According to the World Health Organization, it is estimated that three respiratory diseases–chronic obstructive pulmonary disease (COPD), lower respiratory infections, and trachea/bron-chus/lung cancers–will be among the leading five causes of death in the world by the year 2020, after ischemic heart disease and cerebrovascular disease (Murray & Lopez, 1997; The Lung Association, 2008). In Canada, respiratory diseases were estimated to affect one in every five indi-viduals (The Conference Board of Canada, 2009), and are also responsible for the majority of emergen-cy room visits. An estimated national economic burden of $154 billion was attributed to respira-tory diseases in 2007 (The Lung Association, 2008). First Nations, Inuit and Métis are especially affected by respiratory diseases compared to the non-Aboriginal population in Canada (The Lung Association, 2008). The extent of lung health problems faced by Aboriginal People in Canada closely mimics that of populations in many low- and middle-income countries (Baker, 2008). For example, the high tuberculosis rate among

Aboriginal people is 20-30 times higher than that of the non-Aboriginal Canadian popula-tion (Baker, 2008). Canada’s Aboriginal popula-tion also has higher prevalence rates of asthma, chronic bronchitis, emphysema and tuberculosis, compared to the non-Aboriginal population (Health Canada, 2009; Janz, Seto, & Turner, 2009; Martens et al., 2010; Statistics Canada, 2008). Lung health issues faced by Aboriginal people in Canada reflect the below-standard socio-economic status and living conditions that are common in Aboriginal communities and reserves (Baker, 2008). Smoking prevalence rates are higher in Canada’s Aboriginal populations in comparison to the non-Aboriginal popula-tion (Godel, 2006), contributing to the higher prevalence of several lung health diseases. It is estimated that smoking rates in First Nations and Inuit populations are almost double those of the non-Aboriginal population (First Nations and Inuit Health Branch of Health Canada, 2007; Godel, 2006).Few statistics are available on smoking among Métis in Canada, with the exception of Métis in

www.naho.ca

Respiratory Health of Métis Adults: Findings from the 2006 Aboriginal Peoples Survey

Key Points

•Asthma is the most prevalent respiratory disease among Métis adults (14 per cent).•Métis adults in the youngest age group (15-19 years) are more likely to report asthma than other age groups.•Chronic bronchitis affects six per cent of the Métis adult population.•Only half of those with chronic bronchitis report taking medications or treatment for the disease.•Emphysema and tuberculosis each affect one per cent of the Métis adult population.•Nearly a third of Métis adults (31 per cent) smoke daily; smoking an average of 15 cigarettes a day.•Just over a third of Métis adults (35 per cent) have never smoked.•The average age of smoking initiation among Métis was 16.

Manitoba. One third of Manitoba Métis (12 years and older) smoked daily or occasionally com-pared to about one in five (22 per cent) other Manitobans (Martens et al., 2010). This fact sheet provides information on report-ed respiratory diseases among the Métis adult population in Canada. Since smoking is intri-cately linked to respiratory health, information on smoking among Métis adults is also presented. The information herein is based on data from the 2006 Aboriginal Peoples Survey (APS) and the Métis Supplement. In the 2006 Survey, Métis adults (15 and older) were asked if a doctor, nurse or other health professional had told them that they had the following diseases: asthma, chronic bronchitis, emphysema, tuberculosis or cancer. Several smoking-related questions were also asked. Where available, corresponding statistics for the total Canadian population are provided from the 2005 Canadian Community Health Survey (CCHS) for comparison.

Who are Métis?

