Inequalities in Health between First Nations Adults Living Off-Reserve and Non-Indigenous Adults in Canada: A Decomposition Analysis.

This article examines health inequalities between Status First Nations (SFN), Non-Status First Nations (NFN) adults living off-reserve, and non-Indigenous adults in Canada using 2017 data from the Aboriginal Peoples Survey (APS) and Canadian Community Health Survey (CCHS). Employing the Blinder–Oaxaca decomposition method, the study finds that First Nations adults experience 5–10% poorer outcomes in self-reported general and mental health, diagnosed asthma, and diabetes compared to non-Indigenous adults, with NFN reporting worse general and mental health than SFN except for diabetes prevalence. Socio-economic factors—including education, employment, and income—explain approximately 10–25% of these health disparities, accounting for 20–45% of the overall gaps, while demographic and geographical factors contribute less. The findings suggest that improving socio-economic status among First Nations living off-reserve could reduce health inequalities, though the authors note that historical and ongoing colonialism and other unmeasured factors also play critical roles, indicating the need for holistic, community-led approaches beyond socio-economic interventions.