Indigenous Health Research Articles

Processing and preservation technologies to enhance indigenous food sovereignty, nutrition security and health equity in North America.

Indigenous foods are carriers of traditional native North American food culture and living philosophy. They are featured by the wide varieties in fresh and processed forms, richness in nutrition, flavor, health benefits and diversity in origins, but are usually misunderstood or underrepresented in the modern food systems. Conventional processing and cooking methods are sometimes labor-intensive, less efficient and lack science-based guidelines to prevent unseen safety risks and food loss. Global and regional climate change have caused additional challenges to conventional cooking/processing, and increased native communities' reliance on externally produced foods, which have resulted in increasing nutritional unbalance and prevalence of diet-related health issues. Current and emerging technologies, such as storage and packaging, drying, safety processing, canning, pickling, and fermentation, which treat foods under optimized conditions to improve the safety and extend the shelf-life, are increasingly used in current food systems. Therefore, exploring these technologies for indigenous foods offers opportunities to better preserve their nutrition, safety, and accessibility, and is critical for the sovereignty and independence of indigenous food systems, and sustainability of indigenous food culture. This mini-review focuses on identifying adoptable processing and preservation technologies for selected traditional indigenous foods in North America, summarizing education, extension, and outreach resources and discussing the current challenges and future needs critical to expanding knowledge about indigenous foods and improving food sovereignty, nutrition security, and health equity.

Hospitalization for malaria in the indigenous population of Roraima, in Brazil's Northern Amazon, 2008-2022

ObjectivesTo examine the epidemiology of hospitalized cases of malaria in indigenous people living in the municipalities of Roraima in the northern Brazilian Amazon from 2008 to 2022. MethodsEcological study using secondary data and spatiotemporal analyses based on thematic maps. Average rates were calculated per study period and spatiotemporal clusters were estimated from spatial statistics. ResultsOf the 541 medical records, 77.08% were related to Plasmodium vivax. Higher rates were observed in municipalities in the south and center of the state. The rates increased throughout the study period. The analysis generated three clusters. ConclusionsAlthough Roraima has characteristics that worsen the malaria problem, no studies were found that examined the transmission of the disease in the state as a whole. This increases the importance of this study, which contributes to the discussion in the field of indigenous health.

Health Care Delays and Social Suffering Among Indigenous People with Diabetic Foot Complications in Mexico

ABSTRACT Diabetic foot (DF) is a leading cause of nontraumatic lower-extremity amputations, premature death, and a sign of social inequality in diabetes treatment. In Mexico, the incidence of DF is on the rise yet little is known about its impact among indigenous people, a disadvantaged group. Based on ethnographic research conducted in Oaxaca and analysis of institutional health-data, in this article we show the health care delays that rural indigenous people face when dealing with DF. Indigenous people’s uncertainty regarding their right to health and the structural barriers to medical care favor DF complications, a phenomenon that should be read as social suffering. Since health data concerning indigenous health care service users is patchy and imprecise, indigenous people's social suffering is invisibilized. This omission or partiality in the official records limits public health decision-making and undermines the human rights of the population.

Honoring Inágofli’e’ and Alofa: Developing a Culturally Grounded Health Promotion Model for Queer and Transgender Pacific Islanders

(1) Background: Although culturally grounded health interventions (CGHI) have shown efficacy in improving Indigenous health, few CGHI for Queer and Transgender Pacific Islander (QTPI) communities exist to address their health promotion. This study explores QTPI experiences of health for cultural mechanisms to develop CGHI for QTPI health promotion. (2) Methods: Using Indigenist community-engaged research methodologies, we collaborated with the United Territories of Pacific Islanders Alliance of Washington and Guma’ Gela’ to conduct 11 exploratory semi-structured interviews with QTPI community members living in the Puget Sound area of Washington state. These interviews were analyzed using thematic analysis. (3) Results: QTPI well-being was greatly influenced by how settler colonialism impacted their connectedness to their families, communities, and cultures. We also found that inágofli’e’ and alofa, relational values in CHamoru and Sāmoan culture, played essential roles in facilitating QTPI health. Many participants fostered these values through chosen family, community care, and Indigenous mobilities. (4) Conclusions: Our findings indicate a need for CGHI that facilitate inágofli’e’ and alofa for QTPI to combat settler colonialism’s impacts on QTPI well-being. Finally, we present a community-centered conceptual model for culturally grounded health promotion in QTPI communities.

