Indigenous Health Inequalities Research Articles

Stakeholder perceptions of policy implementation for Indigenous health and cultural safety: A study of Australia's ‘Closing the Gap’ policies

AbstractIndigenous peoples in Australia and similar colonised countries are subject to racism and systemic socioeconomic disadvantages, resulting in worse health outcomes compared to non‐Indigenous counterparts. Such inequities persist despite governments’ attempts to reduce them. Since 2008, Australian governments have committed to a national ‘Closing the Gap’ (CTG) to reduce inequities in health, education, and employment outcomes between Aboriginal and Torres Strait Islander peoples and other Australians, but with limited success. We applied policy theory and a cultural safety framework developed for the research to analyse stakeholder perceptions of CTG policy implementation between 2008 and 2019. We identified policy‐shaping ideas and policy incoherence in the environment surrounding CTG policy that obstructed culturally safe policy. Top‐down, prescriptive modes of implementation were also a barrier. However, Indigenous‐led policy partnerships and community‐controlled services in the health sector have met principles of cultural safety. Identifying these strengths and weaknesses points to ways in which implementation of CTG policies can be improved to achieve cultural safety and reduce Indigenous health inequities. These results may hold lessons for similar countries such as the United States, New Zealand, and Canada.

Indigenous peoples' positive experiences of culturally safe health care: a qualitative systematic review protocol.

The purpose of this systematic review is to explore what is known about Indigenous peoples' positive experiences with culturally safe health care. Research indicates that Indigenous people often experience stigma and discrimination from non-Indigenous health care providers when accessing health care services. One approach that has been put forward to address Indigenous health inequities is cultural safety. Studies have been conducted to identify what comprises culturally safe care for Indigenous people, however, many of these studies target the health care provider's perspective, rather than the perspective of the Indigenous person who is receiving the care. This review will consider studies that involve Indigenous peoples' positive experiences with culturally safe health care from any study setting. Studies that present relevant qualitative findings including descriptions, examples, or stories about how a health care provider enacted cultural safety from Indigenous perspectives will be considered. MEDLINE, CINAHL, Embase, PsycINFO, First Nations Periodical Index, the Native Health Database, the Indigenous Studies Portal, and the Arctic and Antarctic Regions Database will be searched for published studies. The search for unpublished studies will include Google and Google Scholar, ProQuest Dissertations and Theses, and OpenGrey. Databases will be searched from 1988 onward and only studies published in English will be included. The JBI systematic review guidelines will be followed. The JBI process of meta-aggregation will be used to identify categories and synthesize findings. The ConQual approach will be used to assess confidence in the review findings. PROSPERO CRD42020173003.

Neoliberalism and Indigenous oral health inequalities: a global perspective.

Neoliberalism is the dominant ideology underpinning the operation of many governments. Its tenets include policies of economic liberalization such as privatization, deregulation, free trade and reduced public expenditures on infrastructure and social services. Champions of neoliberalism claim that expansion of global trade has rescued millions from abject poverty and that direct foreign investment successfully transfers technology to developing economies. However, critics have urged governments to pay greater attention to how neoliberalism shapes population health. Indigenous populations experience inequalities in ways that are unique and distinct from the experiences of other marginalised groups. This is largely due to colonial influences that have resulted in sustained loss of lands, identity, languages and the control to live life in a traditional, cultural way that is meaningful. Oral health is simultaneously a reflection of material circumstances, structural inequities and access to health services. Indigenous populations carry a disproportionate burden of oral health inequalities at a global level. In this commentary, we contend that neoliberalism has overwhelmingly contributed to these inequities in three ways: (1) increased dominance of transnational corporations; (2) privatization of health and; (3) the neoliberal emphasis on personal responsibility.

How Neoliberalism Shapes Indigenous Oral Health Inequalities Globally: Examples from Five Countries.

