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.

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    • "Across the world, indigenous people bear the burden of ill health (Casas et al. 2001; Montenegro and Stephens 2006). Indigenous health is characterized by stark inequities 1 between the indigenous and non-indigenous population that are the result of socioeconomic factors combined with historical and culturally specific factors (King et al. 2009). Ecuador is no exception. "
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    ABSTRACT: Maternal mortality continues to claim the lives of thousands of women in Latin America despite the availability of effective treatments to avert maternal death. In the past, efforts to acknowledge cultural diversity in birth practices had not been clearly integrated into policy. However, in Otavalo (Ecuador) a local hospital pioneered the implementation of the 'Vertical Birth'-a practical manifestation of an intercultural health policy aimed at increasing indigenous women's access to maternity care. Drawing on agenda-setting theory, this qualitative research explores how the vertical birth practice made it onto the local policy agenda and the processes that allowed actors to seize a window of opportunity allowing the vertical birth practice to emerge. Our results show that the processes that brought about the vertical birth practice took place over a prolonged period of time and resulted from the interplay between various factors. Firstly, a maternal health policy community involving indigenous actors played a key role in identifying maternal mortality as a policy problem, defining its causes and framing it as an indigenous rights issue. Secondly, previous initiatives to address maternal mortality provided a wealth of experience that gave these actors the knowledge and experience to formulate a feasible policy solution and consolidate support from powerful actors. Thirdly, the election of a new government that had incorporated the demands of the indigenous movement opened up a window of opportunity to push intercultural health policies such as the vertical birth. We conclude that the socioeconomic and political changes at both national and local level allowed the meaningful participation of indigenous actors that made a critical contribution to the emergence of the vertical birth practice. These findings can help us advance our knowledge of strategies to set the agenda for intercultural maternal health policy and inform future policy in similar settings. Our results also show that Kingdon's model was useful in explaining how the VB practice emerged but also that it needs modifications when applied to low and middle income countries.
    Full-text · Article · Jan 2016 · Health Policy and Planning
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    • "So, what can history teach us about where social change comes from? Indigenous populations such as the New Zealand Maori suffered serious negative consequences of colonization, the ramifications of which continue today (King et al. 2009). However, for colonizing, predominantly European populations in countries like Canada, the United States, Australia, and New Zealand, colonization appears to be an example, based on the thesis of Gelfand et al. (2011), of looser norms resulting in countries with more resources. "
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    ABSTRACT: The long-standing debate in public health and the wider society concerning the implications of structure and agency for health and well-being generally concludes that structure powerfully influences agency, and does so unequally, exacerbating social and health inequities. In this article, we review this debate in the context of increasing environmental degradation and resource depletion. As the global population rises and environmental resources per person shrink, conflicts over the underlying factors contributing to human health and well-being may intensify. A likely result of nearing limits is a further constraint of agency, for both rich and poor, and greater social and health inequities, including gender inequities.
    Full-text · Article · Sep 2015 · International Journal of Feminist Approaches to Bioethics
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    • "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). "

    Full-text · Dataset · Jul 2015
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