Indigenous Health Part 2: The Underlying Causes of the Health Gap

Department of Medicine, University of Alberta, Edmonton, AB, Canada.
The Lancet (Impact Factor: 45.22). 08/2009; 374(9683):76-85. DOI: 10.1016/S0140-6736(09)60827-8
Source: PubMed


In this Review we delve into the underlying causes of health disparities between Indigenous and non-Indigenous people and provide an Indigenous perspective to understanding these inequalities. We are able to present only a snapshot of the many research publications about Indigenous health. Our aim is to provide clinicians with a framework to better understand such matters. Applying this lens, placed in context for each patient, will promote more culturally appropriate ways to interact with, to assess, and to treat Indigenous peoples. The topics covered include Indigenous notions of health and identity; mental health and addictions; urbanisation and environmental stresses; whole health and healing; and reconciliation.

Download full-text


Available from: Malcolm King, Oct 04, 2015
149 Reads
  • Source
    • "Past segregationist practices of the Big Event have led to existing structural violence. For instance, Indigenous peoples receive inequitable funding for mental health and other social services on-reserve, have insufficient housing and experience home overcrowding , have fewer educational and economic opportunities , and have lost traditional patterns of subsistence (Gracey & King, 2009; King, Smith, & Gracey, 2009; Kirmayer et al., 2014; Richardson & Nelson, 2007; US Commission on Civil Rights, 2004). "
  • Source
    • "The participants in this study described the importance of the land for youth resilience, and research with people of all ages in Rigolet, Nunatsiavut supports this finding and has shown a deep connection to place and nature held by people in the community nurtured by spending time on the land (Cunsolo Willox et al., 2012, 2013a, b). Indeed, access to and connection with the land is a critical component of understandings and perspectives of health and well-being in general held by Indigenous populations globally (Burgess et al., 2009; Gracey and King, 2009; King et al., 2009; Carnie et al., 2011; Kirmayer et al., 2011; Rigby et al., 2011). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The Canadian Arctic is experiencing rapid changes in climatic conditions, with implications for Inuit communities widely documented. Youth have been identified as an at-risk population, with likely impacts on mental health and well-being. This study identifies and characterizes youth-specific protective factors that enhance well-being in light of a rapidly changing climate, and examines how climatic and environmental change challenges these. In-depth conversational interviews were conducted with youth aged 15-25 from the five communities of the Nunatsiavut region of Labrador, Canada: Nain, Hopedale, Postville, Makkovik, and Rigolet. Five key protective factors were identified as enhancing their mental health and well-being: being on the land; connecting to Inuit culture; strong communities; relationships with family and friends; and staying busy. Changing sea ice and weather conditions were widely reported to be compromising these protective factors by reducing access to the land, and increasing the danger of land-based activities. This study contributes to existing work on Northern climate change adaptation by identifying factors that enhance youth resilience and, if incorporated into adaptation strategies, may contribute to creating successful and effective adaptation responses. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Social Science [?] Medicine 07/2015; 141:133-141. DOI:10.1016/j.socscimed.2015.07.017 · 2.89 Impact Factor
  • Source
    • "To be explicit, inequalities in health status are typically the result of societal inequalities (Marmot 2005). Determinants of socioeconomic status are multi factorial: ethnicity, sexual orientation, disability, geographical location, poor nutrition, relatively lower income, poorer economic and education opportunities, poorer housing conditions, access to social support, and greater exposure to environmental risks have all been cited (Adler and Rehkopf 2008, Fiscella et al 2000, King et al 2009). Nevertheless, limitations in accessing health care services do contribute to health inequality (Lurie and Dubowitz 2007) and in New Zealand there are access discrepancies between groups at primary and secondary levels of care (Baxter 2002, Westbrooke et al 2001). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Barriers to accessing health services in New Zealand may manifest in inequalities. This study explored barriers and facilitators to accessing a District Health Board funded musculoskeletal physiotherapy outpatient service situated in two different geographical locations. Participants were purposely and then systematically selected from attendance records, were aged 18 years and older, had failed to attend one or more physiotherapy musculoskeletal outpatient sessions at either location, and lived in a geographical area considered high deprivation. Semi-structured interviews were audio-recorded, transcribed, and analysed using the General Inductive Approach. Seventeen participants with diverse ethnic backgrounds aged between 22 and 67 years were recruited. Four barriers ('Placing value on the unknown', 'Divergent health beliefs', 'Appropriateness of physiotherapy', 'Waiting times') and three facilitators ('Convenience', 'Privacy', 'Physiotherapy works') were identified. No barrier was identified as being more problematic at either clinic site. Participants believed physiotherapy was beneficial. However, uncertainty regarding the aims of physiotherapy affected participants' ability to value its worth and affected attendance. Convenience of location influenced attendance of people living in a high deprivation area.
Show more