Indigenous Identity, Gender, and Self-Rated Health under Universal Healthcare in Canada

Canada's publicly funded universal healthcare system is intended to provide equitable access to medically necessary services regardless of ability to pay. However, universal coverage has not eliminated health differences between Indigenous and non-Indigenous populations. These disparities may be particularly important for Indigenous women, because Indigenous identity and gender intersect with social determinants of health. This study examines how Indigenous identity and gender were associated with self-rated physical and mental health among Canadian adults, and the extent to which selected social determinants were associated with these disparities. Secondary data came from the Canadian Community Health Survey Public Use Microdata Files for 2015–2016, 2017–2018, and 2019–2020. The 196,881 respondents aged 18 to 64 were split into Indigenous women, Indigenous men, non-Indigenous women, and non-Indigenous men. Fair/poor self-rated physical and mental health were analyzed using survey-weighted percentages, logistic regression, and linear regression. Indigenous women reported the highest prevalence of fair/poor physical and mental health; in 2019–2020, 22.0% reported fair/poor mental health versus 13.3% of Indigenous men and 10.3% of non-Indigenous women. After adjustment, Indigenous identity remained associated with higher odds of fair/poor physical (odds ratio = 1.62) and mental health (odds ratio = 1.31), while higher income and education were associated with lower odds. The Indigenous × female interaction for mental health was positive but imprecise on the odds scale and near null for physical health. Universal coverage alone does not eliminate Indigenous health inequities. Gender, Indigenous identity, and social conditions should be examined together to inform culturally safe, gender-responsive care.