Métis are one of the three constitution-ally recognized Aboriginal groups in Canada (Bartlett, Iwasaki, Gottlieb, Hall, & Mannell, 2007). In French, the word “Métis” translates as “mixed,” yet Métis do not simply have a “mix” of European and First Nations heritage; they have a distinct language, culture, values and beliefs that vary between communities and geographic regions (Bartlett et al., 2007; Canadian Institute for Health Information, 2004; Royal Commission on Aboriginal People, 1996; Tjepkema, Wilkins, Senécal, Guimond, & Penney, 2009). The Métis National Council defines Métis as individuals who self-identify as Métis, are of historic Métis Nation ancestry, are distinct from other Aborigi-nal Peoples and are accepted by the Métis Na-tion. The historic Métis Nation refers to Métis or “Half-Breeds” who resided in the historic Métis Homeland, an area of land in west central North America (Métis National Council, 2002). According to Canada’s 2006 Census, there are nearly 400,000 individuals who self-identify as

OUR HEALTH: STRENGTHENED BY SHARING

www.naho.ca

Figure 1. Asthma among Métis adults by age group, 2006 Aboriginal Peoples Survey

† reference group* statistically significant difference from reference group at p < 0.05

Métis in Canada, accounting for 33 per cent of the total Aboriginal population. Significantly, of this Métis population, almost half (43 per cent) are un-der the age of 25, while one quarter (25 per cent) are aged 14 and under (Statistics Canada. Census 2006, 2008).

Asthma among Métis adults Among Métis adults in Canada, an estimated 48,340, or 14 per cent, reported having been told by a health professional that they had asthma (Statistics Canada. Aboriginal Peoples Survey 2006, 2009c). In comparison, 8 per cent of all Canadians had reported the same in 2005 (Statistics Canada, 2010). Métis from different provinces were equally likely to report that they have asthma (Statistics Canada. Aboriginal Peoples Survey 2006, 2009c). Similarly, Métis from six select Census Metropoli-tan Areas/Census Agglomerations (CMAs/CAs)—Winnipeg, Saskatoon, Prince Albert, Calgary, Edmonton and Vancouver—were equally likely to report that they have asthma (Statistics Canada. Aboriginal Peoples Survey 2006, 2009d). No rural versus urban differences were noted (Statistics Canada. Aboriginal Peoples Survey 2006, 2009f). Some differences were, however, observed among different age groups (Statistics Canada. Aboriginal Peoples Survey 2006, 2009b). The younger groups (15-19 years of age) were more likely than all other age groups to report that they have asthma: 20 per cent compared to 15 per cent or less for those in older age groups (Fig. 1)(Statistics Canada. Ab-original Peoples Survey 2006, 2009b). Between the sexes, Métis women were more likely than Métis men to report having been informed by a health professional that they have asthma: 17 per cent of Métis women versus 11 per cent of Métis men. Most Métis (70 per cent) who reported having been diagnosed with asthma were taking medica-tion or treatment for asthma (Statistics Canada. Aboriginal Peoples Survey 2006, 2009e).

Chronic Bronchitis

Among Métis adults in Canada, an estimated 21,380, or six per cent, reported having been told

by a health professional that they had chronic bronchitis (Statistics Canada. Aboriginal Peoples Survey 2006, 2009h). Métis from Nova Scotia (10 per cent), New Brunswick (nine per cent), Quebec (eight per cent) and Ontario (nine per cent) were more likely to report a diagnosis compared to Métis in other provinces (Statistics Canada. Aborigi-nal Peoples Survey 2006, 2009h). Some differences were seen among age groups as well. The younger groups (15-19 and 20-24 years) were less likely to report a diagnosis of chronic bronchitis: four per cent of Métis adults between the ages of 15-19 and 20-24 years compared to 12 per cent for those aged 65 years and over (Statistics Canada. Aboriginal Peoples Survey 2006, 2009g). When comparing the two sexes, Métis women were more likely than Métis men to report having chronic bronchitis: eight per cent of Métis women versus five per cent of Métis men (Statistics Canada. Aboriginal Peoples Survey 2006, 2009j). There were no differences ob-served when comparing Métis in different Census Agglomeration areas (Statistics Canada. Aboriginal Peoples Survey 2006, 2009i) or urban and rural areas (Statistics Canada. Aboriginal Peoples Survey 2006, 2009k). Across Canada, only half of Métis adults with chronic bronchitis reported taking medica-tions or treatment for the condition (Fig. 2) (Statis-tics Canada. Aboriginal Peoples Survey 2006, 2009a).

