• 2,500 women
    were determined to be at high risk for breast cancer by the High Risk Screening Program in Ontario in 2014
  • 84%
    of cancer patients saw a registered dietitian at a regional cancer centre within 14 days of referral in 2015
  • 72%
    of stage III colon cancer patients received chemotherapy within 60 days after surgery
  • 84%
    of all cancer surgery patients received their consult within the recommended wait time in 2015, and 88% received their surgery within the recommend wait time
  • 29%
    of patients with oropharynx cancer and 20% with cervical cancer visited the emergency department while undergoing a course of curative radiation therapy between 2012 and 2015
  • 44%
    of breast cancer patients, 48% of colon cancer patients and 62% of lymphoma patients visited the emergency department or were admitted to hospital at least once while receiving chemotherapy
  • About 25%
    of patients who undergo lung, prostate and colorectal surgery have an unplanned hospital visit following cancer surgery
  • 64%
    of cancer patients had a first consult with an outpatient palliative care team within 14 days of referral in 2015
  • 40%
    of cancer patients visited the emergency department in the last 2 weeks of life in 2012
  • 361,991
    unique patients were screened for symptom severity using ESAS in 2015, representing 60% of patients
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Modifiable Risk Factors in Ontario First Nations, Inuit, Métis


Key findings

A significantly higher proportion of First Nations (on- and off-reserve), Inuit and Métis adults smoke compared to non-Aboriginal adults. Also of concern is the high prevalence of smoking among on- and off-reserve First Nation adolescents, with rates that are 7 and 3 times higher than non-Aboriginal adolescents, respectively. First Nation adults and adolescents (on- and off-reserve) and Métis adults also are more likely to be obese compared to their non-Aboriginal counterparts. Vegetable and fruit intake levels are also concerning, particularly amongst First Nation adults living on-reserve, where only 12% of men and 20% of women consume vegetables and fruit at least 4 times per day. Inuit adults also are more likely to have inadequate fruit and vegetable intake compared to non-Aboriginal adults.

Tobacco smoking, exposure to second-hand smoke, excess body weight and poor diet are modifiable risk factors associated with a number of different cancers. As such, these findings have strong implications for greater risk and burden of cancer among Ontario’s Indigenous peoples compared to the general population of Ontario.

The findings presented in this section that are related to Ontario First Nations are from the Cancer in First Nations in Ontario: Risk Factors and Screening report. This report was a collaboration between the Chiefs of Ontario and Cancer Care Ontario in recognition of their shared goal of reducing the burden of chronic disease, and more specifically cancer, in First Nations in Ontario. More information on cancer risk among the Métis peoples of Ontario is available in the Cancer in the Métis People of Ontario report.

Cancer Care Ontario has recently published Path to Prevention – Recommendations for Reducing Chronic Disease in First Nations, Inuit and Métis. This report provides the Government of Ontario with evidence-based policy recommendations for reducing exposure to four key chronic disease risk factors in First Nations, Inuit and Métis communities: commercial tobacco use, alcohol consumption, physical inactivity and unhealthy eating. It is also a key deliverable of Cancer Care Ontario’s third Aboriginal Cancer Strategy. Although the emphasis of this report is on policy actions for the Government of Ontario, implementation will involve the full participation of key stakeholders including First Nations, Inuit and Métis partners and other organizations working in the field of chronic disease prevention.

Who are the Aboriginal peoples of Ontario?

Three groups 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.” Together, the First Nations, Inuit and Métis people experience significantly poorer health outcomes than their non-Aboriginal peers including lower life expectancy1 and a higher burden of chronic conditions2. The lack of First Nations, Inuit and Métis-specific health data continues to hamper our collective ability to accurately determine and effectively address chronic disease prevention priorities in these at-risk populations.

