title: Back to the basics: Identifying and addressing underlying challenges in achieving high quality and relevant health statistics for indigenous populations in Canada.
abstract: Canada is known internationally for excellence in both the quality and public policy relevance of its health and social statistics. There is a double standard however with respect to the relevance and quality of statistics for Indigenous populations in Canada. Indigenous specific health and social statistics gathering is informed by unique ethical, rights-based, policy and practice imperatives regarding the need for Indigenous participation and leadership in Indigenous data processes throughout the spectrum of indicator development, data collection, management, analysis and use. We demonstrate how current Indigenous data quality challenges including misclassification errors and non-response bias systematically contribute to a significant underestimate of inequities in health determinants, health status, and health care access between Indigenous and non-Indigenous people in Canada. The major quality challenge underlying these errors and biases is the lack of Indigenous specific identifiers that are consistent and relevant in major health and social data sources. The recent removal of an Indigenous identity question from the Canadian census has resulted in further deterioration of an already suboptimal system. A revision of core health data sources to include relevant, consistent, and inclusive Indigenous self-identification is urgently required. These changes need to be carried out in partnership with Indigenous peoples and their representative and governing organizations.
authors.affiliation: Well Living House Action Research Centre for Indigenous Infant Child and Family Health and Wellbeing, Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, ON, Canada; Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto CIHR Applied Public Health Chair in Indigenous Health Knowledge and Information, Toronto, ON, Canada.
authors.forename: Janet
authors.initials: J
authors.lastname: Smylie
authors.affiliation: Well Living House Action Research Centre for Indigenous Health and Wellbeing, Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Firestone
keywords: Indigenous health measurement; indigenous health data and data systems; misclassification; racial and ethnic identification in health data