Indigenous adults in Toronto are hospitalized and visit emergency departments at a substantially higher rate than the general adult population in the city, according to newly released data.

The research, led by Well Living House, an Indigenous health research unit at St. Michael’s Hospital, and Seventh Generation Midwives Toronto, shows First Nations, Inuit & Métis (FNIM) adults in Toronto visited the emergency department (ED) at a rate two times greater than the general Toronto population and were hospitalized 14 per cent more than the general Toronto population.

The data was released in a set of fact sheets and is part of Our Health Counts, a research project aimed at addressing the health information gap for Indigenous peoples in Canada. The Our Health Counts Toronto study has previously demonstrated that the population of FNIM living in Toronto is two – four times higher than Census Canada estimates. The project also ensures that urban Indigenous communities have ownership, access, control, and possession of data that impact their health and wellbeing.

Dr. Janet Smylie (Photo: Samuel Engelking)

“We already knew that we represented a significant proportion of ED and hospital patients – but now we have the data to prove this. Given the size of the FNIM population in Toronto (approximately 88,000), a high population prevalence of chronic disease; and the fact that 1 in 3 of us (approximately 30,000) do not have a regular primary care provider, it is not surprising to see high rates of ER use and hospitalization,” said Dr. Janet Smylie, Director of Well Living House at St. Michael’s Hospital, a site of Unity Health Toronto, and principal investigator of Our Health Counts.

“As a result of attitudinal and systemic racism, Indigenous community members may chose not to self-identify as such when using ED and hospital services – and while we know who we are within our communities, it can be difficult for non-Indigenous providers and organizations to correctly identify us and provide culturally safe services,” said Dr. Smylie, who is also a senior adjunct scientist at ICES and a Tier 1 Canada Research Chair.

Seventh Generation Midwives Toronto recruited 916 adult participants using respondent-driven sampling, a statistical method that uses social networks to recruit Indigenous people living in the city. Of the participants, 97 per cent consented to have their data linked to administrative health data at ICES, a research institute that uses population-based health information to produce knowledge on a broad range of health care issues. Researchers used data from ICES to compare FNIM adult data with Toronto and Ontario’s general population.

Emergency department usage

Researchers analyzed ED usage among FNIM adults in Toronto between 2016 and 2018 and found:

  • Nearly 65 per cent of FNIM adults in Toronto accessed the ED at least one time. This is two times greater than the general Toronto population.
  • Nearly 20 per cent of FNIM visited the ED six or more times. This is 10 times and seven times greater than general Toronto and Ontario ED use rates, respectively.
  • On average, FNIM adults living in Toronto visit the ED seven times over two years. This represents 157,000 ED visits among the FNIM population in Toronto per year.

The researchers attribute the higher rates of ED visits among FNIM adults to limited access to primary care providers and other non-emergent health services and a high prevalence of chronic disease, and multimorbidity and mental health challenges. They also cite baseline rates of unmet health needs that are 2.5 times higher than general population and a high prevalence of experiences of racism while accessing health services, with linked delays and/or avoidance of access.


Researchers also analyzed hospitalizations among FNIM adults in Toronto between 2013 and 2018 and found:

  • Nearly 50 per cent of FNIM adults in Toronto were hospitalized at least one time. This is 14 per cent higher than the general Toronto population.
  • Seven per cent of FNIM adults were hospitalized six or more times. This is three times and two times greater than the general Toronto and Ontario population, respectively.
  • 22,000 FNIM are hospitalized 3.4 times on average over five years, which totals approximately 22,000 hospitalizations among FNIM in Toronto per year.

The researchers attribute the higher rates of hospitalizations to higher birth rates and chronic health conditions among FNIM adults. They also say FNIM adults predominantly experienced hospitalizations for medical or surgical reasons.

“This research demonstrates that systems change is critical to the health and wellbeing of Indigenous peoples, in particular with the opportunities that exist at points of access, like Emergency Department visits. With a strong commitment to evidence based practice in health care policy and delivery, my hope is that these findings shape a new path of accountability with Indigenous peoples in Toronto,” said Cheryllee Bourgeois, Indigenous midwife at Seventh Generation Midwives Toronto and OHC Toronto study co-lead. 

Our Health Counts Toronto is a four-year long study that began January 2014 and concluded March 2018. It is funded by the Canadian Institute of Health Research (CIHR). Our Health Counts has previously studied Indigenous populations in Hamilton, London, Ottawa and Toronto.

About Well Living House

The Well Living House is an action research centre for Indigenous infants, children, and their families’ health and well-being. Our focus is on gathering, using, sharing, and protecting Indigenous health and well-being knowledge and practices. We draw on both Indigenous and public health knowledge to inform cutting-edge scholarship and best practices. At the heart is an aspiration to be a place where Indigenous people can gather, understand, and share what it means to be a healthy child, family, and community–building a “Well Living House”.

About Seventh Generation Midwives Toronto

Seventh Generation Midwives Toronto (SGMT) is a group practice of midwives who provide high quality maternity care to pregnant individuals and their families. Our support area for clients includes the City of Toronto, with a focus on those living downtown, as well as ensuring care for the Indigenous community.

About St. Michael’s

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of St. Joseph’s Health Centre, St. Michael’s Hospital and Providence Healthcare, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education.

About ICES

ICESis an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, visit

By: Marlene Leung