First Nations

Prior to contact with Europeans, First Nations in Ontario represented diverse and stable communities whose economy and governance were sound and thriving. The arrival of Europeans and the resulting relocations, reserves, residential schools, environmental degradation, the Indian Act, rupture of families, denigration of culture, loss of self-worth and cultural identity dramatically impacted the First Nations way of life and all aspects of their health. There are approximately 202,960 First Nations in Ontario who are registered under the Indian Act, of whom 94,312 live on- reserve or on Crown lands (46%)3.  Over one quarter of those living on-reserve live in special access communities with no year-round road access (28%)4. Additionally, Ontario is home to an estimated 75,540 First Nations without registered Indian status5. The First Nations in Ontario are young, with a median age of 30 years, compared to a median age of 40 for non-Aboriginal Ontarians6.


The genesis of Métis culture and nation dates back to the 1600s, when early European settlers first came into contact with local Indigenous communities. Early unions between these predominantly male fur trading European settlers and local Indigenous women led to the emergence of a new and highly distinctive Aboriginal people with a unique identity and consciousness. 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 Canada)5. 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%). It is important to note, however, 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%)7.


Inuit in Ontario constitute a small but fast-growing population. There were 3360 Inuit living in Ontario in 20115. Compared to the Canadian population, the age structure of the Inuit population also is quite young, with more than half (58%) of the Inuit population 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 urban Inuit population continues to grow through high fertility rates and migration away from the Inuit traditional homeland, which stretches across Canada’s Arctic, from the Northwest Territories to Newfoundland. In 2011, 16,000 Inuit (26.9% of all Inuit in Canada) lived outside their homeland5. There are many reasons Inuit come to southern cities such as Ottawa. 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 (Inuit homeland).

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
  • excess body weight (being overweight or obese)
  • vegetable and fruit intake

More information related to the results for all of Ontario is available in the “Modifiable Risk Factors”section.

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What do the results show?

First Nations

  • First Nation adults (age 20 and older) and adolescents (ages 12 to 17) living on-reserve reported a high prevalence of cigarette smoking (50% and 30%, respectively), followed closely by First Nation adults and adolescents living off-reserve (43% and 14%, respectively). These numbers are significantly greater than those among their non-Aboriginal peers (22% in adults and 4.2% in adolescents) (Figure 1).
  • Almost half of First Nation adults (age 18 and older) living on reserve were classified as obese (49%), a significantly greater proportion than First Nation adults living off-reserve (30%). Both on- and off-reserve First Nation adults were significantly more likely to be obese than non-Aboriginal adults (17%). Among adolescents, First Nations living on-reserve were more than 3 times more likely to be obese compared their non-Aboriginal counterparts (18% compared to 4.8%). The prevalence of obesity among First Nation adolescents living off-reserve also was higher (7.5%) than among non-Aboriginal teens, though not significantly (Figure 3).
  • On-reserve First Nation adult males (12%) and females (20%) are significantly less likely to consume at least 4 vegetables and fruit per day, compared to First Nation adult males (27%) and females (40%) living off-reserve. Values for both groups are significantly lower than for non-Aboriginal adult males (35%) and females (52%) (Figure 4).


  • The prevalence of cigarette smoking was significantly higher for Métis adults age 20 and older (32%) and teens ages 12 to 19 (16%) than it was for their non-Aboriginal counterparts (22% and 7.5%, respectively) (Figure 5).
  • Non-smoking Métis adults are 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%). There were no significant differences in public second-hand smoke exposure between Métis and non-Aboriginal adults or teens (Figure 7).
  • A significantly greater proportion of Métis adults were obese (25%) than were non-Aboriginal adults (18%). The proportion of Métis adolescents who were obese (8.0%) was higher than non-Aboriginal adolescents (4.6%), though not significantly (Figure 8).
  • A lower proportion of Métis adults consumed at least 5 vegetables and fruit per day, relative to non-Aboriginal adults (25% and 29%, respectively), but this difference in prevalence was not significant. There was also no significant difference in adequate fruit and vegetable consumption between Métis adolescents (ages 12 to 17) and their non-Aboriginal peers (Figure 9).


