Modifiable Risk Factors for Cancer in Métis 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. 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 2 drinks each day for males and less than 1 per day for females), especially Métis males. Most adult Ontarians, Métis and non-Aboriginal, consumed less than the recommended 5 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 people with lower income and education had a higher prevalence of these modifiable risk factors than those with higher income and education. Very little variation was observed by region of the province (northern vs. southern Ontario). A significantly higher percentage of Métis people in Ontario lived in food insecure households than non-Aboriginal Ontarians.
These findings have strong implications for greater risk and burden of cancer among Métis people of Ontario compared to the general population. As with the general population, Métis people living in more socio-economically disadvantaged conditions are more likely to experience higher rates of modifiable risk factors, and they will be more adversely affected by the future burden of cancer.
More information on cancer risk among Métis people of Ontario is available in Cancer in the Métis People of Ontario: Risk Factors and Screening Behaviours, a recently published report collaboratively developed by the Métis Nation of Ontario and Cancer Care Ontario.
Who are the Métis Peoples of Ontario?
Métis 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.”
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.” They subsequently spread throughout what is now defined as Ontario, as Métis settlements sprung up along the rivers and watersheds surrounding the Great Lakes and in 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. The 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.
The Métis population is one of the fastest growing populations in Canada, having nearly doubled in size from 2006 to 2016 . This rapid growth is largely due to people changing their reported identity to Métis between Census years — a phenomenon known as “ethnic mobility.” In 2016, Ontario had the largest number of Métis living in Canada with 120,585 people – 20.5% of all Métis. The Métis population of Ontario was relatively young, with an average age of 36.5 years . In 2006, nearly 70% of the Métis population in Canada lived in urban areas, less than the non-Aboriginal population (81%). However, Métis living in urban areas were twice as likely as to live in smaller urban centres with populations of less than 100,000 residents (41%) than were urban non-Aboriginal people (20%) .
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
- vegetable and fruit intake
- excess body weight (being overweight or obese)
- physical inactivity
- food security
What do the results show?
- 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 people with less than secondary education vs. 29% for post-secondary graduates) and lower household incomes (58% for the lowest income quintile vs. 20% for the highest income quintile) (Figure 1).
- The percentage of Métis adults who smoked cigarettes showed a pattern of decline from 2007 to 2014, but this decrease was not significant (Figure 2).
- 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% vs. 8%). The prevalence of exposure to second-hand smoke in one’s home or vehicle was also significantly higher for Métis teens (37%) than it was for 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).
- Métis men were significantly more likely than non-Aboriginal men to exceed the cancer prevention guideline of no more than 2 alcoholic drinks per day (15% compared to 10%). 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 people eating less than 5 servings of vegetables and fruit daily was similar for Métis adults living in northern and southern Ontario (68% and 70%, respectively). Métis adults with lower levels of educational attainment were significantly more likely to eat less than 5 servings of vegetables and fruits daily than were Métis adults with higher levels of education (77% for those with less than a post-secondary education vs. 59% for post-secondary graduates). Across quintiles of incomes, Métis people with the lowest levels of income were the most likely to eat an inadequate number of vegetables and fruit (80% for the lowest income quintile vs. 58% for the highest income quintile) (Figure 5).
Overweight and obesity
- The prevalence of obesity was high for both Métis and non-Aboriginal teens (8% and 5%, 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).
- Métis adults with lower levels of education appeared to be less physically active 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).
- From 2007 to 2014, a significantly higher percentage of Métis people in Ontario lived in food insecure households (21%) than non-Aboriginal Ontarians (12%) (Figure 9).
Why is this important to Ontarians?
Healthier behaviour reduces cancer risk.
- Very little is currently known about cancer rates among the Métis people of in Ontario. Information about the prevalence of cancer risk factors therefore 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. Strategies, policies and programs to reduce smoking should therefore 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 limited . 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 risk .
- Given the relatively high levels of obesity among Métis people 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 the prevention of chronic disease and 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 risk .
- Socio-economic factors such as where we live and our level of education and income all contribute to our quality of life, which in turn affects our health and well-being . Compared to their non-Aboriginal counterparts, Métis people completed less education with a higher proportion reported to have “no certificate, diploma or degree” . They also earned lower median total incomes in 2011. These factors put Métis people at greater risk for low socio-economic status and the 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.
Healthy eating behaviours are influenced by economic resources for obtaining sufficient and nutritious food.
- Food insecurity occurs when access to healthy food is compromised due to limited financial resources . Food insecurity is a strong determinant of health because it directly influences the quality and quantity of food eaten. Levels of food insecurity also relate to the food access and affordability issues facing many remote Métis communities. Individuals or households are defined as food secure when they “at all times have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life.”
- The higher prevalence of food insecurity among Métis communities in Ontario suggests that Métis face greater difficulty in accessing and affording food than non-Aboriginal people in Ontario, which has implications for inadequate nutrition.
What is happening in Ontario?
The 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 peoples 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 partners, the MNO hosts regular community events and culture-based health promotion and disease prevention workshops for MNO community members and clients. These focused 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, exposures to second-hand smoke in the home, and 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 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.
- 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 the 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.