Health Of Indigenous Populations Research Articles

Critical epidemiology in action: Research for and by indigenous peoples

Global social justice movements, including transnational activism for indigenous rights, are working to promote health equity by transforming public health research and policy. Yet little social scientific research has examined how professional epidemiologists are figuring within such efforts. Discussions are unfolding, however, in critical sectors of epidemiology about how to improve the profession’s input into advocacy. Findings from a multi-sited ethnographic study of epidemiological research for and by indigenous peoples in three settings (Aotearoa/New Zealand, the continental U.S., and Hawai’i) demonstrate how researchers/practitioners connect epidemiology and advocacy by: (1) linking the better-known legitimacy of quantitative methods to a lesser-known causal framework that positions colonialism as a sociopolitical determinant of health, (2) producing technical critiques that aim to improve the accuracy and accessibility of indigenous population health statistics, and (3) adopting a pragmatic flexibility in response to the shifting political conditions that shape when, whether and how epidemiological findings support advocacy for indigenous health equity. Attending closely to the credibility tactics at hand in this work, and to the skills and sensibilities of its practitioners, charts new directions for future research about epidemiology’s contributions to advocacy for health equity.

Consequences of colonialism: A microbial perspective to contemporary Indigenous health.

Nearly all Indigenous populations today suffer from worse health than their non-Indigenous counterparts, and despite interventions against known factors, this health "gap" has not improved. The human microbiome-the beneficial, diverse microbial communities that live on and within the human body-is a crucial component in developing and maintaining normal physiological health. Disrupting this ecosystem has repercussions for microbial functionality, and thus, human health. In this article, we propose that modern-day Indigenous population health may suffer from disrupted microbial ecosystems as a consequence of historical colonialism. Colonialism may have interrupted the established relationships between the environment, traditional lifeways, and microbiomes, altering the Indigenous microbiome with detrimental health consequences.

Atenção primária à saúde de indígenas sul-americanos: revisão integrativa da literatura

RESUMOObjetivoRevisar a literatura acerca do acesso à atenção primária à saúde (APS) por comunidades indígenas da América do Sul, identificando os principais obstáculos a esse acesso.MétodosRevisão integrativa de artigos publicados de 2007 a 2017 nas bases de dados LILACS, PubMed e SciELO. Para a busca, foram utilizados os descritores “indígenas AND saúde AND Brasil” e “indígenas AND saúde NOT Brasil” nos idiomas português e inglês. Foram incluídos artigos publicados em inglês, português ou espanhol e que abordassem estritamente a APS em indígenas sul-americanos.ResultadosForam incluídos 40 artigos que descreveram aspectos da APS de indígenas em oito países: Brasil, Peru, Colômbia, Bolívia, Argentina, Chile, Paraguai e Equador. Os principais obstáculos de acesso à APS detectados foram a dificuldade de acesso aos serviços de saúde mais próximos das aldeias; linguagem e ilustrações das cartilhas de educação em saúde inapropriadas ao contexto indígena; dificuldade de comunicação com os profissionais de saúde; carência de meios de transporte adequados até as unidades de saúde; escassez de dados epidemiológicos das aldeias indígenas; ausência de informação sobre as culturas indígenas locais; e medo de discriminação ou humilhação por parte do paciente indígena.ConclusõesAinda são escassos os estudos sobre saúde indígena na América do Sul. Também é evidente que os sistemas de saúde nacionais ainda precisam avançar na direção de uma medicina intercultural, de respeito às realidades sociais, culturais e econômicas de todas as comunidades assistidas, com conhecimento e consideração pelas diferentes formas de cuidado.

Caries and periodontal disease in Indigenous adults in Australia: a case of limited and non-contemporary data.

