Well Living House, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
Tungasuvvingat Inuit, Ottawa, ON, Canada.
Can J Public Health. 2024 Nov;115(Suppl 2):209-226. doi: 10.17269/s41997-024-00957-8. Epub 2024 Oct 30.
Our Health Counts (OHC) methods are designed to address gaps in urban-based Indigenous health information. In partnership with local Indigenous health service providers, we have successfully implemented OHC in six Ontario cities. The aim of this study is to summarize findings regarding Indigenous population undercount, health inequities, and health service access barriers across study sites.
We estimated Indigenous population size using OHC census participation survey responses and a multiplier approach. Health inequities between Indigenous populations and overall populations in each city were examined using respondent-driven sampling (RDS), adjusted OHC survey results, and existing public data. Measures included health status outcomes; determinants of health; barriers to health service access, including discrimination by health service providers; and unmet health needs.
Indigenous social networks were strong and extensive, and the urban populations demonstrate resilience and cultural continuity across multiple measures. Self-reported rates of census participation for Indigenous populations were markedly lower than those for the general population in each city, and OHC Indigenous population size estimates were consistently 2‒4 times higher than reported in the census. Indigenous to general population health inequities cut across measures of chronic disease, determinants of health, and unmet health needs. Indigenous populations experienced multiple barriers to health services access, including racial discrimination by health service providers.
The Canadian census appears to markedly underestimate Indigenous population size in urban areas. Indigenous health inequities and service access barriers are striking and cross-cutting. Timely adaptation of health policies, services, and funding allocations in response to these findings is recommended.
我们的“健康计数”（OHC）方法旨在解决基于城市的原住民健康信息中的差距。通过与当地原住民健康服务提供商合作，我们已成功在安大略省的六个城市实施了 OHC。本研究旨在总结各研究点关于原住民人口漏报、健康不平等以及获取健康服务障碍的发现。
我们使用 OHC 人口普查参与调查的回复和乘数方法来估计原住民人口规模。通过受访者驱动抽样（RDS）、调整后的 OHC 调查结果和现有公共数据，研究每个城市原住民和整体人口之间的健康不平等。措施包括健康状况结果；健康决定因素；包括健康服务提供者歧视在内的获取健康服务的障碍；以及未满足的健康需求。
原住民社会网络强大而广泛，城市人口在多个方面表现出韧性和文化连续性。每个城市原住民的人口普查参与率自报率明显低于总人口普查率，而 OHC 原住民人口规模估计始终比人口普查报告高出 2 至 4 倍。原住民与总人口之间的健康不平等现象贯穿慢性病、健康决定因素和未满足的健康需求的衡量标准。原住民获取健康服务面临多种障碍，包括健康服务提供者的种族歧视。
加拿大人口普查似乎明显低估了城市地区的原住民人口规模。原住民的健康不平等和服务获取障碍令人震惊且具有交叉性。建议根据这些发现及时调整健康政策、服务和资金分配。
