Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Med Life with Dr. Horton
    • Podcasts
    • Videos
    • Alerts
    • RSS
    • Classified ads
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Activate online account
    • Look up login
    • Earn CPD Credits
    • Members Corner
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
    • Activate subscription
    • Look up login
    • Manage account
    • Manage IPs
    • View Reports
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JPN

User menu

  • Subscribe
  • My alerts
  • My Cart
  • Log in

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JPN
  • Subscribe
  • My alerts
  • My Cart
  • Log in
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Med Life with Dr. Horton
    • Podcasts
    • Videos
    • Alerts
    • RSS
    • Classified ads
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Activate online account
    • Look up login
    • Earn CPD Credits
    • Members Corner
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
    • Activate subscription
    • Look up login
    • Manage account
    • Manage IPs
    • View Reports
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Commentary

Getting to the root of trauma in Canada's Aboriginal population

Nadine R. Caron
CMAJ April 12, 2005 172 (8) 1023-1024; DOI: https://doi.org/10.1503/cmaj.050304
Nadine R. Caron
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Responses
  • Metrics
  • PDF
Loading

Aboriginal Canadians bear a disproportionate risk of injury and illness compared with their non-Aboriginal counterparts.1 Age-standardized, all-cause mortality rates for our Aboriginal population are almost twice those of the whole population of Canada, men (561 v. 340 per 100 000) and women (335 v. 172 per 100 000) alike.2 A major contributor to these differences is traumatic injury and death, accounting for one-third of all deaths in the Aboriginal population.2

The article by Karmali and colleagues3 in this issue (see page 1007) is an important first step toward understanding this problem. This population-based, observational study describes the epidemiologic characteristics of severe trauma among status Aboriginal Canadians (First Nations individuals officially registered with the Canadian federal government under the Indian Act) within the Calgary Health Region. They found that severe trauma occurred almost 4 times as often among status Aboriginals as in a reference population of all other inhabitants of the region, an excess that held for men and women of all ages. Moreover, huge differences in rates were present for specific causes: assault (RR 11.1, 95% confidence interval [CI] 6.2– 18.6), traumatic suicide (RR 3.1, 95% CI 1.4–6.1) and motor vehicle crashes (RR 4.8, 95% CI 3.5–6.5), for example.

Before the epidemiologic characteristics of trauma in Canada's Aboriginal population and the reasons behind these statistics can be understood, several issues need to be addressed. First, it is important that trauma within Canada's Aboriginal population be assessed and documented, not just for mortality but also for associated morbidity. Morbidity, which is much more challenging to quantify, requires longer-term evaluation. Although most trauma patients survive their ordeal, few studies describe or quantify the associated morbidity, whether acute or long term. The social and economic costs of this morbidity are considerable, not only for the individual but also for their community. Accurate depiction of the true effect of trauma cannot be obtained from trauma registries or even regional hospital chart review, as much of the burden of injury and illness occurs after discharge. Some consequences from trauma are evident only during the recovery phase … or lack thereof. For example, a patient with multiple injuries from a motor vehicle crash may not die or undergo major medical complications while in hospital but may, along with their families (and indeed whole communities), experience psychosocial problems, disability, subsequent unemployment and other ill effects — effects that can last a lifetime and even extend to burden the next generation. Our current knowledge and available statistics do not reflect the short- and longer-term negative effects of trauma on these communities. Our efforts in trauma research must begin to address them.

Second, it is vitally important to include all Aboriginal populations in research projects and programs aiming to reduce the health burdens of traumatic injury. Canada's Aboriginal population includes not only status First Nations, but also the non-status First Nations, Métis and Inuit populations. Future research should also examine the morbidity and mortality of trauma among Aboriginal populations living on reserve or off, and assess differences between the urban and rural communities. A recent systematic review highlights these research limitations: only 1% of studies involving First Nation populations dealt with those living off-reserve; less than 2% provided information on urban Aboriginal people; and only 3% even addressed the issue of trauma, most commonly suicide.2 As shown by Karmali's group,3 even when a study population is well defined, identifying its members can be challenging and suboptimal. Although similarities across these Aboriginal populations will certainly exist, critical differences might be found that could guide proposed social, medical and political solutions for each specific community.

Third, the factors contributing to Aboriginal trauma must be identified and quantified. In the classic Haddon matrix,4 the root causes of these trauma statistics and outcomes can be expected to comprise various elements, including host /patient, vector and physical and social environmental factors.5 Whereas mortality data are dichotomous, causes of traumatic injuries and deaths require careful, in-depth evaluation of each square in Haddon's matrix.6 This evaluation must extend far past the obvious “drinking and driving” or “depression and suicide” cause-and-effect assumptions to question additional factors related to personal, social, environmental or economic components. Although less quantifiable than mortality statistics, these will shed valuable light on causative factors, which can be then be systematically addressed to decrease the incidence of traumatic injury and death in a specific population.

