Modifiable Risk Factors for Cancer in Inuit in Ontario
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 Inuit Nunangat (the Inuit traditional homeland across Arctic regions in Canada) and outside Inuit Nunangat were more likely to smoke cigarettes or be exposed to second-hand smoke in the home than non-Aboriginal Ontarians. Inuit women living in Inuit Nunangat were more likely to have 5 or more drinks on a single occasion 2 to 3 times per month than were non-Aboriginal women in Ontario. The prevalence of obesity was higher among Inuit women living in and outside Inuit Nunangat compared to non-Aboriginal Ontarians. Fewer Inuit lived in food-secure households, irrespective of geography, which has implications for the quality of the Inuit diet as it relates to food access and affordability.
More information on cancer risk among Inuit living in Ontario and other regions of Canada is available in Cancer Risk Factors and Screening among Inuit in Ontario and Other Regions of Canada, a forthcoming report developed collaboratively by Tungasuvvingat Inuit and Cancer Care Ontario.
Who are Inuit in Ontario and other regions in Canada?
Inuit are one of 3 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.”
Inuit in Ontario constitute a small but fast-growing population. According to the 2016 Census, 65,025 people in Canada (3,860 in Ontario) identified as being Inuit .* Inuit in Ontario are a young population, with an average age of 29 . Rapid Inuit population growth and the corresponding young age distribution are demographic trends that are expected well into the future.
* Canadian Census data may underestimate Inuit population numbers.
The Inuit population in Ontario continues to grow through high fertility rates and migration away from Inuit Nunangat (“the place where Inuit live”). Inuit Nunangat is made up of 4 regions: Inuvialuit Settlement Region (including parts of Northwest Territories and Yukon), Nunavut, Nunavik (Northern Quebec) and Nunatsiavut (Labrador). In 2016, over one-quarter (27%) of self-identifying Inuit in Canada lived outside of Inuit Nunangat .
A growing number of Inuit live in southern urban centres, such as Ottawa and Toronto. Inuit move to southern cities for many reasons. Some go 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 care . 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 Canadians . Inuit living in the Qikiqtaaluk (Baffin) region of Nunavut primarily travel south to Ottawa for medical treatment via Iqaluit , while those living in the Kivalliq Region (the western region of Hudson Bay) are transferred to Winnipeg and those in the Kitikmeot Region go to Edmonton (via Yellowknife). Inuit living in Nunavik or Nunatsiavut who need complex medical care 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 education .
What are modifiable risk factors?
Modifiable risk factors are behaviours and exposures that can lower or raise a person’s risk of cancer. They can, in theory, be changed.
The specific modifiable risk factors in this section include
- cigarette smoking
- second-hand smoke exposure
- alcohol consumption
- excess body weight (being overweight or obese)
- food security
What do the results show?
- 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 Inuit Nunangat (37%).
- Cigarette smoking was significantly more common in Inuit men and women living in Inuit Nunangat than it was in Inuit living outside of Inuit Nunangat or in non-Aboriginal Ontarians. The prevalence of cigarette smoking was highest among Inuit living in Inuit 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).
- A significantly higher proportion of Inuit women living outside Inuit Nunangat smoked cigarettes daily or occasionally (41%) than did non-Aboriginal Ontario women (18%). Among men, roughly 33% of Inuit living outside Inuit Nunangat smoked cigarettes, compared to 27% of non-Aboriginal men in Ontario.
- The proportion of non-smoking Inuit living in and outside Inuit Nunangat who were exposed to second-hand smoke in the home (28% and 19%, respectively) was significantly higher than the proportion of non-Aboriginal non-smoking Ontarians exposed to second-hand smoke in the home (7%) (Figure 3).
- Inuit adults living outside Inuit Nunangat (12.2%) were significantly less likely to have abstained from drinking alcohol in the previous year than non-Aboriginal Ontarians (19.1%) (Figure 4).
- More than one-third (35.4%) of Inuit adults living in Inuit Nunangat abstained from drinking alcohol in the previous year, which was significantly more than non-Aboriginal Ontarians (Figure 4).
- Similar proportions of Inuit men living outside Inuit Nunangat (26%), Inuit men living in Inuit Nunangat (20%) and non-Aboriginal men living in Ontario (21%) reported binge drinking (i.e., having 5 or more alcoholic drinks on a single occasion at least 2 to 3 times a month) in the past year (data not shown). The proportion of binge drinking was the same in Inuit women living in and outside Inuit Nunangat (13%), slightly higherthan in non-Aboriginal women in Ontario (9%).
Excess body weight
- A higher proportion of Inuit women living in Ontario (60%) had excess body weight—that is, they 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%).
- The proportion of Inuit women who were obese inside Nunangat (28%) and outside Inuit Nunangat (30%) was nearly twice that of non-Aboriginal women living in Ontario (17%) About 20% of Inuit men living in Inuit Nunangat and 24% of men living outside Inuit 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 Inuit Nunangat as it was in Inuit women living inside Inuit Nunangat and in non-Aboriginal women in Ontario A lower proportion of Inuit men living inside Inuit Nunangat (28%) were overweight than were non-Aboriginal men in Ontario (38%).
- A significantly lower percentage of Inuit living in Ontario lived in food-secure households (67%) than did non-Aboriginal Ontarians (94%) (Figure 6).
- A significantly lower proportion of Inuit living in and outside of Inuit Nunangat reported that their household was food secure than did non-Aboriginal Ontarians.
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 Inuit 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 to reduce the future burden of cancer and other chronic diseases.
- With their current high rates of cigarette smoking, Inuit both in and outside Inuit Nunangat 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. Smoking cessation interventions should consider the many factors that influence the high smoking prevalence among Inuit from a holistic perspective. In 2014, Inuit Tapiriit Kanatami published a report entitled Social Determinants of Inuit Health in Canada, which 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 fruit . The Aboriginal Peoples Survey does not include any direct measures of vegetable and fruit intake (e.g., number of servings eaten per day), so 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 Inuit Nunangat, outside Inuit 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 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, Tungasuvvingat Inuit 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.
- Tungasuvvingat Inuit holds weekly program activities involving community health and well-being. The integration of all the programs is the cornerstone of Tungasuvvingat Inuit’s community of services.
- 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 the care of Children’s Aid Society or those who will soon be leaving care. Tungasuvvingat Inuit’s Youth in Transition Worker program helps youth connect with educational, employment, housing, life skills, mental health and other supports in their communities, and it 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.
- In the 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, Tungasuvvingat Inuit supports will “catch” anyone who is in need of support.
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 groups. 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, and 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 ACS III. CISPRT also provides a forum for discussing Inuit-specific initiatives regarding the implementation of Path to Prevention.
- Inuit Tapiriit Kanatami is the national representational organization protecting and advancing the rights and interests of Inuit in Canada. Inuit Tapiriit Kanatami carries out research, advocacy, public outreach and education on the issues affecting Inuit.
- Pauktuutit is the national representative organization of Inuit women in Canada. It has partnered with the 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 with plain language information in English and 5 dialects of Inuktitut.
- The Ontario Federation of Indigenous Friendship Centres, with funding from the Ontario Ministry of Health and Long-Term Care, coordinates the Urban Aboriginal Healthy Living program, which provides support to urban First Nations, Inuit and Métis communities in the areas of nutrition, physical activity and smoking cessation.
- The Ontario Ministry of Health and Long-Term Care 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.