Emphysema

Among Métis adults in Canada, an estimated 3,730, or one per cent, reported having been told by a health professional that they have emphysema (Statistics Canada. Aboriginal Peoples Survey 2006, 2009l). No differences were seen in rates among comparable geographic locations: CMAs/CAs (Statistics Canada. Aboriginal Peoples Survey 2006, 2009m), provinces and territories (Statistics Canada. Aboriginal Peoples Survey 2006, 2009l), and urban and rural areas (Statistics Canada. Aboriginal Peoples Sur-vey 2006, 2009o), nor among age groups (Statistics Canada. Aboriginal Peoples Survey 2006, 2009p), nor between sexes (Statistics Canada. Aboriginal Peoples Survey 2006, 2009n).

OUR HEALTH: STRENGTHENED BY SHARING

www.naho.ca

OUR HEALTH: STRENGTHENED BY SHARING

www.naho.ca

Figure 2.

Notes: Numbers in red under the names of provinces, territories, CMAs and CAs are the per cent of Métis adults in that geographic area that indicated that had been told by a doctor, nurse or other health care professional that they had chronic bronchitis. The green bars represent the per cent of arthritic Métis adults who reported that they were taking medications or treatments for the condition (“yes” column in the table) and the red bars represent the per cent of those who were not (“no” column in the table) . Coverage indicates the denominator or the portion of the population to which the question is applicable. For example, while the question “have you been told by a doctor, nurse or other health professional that you have chronic bronchitis?” applies to all Métis adults, the subsequent question “do you take any treatment or medication for this condition?” is only applicable to those who replied “yes” to the former question.

Tuberculosis

Among Métis adults in Canada, an estimated 2,700, or one per cent, reported having been told by a health professional that they have tuberculosis (Sta-tistics Canada. Aboriginal Peoples Survey 2006, 2009q). There were no differences in rates among compa-rable geographic locations, including CMAs/CAs

(Statistics Canada. Aboriginal Peoples Survey 2006, 2009r), provinces and territories (Statistics Canada. Aboriginal Peoples Survey 2006, 2009q), and urban and rural areas (Statistics Canada. Aboriginal Peoples Survey 2006, 2009t), as well as age groups (Statistics Canada. Aboriginal Peoples Survey 2006, 2009p) and sex (Statistics Canada. Aboriginal Peoples Survey 2006, 2009s).

Smoking

Among Métis, approximately 106,060, or nearly one in three (31 per cent), adults reported being daily smokers, 23 per cent were former daily smok-ers but current non-smokers, five per cent were oc-casional smokers but had been daily smokers previ-ously, three per cent were current non-smokers who had occasionally smoked in the past and two per cent had always been an occasional smoker (Fig. 3) (Statistics Canada. Aboriginal Peoples Survey 2006, 2009z). One in three (35 per cent) reported never having smoked (Statistics Canada. Aboriginal Peoples Survey 2006, 2009z). The mean age of smoking initiation was 16 (Statistics Canada. Aboriginal Peoples Survey 2006, 2009u). Métis from some regions were less likely to be daily smokers than others. For example, Métis from Nova Scotia and British Columbia were less likely (25 per cent) to be daily smokers than those in Saskatchewan (37 per cent), Alberta (36 per cent) and Nunavut (59 per cent) (Statistics Canada. Aborigi-nal Peoples Survey 2006, 2009). Some age groups were less likely to report being daily smokers than others. Métis in the youngest (15-19 years: 20 per cent) and oldest age groups (65+ years: 18 per cent) were less