  • The prevalence of cigarette smoking among Inuit adults (61%) was almost 3 times greater than the prevalence of cigarette smoking among non-Aboriginal adults (21%). Due to small sample size, the prevalence of smoking among Inuit teens in Ontario is unreportable (Figure 10).
  • Inuit adults were twice as likely to be exposed to second-hand smoke from cigarettes (36%) than non-Aboriginal adults (17%), a statistically significant difference (data now shown).
  • More than three quarters of Inuit adults were classified as overweight or obese (79%). This proportion was significantly greater than among non-Aboriginal adults (52%). Due to small sample sizes, the prevalence of just obesity among Inuit adults—as well as the prevalence of obese and overweight Inuit adolescents—are unreportable (Figure 11).
  • Inuit adults were more likely to report inadequate (fewer than 5 servings per day) vegetable and fruit consumption (84%) relative to non-Aboriginal adults (65%). A greater proportion of Inuit adolescents had inadequate fruit and vegetable consumption than non-aboriginal adolescents, but the difference was not significant (64% vs. 60%) (Figure 12).

Why is this important to Ontarians?

  • Very little is currently known about cancer rates among Ontario’s Indigenous peoples. Information about the prevalence of cancer risk factors offers perhaps the best method for determining where cancer prevention resources can be directed to most effectively reduce the future burden of cancer and other chronic diseases.Cigarette smoking is common among First Nations, Inuit and Métis populations in Ontario. While traditional tobacco plays an important medicinal and ceremonial role in many Indigenous communities, the spiritual use of traditional tobacco has no connection to the recreational use of commercial tobacco. Exposure to tobacco through cigarette smoking and second-hand smoke is associated with an increased risk of many types of cancer (especially lung cancer), chronic respiratory diseases and other serious chronic conditions (including cardiovascular disease and possibly diabetes)8.
  • Quitting smoking reduces the risk of cancer and other chronic diseases, with the risk gradually decreasing over time9.
  • With their current high rates of smoking, First Nations, Inuit and Métis populations are expected to experience a substantial future burden of tobacco-related chronic disease. Strategies, policies and programs to reduce smoking therefore should be a priority.
  • So-called convenience foods that are higher in fat and lower in nutritional value are increasingly being integrated into modern 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 limited10. 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 risk11.
  • While eating a diet rich in vegetables and fruits contribute to maintaining a normal body weight it also confers independent health benefits for chronic disease and prevention of several types of cancer.
  • Given the relatively low intake of vegetables and fruit—and the high levels of obesity—among Aboriginal Ontarians compared to non-Aboriginal Ontarians, an increased burden of cancers and other chronic diseases related to these factors may be anticipated.

What is happening in 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 Aboriginal cancer control policies and programs that improve the performance of the cancer system for Aboriginal peoples in a way that honors the Aboriginal Path to 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 Indigenous communities through culturally appropriate awareness and education initiatives that support capacity-building with (and in) Indigenous communities in order to address commercial tobacco prevention, cessation and protection.
  • Cancer Care Ontario’s forthcoming 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.
  • The Ontario Ministry of Health and Long-Term Care (MOHLTC) supports a number of initiatives designed to address the specific health needs of Aboriginal 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.
  • 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 Indigenous community in the areas of nutrition, physical activity and smoking cessation.

First Nations

  • The Chiefs of Ontario continues to advocate for better health outcomes for First Nations peoples by partnering with organizations such as Cancer Care Ontario to build knowledge and evidence that can be used by First Nations both for taking control of their health and for planning and prioritizing programs.
  • The Chiefs of Ontario Health Department has developed The COO Health Portal, an online resource that outlines The Chiefs of Ontario’s health priorities and amalgamates resources available to health practitioners and organizations caring for Ontario First Nations communities.
  • The Chiefs of Ontario and Cancer Care Ontario have collaborated to produce the report Cancer in the First Nations in Ontario: Risk Factors and Screening. The report provides essential evidence that First Nations can use to support cancer prevention and screening.
  • Data collection for Phase 3 of the First Nations Regional Health Survey (RHS) is underway, taking place between 2015 and 2016.