Evidence suggests that countries with neoliberal political and economic philosophical underpinnings have greater health inequalities compared to less neoliberal countries. But few studies examine how neoliberalism specifically impacts health inequalities involving highly vulnerable populations, such as Indigenous groups. Even fewer take this perspective from an oral health viewpoint. From a lens of indigenous groups in five countries (the United States, Canada, Australia, Aotearoa/New Zealand and Norway), this commentary provides critical insights of how neoliberalism, in domains including colonialism, racism, inter-generational trauma and health service provision, shapes oral health inequalities among Indigenous societies at a global level. We posit that all socially marginalised groups are disadvantaged under neoliberalism agendas, but that this is amplified among Indigenous groups because of ongoing legacies of colonialism, institutional racism and intergenerational trauma.

Transforming a global order in New Zealand to reduce health inequities in service provision

Abstract St John has been providing service in New Zealand for nearly 140 years since its arrival. It has now close to 4000 staff and nearly 20000 Members and over 8500 volunteers. In New Zealand the major work of St John is its Ambulance service providing front line first responders to crash, medical emergency and other life-threatening situations. St John New Zealand also provides a number of 'Community Health' initiatives focused on strengthening communities and prevention. In recent years St John has recognised that they have not engaged well with Indigenous communities and that their organisation in New Zealand must become skilled and relevant in addressing the needs of the Indigenous people of New Zealand, as they suffer the greater burden of disease and illness than any other population in the country. St John NZ Community and Health Services are embarking on a process of transformation through re-orienting its culture and practice by adopting Public Health approaches and an equity lens over all its programmes. They also have committed to understanding and using Indigenous knowledge to support this re-orientation to most effectively engage and implement programmes that will reduce Indigenous health inequities. This presentation will describe the process by which they will be implementing their strategy for change and highlight best practice for working with Indigenous communities. Key messages Indigenous Knowledge is key to addressing Indigenous Health inequities. Mainstream Public Health can learn from Indigenous Public Health approaches.

Indigenous engagement in health: lessons from Brazil, Chile, Australia and New Zealand

BackgroundGiven the persistence of Indigenous health inequities across national contexts, many countries have adopted strategies to improve the health of Indigenous peoples. Governmental recognition of the unique health needs of Indigenous populations is necessary for the development of targeted programs and policies to achieve universal health coverage. At the same time, the participation of Indigenous peoples in decision-making and program and policy design helps to ensure that barriers to health services are appropriately addressed and promotes the rights of Indigenous peoples to self-determination.Due to similar patterns of Indigenous health and health determinants across borders, there have been calls for greater global collaboration in this field. However, most international studies on Indigenous health policy link Anglo-settler democracies (Canada, Australia, Aotearoa/New Zealand and the United States), despite these countries representing a small fraction of the world’s Indigenous people.AimThis paper examines national-level policy in Australia, Brazil, Chile and New Zealand in relation to governmental recognition of differential Indigenous health needs and engagement with Indigenous peoples in health. The paper aims to examine how Indigenous health needs and engagement are addressed in national policy frameworks within each of the countries in order to contribute to the understanding of how to develop pro-equity policies within national health care systems.MethodsFor each country, a review was undertaken of national policies and legislation to support engagement with, and participation of, Indigenous peoples in the identification of their health needs, development of programs and policies to address these needs and which demonstrate governmental recognition of differential Indigenous health needs. Government websites were searched as well as the following databases: Google, OpenGrey, CAB Direct, PubMed, Web of Science and WorldCat.FindingsEach of the four countries have adopted international agreements regarding the engagement of Indigenous peoples in health. However, there is significant variation in the extent to which the principles laid out in these agreements are reflected in national policy, legislation and practice. Brazil and New Zealand both have established national policies to facilitate engagement. In contrast, national policy to enable engagement is relatively lacking in Australia and Chile. Australia, Brazil and New Zealand each have significant initiatives and policy structures in place to address Indigenous health. However, in Brazil this is not necessarily reflected in practice and although New Zealand has national policies these have been recently reported as insufficient and, in fact, may be contributing to health inequity for Māori. In comparison to the other three countries, Chile has relatively few national initiatives or policies in place to support Indigenous engagement or recognise the distinct health needs of Indigenous communities.ConclusionsThe adoption of international policy frameworks forms an important step in ensuring that Indigenous peoples are able to participate in the formation and implementation of health policy and programs. However, without the relevant principles being reflected in national legislature, international agreements hold little weight. At the same time, while a national legislative framework facilitates the engagement of Indigenous peoples, such policy may not necessarily translate into practice. Developing multi-level approaches that improve cohesion between international policy, national policy and practice in Indigenous engagement in health is therefore vital. Given that each of the four countries demonstrate strengths and weaknesses across this causal chain, cross-country policy examination provides guidance on strengthening these links.

