Why Are Aboriginal People Who Use Toronto's Community Clinics Dying So Young?

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Indigenous people who use community clinics in Toronto have an average age of death of 37.

That’s right. Toronto—home of pricey condos, Rob Ford, and organic pet food—is also home to a group of citizens who regularly die by 37 years of age. To put that into perspective, the average age of death for all Torontonians is 75. Thirty-seven is closer to the average age of death for a failed state like Yemen (35) or the former host of an American drone base, Djibouti (38).

This depressing finding comes from a new report published by two physicians and a clinical psychologist entitled: “Early Deaths Among Members of Toronto’s Aboriginal Community.” Dr. Chandrakant Shah, Dr. Rajbir Klair, and Dr. Allison Reeves studied the ages of death for 109 urban indigenous people who accessed four GTA health and social service centers. They also investigated the earlier life experiences of 20 of the deceased. What they heard led them to conclude there is a common root cause behind many of the early deaths.

“It started with colonization—particularly Residential Schools, the Indian Act, and the 60s Scoop,” says lead investigator Dr. Shah. “That’s the real root cause.”

Dr. Shah has thought a lot about colonization. Since coming to Canada from India in 1965, he has devoted much of his career to working with indigenous peoples. Reflecting on his birth country’s history, he conceded that many in his generation saw the British as superior. “We still had a colonized mind,” he says. “But my children… Their minds are free. They think they can do anything.”

Witnessing that transformation might be why today you can find an “Idle No More” poster on the door to his office at Anishnawbe Health Toronto. AHT, located in a brick building at Queen and Sherbourne, is one of the four GTA sites in the report. It is funded by the Province of Ontario.

Dr. Shah describes the mechanism by which colonial policies result in early deaths as a “delayed Tsunami effect. The effects are slow, but big,” he told me. Residential schools and other similarly damaging policies cause trauma in individuals, which often leads to lives marred by high-risk behaviors like violence and substance abuse. Those high-risk behaviors in turn lead to early deaths.

At 51, Doll Pangowish has outlived many of those in the study, but the “delayed Tsunami” struck her all the same. After 25 years in Toronto, she knows what it is like to be poor, urban-dwelling, and indigenous. “Homelessness became a part of our life because I was drinking,” she says, acknowledging her youngest son, now 17. Pangowish avoided the streets by couch surfing. She adds: “The amount of money we had, we couldn’t afford a proper home.”

That lifestyle eventually caught up with Pangowish. A diabetic, the drinking complicated her condition, leading to nerve damage in her legs and ulcers on her feet. “I couldn’t apply pressure on my foot,” she recalls. “There was always pain, there was bleeding.”

Today Pangowish speaks bluntly about her experience: “I’m not ashamed to talk about it any more.” When asked what led her to such a self-destructive lifestyle, she refers back to her childhood on the Wikwemikong Unceded Indian Reserve on Manitoulin Island. “We were very dysfunctional,” she told me. Many in her mother's family went to Residential Schools. “That played a great big role,” Pangowish says. “And my father was abusive, physically.”

“Anyone with a sense and knowledge of Aboriginal lives would see that their circumstances contribute to their outcomes,” explains Dr. Evan Adams, a Coast Salish Medical Doctor and Deputy Provincial Health Officer for British Columbia (you may also recognize him as “Thomas Builds-The-Fire” from the classic Native American film Smoke Signals).

Turning to the “Early Deaths,” report, however, Dr. Adams urges caution. “This is a disturbing, but tiny set of data,” he says. “I think they’re describing an at-risk urban Aboriginal population, not the entire urban Aboriginal population.” To understand his perspective, compare the 109 deaths Dr. Shah and colleagues examined to the overall Toronto indigenous population of 37,000.

Dr. Adams is familiar with the challenges of many urban poor, having worked in Vancouver’s Downtown Eastside for five years. Still, he is concerned that focusing only on the most vulnerable indigenous people in Canada’s cities will obscure the reality that many other First Nations, Métis, and Inuit are thriving. It is of course very hard to forget the urban indigenous success stories when you are speaking to an Actor/Physician with a Master’s in Public Health degree like Dr. Adams.

He says this study helps underscore the need for better data on the health of urban indigenous people. “We know more about First Nations people on-reserve, who are the minority, than we do about urban First Nations people.” He is right about First Nations people on-reserve being the minority. Some 55 percent of First Nations people lived off-reserve in 2011, according to Statistics Canada. The off-reserve figure is closer to 75 percent if you include all Aboriginal people (First Nations, Métis, and Inuit).

Better data, including an analysis of the causes (and not just ages) of death, would help provide better solutions, according to Dr. Adams.

So how does Canada fix the problem of early deaths among vulnerable urban indigenous people?

Pangowish found a way to solve her most pressing personal issues when she went to treatment. It helped her change her life for the better, and led to a renewed focus on her health. She improved her diet and her ulcers are gone, at least for now. Her teenaged son was a big help too, becoming a live-in caregiver while she was bedridden. “He was my legs,” Pangowish remembers. She would like to see more urban, indigenous-based, support and health services. “People need somebody they can trust. I had to go to another community to understand what I was doing to my body and my children,” she says. “We need that in our own community.”

For Dr. Shah, he hopes reports like his will motivate mainstream Canadians to educate themselves on indigenous issues. “If you have no knowledge of the impact of Residential Schools or the 60s scoop, you don’t have empathy,” he says. “If you don’t have empathy, you don’t have good policies and programs.” Dr. Shah also believes reconnecting with indigenous culture is key to healthier outcomes for indigenous people.

Dr. Adams goes further, arguing that medical practices need to change too. One of his recommendations is that a patient’s history with Residential Schools should be included in their charts. “It can be important,” he says. “We need to make room for clinicians like Dr. Shah to look at those social determinants of health.”

Pointing to similar rates of health care spending in Canada and the US, Dr. Adams argues that having a more egalitarian health system does not necessarily mean a more expensive one.

“You can let people die in the streets, but it will cost about the same,” Dr. Adams concludes. “Or you can do what’s morally right.” @wabkinew