Indigenous bridging/foundation education: student feedback on programme successes, challenges and opportunities

Hikitia te Ora (Certificate in Health Sciences) is a 1 year Indigenous bridging foundation programme at the University of Auckland, Aotearoa New Zealand. The programme aims to increase Māori and Pacific health workforce representation. This qualitative study applied a Kaupapa Māori positioning to elucidate the strengths, challenges, and opportunities of the programme. Data were collected through two workshops and seven focus groups with a total of 67 participants who were students of Hikitia te Ora from past and present cohorts, or their family members. Using a general inductive thematic analysis, the primary themes identified were that programme successes encompassed whanaungatanga (process of establishing relationships), academic and pastoral support, programme structure and the teaching content. Challenges included social cliques and divisive social groupings, timetabling of courses and high workloads. The three areas that emerged for further development include extending Pacific content, increasing the number of students in the programme, and maintaining a programme-specific study space for students. Implementing the findings from this study into Hikitia te Ora is expected to improve educational outcomes for Māori and Pacific students and may have the potential to benefit other bridging foundation courses aiming to promote Indigenous health workforce development.

Retreat builds on CFPC commitments to advance work on Indigenous health.

Retreat builds on CFPC commitments to advance work on Indigenous health.

Nicole Redvers: Indigenous health scholar

Nicole Redvers: Indigenous health scholar

Federal field nurses and Indigenous births

Beginning in 1924, the US Office of Indian Affairs sent public health or ‘field’ nurses to Native nations to provide preventative healthcare and education. The field nurse programme began under...

Diversity and development of Indigenous rehabilitation professional student identity

BackgroundIn Canada, disparities between Indigenous and non-Indigenous Peoples continue to exist in health and education because of the past and current harms of racism and colonization. One step towards closing health gaps is clinicians who can provide health and social care services that are free of racism and mistrust. Indigenous health providers are in the best position to provide this culturally relevant and safe care to their own communities. Therefore, more Indigenous students graduating from health professional programs are required to meet these needs. Indigenous identity support can be a facilitator for Indigenous student academic success but developing one’s Indigenous identity can be challenging in post-secondary education environments. We explored how Indigenous rehabilitation students expressed, and wanted to be supported in their identity and academic success.MethodsUsing a narrative inquiry approach, we conducted interviews with seven students from the occupational, physical, and respiratory therapy programs of a Canadian university. Students were asked to tell their story of learning about, applying to, and being in their rehabilitation program and how their Indigenous identity impacted these experiences. Data analysis was conducted by Indigenous and non-Indigenous team members, analyzing the stories on interaction of the participant with (1) themselves and others, (2) time, and (3) situation or place.ResultsThe researchers developed seven mini-stories, one for each participant, to illustrate the variation between participant experiences in the development of their Indigenous and professional identity, before and during their rehabilitation program. The students appreciated the opportunities afforded to them by being admitted to their programs in a Indigenous Peoples category, including identity affirmation. However, for most students, being in this category came with feared and/or experienced stigma. The work to develop a health professional identity brought even more complexity to the already complex work of developing and maintaining an Indigenous identity in the colonized university environment.ConclusionThis study highlights the complexity of developing a rehabilitation professional identity as an Indigenous student. The participant stories call for universities to transform into an environment where Indigenous students can be fully accepted for their unique gifts and the identities given to them at birth.