  • The Métis Nation of Ontario (MNO) is developing and will begin implementing a Métis culture-based smoking cessation intervention with Métis people across Ontario over the coming year.
  • MNO works closely with a wide range of government and other partners at the provincial and federal level—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.
  • Working with Aboriginal and other partners, MNO hosts regular community events and health promotion and disease prevention workshops across the province to promote Métis health and reduce the risk of cancer and other chronic diseases and conditions in Métis and other Aboriginal families. Workshop topics include smoking cessation, and healthy cooking and nutrition.
  • MNO is collaborating with researchers from the University of Waterloo and Western University to implement the Healthy Weights Connection, a public health system intervention designed to reduce obesity and overweight in Métis children. This applied research and intervention project aims to identify and address family, cultural, geographic and system- related factors associated with obesity and overweight in Métis children.


  • 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:
    • Healthy Parents, Healthy Babies;
    • healthy meals and physical activities for families;
    • food security and community kitchen programming to promote menu and skills development with food basics and traditional (country) foods;
    • Elders tea and nutrition (Elders’ perspective on traditional diets and the transition to urban trends); and
    • youth engagement in healthy lifestyle choices (including diet and exercise).
  • Inuit Blanket Toss: Community members gather around the blanket and 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’s supports will “catch” anyone who is in need of support. The integration of all our programs is the cornerstone of our community of services.

View Notes

  1. Tjepkema M, Wilkens R, Senécal S, Guimond É, Penney C. Mortality of Métis and Registered Indian adults in Canada: an 11-year follow-up study. Health Rep. 2009; 20(4):31–51.
  2. Gionet L, Roshanafshar S. Study: select health indicators of First Nations people living off-reserve, Métis and Inuit 2007 to 2010. Ottawa: Stats Can; 2013.
  3. Indigenous and Northern Affairs Canada [Internet]. Ottawa: Government of Canada. Registered Indian population by sex and residence 2014—Statistics and Measurement Directorate; 2015 May 21 [cited 2015 Sep 4]. Available from: http://www.aadnc-aandc.gc.ca/eng/1429798605785/1429798785836#tbc1303.
  4. Chiefs of Ontario and Cancer Care Ontario. Cancer in First Nations in Ontario: risk factors and screening. Toronto:  2015.
  5. Statistics Canada. Aboriginal Peoples in Canada: First Nations people, Métis and Inuit: National Household Survey, 2011. Ottawa: Statistics Canada; 2013. Available from: http://www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-011-x/99-011-x2011001-eng.cfm.
  6. Statistics Canada. Aboriginal Peoples and language. Catalogue no. 99-011-X2011003 [Internet]. Ottawa: Statistics Canada; [cited 2015 Sep 4]. Available from: http://www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-011-x/99-011-x2011001-eng.cfm#a4
  7. Statistics Canada. Aboriginal Peoples in Canada in 2006. Inuit, Métis and First Nations, 2006 Census: Métis.Ottawa: Statistics Canada; 2008.
  8. Cancer Care Ontario [Internet]. Toronto: Cancer Care Ontario. Cancer risk factors in Ontario: tobacco; 2014 Apr 30 [cited 2015 Mar 9]. Available from: https://cancercare.on.ca/ocs/csurv/info/cancer_risk_factors_in_ontario/tobacco_report.
  9. Centers for Disease Control and Prevention [Internet]. Atlanta: Centers for Disease Control; 2015. Quitting smoking; 2016 Feb 17 [cited 2014 Oct 8]. Available at: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/cessation/quitting/.
  10.  Métis Centre and National Aboriginal Health Organization. Métis cookbook and guide to healthy living. Second Edition [Internet]. Ottawa: National Aboriginal Health Organization; 2008 [cited 2015 Mar 9]. Available from: http://www.naho.ca/documents/metiscentre/english/Cookbook_SecondEdition.pdf.
  11. 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.