Objective The aim of the present study was to identify all evidence about the prevalence and severity of clinically measured caries and periodontal disease in Indigenous adults in Australia published in peer-reviewed journals and to summarise trends over time. In addition, we examined whether the studies investigated associations between putative risk factors and levels of caries and periodontal disease. Methods PubMed was searched in September 2014, with no date limitations, for published peer-reviewed articles reporting the prevalence rates and/or severity of caries and periodontal disease in Indigenous adults living in Australia. Articles were excluded if measurement was not based on clinical assessment and if oral disease was reported only in a specific or targeted sample, and not the general population. Results The search identified 18 papers (reporting on 10 primary studies) that met the inclusion criteria. The studies published clinical data about dental caries and/or periodontal disease in Australian Indigenous adults. The studies reported on oral health for Indigenous adults living in rural (40%), urban (10%) and both urban and rural (50%) locations. Included studies showed that virtually all Indigenous adults living in rural locations had periodontal disease. The data also showed caries prevalence ranged from 46% to 93%. Although 10 studies were identified, the peer-reviewed literature was extremely limited and no published studies were identified that provided statistics for a significant proportion of Australia (Victoria, Tasmania, Queensland or the Australian Capital Territory). There were also inconsistencies in how the data were reported between studies, making comparisons difficult. Conclusions This review highlights a lack of robust and contemporary data to inform the development of policies and programs to address the disparities in oral health in Indigenous populations living in many parts of Australia. What is known about the topic? Many studies report that Indigenous people in Australia have poorer general health compared with non-Indigenous people. What does this paper add? This paper documents the available caries and periodontal disease prevalence and experience for Indigenous adults in Australia published in peer-reviewed journals. It demonstrates significant limitations in the data, including no data in several large Australian jurisdictions, inconsistency with reporting methods and most data available being for Indigenous adults living in rural locations. Therefore, the oral health data available in the peer-reviewed literature do not reflect the situation of all Indigenous people living in Australia. What are the implications for practitioners? It is important for oral health practitioners to have access to current and relevant statistics on the oral health of Indigenous Australians. However, we have highlighted significant evidence gaps for this population group within the peer-reviewed literature and identified the limitations of the available data upon which decisions are currently being made. This paper also identifies ways to capture and report oral health data in the future to enable more meaningful comparisons and relevance for use in policy development.

SOCIOECONOMIC AND BEHAVIORAL RISK FACTORS OF DISABILITIES AMONG THE INDIGENOUS POPULATION IN THE FAR NORTH

Purpose: to study the socioeconomic and behavioral risk factors of disabilities among indigenous population of Far North and make proposals for their prevention. Methods: The study tested the level of income, employment, education and alcohol consumption on the basis of the survey and analyzed the data of the official statistics. We used Statistica v.12 and IBM SPSS Statistics v.22 for calculating the chi-square, Wilcoxon signed- rank test criteria, T-test for paired samples and made regression and correlation analysis. Results: We did not discover significant differences in income levels, unemployment and alcohol consumption in the cohort study (2001-2010) of indigenous population in Chukotka Autonomous Region. In addition, the income of the natives is still low, unemployment and alcohol consumption are high. There is a correlation between the socioeconomic and behavioral factors and health indicators. We also propose a mathematical model which allows to suggest that the level of income above the subsistence level in 6-7 times is sufficient to minimize the impact of socioeconomic factors on population health. Conclusion: In order to prevent irreversible process of indigenous population health deterioration and society degradation it is necessary to create the accessible vocational education, increase employment and number of leisure centers. These measures will lead to income growth, increase in life expectancy and infant mortality decrease.

Research and the health of indigenous populations in low- and middle-income countries

In low- and middle-income countries (LMICs)-when there are available data-a 'health divide' exists between indigenous and non-indigenous populations living in the same society. Despite the limited available evidence suggesting that indigenous populations have high levels of health needs, there is scant research on indigenous health, especially in Africa, China and South Asia. Pursuing research, however, is clouded by the prior negative experiences that indigenous populations have had with researchers. In this paper, we describe the current evidence base on indigenous health in LMICs, propose practical strategies for undertaking future research, and conclude by describing how global health researchers can contribute to improving the health of indigenous populations.

