Current Problems

Health (18-24)

First Nations Life Expectancy Has Plummeted. How to Change That

March 8, 2024

Solutions exist in culturally competent health care, safer supply, better recovery options and community connection, experts say.

A carved and painted wooden totem pole in front of a painted wooden longhouse in Klemtu.
The Kitasoo Xai’xais Big House in Klemtu, BC. Experts say fostering cultural connection is one powerful way to improve First Nations health outcomes. Photo for The Tyee by Michelle Gamage.

[Editor’s note: This story contains discussion of intergenerational trauma and the impacts of residential schools.]


If you need support, call the Indian Residential School Survivors Society at 1-800-721-0066 or 1-866-925-4419 for the 24-7 crisis line.

The KUU-US Crisis Line Society also offers round-the-clock support. Call 250-723-4050 for adults, 250-723-2040 for youth or toll-free at 1-800-588-8717.

The Tyee: Due to the toxic drug crisis and later the COVID-19 pandemic, life expectancy for First Nations people in British Columbia decreased by 7.1 years between 2015 to 2021.

The largest drop happened between 2019 and 2021 when life expectancy shortened 5.8 years, says Dr. Nel Wieman, chief medical officer at the First Nations Health Authority. Wieman is Anishinaabe from Little Grand Rapids First Nation.

The unregulated toxic drug supply is the leading cause of the decrease, with First Nations people “vastly overrepresented” in toxic drug deaths, Wieman says. 

In comparison, life expectancy of non-Indigenous residents of B.C. decreased by 1.1 years between 2019 to 2021. 

Some of the biggest factors are inequities and trauma caused by colonialism:

  • Indigenous-specific racism in every part of the health-care system, as reflected in the 2020 “In Plain Sight” report;
  • stigma around drug use; and
  • a lack of services available for First Nations people, experts told The Tyee. 

For the last 50 years, First Nations life expectancy had been increasing annually by 0.2 years, says Dr. Danièle Behn Smith, deputy provincial health officer for Indigenous health. Behn Smith is Eh Cho Dene of Fort Nelson First Nation and Franco-Manitoban/Métis from the Red River Valley.

In 2011, life expectancy was 75.9 years. Then 2014 hit, when the powerful synthetic opioid fentanyl entered the unregulated drug market and drove up toxic drug deaths for First Nations and the general population alike. The COVID-19 pandemic exacerbated harm by isolating people, keeping them from harm reduction services and driving them to use alone.

Historic and present-day colonial impacts create inequity in almost every part of society for First Nations people, Behn Smith says:

  • There is food insecurity when people are unable to access traditional food systems
  • There is “manufactured poverty” — where Canada has gotten rich from resource extraction, but the majority of First Nations have not.
  • There are high rates of overcrowding or being unhoused. 

For these reasons and others, First Nations have higher rates of underlying health conditions that, for example, affect lung health and increase rates of diabetes. 

Then there’s intergenerational trauma from a history of colonialism and system of oppression. 

Tania Dick, Indigenous nursing lead at the University of British Columbia’s school of nursing, says residential schools added “hugely traumatic layers to our existence that are still raw and fresh.” Indigenous Peoples are trying to work their way through the trauma and heal but society at large isn’t helping them do that, she adds. Some Indigenous people use drugs and alcohol as a coping mechanism, leading to high rates of addiction. 

Behn Smith says that when she worked as a family doctor, she would acknowledge drug use as “really powerful medicines that they need right now,” and then see if she could shift a patient to something with less harmful side-effects over time.

The increasing toxicity of illicit drugs has increased the chances these side-effects will be deadly. Behn Smith compares the current unregulated drug supply to “Russian roulette” because the drugs are so potent and likely contaminated with a toxic level of other substances. 

Then there’s Indigenous-specific racism, pushing Indigenous people away from health services the same way getting repeatedly burned after touching a hot object teaches you to stay away, Dick says. 

Wieman says she’s heard racism called the third undeclared public health emergency because it negatively affects people’s ability to access harm reduction services or prescribed safer supply. 

“People choose not to access health services because they fear the treatment or are worried because of a past experience or stories they heard from friends and family,” Wieman says. 

Canada has also had “decades and decades of approaching drugs in quite a punitive way that created a lot of stigma,” Behn Smith says. This pushes people to use alone, not access harm reduction services and not ask for help when they need it. 

There’s also the issue of access. 

