Ancestry or identity? The importance of Indigenous engagement in articulating First Nations, Inuit and Métis peoples in the 2006 Canadian Census Health and Environmental Cohort (CanCHEC).

Statistics Canada uses two self-report measures - Ancestry and Identity - in the Canadian Census to identify First Nations, Inuit and Métis (FNIM) peoples. How these measures are employed alone or in combination to assess definitional impact on the reporting of health conditions has not been investigated. To illustrate, we assessed how these measures, alone or in combination, estimate colorectal cancer rates. A working group comprised of Indigenous and non-Indigenous academics assessed the response patterns to the Identity and Ancestry questions in the 2006 Canadian Census Health and Environment Cohort and categorised the responses into groups: A) Identity only; B) Ancestry only; C) any Ancestry or Identity; D) both Ancestry and Identity. We then assessed concordance, and subsequently examined the way these groupings may impact the reporting of colorectal cancer rates (2010-2015). FNIM responses varied across the different combinations of the Ancestry and Identity questions. Concordance for FNIM was 76%, 81%, and 18% respectively for single responses, which impacted the estimation of colorectal cancer rates. To improve health reporting, it is essential that research teams choose the most appropriate definition in partnership with FNIM and urban Indigenous organisations to ensure the right data are analysed to align with community priorities.