Enablers and barriers to the implementation of primary health care interventions for Indigenous people with chronic diseases: a systematic review.

BackgroundAccess to appropriate, affordable, acceptable and comprehensive primary health care (PHC) is critical for improving the health of Indigenous populations. Whilst appropriate infrastructure, sufficient funding and knowledgeable health care professionals are crucial, these elements alone will not lead to the provision of appropriate care for all Indigenous people. This systematic literature review synthesised international evidence on the factors that enable or inhibit the implementation of interventions aimed at improving chronic disease care for Indigenous people.MethodsA systematic review using Medical Literature Analysis and Retrieval System Online (MEDLINE) (PubMed platform), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Excerpta Medica Database (EMBASE), ATSIHealth, Australian Indigenous HealthInfoNet via Informit Online and Primary Health Care Research and Information Service (PHCRIS) databases was undertaken. Studies were included if they described an intervention for one or more of six chronic conditions that was delivered in a primary health care setting in Australia, New Zealand, Canada or the United States. Attitudes, beliefs, expectations, understandings and knowledge of patients, their families, Indigenous communities, providers and policy makers were of interest. Published and unpublished qualitative and quantitative studies from 1998 to 2013 were considered. Qualitative findings were pooled using a meta-aggregative approach, and quantitative data were presented as a narrative summary.ResultsTwenty three studies were included. Meta-aggregation of qualitative data revealed five synthesised findings, related to issues within the design and planning phase of interventions, the chronic disease workforce, partnerships between service providers and patients, clinical care pathways and patient access to services. The available quantitative data supported the qualitative findings. Three key features of enablers and barriers emerged from the findings: (1) they are not fixed concepts but can be positively or negatively influenced, (2) the degree to which the work of an intervention can influence an enabler or barrier varies depending on their source and (3) they are inter-related whereby a change in one may effect a change in another.ConclusionsFuture interventions should consider the findings of this review as it provides an evidence-base that contributes to the successful design, implementation and sustainability of chronic disease interventions in primary health care settings intended for Indigenous people.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0261-x) contains supplementary material, which is available to authorized users.

Lessons learned in developing community mental health care in Australasia and the South Pacific

This paper summarizes the findings for the Australasia and Pacific Region of the WPA Task Force on Steps, Obstacles and Mistakes to Avoid in the Implementation of Community Mental Health Care. We present an overview of mental health services in the region; discuss policies, plans and programmes; chart progress towards achieving community-oriented services, and detail the lessons learned.

Socioeconomic disparities in physical health among Aboriginal and Torres Strait Islander children in Western Australia

Objective. Few empirical studies have specifically examined the relationship between socio-economic status (SES) and health in Indigenous populations of Australia. We sought to provide insights into the nature of this relationship by examining socio-economic disparities in physical health outcomes among Aboriginal and Torres Strait Islander children in Western Australia. Design. We used a diverse set of health and SES indicators from a representative survey conducted in 2000–2002 on the health and development of 5289 Indigenous children aged 0–17 years in Western Australia. Analysis was conducted using multivariate logistic regression within a multilevel framework. Results. After controlling for age and sex, we found statistically significant socio-economic disparities in health in almost half of the associations that were investigated, although the direction, shape and magnitude of associations differed. For ear infections, recurring chest infections and sensory function problems, the patterns were generally consistent with a positive socio-economic gradient – where better health was associated with higher SES. The reverse pattern was found for asthma, accidents and injuries, and oral health problems, although this was primarily observed for area-level SES indicators. Conclusion. Conventional notions of social position and class have some influence on the physical health of Indigenous children, although the diversity of results implies that there are other ways of conceptualising and measuring SES that are important for Indigenous populations. We need to consider factors that relate specifically to Indigenous circumstances and culture in the past and present day, and give more thought to how we measure social position in the Indigenous community, to gain a better understanding of the pathways from SES to Indigenous child health.