Indigenous Oral Health Inequalities at an International Level: A Commentary.

Oral health inequalities reflect social injustice. This is because oral health simultaneously reflects material circumstances, access to health services and inequities across the life course. Oral health inequalities between Indigenous and non-Indigenous populations are among the largest in the world. This paper provides a critical commentary on Indigenous oral health inequalities at an international level based on existing literature and policies. We include the role of systematic and institutionalized racism and how this enables the persistence and flourishing of Indigenous oral health inequalities. We discuss theoretical frameworks—including Shiffman and Smith’s Political Power Framework—that underpin the power constructs that contribute to those. This theory posits that power is exercised in four ways: (i) the power of ideas; (ii) the power of the issue; (iii) the power of the actors; and (iv) the power of the political context. We will demonstrate, using examples of Indigenous oral health inequalities from several countries, how intervening at key leverage points, acting simultaneously on multiple subsystems and counteracting the social determinants of health are crucial strategies for ameliorating Indigenous oral health inequalities at a global level.

More than a refresh required for closing the gap of Indigenous health inequality.

Medical Journal of AustraliaVolume 212, Issue 5 p. 198-199.e1 Perspectives More than a refresh required for closing the gap of Indigenous health inequality Chelsea J Bond, Corresponding Author Chelsea J Bond c.bond3@uq.edu.au orcid.org/0000-0002-5246-235X University of Queensland, Brisbane, QLDc.bond3@uq.edu.auSearch for more papers by this authorDavid Singh, David Singh University of Queensland, Brisbane, QLDSearch for more papers by this author Chelsea J Bond, Corresponding Author Chelsea J Bond c.bond3@uq.edu.au orcid.org/0000-0002-5246-235X University of Queensland, Brisbane, QLDc.bond3@uq.edu.auSearch for more papers by this authorDavid Singh, David Singh University of Queensland, Brisbane, QLDSearch for more papers by this author First published: 06 February 2020 https://doi.org/10.5694/mja2.50498Citations: 33Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume212, Issue5March 2020Pages 198-199.e1 RelatedInformation

Interventions Focusing on Indigenous Populations May Improve Oral Health Outcomes

Reducing indigenous oral health inequalities: a review from 5 nations. Tiwari T, Jamieson L, Broughton J, Lawrence HP, Batliner TS, Arantes R, Albino J. J Dent Res 2018;97(8):869-77. None. Literature review.

Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition

BackgroundEliminating indigenous and ethnic health inequities requires addressing the determinants of health inequities which includes institutionalised racism, and ensuring a health care system that delivers appropriate and equitable care. There is growing recognition of the importance of cultural competency and cultural safety at both individual health practitioner and organisational levels to achieve equitable health care. Some jurisdictions have included cultural competency in health professional licensing legislation, health professional accreditation standards, and pre-service and in-service training programmes. However, there are mixed definitions and understandings of cultural competency and cultural safety, and how best to achieve them.MethodsA literature review of 59 international articles on the definitions of cultural competency and cultural safety was undertaken. Findings were contextualised to the cultural competency legislation, statements and initiatives present within Aotearoa New Zealand, a national Symposium on Cultural Competence and Māori Health, convened by the Medical Council of New Zealand and Te Ohu Rata o Aotearoa – Māori Medical Practitioners Association (Te ORA) and consultation with Māori medical practitioners via Te ORA.ResultsHealth practitioners, healthcare organisations and health systems need to be engaged in working towards cultural safety and critical consciousness. To do this, they must be prepared to critique the ‘taken for granted’ power structures and be prepared to challenge their own culture and cultural systems rather than prioritise becoming ‘competent’ in the cultures of others. The objective of cultural safety activities also needs to be clearly linked to achieving health equity. Healthcare organisations and authorities need to be held accountable for providing culturally safe care, as defined by patients and their communities, and as measured through progress towards achieving health equity.ConclusionsA move to cultural safety rather than cultural competency is recommended. We propose a definition for cultural safety that we believe to be more fit for purpose in achieving health equity, and clarify the essential principles and practical steps to operationalise this approach in healthcare organisations and workforce development. The unintended consequences of a narrow or limited understanding of cultural competency are discussed, along with recommendations for how a broader conceptualisation of these terms is important.