Fourth, as important as it is to develop better emergency treatment for Aboriginal trauma patients, we must also move beyond this to address other health-services issues. Geographic location often limits timeliness, access and level of health care available in rural and isolated regions, which constitute well-documented predictive factors for trauma outcomes.7,8 Health services may lack culturally sensitive care, perhaps exacerbated by the persisting under-representation of Aboriginal professionals in health care.1,9 Delivery of health care in remote and rural regions across Canada is an ongoing struggle; a novel approach is the development of northern medical-school campuses in British Columbia (by the University of British Columbia) and Ontario (by the Northern Ontario School of Medicine) to train physicians “in the north, for the north.” Although vital, solutions to the trauma epidemic in our Native populations must look past the emergency departments and surgical suites that care for the injured, to the individual, community, environmental, social and economic factors that set the scene for these traumas.

Last, and perhaps most importantly, each step in this vital process cannot be done for Canada's Aboriginal population; it can only be done with us. These issues cannot be addressed without understanding Canada's history with its Aboriginal people, as each of these steps, from surveillance to solution to program implementation, can no longer be imposed on or adapted to the community without its approval and participation.

Traumatic injury and death may be the most preventable of all health issues. It is time that we, as health care professionals and researchers, treated them as such.

𝛃 See related article page 1007

Footnotes

  • Competing interests: None declared.

References

  1. 1.↵
    MacMillan HL, MacMillan AB, Offord DR, Dingle JL. Aboriginal health [review]. CMAJ 1996;155(11):1569-78.
    OpenUrlAbstract
  2. 2.↵
    Young TK. Review of research on aboriginal populations in Canada: relevance to their health needs. BMJ 2003;327:419-22.
    OpenUrlAbstract/FREE Full Text
  3. 3.↵
    Karmali S, Laupland K, Harrop AR, Findlay C, Kirkpatrick AW, Winston B, et al. Epidemiology of severe trauma among status Aboriginal Canadians: a population-based study. CMAJ 2005;172(8):1007-11.
    OpenUrlAbstract/FREE Full Text
  4. 4.↵
    Lett R, Kobusingye O, Sethi D. A unified framework for injury control: the public health approach and Haddon's Matrix combined. Inj Control Saf Promot 2002;9:199-205.
    OpenUrlCrossRefPubMed
  5. 5.↵
    Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet 1997;349(9061):1269-76.
    OpenUrlCrossRefPubMed
  6. 6.↵
    Conroy C, Fowler J. The Haddon matrix: applying an epidemiologic research tool as a framework for death investigation. Am J Forensic Med Pathol 2000;21:339-42.
    OpenUrlCrossRefPubMed
  7. 7.↵
    Auer AM, Andersson R. Canadian Aboriginal communities and medical service patterns for the management of injured patients: a basis for surveillance. Public Health 2001;115:44-50.
    OpenUrlPubMed
  8. 8.↵
    Auer AM, Andersson R. Canadian Aboriginal communities: a framework for injury surveillance. Health Promot Int 2001;16:169-77.
    OpenUrlAbstract/FREE Full Text
  9. 9.↵
    Dhalla IA, Kwong JC, Streiner DL, Baddour RE, Waddell AE, Johnson IL. Characteristics of first-year students in Canadian medical schools. CMAJ 2002;166(8):1029-35.
    OpenUrlAbstract/FREE Full Text
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 172 (8)
CMAJ
Vol. 172, Issue 8
12 Apr 2005
  • Table of Contents
  • Index by author
  • Canadian Adverse Reaction Newsletter (1133 - 1140)

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Getting to the root of trauma in Canada's Aboriginal population
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
Citation Tools
Getting to the root of trauma in Canada's Aboriginal population
Nadine R. Caron
CMAJ Apr 2005, 172 (8) 1023-1024; DOI: 10.1503/cmaj.050304

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Getting to the root of trauma in Canada's Aboriginal population
Nadine R. Caron
CMAJ Apr 2005, 172 (8) 1023-1024; DOI: 10.1503/cmaj.050304
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Footnotes
    • References
  • Responses
  • Metrics
  • PDF

Related Articles

  • Highlights of this issue
  • Epidemiology of severe trauma among status Aboriginal Canadians: a population-based study
  • Scopus
  • PubMed
  • Google Scholar

Cited By...

  • Are we homogenising risk factors for public health surveillance? Variability in severe injuries on First Nations reserves in British Columbia, 2001-5
  • Scopus (11)
  • Google Scholar

More in this TOC Section

  • Bone and Joint Health Strategic Clinical Network
  • Emergency Strategic Clinical Network
  • Innovating to achieve service excellence in Alberta Health Services
Show more Commentary

Similar Articles

Collections

  • Topics
    • Aboriginal health

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Videos
  • Alerts
  • RSS

Information for

  • Advertisers
  • Authors
  • CMA Members
  • Copyright and Permissions
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact

Copyright 2019, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

Powered by HighWire