likely to be daily smokers compared to those in other age groups (28-37 per cent) (Statistics Canada. Aborigi-nal Peoples Survey 2006, 2009z). Significant differences between daily smokers, non-smokers and occasional smokers by geographic locations (CMAs/CAs, prov-inces and territories, and urban versus rural), age groups, and sex were noted (data not shown). Daily smokers, on average, smoked 15 cigarettes a day (Statistics Canada. Aboriginal Peoples Survey 2006, 2009x). Métis men smoked 17 cigarettes daily compared to 14 cigarettes daily for Métis women (Statistics Canada. Aboriginal Peoples Survey 2006, 2009x). Some differences were observed by geographic location when comparing the number of cigarettes smoked by Métis adults. Métis adults in Newfound-land and Labrador smoked an average of 13 ciga-rettes daily compared to 17 cigarettes a day for those in Quebec and Nova Scotia (Statistics Canada. Aborigi-nal Peoples Survey 2006, 2009v). There were no signifi-cant differences when comparing different CMAs and CAs or urban and rural areas (Statistics Canada. Aboriginal Peoples Survey 2006, 2009w, 2009y).

OUR HEALTH: STRENGTHENED BY SHARING

www.naho.ca

Figure 3. Smoking among Métis adults by type of smoker, 2006 Aboriginal Peoples Survey

† reference group* statistically significant difference from reference group at p < 0.05

In 2009, the Métis Centre of the National Aboriginal Health Organization (NAHO) met with Métis in different parts of Canada to share and collect stories, teachings and information about maternal-child well-being. Our objective with this project was to collect and share experiences, traditions and health information for the benefit of Métis families. After meeting with Métis midwives, health professionals, Elders and parents across the country, we have created a DVD entitled Healthy Beginnings, Supportive Communities: A Strong Future. Themes discussed in the DVD include, among others, cultural continuity, birthing options, historical birthing practices, breastfeeding, self-care for pregnant women, and the role of community in raising children.

Subtitle (optional)As we travelled from Ontario to British Colum-bia, we found that Métis culture and traditions are indeed diverse, but everywhere we visited we did find two things in common: a strong sense of pride in the Métis past and great hope for the Métis future! We hope that you find the health information and stories in our DVD both informative and entertaining.

Everywhere we visited we did find two things in common: a strong sense of pride in the Métis past and great hope for the Métis future! We hope that you find the health information and stories in our DVD both informative and entertaining.

A final report is also available on our website at www.naho.ca/metiscentre. Themes discussed in the DVD include, among others, cultural continuity, birthing options, historical birthing practices, breastfeeding, self-care for pregnant women, and the role of community in raising children. As we travelled from Ontario to Brit-ish Columbia, we found that Métis culture and traditions are indeed diverse, but everywhere we visited we did find two things in common: a strong sense of pride in the Métis past and great hope for the Métis future!

We hope that you find the health information and stories in our DVD both informative and entertaining.

OUR HEALTH: STRENGTHENED BY SHARING

Title block line 1Title block line 2 (optional)

www.naho.ca www.naho.ca

About the Aboriginal Peoples Survey and Métis Supplement Questionnaire

The 2006 Aboriginal Peoples Survey (APS) provides an extensive set of data about Métis, Inuit and off-reserve First Nations adults 15 years of age and over and children aged 6 to 14, living in urban, rural and northern locations across Canada. The Aboriginal Peoples Survey was conducted between October 2006 and March 2007. The overall response rate for the Ab-original Peoples Survey was 80.1 per cent. This paper focused on the population that is 15 and older. The Métis population includes those who reported identi-fying as Métis (either as a single response or in com-bination with North American Indian and/or Inuit). Data in this study are for the off-reserve Métis popula-tion only, except for those living in the three territories where the on-reserve population is included. Also not included are those living in institutions.

Métis Supplement

The Métis Supplement was designed specifically for the Métis population and it was given to people 15 years of age and older who identified themselves as Métis and/or who have Métis ancestry. The supplemen-tal questionnaire was developed by Métis organizations in cooperation with Statistics Canada. This supplemen-tal survey asks a wide variety of questions regarding family background, child welfare, social interaction, and health. For more information, please see the Ab-original Peoples Survey 2006 and Métis Supplement, http://www.statcan.gc.ca/imdb-bmdi/instrument/3250_Q7_V1-eng.pdf and Aboriginal Peoples Survey, 2006: Concepts and Methods Guide, http://www.statcan.gc.ca/pub/89-637-x/89-637-x2008003-eng.htm#a5.