“My feelings and my thoughts are my lived experience, not the numbers they show me on a piece of paper”: Indigenous experiences of liver transplantation in British Columbia, Canada

ABSTRACT Indigenous Peoples in Canada face healthcare inequities impacting access to solid organ transplantation. The experiences of Indigenous patients during the liver transplant process, and how transplant professionals perceive challenges faced by Indigenous Peoples, has not been studied. Thirteen semi-structured qualitative interviews were conducted via telehealth with Indigenous liver transplant patients (n = 7) and transplant care providers (n = 6) across British Columbia, Canada between April 2021—May 2022. Themes were identified to inform clinical approaches and transplant care planning and validated by Indigenous health experts. Among patient participants: transplants occurred between 1992–2020; all were women; and the mean age at the time of interview was 60 years. Among transplant care provider participants: roles included nursing, social work, and surgery; 83% were women; and the median number of years in transplant care was ten. Three broad themes were identified: Indigenous strengths and resources, systemic and structural barriers, and inconsistent care and cultural safety across health professions impact Indigenous patient care during liver transplantation. This study contributes insights into systemic barriers and Indigenous resilience in the liver transplant journey. Dismantling structural barriers to early linkage to care is needed, and training for transplant clinicians on Indigenous histories, cultural protocols, and cultural safety is strongly recommended.

Ethnographic profile and difficulties in accessing oral health care in Amazon region – an experience report

The Indigenous People living in the surrounding areas of the lower course of the Amazon River have little and outdated epidemiological information on oral health. The access to oral health is a distant reality for this population and the precariousness of primary health care in these regions is alarming, thus access to oral health care becomes an unmet need. Objective: This experience report aims to contribute to a critical reflection on the barriers to access to oral health for the Sateré-Mawé Indigenous People of the Andirá-Marau Indigenous Reserve (Amazonas, Brazil). Case report: Traditional medicine practiced by healers proved to be active in the region, nevertheless, the precariousness of access to institutionalized health in Indigenous Health Districts is also part of the reality of these peoples, being justified by the difficulty of traveling to the regions with professionals and specialists. This situation reflects on the sparse results of the available health surveys, which show they have worse oral health conditions compared to the non-indigenous population. Conclusion: After daily experience, it was possible to register that more adequate sanitary approaches are needed that meet real needs of this community.

Meeting in the margin: can participatory research address the root causes of Indigenous mental health problems?

Although Indigenous Peoples represent 5% of the population in Canada, they present higher rates of psychosocial problems including mental health issues and suicide than their non-Indigenous counterparts. They are also over-represented in the youth protection and prison systems. This must be understood within the specific context of the oppression of Indigenous Peoples in Canada through colonization and colonialist policies. To improve Indigenous mental health and wellbeing, the oppression underlying it must be addressed. The objective of this article is to illustrate how we, as mental health researchers, can contribute to this process. Based on Collins’ matrix of domination, and bell hooks’s space of resistance, an analysis of community-based participatory research and its impacts on helping Indigenous People overcome oppression is offered. Limits of participatory research’s contributions to social change are presented. Anti-oppressive participatory research is offered as a promising alternative.

Corporate sector engagement with Aboriginal and Torres Strait Islander peoples: an analysis of stakeholder submissions

The commercial determinants of health are an emerging area of inquiry; however, a comprehensive understanding of commercial activities impacting Indigenous peoples remains elusive. In 2021, an Australian parliamentary inquiry was initiated to examine how the corporate sector can better engage with Indigenous consumers. This study examined the commercial determinants of Indigenous health and social wellbeing by analysing submissions to the Inquiry. Twenty-five submissions were analysed: seven from Indigenous actors, five supplementary submissions, and the Inquiry’s interim report. Findings revealed exclusion of Indigenous leadership from the commercial sector, supply of harmful products, misleading branding, and predatory lending. This meant increased stress and reduced access to essential services for Indigenous consumers, despite affirmative corporate social responsibility strategies towards Indigenous peoples. Government policy should prioritise ongoing collaboration with Indigenous peoples in the development of regulatory mechanisms to mitigate the negative impact of commercial practices on health and social wellbeing.

