A country’s ability to count its inhabitants is essential for serving the general population and ensuring that socially marginalized groups, at risk of being undercounted, receive appropriate health and social services. New research co-led by York University, St. Michael’s Hospital and Seventh Generation Midwives Toronto sought to alleviate a major problem in methodology: the undercounting of urban Indigenous peoples.
The situation is serious. “Our Toronto-based study is a cautionary note on the shortfall of national census data on hard-to-reach populations in Canada. We saw that when the short-form Canadian census is combined with data from the National Household Survey (NHS) to obtain estimates of the size of the Indigenous community, the result was a severe undercount of the Indigenous population in Toronto,” says Faculty of Health Professor Michael Rotondi, who initiated the research.
This work was funded by the Canadian Institutes of Health Research and the findings were published in the British medical journal BMJ Open (2017).
A history of challenges in collecting this data
Today, most First Nations and Métis peoples in Canada live in cities, and the urban Indigenous population is rapidly increasing, according to Statistics Canada. But existing research tells us that many urban Indigenous people tend not to participate in the census due to factors such as poverty and its associated lack of a fixed address, mobility between communities and historical distrust of government and colonial policies.
Another issue that adds to the challenges of enumerating this population stems from a highly consequential federal decision eight years ago. Back in 2011, the Canadian government profoundly changed how population data was collected. It eliminated the mandatory long-form census, replacing it with the voluntary NHS – a decision that was met with grave concerns by statisticians and social scientists across the country.
“This further complicated the accurate enumeration of Indigenous peoples because questions regarding Indigenous identity were part of the content that was transferred from the long-form census to the NHS, which had a much lower global response rate (69 per cent) than the previous long-form census (94 per cent),” Rotondi explains.
Study sought evidence of the magnitude of the census undercounts
Given these challenges, the researchers wanted to provide evidence of the size and scale of the census undercounts of this hard-to-reach population and, in doing so, improve estimation of the size of the urban Indigenous community living in Toronto.
Community partnerships facilitated participation
The study took place in the Indigenous community living in Toronto. Participants were recruited from March 2015 to March 2016. The Seventh Generation Midwives Toronto, in partnership with the Centre for Urban Health Solutions at St. Michael’s Hospital, recruited Indigenous adults who lived, worked or received health services in the city, using a large-scale, community-based, respondent-driven sampling (RDS) design. RDS is a chain-referral sampling method where participants recruit other people they know. This technique is useful for sampling from hard-to-reach populations and has a number of practical and statistical advantages for studying hidden populations.
A total of 908 adults, ages 15 years and up, participated in this study. They all self-identified as Indigenous (First Nation, Inuit or Métis). Study participants were young; more than 60 per cent were under 45 years of age. Household income was low; 60 per cent of the study participants earned less than $20,000 in the year before the study took place. As well as income and age, the researchers also gathered demographic data such as gender, household type and household size.
The key question the researchers asked participants was: “Did you complete the 2011 census Canada questionnaire?”
Improved methodology realizes double population size, points to policy implications
Using advanced statistical modelling, the researchers found that the most recent Canadian census grossly underestimated the size of the Indigenous population in Toronto.
“Under conservative assumptions, there are approximately 55,000 Indigenous people living in Toronto – at least double the current estimate of 19,270,” Rotondi explains.
The methods that the research team used to secure an accurate estimate of the size of the urban Indigenous community will be useful to many. “The results of this study may have potential implications for the enumeration of other impoverished or marginalized groups, including homeless people or illegal immigrants who may not have fixed addresses or who may be reluctant to identify themselves,” says Rotondi.
He underscores the policy implications of this research: “Our methods, including respondent-driven sampling and census completion information, will have broad impacts across governmental and health policy, potentially improving health-care access and equity for these marginalized communities.”
To read the BMJ Open article, “Our Health Counts Toronto: using respondent-driven sampling to unmask census undercounts of an urban indigenous population in Toronto, Canada,” visit the website. To learn more about Rotondi, visit his faculty profile page.
By Megan Mueller, senior manager, research communications, Office of the Vice-President Research & Innovation, York University, email@example.com