Methods

The statistics used are from the 2006 Aboriginal Peoples Survey (APS) and the Métis Supplement Ques-tionnaire. Significant statistical differences in propor-tions are identified based on 95 per cent confidence intervals, i.e. the 95 per cent confidence intervals for two estimates were compared and estimates with non-overlapping confidence intervals were deemed to be statistically different.

References

Baker, K. (2008). Lung Health of Indigenous Peoples of Canada. Paper presented at the Second Global Lung Health Symposium, Edmonton, Alberta. Bartlett, J. G., Iwasaki, Y., Gottlieb, B., Hall, D., & Mannell, R. (2007). Framework for Aboriginal-guided decolonizing research involving Metis and First Nations persons with diabetes. Soc Sci Med, 65(11), 2371-2382. Canadian Institute for Health Information. (2004). Improving the Health of Canadians. Ottawa: Canadian Institute for Health Information. First Nations and Inuit Health Branch of Health Canada. (2007). Tobacco. Inuit: Facts on smoking rates. Retrieved Janu-ary 4, 2011, from http://www.hc-sc.gc.ca/fniah-spnia/substan/tobac-tabac/index-eng.php. Godel, J. (2006). Use and misuse of tobacco among Aboriginal peoples. Journal, 11(10), 681-685. Retrieved from http://www.ceitc.org.au/international_indigenous_tobacco_control.

Health Canada. (2009). A statistical profile on the health of First Nations in Canada: Self-rated health and selected condi-tions, 2002 to 2005. Ottawa: Health Canada. Janz, T., Seto, J., & Turner, A. (2009). An Overview of the Health of the Métis Population Retrieved May 4, 2009, from http://www.statcan.gc.ca/bsolc/olc-cel/olc-cel?catno=89-637-X2009004&lang=eng. Martens, P. J., Bartlett, J., Burland, E., Prior, H., Burchill, C., Huq, S., et al. (2010). Profile of Metis health status and health-care utilization in Manitoba: a population-based study. Win-nipeg, MB: Manitoba Centre for Health Policy. Métis National Council. (2002). Who are the Métis: National Definition of Métis. Retrieved December 9, 2009, from http://www.metisnation.ca/who/definition.html. Murray, C. J., & Lopez, A. D. (1997). Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet, 349(9064), 1498-1504. Royal Commission on Aboriginal People. (1996). Final Report of the Royal Commission on Aboriginal People. Ottawa: Royal Commission on Aboriginal People. Statistics Canada. (2008). Aboriginal Peoples Survey, 2006: Inuit Health and Social Conditions. Ottawa: Statistics Canada. Statistics Canada. (2010). CANSIM. Retrieved Decem-ber 10, 2010: http://cansim2.statcan.gc.ca/cgi-win/cnsmcgi.exe?Lang=E&CNSM-Fi=CII/CII_1-eng.htm. Statistics Canada. Aboriginal Peoples Survey 2006. (2009a). Chronic Bronchitis: Do you take any treatment or medica-tion for this condition? by province and territory for the Métis identity population, Canada, APS 2006. Retrieved November 11, 2010, from the Métis Centre of the National Aboriginal Health Organization: http://www.metiscentreresearch.ca/node/7946. Statistics Canada. Aboriginal Peoples Survey 2006. (2009b). Have you been told by a doctor, nurse or other health profes-sional that you have asthma? by age group for the Métis identity population, Canada, APS 2006. Retrieved November 11, 2010, from the Métis Centre of the National Aboriginal Health Orga-nization: http://www.metiscentreresearch.ca/node/7793.

In 2009, the Métis Centre of the National Aboriginal Health Organization (NAHO) met with Métis in different parts of Canada to share and collect stories, teachings and information about maternal-child well-being. Our objective with this project was to collect and share experiences, traditions and health information for the benefit of Métis families. After meeting with Métis midwives, health professionals, Elders and parents across the country, we have created a DVD entitled Healthy Beginnings, Supportive Communities: A Strong Future. Themes discussed in the DVD include, among others, cultural continuity, birthing options, historical birthing practices, breastfeeding, self-care for pregnant women, and the role of community in raising children.