The role of social accountable medical education in addressing health inequity in Aotearoa New Zealand

ABSTRACTMedical education provides a locus to apply the principles of social justice to advocate for indigenous health inequities. Within the education field, social accountability measures have been used to increase equity. This study uses a social accountability lens to explore the perspectives and experiences of academic and clinical leaders, students, and patients engaged with the Hauora Māori curriculum at the University of Otago Christchurch. Using Kaupapa Māori research as a theoretical framework, and drawing on qualitative analysis, three themes were identified; horopaki/contexts, mihini/mechanisms and tukunga iho/outcomes. These three themes described the activities, enablers and mechanisms that identified the Hauora Māori curriculum as a method for achieving social accountability among Māori communities, medical education, and health services.

Social Determinants of Health Inequities in Indigenous Canadians Through a Life Course Approach to Colonialism and the Residential School System.

Indigenous populations in Canada have experienced social, economic, and political disadvantages through colonialism. The policies implemented to assimilate Aboriginal peoples have dissolved cultural continuity and unfavorably shaped their health outcomes. As a result, indigenous Canadians face health inequities such as chronic illness, food insecurity, and mental health crises. In 2015, the Canadian government affirmed their responsibility for indigenous inequalities following a historic report by the Truth and Reconciliation Commission of Canada. It has outlined intergenerational traumata imposed upon Aboriginals through decades of systemic discrimination in the form of the Residential School System and the Indian Act. As these policies have crossed multiple lifespans and generations, societal conceptualization of indigenous health inequities must include social determinants of health (SDOH) intersecting with the life course approach to health development to fully capture the causes of intergenerational maintenance of poor health outcomes. To provide culturally sensitive care for those who have experienced intergenerational trauma, health care providers should be aware of and understand two key SDOH inequity influencing the indigenous life course, including the residential school system and loss of socioeconomic status, over time due to colonialism.

Predictors of medical student interest in Indigenous health learning and clinical practice: a Canadian case study

BackgroundIncluding content on Indigenous health in medical school curricula has become a widely-acknowledged prerequisite to reducing the health disparities experienced by Indigenous peoples in Canada. However, little is known about what levels of awareness and interest medical students have about Indigenous peoples when they enter medical school. Additionally, it is unclear whether current Indigenous health curricula ultimately improve students’ beliefs and behaviours.MethodsA total of 129 students completed a 43-item questionnaire that was sent to three cohorts of first-year medical students (in 2013, 2014, 2015) at one undergraduate medical school in Canada. This survey included items to evaluate students’ sociopolitical attitudes towards Indigenous people, knowledge of colonization and its links to Indigenous health inequities, knowledge of Indigenous health inequities, and self-rated educational preparedness to work with Indigenous patients. The survey also assessed students’ perceived importance of learning about Indigenous peoples in medical school, and their interest in working in an Indigenous community, which were examined as outcomes. Using principal component analysis, survey items were grouped into five independent factors and outcomes were modelled using staged multivariate regression analyses.ResultsGenerally, students reported strong interest in Indigenous health but did not believe themselves adequately educated or prepared to work in an Indigenous community. When controlling for age and gender, the strongest predictors of perceived importance of learning about Indigenous health were positive sociopolitical attitudes about Indigenous peoples and knowledge about colonization and its links to Indigenous health inequities. Significant predictors for interest in working in an Indigenous community were positive sociopolitical attitudes about Indigenous peoples. Knowledge about Indigenous health inequities was negatively associated with interest in working in an Indigenous community.ConclusionsStudents’ positive sociopolitical attitudes about Indigenous peoples is the strongest predictor of both perceived importance of learning about Indigenous health and interest in working in Indigenous communities. In addition to teaching students about the links between colonization, health inequities and other knowledge-based concepts, medical educators must consider the importance of attitude change in designing Indigenous health curricula and include opportunities for experiential learning to shape students’ future behaviours and ultimately improve physician relationships with Indigenous patients.