The representation of Aboriginal health and wellbeing values within coastal marine and fisheries policies of the Northern Territory of Australia

Aboriginal Peoples in the Northern Territory (NT) of Australia have customary connections to seafood for cultural practices, nourishment, livelihoods, and social connections which have been linked to health and wellbeing outcomes. Global and national entities have called for health and self-determination principles to be considered across all public policies to continue to improve health and wellbeing outcomes. Specifically, there is a growing acknowledgement that the fisheries sector plays a crucial role in enhancing and supporting Indigenous health and wellbeing. However, there is limited understanding of how this can be achieved. This study applies a content analysis of ten NT fisheries policy documents to investigate: (1) the representation of Indigenous values; (2) Indigenous health and wellbeing outcomes and (3) the positioning of self-determination within NT coastal, marine and fishery policies. Findings reveal that policy focus is primarily concerned with the conservation and management of environments and resources, fisheries, management and sustainability, and fisheries-based economic development. The consideration of health and wellbeing outcomes are not explicitly represented, including fisheries as a source of food production. This is concerning considering the contribution of seafood to Indigenous Peoples diets and food security. Despite these limitations, self-determination principles were represented within the policies by recognising Aboriginal aspirations through, for example social, cultural, and environmental outcomes.

Underrepresentation of Indigenous mental health professionals in Bangladesh

Indigenous people worldwide are at increased risk of mental health problems compared with non-Indigenous people. Longstanding impacts of colonisation, systematic exclusion from rights and subsequent discrimination, and lack of access to quality education and healthcare, including mental healthcare, have been identified as contributory factors to these disproportionate mental health problems. With limited access, Indigenous people are less likely to seek healthcare, owing to the insufficient number of healthcare professionals representing Indigenous communities. In the face of growing numbers of mental health problems in Indigenous people in Bangladesh, this paper sheds light on the inadequate number of mental health professionals, particularly from Indigenous communities, and the potential impacts of this on the well-being of Indigenous people, and considers ways to increase representation of Indigenous mental health professionals. The aim is to ensure that the mental health system in Bangladesh is inclusive and embraces the country's diversity.

Exploring medical students’ experiences with indigenous patient care: a phenomenological study

ABSTRACT Background Indigenous Peoples in Canada bear a disproportionate burden of disease and experience poorer health outcomes as compared to non-Indigenous populations within Canada; these conditions are said to be mediated and exacerbated by pervasive and uninterrupted anti-Indigenous racism. Third and fourth-year medical students at a Canadian medical school were asked to reflect on their experiences working with Indigenous patients in clinical settings, and how their preclinical Indigenous health curriculum impacted these experiences. Method Phenomenology was used, guided by Goffman’s theory of social stigma. Eleven undergraduate medical students were recruited using purposeful sampling. Semi-structured phone interviews were conducted to gain an in-depth understanding of the participants’ experiences. Interviews were recorded and transcribed verbatim. Data were analyzed using the four main processes for phenomenological analysis. Results Four main themes emerged from students’ descriptions of clinical experiences involving Indigenous patients: 1) students describe how their Indigenous patients encounter the health care system and their own lack of cultural sensitivity in this context; 2) racism was evident in students’ clinical interactions with Indigenous patients, but students do not always perceive these biases nor the impact of this on patient care; 3) identifying the impact of racism on care is complicated by situational clinical encounters; and 4) practicality of preclinical Indigenous health education is desired by students to prepare them for working with Indigenous patients in the clinical setting. Conclusions In their clinical experiences, students witness racism against Indigenous peoples yet are unprepared to stand up against it. Findings highlight the importance of enhancing undergraduate medical training to allow students to better understand the unique experiences and perspectives of Indigenous patients. The results support the need for ongoing Indigenous health education, to foster culturally sensitive experiences while learning about Indigenous patients.

Integrating Indigenous and Western Health Practices as Synergy for African Development in the Globalization Era: The Nigerian Example

The health policy of colonial rule precipitated structural and institutional changes in the healthcare system of the colonized Africans, as Western medicine was imposed across Africa as a better system of health management. This development fundamentally altered the professional and practical acceptability of indigenous medicine even beyond the colonial era. The much-acclaimed theoretical incompatibility of western and indigenous medical systems is one of the major causes of the strain in the levels of acceptance between indigenous medicine and western medicine in post-colonial Africa. In the case of Nigeria, a majority of the populace, especially in the rural areas, still consult the indigenous medical care providers. This consultation is arguably as a result of some factors, including the people’s thin financial resources,the mythical belief in the therapeutic efficacy of indigenous medicine, and closeness of the indigenous healthcare centres to the patients, among others. Given this, it becomes imperative to explore the historical development and value of Adepoju Adewale Toyin and Onagun Rasheed: Integrating Indigenous and… 415 indigenous healthcare practices in Nigeria and determine the possibility of its integration with western medicine. Towards accomplishing this, we explore historical-analytic method, using primary and secondary sources to examine the current state of indigenous traditional health practice in Nigeria, identify the factors that drive (mis)communication between patient and practitioner, and suggest solutions that can be implemented to address existing challenges. In addition, with illustrations drawn from successful examples of integration of indigenous and modern health practices in developing countries, the paper argues in the context of globalization that an advantageous synergy between indigenous and western health practices is feasible as a development strategy for Africa.