Subtitle (optional)As we travelled from Ontario to British Colum-bia, we found that Métis culture and traditions are indeed diverse, but everywhere we visited we did find two things in common: a strong sense of pride in the Métis past and great hope for the Métis future! We hope that you find the health information and stories in our DVD both informative and entertaining.

Everywhere we visited we did find two things in common: a strong sense of pride in the Métis past and great hope for the Métis future! We hope that you find the health information and stories in our DVD both informative and entertaining.

A final report is also available on our website at www.naho.ca/metiscentre. Themes discussed in the DVD include, among others, cultural continuity, birthing options, historical birthing practices, breastfeeding, self-care for pregnant women, and the role of community in raising children. As we travelled from Ontario to Brit-ish Columbia, we found that Métis culture and traditions are indeed diverse, but everywhere we visited we did find two things in common: a strong sense of pride in the Métis past and great hope for the Métis future!

We hope that you find the health information and stories in our DVD both informative and entertaining.

OUR HEALTH: STRENGTHENED BY SHARING

Title block line 1Title block line 2 (optional)

www.naho.cawww.naho.ca

Statistics Canada. Aboriginal Peoples Survey 2006. (2009c). Have you been told by a doctor, nurse or other health professional that you have asthma? by province and territory for the Métis identity population, Canada, APS 2006. Retrieved November 11, 2010, from the Métis Centre of the National Aboriginal Health Organi-zation: http://www.metiscentreresearch.ca/node/7391. Statistics Canada. Aboriginal Peoples Survey 2006. (2009d). Have you been told by a doctor, nurse or other health professional that you have asthma? by selected Census Metropolitan Areas for the Métis identity population, Canada, APS 2006. Retrieved November 11, 2010, from the Métis Centre of the National Ab-original Health Organization: http://www.metiscentreresearch.ca/node/7395. Statistics Canada. Aboriginal Peoples Survey 2006. (2009e). Have you been told by a doctor, nurse or other health professional that you have asthma? by sex for the Métis identity population, Canada, APS 2006. Retrieved November 11, 2010, from the Métis Centre of the National Aboriginal Health Organization: http://www.metiscentreresearch.ca/node/7387. Statistics Canada. Aboriginal Peoples Survey 2006. (2009f). Have you been told by a doctor, nurse or other health professional that you have asthma? by urban-rural for the Métis identity population, Canada, APS 2006. Retrieved November 11, 2010, from the Métis Centre of the National Aboriginal Health Organization: http://www.metiscentreresearch.ca/node/7393. Statistics Canada. Aboriginal Peoples Survey 2006. (2009g). Have you been told by a doctor, nurse or other health professional that you have chronic bronchitis? by age group for the Métis identity population, Canada, APS 2006. Retrieved November 11, 2010, from the Métis Centre of the National Aboriginal Health Organi-zation: http://www.metiscentreresearch.ca/node/7411. Statistics Canada. Aboriginal Peoples Survey 2006. (2009h). Have you been told by a doctor, nurse or other health professional that you have chronic bronchitis? by province and territory for the Mé-tis identity population, Canada, APS 2006. Retrieved November 11, 2010, from the Métis Centre of the National Aboriginal Health Organization: http://www.metiscentreresearch.ca/node/7414. Statistics Canada. Aboriginal Peoples Survey 2006. (2009i). Have you been told by a doctor, nurse or other health professional that you have chronic bronchitis? by selected Census Metropolitan Areas for the Métis identity population, Canada, APS 2006. Re-trieved November 11, 2010, from the Métis Centre of the National Aboriginal Health Organization: http://www.metiscentreresearch.ca/node/7420. Statistics Canada. Aboriginal Peoples Survey 2006. (2009j). Have you been told by a doctor, nurse or other health professional that you have chronic bronchitis? by sex for the Métis identity popula-tion, Canada, APS 2006. Retrieved November 11, 2010, from the Métis Centre of the National Aboriginal Health Organization: http://www.metiscentreresearch.ca/node/7408. Statistics Canada. Aboriginal Peoples Survey 2006. (2009k). Have you been told by a doctor, nurse or other health professional that you have chronic bronchitis? by urban-rural for the Métis identity