Impact from lack of services

Dick, who is a member of Dzawada̱ʼenux̱w First Nation of Kingcome Inlet, says nurses fly into her community to offer health care, but two weeks can go by without a visit. 

Health-care providers often must fly into an Indigenous community, or people are expected to drive out to access mainstream services that can be culturally unsafe, she says. 

“Our people are unwell and want to deal with their issues but they only see harm and fear, so they generally avoid the health-care industry,” Dick adds. “It has so many layers and complexities to it. Nurses are on the ground and often people’s first and last point of contact. We can do better.” 

One improvement Dick would like to see is the regular deployment of registered psychiatric nurses to communities to offer mental health services. 

Geography can also prohibit people from accessing services. Prescribed safer supply programs, for example, may require a pharmacist to supervise someone every time they take their medication, which can mean hours of daily driving for some patients, Wieman says. 

People who want to access culturally safe mental health services, detox and treatment programs are also often put on waiting lists that can take two to nine weeks, Dick says. 

“If someone wants to stop using drugs and wants to access medically supervised detox, we need to respond to them that minute because the odds are they will end up back on the street and using drugs if they can’t get help that day,” Dick adds. 

Intergenerational trauma and effects on youth

First Nations communities are seeing a lot of toxic drug deaths in younger generations. “The youth being affected in these numbers is devastating,” Dick says. “This is heartbreaking. We look at these children as our future.” 

Dick’s village has lost a couple of people who were in their early 20s and living outside of the community to go to school. The deaths “absolutely rocked our village and turned it upside down,” she says. 

“People are grieving and they don’t have time to finish grieving before there’s another death,” Behn Smith says. This can push people back towards medicating emotional, physical and spiritual pain with substances. 

The COVID-19 pandemic further disconnected people from their families, community and services.

“It made us sit still in our own skin, which let traumas come up because you can’t keep busy,” Dick says. 

Dick says she isolated with aunts, uncles and cousins during the lockdowns. Her parents are both residential school survivors, and she was surprised at how many complex feelings came up during that time. But she was grateful to be surrounded with family where they could all talk about what they were thinking and feeling. 

“Imagine what it was like for people disconnected from their community or away from home who weren’t able to unpack everything,” she says. “They just had to sit in it and spiral.” 

Because of the likelihood of other underlying health conditions, Indigenous people were more likely to suffer severe infections, be hospitalized and die, Behn Smith says.

“Every time one of our relatives or member of our nation dies, it’s a threat to our cultural community,” she says. “Many people hold teachings in our communities, and if they die suddenly, then that knowledge is gone. Every Elder we lose, especially in communities with few fluent language speakers, is truly an existential threat in many ways.”

Where to go from here

Each expert had their own recommendations for how to improve First Nations’ life expectancy. 

The studies showing us where to go have already been done, Behn Smith says. We just need to implement them. She points to the Truth and Reconciliation Commission’s Calls to Action, the “In Plain Sight” report, the final report of the National Inquiry into Missing and Murdered Indigenous Women and Girls and the Declaration Act Action Plan. All the solutions emerge in simply listening to Indigenous people, “who have been very clear and articulate for what are life-saving solutions for us,” she says. 

Behn Smith also echoed Dr. Bonnie Henry’s call for B.C. to explore a medical and non-medical prescribed safer supply program. The existing prescription model has been accessed by only about five per cent of the total estimated people who could benefit from it. A different model could reach more people by reducing barriers. 

Wieman says that for First Nations people the recovery journey should offer harm reduction, treatment and healing. This can be participation in traditional activities, ceremonies or other cultural involvement.

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Indigenous People Bear the Brunt of the Toxic Drug Crisis


“Substance use is in many cases a symptom of trauma and not knowing how to deal with trauma,” she says. “We need to look at short-term and long-term healing so people don’t feel compelled to use substances as coping mechanisms when distressed.” 

Dick also highlights the importance of culture. 

She says she went home for a potlatch recently and saw youth taking on roles and responsibilities in the ceremonies and engaging with traditions and language. They had such confidence and an aura of intense joy to have this path and purpose, she says. 

The legacy of residential schooling means that Dick does not speak her language — her parents were not able to teach her. Through her learning, she says, she’s showing younger generations how to reconnect with culture. 

“We’re reclaiming space and culture and knowledge and finding more resources to relearn and reclaim,” Dick says. “It’s happening more and more and having a big impact.” 

Michelle Gamage, The Tyee

Michelle Gamage is The Tyee’s health reporter. This reporting beat is made possible by the Local Journalism Initiative.

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