Economics and Environmental Change: The Challenges We Face, by Clement A.Tisdell. Published by Edward Elgar, Cheltenham, UK, 2017, pp. 256, ISBN: 978‐1782549628, AU$175.00 (Hardcover).

Economics and Environmental Change: The Challenges We Face, by Clement A.Tisdell. Published by Edward Elgar, Cheltenham, UK, 2017, pp. 256, ISBN: 978‐1782549628, AU$175.00 (Hardcover).

Research round-up

In a systematic review and network meta-analysis of 522 trials (116 477 participants), Cipriani andcolleagues compare 21 antidepressants for the acute management of unipolar major depressive disorder in adults. When compared with placebo, response rate at 8 weeks was superior with antidepressant medication, with the highest odds ratio (OR) achieved for amitriptyline (OR 2·13, 95% credible interval [CrI] 1·89–2·41) and the lowest for reboxetine (1·37, 1·16–1·63). In head-to-head comparisons (194 studies, 34 196 participants), response rate was higher with some antidepressants (ie agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine), with some drugs being more tolerable than others (ie, greater tolerability with agomelatine, citalopram, escitalopram, fluoxetine, sertraline, and vortioxetine). The authors noted CrIs were wide for many head-to-head comparisons, and quality of evidence was variable. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysisAll antidepressants were more efficacious than placebo in adults with major depressive disorder. Smaller differences between active drugs were found when placebo-controlled trials were included in the analysis, whereas there was more variability in efficacy and acceptability in head-to-head trials. These results should serve evidence-based practice and inform patients, physicians, guideline developers, and policy makers on the relative merits of the different antidepressants. Full-Text PDF Open AccessClinical phenotypes of delirium during critical illness and severity of subsequent long-term cognitive impairment: a prospective cohort studyOur findings suggest that clinicians should consider sedative-associated, hypoxic, and septic delirium, which often co-occur, as distinct indicators of acute brain injury and seek to identify all potential risk factors that may impact on long-term cognitive impairment, especially those that are iatrogenic and potentially modifiable such as sedation. Full-Text PDF Health and wellbeing of Indigenous adolescents in Australia: a systematic synthesis of population dataDespite Australia's adolescents having one of the best health profiles globally, Indigenous adolescents have largely been left behind. Adequate responses will require intersectoral actions, including a health system responsive to the needs of Indigenous adolescents. Without a specific focus on adolescents, Australia will not redress Indigenous health inequalities. Full-Text PDF

Try Bravery for a Change: Supporting Indigenous Health Training and Development in Canadian Universities

The persistence of egregious inequities signals that we are at a critical juncture regarding the health of Canada’s Indigenous peoples. Now is the time to seriously reflect on the relationships between Indigenous realities, public policy, and the role of Indigenous research environments therein. Addressing the complexity of contemporary Indigenous health inequity requires a fundamental reorientation in the ways we conduct and think about research. This commentary explores the transition currently taking place in Indigenous health training and development in Canadian universities, with a focus on Ontario’s Indigenous Mentorship Network. At the heart of the Ontario Network is the Anishinabe philosophy Mno Nimkodadding Geegi (“We Are All Connected”). In our attempts to address Indigenous health inequality in Canada, we take the perspective that the most important answers will come when we take the time to listen to Indigenous communities. This commentary closes with a discussion on bravery. Just as Indigenous scholars push to make space for their scholarship within the university environments, so too must our institutions have the bravery needed to address the structural changes required to foster that success.

