Indigenous peoples' access to health services in Cuiabá, Mato Grosso State, Brazil

Understanding Indigenous people’s experiences of acute health care with a focus on heart health

Ian Anderson: transforming Indigenous medicine and education

This paper focuses on a series of cookbooks published by Indigenous Australian groups. These cookbooks are typically produced with government funding, and are developed by nutritionists, dieticians, and health workers in consultation with local communities. They are designed to teach Indigenous Australians to cook healthy, nutritious, low-cost meals. In this paper, Fredericks and Anderson identify the value of these cookbooks as low-cost, public health interventions. However, they note that their value as health interventions has not been tested. Fredericks and Anderson question the value of these cookbooks within the broader context of the health disadvantage faced by Indigenous Australians. They argue that the cookbooks are developed from a Western perspective of health and nutrition that fails to recognise the value of traditional Indigenous foodways. They suggest that incorporating more Indigenous food knowledge and food-related traditions into cookbooks may be one way of improving health among Indigenous peoples and revitalising Indigenous knowledge.

Sharing the challenge of cancer control for Indigenous Australians: a national agenda.

Review question/objective The objective of this review is to analyse and synthesise the best available evidence on the experiences of Indigenous people who engage in health care encounters in Western settings and contexts. The review question is: What are the experiences of Indigenous people engaged in health care encounters in Western settings and contexts? Inclusion Criteria Types of Participants Studies including two groups of participants, regardless of age or gender, will be considered for this systematic review. The first group is persons of Indigenous descent from the following countries and continents appearing most frequently in the literature: North America, South America, New Zealand, Australia, and Scandinavian countries. These countries include peoples such as First Nations, Native Americans, Metis, Inuit, North American Indians, South American Indians, Inca, Maori, Aboriginal and Torres Strait Islander peoples of Australia, and Sapmi. This list is not exhaustive, and any Indigenous population identified in a study will be included. Indigenous populations who immigrate to new countries will be excluded, given that immigrant status can confound Indigenous status. The second group of participants to be considered for inclusion is health care providers who work in Western settings and context, including, but not limited to, nurses, physicians, nutritionists, midwives, social workers, physiotherapists, occupational therapists, speech and language therapists, and respirologists. Phenomena of Interest The phenomenon of interest is the experience of Indigenous people in health care encounters in Western health care settings and context. Health care encounters refer to any interactions between an Indigenous person and a health care provider within the scope of Western health care services. All reasons for health encounters will be considered. Context The context will be Indigenous persons seeking health care services in Western settings and context. These services may be located within urban, rural, or remote health care settings where Western health care services are delivered.

Summary: Indigenous people across the world experience more health related problems as compared to the population at large. So, this review article is broadly an attempt to highlight the important factors for indigenous peoples' health problems, and to recommend some suggestions to improve their health status. Standard database for instance, Pubmed, Medline, Google scholar, and Google book searches have been used to get the sources. Different key words, for example, indigenous people and health, socio-economic and cultural factors of indigenous health, history of indigenous peoples' health, Australian indigenous peoples' health, Latin American indigenous peoples' health, Canadian indigenous peoples' health, South Asian indigenous peoples' health, African indigenous peoples' health, and so on, have been used to find the articles and books. This review paper shows that along with commonplace factors, indigenous peoples' health is affected by some distinctive factors such as indigeneity, colonial and post-colonial experience, rurality, lack of governments' recognition etc., which non- indigenous people face to a much lesser degree. In addition, indigenous peoples around the world experience various health problems due to their varied socio-economic and cultural contexts. Finally, this paper recommends that the spiritual, physical, mental, emotional, cultural, economic, socio-cultural and environmental factors should be incorporated into the indigenous health agenda to improve their health status.

The influence of Identity, Roles and Expectations on Indigenous students studying at university which impacts on building the Indigenous health workforce

The dichotomy of commissioning Indigenous health and wellbeing program evaluations: What the Funder wants vs what the Community needs.