PROBLEMAS BIOÉTICOS DE LA INVESTIGACIÓN BIOMÉDICA CON PUEBLOS INDÍGENAS DE CHILE

In Chile there are diverse governmental and social instances to work with the health of indigenous populations and there has been fruitful outcome; nevertheless, some health care access and coverage inequities persist in these populations. Biomedical research effort carried out with aboriginal populations in our country is hidden, what threatens many times the genetic patrimony of these communities. This text would like to build a bridge between medical anthropology, public health and bioethics. Considering the state of the art in the issue, we propose some elemental work axis on the issue, which serves as basis to get a place within bioethics endeavors at Chile, with the goal of contributing to a process both necessary and urgent: the formulation of a public health culturally aware.

Cognitive health in indigenous peoples

Indigenous peoples are self-identified, culturally distinct groups of individuals that inhabited a territory prior to colonization and formation of current states. There are an estimated 5,000 groups of indigenous people in more than 70 countries, with an estimated population of 370 million, about 6% of the world’s population.1 The health of indigenous populations suffered greatly following colonial expansion by Western European powers in the 15th century. Life expectancy improved over the past century and diseases common in the relatively older majority populations such as heart disease and cancer have become increasingly prevalent.2 Dementia is the most common age-related neurologic condition. With the exception of the indigenous Chamorro on Guam, whose peculiar dementia syndrome has been well studied,3,4 little information is available regarding dementia among indigenous peoples elsewhere. There are almost half a million indigenous Australians (about 2.5% of the population). Compared to the majority population, life expectancy is more than 15 years lower, infant mortality is three times higher, and income is barely half. …

Measuring emotional and social wellbeing in Aboriginal and Torres Strait Islander populations: an analysis of a Negative Life Events Scale

Aboriginal and Torres Strait Islander Australians experience widespread socioeconomic disadvantage and health inequality. In an attempt to make Indigenous health research more culturally-appropriate, Aboriginal and Torres Strait Islander Australians have called for more attention to the concept of emotional and social wellbeing (ESWB). Although it has been widely recognised that ESWB is of crucial importance to the health of Aboriginal and Torres Strait Islander peoples, there is little consensus on how to measure in Indigenous populations, hampering efforts to better understand and improve the psychosocial determinants of health. This paper explores the policy and political context to this situation, and suggests ways to move forward. The second part of the paper explores how scales can be evaluated in a health research setting, including assessments of endorsement, discrimination, internal and external reliability.We then evaluate the use of a measure of stressful life events, the Negative Life Events Scale (NLES), in two samples of Aboriginal people living in remote communities in the Northern Territory of Australia. We argue that the Negative Life Events Scale is a promising assessment of psychosocial wellbeing in Aboriginal and Torres Strait Islander populations. Evaluation of the scale and its performance in other samples of Aboriginal and Torres Strait Islander populations is imperative if we hope to develop better, rather than more, scales for measuring ESWB among Indigenous Australians. Only then will it be possible to establish standardized methods of measuring ESWB and develop a body of comparable literature that can guide both a better understanding of ESWB, and evaluation of interventions designed to improve the psychosocial health of Indigenous populations and decrease health inequalities.

Psychiatric Disorders among the Mapuche in Chile

The Mapuche are the largest indigenous group in Chile; yet almost all data on the mental health of indigenous populations are from North America. The study examines the differential DSM-III-R prevalence rates of psychiatric disorders and service utilization among indigenous and non-indigenous community residence. The Composite International Diagnostic Interview (CIDI) was administered to a stratified random sample of 75 Mapuche and 434 non-Mapuche residents of the province of Cautín. Lifetime prevalence and 12-month prevalence rates were estimated. Approximately 28.4% of the Mapuche population had a lifetime, and 15.7% a 12-month, prevalent psychiatric disorder compared to 38.0% and 25.7%, respectively, of the non-Mapuche. Few significant differences were noted between the two groups; however, generalized anxiety disorder, simple phobia, and drug dependence were less prevalent among the Mapuche. Service utilization among the Mapuche with mental illness was low. This is a preliminary study based on a small sample size. Further research on the mental health of indigenous populations of South America is needed.