Cultural Competence: Facilitating Indigenous Voices Within Health Promotion Competencies

Indigenous voices must inform health promotion strategies aiming to address significant and persistent Indigenous health inequities. Consequently, Indigenous knowledge and practice must inform capacity development tools such as health promotion competencies. To ensure Indigenous voices are heard, culturally appropriate consultations must be undertaken. This article analyzes the consultation process undertaken to develop the 2012 Aotearoa/New Zealand health promotion competency framework. Analysis was undertaken to identify aspects within the consultation process that facilitated participation by Māori, the Indigenous peoples of Aotearoa/New Zealand. This qualitative research study was undertaken with health promotion practitioners involved in the consultation process; data were obtained from individual semistructured interviews and analyzed using thematic analysis. Findings demonstrate that using culturally appropriate consultative approaches, and integrating Māori values within the consultation process, resulted in a culturally competent framework. Findings can inform future consultation processes undertaken with Māori alongside Indigenous populations and culturally diverse populations globally.

Ethnic bias and clinical decision-making among New Zealand medical students: an observational study

BackgroundHealth professional racial/ethnic bias may impact on clinical decision-making and contribute to subsequent ethnic health inequities. However, limited research has been undertaken among medical students. This paper presents findings from the Bias and Decision-Making in Medicine (BDMM) study, which sought to examine ethnic bias (Māori (indigenous peoples) compared with New Zealand European) among medical students and associations with clinical decision-making.MethodsAll final year New Zealand (NZ) medical students in 2014 and 2015 (n = 888) were invited to participate in a cross-sectional online study. Key components included: two chronic disease vignettes (cardiovascular disease (CVD) and depression) with randomized patient ethnicity (Māori or NZ European) and questions on patient management; implicit bias measures (an ethnicity preference Implicit Association Test (IAT) and an ethnicity and compliant patient IAT); and, explicit ethnic bias questions. Associations between ethnic bias and clinical decision-making responses to vignettes were tested using linear regression.ResultsThree hundred and two students participated (34% response rate). Implicit and explicit ethnic bias favoring NZ Europeans was apparent among medical students. In the CVD vignette, no significant differences in clinical decision-making by patient ethnicity were observed. There were also no differential associations by patient ethnicity between any measures of ethnic bias (implicit or explicit) and patient management responses in the CVD vignette. In the depression vignette, some differences in the ranking of recommended treatment options were observed by patient ethnicity and explicit preference for NZ Europeans was associated with increased reporting that NZ European patients would benefit from treatment but not Māori (slope difference 0.34, 95% CI 0.08, 0.60; p = 0.011), although this was the only significant finding in these analyses.ConclusionsNZ medical students demonstrated ethnic bias, although overall this was not associated with clinical decision-making. This study both adds to the small body of literature internationally on racial/ethnic bias among medical students and provides relevant and important information for medical education on indigenous health and ethnic health inequities in New Zealand.

Health and wellbeing of Indigenous adolescents in Australia: a systematic synthesis of population data