population, Canada, APS 2006. Retrieved November 11, 2010, from the Métis Centre of the National Aboriginal Health Orga-nization: http://www.metiscentreresearch.ca/node/7417. Statistics Canada. Aboriginal Peoples Survey 2006. (2009l). Have you been told by a doctor, nurse or other health profes-sional that you have emphysema? by province and territory for the Métis identity population, Canada, APS 2006. Retrieved November 11, 2010, from the Métis Centre of the National Ab-original Health Organization: http://www.metiscentreresearch.ca/node/7448. Statistics Canada. Aboriginal Peoples Survey 2006. (2009m). Have you been told by a doctor, nurse or other health profes-sional that you have emphysema? by selected Census Metropoli-tan Areas for the Métis identity population, Canada, APS 2006. Retrieved November 11, 2010, from the Métis Centre of the National Aboriginal Health Organization: http://www.metiscen-treresearch.ca/node/7454. Statistics Canada. Aboriginal Peoples Survey 2006. (2009n). Have you been told by a doctor, nurse or other health profes-sional that you have emphysema? by sex for the Métis identity population, Canada, APS 2006. Retrieved November 11, 2010, from the Métis Centre of the National Aboriginal Health Orga-nization: http://www.metiscentreresearch.ca/node/7442. Statistics Canada. Aboriginal Peoples Survey 2006. (2009o). Have you been told by a doctor, nurse or other health profes-sional that you have emphysema? by urban-rural for the Métis identity population, Canada, APS 2006. Retrieved November 11, 2010, from the Métis Centre of the National Aboriginal Health Organization: http://www.metiscentreresearch.ca/node/7451. Statistics Canada. Aboriginal Peoples Survey 2006. (2009p). Have you been told by a doctor, nurse or other health professional that you have tuberculosis? by age group for the Métis identity population, Canada, APS 2006. Retrieved November 11, 2010, from the Métis Centre of the National Ab-original Health Organization: http://www.metiscentreresearch.ca/node/7685. Statistics Canada. Aboriginal Peoples Survey 2006. (2009q). Have you been told by a doctor, nurse or other health profes-sional that you have tuberculosis? by province and territory for the Métis identity population, Canada, APS 2006. Retrieved November 11, 2010, from the Métis Centre of the National Ab-original Health Organization: http://www.metiscentreresearch.ca/node/7686. Statistics Canada. Aboriginal Peoples Survey 2006. (2009r). Have you been told by a doctor, nurse or other health profes-sional that you have tuberculosis? by selected Census Metro-politan Areas for the Métis identity population, Canada, APS 2006. Retrieved November 11, 2010, from the Métis Centre of the National Aboriginal Health Organization: http://www.metiscentreresearch.ca/node/7688.