Bridging the Information Gap: IT and Health in Indigenous Populations

Objective: A proof of concept evaluation of the use of touch-screen technology to address specific health issues in Indigenous settings and exploration of potential relevance to Indigenous mental health.Methods: Quantitative and qualitative approaches were utilised to evaluate two touchscreen units with sound located in Indigenous settings (one clinical and the other a Centrelink office) with content on two topics-diabetes and musculoskeletal problems. Quantitative information included trace analysis and on-screen questionnaires. Qualitative information included individual and group interviews, and observation over a period of 10 months.Results: Use was consistent over time. Subject areas were equally accessed with most users entering only one area per session. Mean session time was five minutes and clinical setting users were more likely to answer on-screen questions. The majority considered use ‘easy’ with the proportion indicating use‘very hard’ increasing with age. Across both sites, women's health, c...

The Return of the Native

The Return of the Native

Ways of Seeing: Changing Directions in the Health of Indigenous Populations

Nearly a decade ago (1988) Australians celebrated the bicentennial of British settlement in New South Wales. Indigenous Australians, despite their small numbers, were prominent at that time - not, however, in celebration, but protest. Rather than joining the self-congratulatory activities of the mainstream, they drew attention to the continuing disadvantage of indigenous populations, bleakly emphasized at that time by the emerging findings of the Royal Commission into Aboriginal Deaths in Custody (1991). That report documented profound social disadvantage and its physical and emotional consequences. Few of those findings were new then and, sadly, little has changed since. Australians are now trying to digest the findings of another major investigation, the Human Rights and Equal Opportunity Commission's National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from Their Families (1997). Perhaps the cumulative weight of reports and recommendations will ultimately tell. In this article changing non-indigenous constructions of Aboriginal Australians over the last half-century and the volatile contemporary political arena are explored. Using the concept of social capital, the consequences of colonization for indigenous societies is explored. The implications of this analysis for a public health approach to addressing problems of indigenous social and emotional well-being in Australia are presented, with reflection on the roles of mental health clinicians.

Primary Health Care initiatives in colonial Kenya

Most contemporary development practitioners have only passing familiarity with development strategies employed by their predecessors, especially for programs that occurred during colonial periods. An examination of the colonial medical system of Kenya reveals that many of the strategies now employed in Primary Health Care programs were preceded by comparable programs administered by the colonial medical authorities. The colonial system did not include universal or egalitarian access to health care, nor were the programs ever adequate to remedy many of the major threats to health, but the lessons derived from a careful review of this period validate the appropriateness of many Primary Health Care approaches now promoted. In particular, the emphasis on decentralized, preventive medical services, the use of comprehensive immunization programs, concerted efforts at improvements in sanitation, and promotion of health education were important components of the colonial medical services, that effected positive changes in the health of indigenous populations. Examination of specific colonial programs should inform contemporary Primary Health Care policies.

The Idea of Indigenous People

Malgre les nombreux changements de la pratique anthropologique depuis une cinquantaine d'annees, notamment une amplitude des objets de recherche, les societes dites traditionnelles, primitives, orales, simples font toujours l'objet de l'interet privilegie des ethnologues. Si la terminologie utilisee pour designer ces societes a ete modifiee au cours du temps (afin de s'eloigner, entre autres, des theories evolutionnistes), les definitions restent encore imprecises, en particulier celle de tribu. L'expression peuple autochtone, utilisee depuis peu, laisse apparaitre une idee de morale et d'ethique mais ne peut s'appliquer qu'a des contextes particuliers, a l'instar de la notion de tribu, et peut alimenter des ideologies diverses qui pronent les liens du sang et de la terre et pour lesquelles les ethnologues ne mesurent peut-etre pas les utuilisations ambivalentes.