Indigenous populations have high rates of disease and premature mortality. Most Indigenous communities are young, and adolescence (age 10-24 years) provides great opportunities for population health gain. However, the absence of a comprehensive account of Indigenous adolescents' health has been a barrier to effective policy. We aimed to report a national health profile for Indigenous adolescents in Australia. We undertook a systematic synthesis of population data to report the health and wellbeing of Indigenous adolescents in Australia. A reporting framework for Indigenous adolescent health in Australia was defined to measure health outcomes, health risks, and sociocultural determinants. Available data (primary data from national surveys and administrative datasets, and available published data) were mapped against the defined reporting framework, and the quality graded, with the highest quality data selected to report a health profile for Indigenous adolescents. Comparison with non-Indigenous adolescents was made where possible, and estimates (disaggregated by age, sex, and remoteness) were reported as relative risks. A national advisory group (six Indigenous young people, three Indigenous adult community members, three researchers, three policy makers, and two service providers, all aged ≥16 years) provided input about the reporting framework, interpretation of findings, and policy recommendations. Data were available for 184 (79%) of 234 elements of the reporting framework. All-cause mortality for Indigenous adolescents (70 per 100 000) was more than twice that of non-Indigenous adolescents, with about 60% of deaths due to intentional self-harm and road traffic injury. 80% of all deaths among Indigenous adolescents were considered as potentially avoidable in the current health system. Communicable diseases (particularly sexually transmitted infections) were leading contributors to morbidity. Almost a third of Indigenous adolescents aged 18-24 years reported high levels of psychological distress (twice the non-Indigenous rate). There was an excess burden of mental disorders and substance use, alongside emerging type 2 diabetes and ischaemic heart disease. Additionally, there were excess intentional and unintentional injuries. Many aspects of this health profile differed markedly from that of non-Indigenous adolescents: rates of acute rheumatic fever, pneumococcal infection, gonorrhoea, and type 2 diabetes resulting in admission to hospital were ten times higher; rates of assault and childbirth in those aged 15-19 years were five times higher; whereas rates of eating disorders, melanoma and other skin cancers, and anaphylaxis were significantly lower. Risks for future ill-health were common; 43% of 15-24 year olds were current tobacco smokers and about 45% had high body mass (overweight or obese). Disadvantage across sociocultural health determinants also emerged, particularly around education. Despite Australia's adolescents having one of the best health profiles globally, Indigenous adolescents have largely been left behind. Adequate responses will require intersectoral actions, including a health system responsive to the needs of Indigenous adolescents. Without a specific focus on adolescents, Australia will not redress Indigenous health inequalities. Australia's National Health and Medical Research Council, Sidney Myer Foundation, and the Murdoch Children's Research Institute.

Educational content related to postcolonialism and indigenous health inequities recommended for all rehabilitation students in Canada: a qualitative study

Background: Postcolonial analysis can help rehabilitation providers understand how colonization and racialization create and sustain health inequities faced by indigenous peoples. However, there is little guidance in the literature regarding inclusion of postcolonialism within rehabilitation educational curricula. Therefore, this study explored perspectives regarding educational content related to postcolonialism and indigenous health that rehabilitation students in Canada should learn to increase health equity.Methods: This qualitative study involved in-depth, semi-structured interviews with 19 individuals with insight into postcolonialism and health in Canada. Data were analyzed collaboratively to identify, code, and translate themes according to a structured six-phase method.Results: Four themes emerged regarding educational content for rehabilitation students: (1) the historic trauma of colonization and its ongoing impacts on rehabilitation for indigenous peoples; (2) disproportionate health burden and inequitable access to health services; (3) how rehabilitation is related to Indigenous ways of knowing; and (4) why rehabilitation is well-positioned to address health inequities with Indigenous Peoples.Conclusion: Results call for reflection on assumptions underpinning the rehabilitation professions that may unintentionally reinforce health inequities. A postcolonial lens can help rehabilitation educators promote culturally safe services for people whose ill health and disability are linked to the effects of colonization.Implications for RehabilitationGiven the powerful, ongoing effects of colonization and racialization on health and disability, recommendation #24 from the Truth and Reconciliation Commission of Canada calls for the education of health professionals related to Indigenous history, rights, and anti-racism. However, there is little curricula on these areas in the education of rehabilitation professional students or in continuing education programs for practicing clinicians.This is the first study to investigate expert perspectives on content related to postcolonialism and indigenous-settler inequities that should be included in the education of rehabilitation students in Canada.According to the participants in this study, rehabilitation educators in Canada should consider incorporating the following four themes into curricula to better address Indigenous-settler inequities in the context of rehabilitation: (1) the historic trauma of colonization and its ongoing impacts on rehabilitation for Indigenous Peoples in Canada; (2) disproportionate health burden and inequitable access to health services; (3) how rehabilitation is related to Indigenous ways of knowing; and (4) why rehabilitation is well-positioned to rise to the challenge of addressing health inequities with Indigenous Peoples in Canada.Postcolonialism is useful for rehabilitation providers because it is an approach that redirects the focus of problems from Indigenous People to the systems of oppression (specifically colonization and racialization) that cause ill health and disability.