from: http://www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-011-x/99-011-x2011001-eng.cfm
  2. Gionet L. Métis in Canada: Selected Findings of the 2006 Census [Internet]. Ottawa: Statistics Canada; 2014 [cited 2015 Mar 9]. Available from: http://www.statcan.gc.ca/pub/11-008-x/2009001/article/10769-eng.htm
  3. Statistics Canada. Population Projections by Aboriginal Identity in Canada, 2006 to 2031 [Internet]. Ottawa: Statistics Canada; 2015 [cited 2017 Feb 10]. Available from: http://www.statcan.gc.ca/pub/91-552-x/91-552-x2011001-eng.htm
  4. 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 2015 Mar 9]. Available from: http://www12.statcan.ca/census-recensement/2006/as-sa/97-558/pdf/97-558-XIE2006001.pdf
  5. Métis Centre and National Aboriginal Health Organization. Métis cookbook and guide to healthy living. Second Edition [Internet]. Ottawa: National Aboriginal Health Organization; [cited 2015 Mar 9]. Available from: http://www.naho.ca/documents/metiscentre/english/Cookbook_SecondEdition.pdf
  6. World Cancer Research Fund and American Institute for Cancer Research (AIRC). Food, nutrition, physical activity, and the prevention of cancer: a global perspective [Internet]. Washington (DC): AIRC; 2007 [cited 2015 Mar 9]. Available from: http://www.aicr.org/assets/docs/pdf/reports/Second_Expert_Report.pdf
  7. Freidenreich C, Neilson H, Lynch B. State of the epidemiological evidence on physical activity and cancer prevention. Eur J Cancer. 2010;46(14):2593-604.
  8. Canadian Institute for Health Information. Reducing Gaps in Health: A Focus on Socio-Economic Status in Urban Canada [Internet]. Ottawa: The Institute; 2008 [cited 2017 Feb 10]. Available from: https://secure.cihi.ca/free_products/Reducing_Gaps_in_Health_Report_EN_081009.pdf
  9. Statistics Canada. Aboriginal Peoples: Fact Sheet for Canada: National Household Survey, 2011 [Internet]. Ottawa: Statistics Canada; 2015 [cited 2015 Mar 9]. Available from: http://www.statcan.gc.ca/pub/89-656-x/89-656-x2015001-eng.htm