ObjectivesOur Health Counts (OHC) methods are designed to address gaps in urban-based Indigenous health information. In partnership with local Indigenous health service providers, we have successfully implemented OHC in six Ontario cities. The aim of this study is to summarize findings regarding Indigenous population undercount, health inequities, and health service access barriers across study sites.MethodsWe estimated Indigenous population size using OHC census participation survey responses and a multiplier approach. Health inequities between Indigenous populations and overall populations in each city were examined using respondent-driven sampling (RDS), adjusted OHC survey results, and existing public data. Measures included health status outcomes; determinants of health; barriers to health service access, including discrimination by health service providers; and unmet health needs.ResultsIndigenous social networks were strong and extensive, and the urban populations demonstrate resilience and cultural continuity across multiple measures. Self-reported rates of census participation for Indigenous populations were markedly lower than those for the general population in each city, and OHC Indigenous population size estimates were consistently 2‒4 times higher than reported in the census. Indigenous to general population health inequities cut across measures of chronic disease, determinants of health, and unmet health needs. Indigenous populations experienced multiple barriers to health services access, including racial discrimination by health service providers.ConclusionThe Canadian census appears to markedly underestimate Indigenous population size in urban areas. Indigenous health inequities and service access barriers are striking and cross-cutting. Timely adaptation of health policies, services, and funding allocations in response to these findings is recommended.

Given that Indigenous populations globally are impacted by similar colonial global legacies, their health and other disaprities are usually worse than non-indigenous people. Indigenous peoples of Australia have been seriously impacted by colonial legacies and as a result, their health has negatively been affected. If Indigenous health and wellbeing are to be promoted within the existing Australian health services, a clear understanding of what preventive health means for Indigenous peoples is needed. The aim of this scoping review was to explore the available literature on the uptake/engagement in health assessments or health checks by Indigenous Australian peoples and to determine the enablers and barriers and of health assessment/check uptake/engagement. Specifically, we aimed to: investigate the available evidence reporting the uptake/engagement of health checks/assessments for Australian Indigenous; assess the quality of the available evidence on indigenous health checks/assessments; and identify the enablers or barriers affecting Indigenous persons’ engagement and access to health assessment/health checks. A systematic search of online databases (such as Cinhl, Scopus, ProQuest health and medicine, PubMed, informit, google scholar and google) identified 10 eligible publications on Indigenous preventive health assessments. Reflexive thematic analysis identified three major themes on preventive health assessments: (1) uptake/engagement; (2) benefits and limitations; and (3) enablers and barriers. Findings revealed that Indigenous peoples’ uptake and/or engagement in health assessments/check is a holistic concept varied by cultural factors, gender identity, geographical locations (living in regional and remote areas), and Indigenous clinical leadership/staff’s motivational capacity. Overall, the results indicate that there has been improving rates of uptake of health assessments by some sections of Indigenous communities. However, there is clearly room for improvement, both for aboriginal men and women and those living in regional and remote areas. In addition, barriers to uptake of health asessments were identified as length of time required for the assessment, intrusive or sensitive questions and shame, and lack of access to health services for some. Indigenous clinical leadership is needed to improve services and encourage Indigenous people to participate in routine health assessments.