Supporting best practice in the management of chronic diseases in primary health care settings: a scoping review of training programs for Indigenous Health Workers and Practitioners.

Background To improve diabetes management in primary health care for the Aboriginal and Torres Strait Islander peoples population, training programs that are culturally and contextually relevant to the local context are required. Using a scoping review methodology, the aim of this review was to describe the characteristics of chronic disease management training programs for Aboriginal Health Workers and Practitioners, their effectiveness on knowledge and skills, and client-related outcomes, and the enablers, barriers to delivery and participation. Methods Following protocol parameters, a systematic search was conducted in relevant databases and grey literature. Two independent reviewers screened the title and abstract of each paper to determine if the study met the inclusion criteria. Results Of the 23 included studies, most were developed with stakeholders, profession facilitated and delivered by cultural facilitators. All training programs included content knowledge, two included a professional support network, four provided on-the-job support and six had follow-up support post-training. Modes of delivery ranged from didactic, storytelling and hands-on learning. Two studies reported significant improvement in participants' knowledge and confidence; one reported improvement in knowledge (12.7% increase pre-post training), and an increase in confidence in both clinical and non-clinical skills. Enablers (relevance, modes of learning, power of networking, improved knowledge, confidence and clinical practice) and barriers (adult learning capabilities, competing work-family commitments) were reported. Few studies reported on knowledge transfer into clinical practice and client-related outcomes. Conclusions Multifaceted training programs for Aboriginal health workers are well received and may improve workforce capability.

One Health approach to Coxiella burnetii in Brazilian indigenous communities

Indigenous health has posted complex challenges worldwide, particularly due to historical economic, territorial, social and environmental processes, which may lead to emergence and reemergence of pathogens. In addition to few Coxiella burnetii serosurveys in vulnerable populations, especially in developing tropical countries, no comprehensive One Health approach has focused on human-animal infection along with potential environmental determinants. Accordingly, this study aimed to assess the seroprevalence of anti-C. burnetii antibodies in indigenous populations and their dogs from 10 indigenous communities distributed in southern and southeastern Brazil, along with the correspondent healthcare professionals. In overall, 8/893 (0.90%; 95% CI 0.45–1.76) indigenous and 1/406 (0.25%) dog samples were seropositive, with 7/343 (2.04%) individuals the 1/144 (0.69%) dog from the Ocoy community, located in the city of São Miguel do Iguaçu, bordering Argentina at south, and far 10 km at west from Paraguay. All 84 healthcare professionals tested seronegative.

Climate change and its impact on the mental health well‐being of Indigenous women in Western cities, Canada

AbstractThis collaborative paper explores the interconnections between climate change and the mental health and well‐being of Indigenous women in Western Canada. As the impacts of climate change intensify globally, vulnerable populations, particularly Indigenous communities, face disproportionate and multifaceted challenges. Centering on Indigenous women in Western Canada, this study explores how the climate crisis magnifies Indigenous communities' mental health disparities. Drawing from the Indigenist feminist research approach, the investigation focuses on Indigenous women's lived experiences, perceptions, and land‐based coping strategies amidst climate challenges, while simultaneously addressing the unique social, cultural, and historical factors influencing their mental health vulnerabilities within the context of climate change. The findings shed light on the complex relationships between environmental degradation, ongoing colonial impacts on traditional practices, and the mental well‐being of Indigenous women. Concluding with implications for policy and community‐led interventions, this research contributes to the discourse on the intersectionality of climate change impacts and mental health, particularly focusing on Indigenous women in Western Canada.