Statistics Canada. Aboriginal Peoples Survey 2006. (2009r). Have you been told by a doctor, nurse or other health professional that you have tuberculosis? by se-lected Census Metropolitan Areas for the Métis identity population, Canada, APS 2006. Retrieved November 11, 2010, from the Métis Centre of the National Aboriginal Health Organization: http://www.metiscentreresearch.ca/node/7688. Statistics Canada. Aboriginal Peoples Survey 2006. (2009s). Have you been told by a doctor, nurse or other health professional that you have tuberculosis? by sex for the Métis identity population, Canada, APS 2006. Retrieved November 11, 2010, from the Métis Centre of the National Aboriginal Health Organization: http://www.metiscentreresearch.ca/node/7684. Statistics Canada. Aboriginal Peoples Survey 2006. (2009t). Have you been told by a doctor, nurse or other health professional that you have tuberculosis? by urban-rural for the Métis identity population, Canada, APS 2006. Retrieved November 11, 2010, from the Métis Centre of the National Aboriginal Health Organization: http://www.metiscentreresearch.ca/node/7687. Statistics Canada. Aboriginal Peoples Survey 2006. (2009u). The mean and median age at which respondents began to smoke cigarettes daily by age-group for the Métis identity population, Canada, APS 2006. Retrieved November 11, 2010, from the Métis Centre of the National Aboriginal Health Organization: http://www.metiscentreresearch.ca/node/6697. Statistics Canada. Aboriginal Peoples Survey 2006. (2009v). The mean and median number of cigarettes re-spondents smoke each day now by province and territory for the Métis identity population, Canada, APS 2006. Retrieved November 11, 2010, from the Métis Centre of the National Aboriginal Health Organization: http://www.metiscentreresearch.ca/node/6703. Statistics Canada. Aboriginal Peoples Survey 2006. (2009w). The mean and median number of cigarettes respondents smoke each day now by selected Census Metropolitan Areas for the Métis identity population, Canada, APS 2006. Retrieved November 11, 2010, from the Métis Centre of the National Aboriginal Health Organization: http://www.metiscentreresearch.ca/node/6705. Statistics Canada. Aboriginal Peoples Survey 2006. (2009x). The mean and median number of cigarettes respondents smoke each day now by sex for the Métis identity population, Canada, APS 2006. Retrieved No-

vember 11, 2010, from the Métis Centre of the National Aboriginal Health Organization: http://www.metiscen-treresearch.ca/node/7949. Statistics Canada. Aboriginal Peoples Survey 2006. (2009y). The mean and median number of cigarettes respondents smoke each day now by urban-rural for the Métis identity population, Canada, APS 2006. Retrieved November 11, 2010, from the Métis Centre of the National Aboriginal Health Organization: http://www.metiscentreresearch.ca/node/6704. Statistics Canada. Aboriginal Peoples Survey 2006. (2009z). Type of cigarette smoker; smoking of cigars or pipes, or chewing tobacco are not considered by age group for the Métis identity population, Canada, APS 2006. Retrieved November 11, 2010, from the Métis Centre of the National Aboriginal Health Organization: http://www.metiscentreresearch.ca/node/5881. Statistics Canada. Aboriginal Peoples Survey 2006. (2009{). Type of cigarette smoker; smoking of cigars or pipes, or chewing tobacco are not considered by province and territory for the Métis identity population, Canada, APS 2006. Retrieved November 11, 2010, from the Métis Centre of the National Aboriginal Health Organization: http://www.metiscentreresearch.ca/node/5557. Statistics Canada. Census 2006. (2008). 2006 Census: Data products. Topic-based tabulations. Retrieved July 10, 2009: http://www12.statcan.gc.ca/census-recense-ment/2006/dp-pd/tbt/Rp-eng.cfm?LANG=E&APATH=3&DETAIL=0&DIM=0&FL=A&FREE=0&GC=0&GID=0&GK=0&GRP=1&PID=97446&PRID=0&PTYPE=88971,97154&S=0&SHOWALL=0&SUB=0&Temporal=2006&THEME=73&VID=0&VNAMEE=&VNAMEF=. The Conference Board of Canada. (2009). Mortality Due to Respiratory Diseases. Retrieved March 10, 2010, from http://www.conferenceboard.ca/hcp/details/health/mortality-respiratory-system.aspx#_ftnref12. The Lung Association. (2008). The National Lung Health Framework. Retrieved March 22, 2010, from http://www.lunghealthframework.ca/2CFFE694-DD95-4E1F-8624-7F2E90733045/FinalDownload/Download-Id-C4B7D181230CB588A23FB8D69AAF8208/2CFFE694-DD95-4E1F-8624-7F2E90733045/sites/default/files/LungHealth_aug27_e.pdf?phpMyAdmin=26347d763dbbf835a1c37fec3f211071. Tjepkema, M., Wilkins, R., Senécal, S., Guimond, E., & Penney, C. (2009). Mortality of Métis and Registered Indian adults in Canada: An 11-year follow-up study. Health Rep(82-003-X).

OUR HEALTH: STRENGTHENED BY SHARING

www.naho.ca