Health care in remote Australian Indigenous communities

There are two factors which will be absolutely critical if we are to truly make progress in improving Indigenous health. They are, in my view, the most important steps we can take to closing the gap between Indigenous and non-Indigenous health indicators, and our success or otherwise in achieving these two things will ultimately determine how we will be judged by future generations.The fi rst is increasing the number of Indigenous health professionals, but particularly nurses and midwives.Primary health care is the backbone of the health system and nurses and midwives are major contributors to primary health care. Indigenous health professionals are clearly best placed to provide high quality primary care to Indigenous people. They have the expertise and experience in Indigenous health issues as well as deep understanding of cultural, spiritual and community needs.The second most important way we can improve health outcomes for Indigenous people is to increase our understanding of how health care needs are best interpreted and met for each Indigenous person seeking health care.To turn to the fi rst point, we have a daunting task. Indigenous nurses constitute 0.8% of all nurses in Australia, while Indigenous Australians make up 2.4% of the population. To make these numbers 'even', we should ideally aim to triple the number of Indigenous nurses and midwives.While our job may be daunting it is not impossible. Our medical colleagues are proving it can be done. Between 1997 and 2010, Indigenous doctor numbers have increased from 15 to approximately 150 - a 1000% increase!There are many ways we can work together to raise the numbers of Indigenous nurses and midwives, but generally speaking these involve policy and structural changes which need to be implemented at least initially at the level of the system.My second point involving the interpretation of individual health needs is one which can be addressed locally at the health service level and by every one of us.At the outset I should note that I am referring to regional and urban centres as well as rural and remote communities given that only 25% of Indigenous Australians live remotely. Sydneybased Professor Behrendt (2011) reminds us:I am often asked, 'How often do you visit Aboriginal communities?' And I reply, 'Every day, when I go home'.le are correct when they say that government and other leaders need to take responsibility to close the gap. They absolutely do. But I believe that if we are to truly make a difference then it's up to each and every one of us as health professionals to take responsibility to do what we can.Taking responsibility is essential because the 'gap', while deplorable, is only the surface of the story. It is symptom, if you like, of much deeper disorder.We know that the difference in health indicators between Indigenous and non-Indigenous people refl ects profound and long-standing issues, and we must always remember that any measures which address the gap must take into account broader cultural and social factors. Professor Behrendt (2009) again:... this is not just a simple matter of 'closing the gap', as the popular political catch-phrase describes it. Equality, I would argue, is not simply matching the socioeconomic statistics and giving Aboriginal people and their children the same opportunities, it also includes ensuring that the space is given to ensure that Aboriginal culture and Aboriginal communities remain vibrant and strong and that Aboriginal identity and history is given space in Australia's national story. …

Marlene Kong: one of Australia's few Indigenous doctors

Dear Editor, We want to manifest our concern about a recent original article published in your journal that cited one of our articles. Gabriela Minaya and Joel Roque have included our work about indigenous people and sexually transmitted infections (STIs) in the Peruvian Amazon (Zavaleta et al. 2007a) in their discussion about “Ethical problems in health research with Indigenous or originary peoples in Peru”(Minaya and Roque 2015). We have detected a number of serious discrepancies between their affirmations regarding what we did vs. what we have published in 2007. Minaya and Roque questioned if we provided education and treatment for our participants. In the introduction of the paper, we explain that the Ministry of Health (MoH) workers participated in this research and the MoH and Chayahuita community leaders approved of our study, which originally was motivated by the deep concern of a local Indigenous health promoter about an increasing number of fevers that were potentially STI associated. Once in the community, all procedures were realized in accordance with existing MoH guidelines, which included treatment for syphilis and individual pre- and post-test counselling for HIV. With the knowledge of the HIV positive results, as Peruvian health researchers and workers, we felt very concerned that highly active antiretroviral therapy was not available to this remote region, given the absence of appropriate facilities and staff for the frequent monitoring required. At that time, HAART was not being fully implemented in Peru, and it was only introduced around 2005, but only at tertiary hospitals with infectologists. Given that the local health personnel was aware of the lack of treatment availability for HIV, they prioritized preventive education for this ethnic group. Precisely because of this lack of treatment, the counselling process and a better understanding about the extension of the epidemics was critical as a public health strategy. Indeed, following our work, multiple initiatives have been undertaken to quantify the prevalence of STI, clarify their risk factors (Alva and Orellana 2012; Bartlett et al. 2008; Zavaleta et al. 2008; Ormaeche et al. 2012) and design an intercultural preventive strategy lead by the national Indigenous health authority (Zavaleta et al. 2007b). Although we agree that more work should be done to provide effective HIV treatment for remote Indigenous populations, our work has provided as much education and promoted access to health care. Minaya and Roque also implied that our findings serve to stigmatize the population studied. We do not consider that the attribution of AIDS dissemination to “absence of use of condoms, homosexual behaviour, early initiation of sexual relations and polygamy”, as we mentioned in our paper, promotes stigmatization. On the contrary, we believe that the recognition, knowledge and respectful understanding of multiple cultures are key to initiate effective preventive measures on the ground. We believe that the increase of information about Indigenous culture including acceptable sexual practices and traditional social institutions such as polygamy, rather than serving to stigmatize these populations, is a way to increase the voice of underrepresented people to create more cultural adapted health policies in our Peruvian society. Lastly, the authors wrote that our study results were generalized to the all Indigenous People of the region. We presented our results specifically for the community studied, although we made recommendations to take actions for preventing STIs among the Indigenous People living in the Amazon. We do not consider that extrapolating our preventive recommendations to more Indigenous People located in the Amazon was wrong. We felt that a strong call for attention was needed to mobilize the national and international public health community since the level of STIs was extremely high in a location with virtually absent health resources. Our work was instrumental in mobilizing local health authorities, international agencies and other groups to work towards stopping the spread of HIV among Chayahuita and other Amazon remote Indigenous People. Instead of visualizing our publication as an ‘ethical problem’, the complete description of our work proves an example of how health researchers in Peru are doing investigations by prioritizing Indigenous health concerns, adapting western methods and ethical approaches to work in a respectful manner with Amazon Indigenous People and to contribute with culturally appropriate public health initiatives for historically excluded minorities. The publication was an initial report and did not include all of our subsequent work in Indigenous health. Perhaps, if the work had ended with the content of the original report, we would be in agreement with some of the criticism; nonetheless, we consider the interpretation of our work to be inaccurate and believe that the context is important to tell the full story of our investigation.

This issue of Contemporary Nurse provides a powerful forum for Indigenous and non- Indigenous nurses to refl ect on nursing's commitment to advancing knowledge of Indigenous health. As a second edition of Advances in Indigenous Health Care (ISBN 978-1-921348- 89-1) it is an opportunity to extend the dialogue of the fi rst edition and ensure that we share what has been learned as the impetus for further understanding. My comments on Indigenous health issues are offered here from the standpoint of a non-Indigenous nurse, and my frame of reference is the social justice agenda of primary health care and nursing. At the heart of this agenda is equity. As a society, our failure to create equitable conditions within which Indigenous people can live healthy lives is a tragedy. It is also a source of professional and personal distress to nurses everywhere. The inequities embedded in Indigenous lives live in our collective conscience as moral obligations, and few nurses take this responsibility lightly. The challenges and frustrations of trying to promote equitable conditions for Indigenous people are experienced daily, especially by nurses in rural and remote areas. For others it is a subconscious dilemma, never far from the surface, creating a disquiet that leaves us to ponder how we can transcend the past and move towards a fairer future. The issues that have impeded our work with Indigenous communities are complex, yet they warrant close and ongoing perusal.One of the major problems in working towards Indigenous health is the way problems are framed. Current government policy rhetoric revolves around closing the gap in health status and life expectancy between Indigenous and non-Indigenous people. This is based on an assumption that there are deliberate health interventions that can equalise health status and life expectancy. Measuring the gap is problematic in itself. In 2008 the gap was declared to be 11 years, a reduction from the previous fi gure of 17 years. Even the statisticians from the Australian Bureau of Statistics (ABS) acknowledge that this may be an artefact of a radical change in the calculation methods rather than any real reduction (Hudson, 2009). Placing the focus on the 'gap' is as distracting as concentrating on the emissions trading scheme (ETS) in the climate change debate, rather than attending to population policy, the availability and distribution of fresh water, alternative sources of energy and how best to ensure food security (National Rural Health Alliance, 2009). The 'gap' will only shrink when there is a common commitment to inclusive social policies that work towards redistributing resources and opportunities where they are most needed. These include resources for maternal and child health care, safe, affordable and well- maintained housing, education, food and water, safe communities, and preservation of the environment. Concentrating on 'the gap' and dispatching bureaucrats and untargeted bucket funding to various Indigenous communities may make health authorities feel better, but it does not get the resources or opportunities to where they are most needed (Hudson, 2009). Equity of access can only be achieved where people are empowered to identify their needs, make decisions, and attract respect for their capacity to do so.A more progressive and accountable approach to considering the health challenges faced by Indigenous people is to focus on the source of the disparities. This is also congruent with the principles of primary health care. The WHO's commitment to Indigenous people was re-affi rmed in their 2008 report 'Primary health care: Now more than ever', which reminded health service providers that many Indigenous people continue to be disadvantaged by their remoteness and lack of health services, not their Aboriginality (World Health Organization, 2008). In Australia, Indigenous people are over-represented in the incidence of chronic illness, not only because of the diffi culties of accessing health services but because of the lack of a healthy start to life and exposure to some communicable diseases prevalent in remote communities (Australian Institute for Health and Welfare, 2008). …