Indigenous Populations Worldwide Research Articles

Embodiment of discrimination: a cross-sectional study of threats, humiliating treatment and ethnic discrimination in relation to somatic health complaints among Sámi in Sweden

BackgroundEthnic discrimination is acknowledged as a social determinant of health for Indigenous populations worldwide. This study aimed to investigate embodiment of perceived ethnic discrimination among the Sámi population in Sweden.MethodsA...

Highlighting models of Indigenous leadership and self-governance for COVID-19 vaccination programmes

The COVID-19 pandemic has disproportionately impacted Indigenous populations worldwide placing much importance on rapid and equitable vaccination. Nevertheless, many Indigenous communities have reported high vaccine hesitancy and low COVID-19 vaccine uptake. This may be attributed to various factors, including a lack of support for Indigenous leadership efforts to protect their communities and the pervasive infodemic targeting First Nations Peoples. In August 2022, we hosted an international symposium to bring together Indigenous and non-Indigenous community leaders, clinicians, and researchers to discuss pandemic experiences and lessons learnt. This commentary highlights examples of harnessing Indigenous leadership and self-governance to design and deliver tailored community-based and culturally appropriate COVID-19 vaccination programmes that improved vaccine uptake in Australia and Canada. These case studies demonstrate that Indigenous social-governance systems need to be valued, respected, and upheld if we are to make meaningful efforts to address health inequities among Indigenous communities during future pandemics.

Toxoplasma gondii exposure in Brazilian indigenous populations, their dogs, environment, and healthcare professionals

Although Toxoplasma gondii exposure has been reported in indigenous populations worldwide, a One Health approach has not been applied to date. This study concurrently assessed T. gondii exposure in indigenous populations, and their dogs, environment, and indigenous or non-indigenous healthcare professionals (HPs). Human and dog serum samples from 9 indigenous communities in Brazil were assessed by indirect immunofluorescence antibody test for anti-T. gondii antibodies. Soil samples (30 per community) were processed with PCR to amplify T. gondii DNA. Associated risk factors and seroprevalence were analyzed using logistic regression models. Human seropositivity and type of water source were assessed by generalized linear mixed model (GLMM) with binomial error distribution, and game meat consumption with chi-squared test. Overall, 225/463 (49%) indigenous persons were seropositive for anti-T. gondii antibodies. Of all the HPs, 67/168 (40%) were positive, and included 54/147 (37%) positive non-indigenous HPs. Indigenous persons more likely to be seropositive compared with non-indigenous HPs (OR: 1.63; 95% CI: 1.11–2.39). A total of 97/253 (38%) dogs were seropositive and highly associated with seropositive owners (p < 0.001). Based on univariate analysis for indigenous individuals, state location of community (p < 0.001), ethnicity (p < 0.001), consumption of game meat (p < 0.001), type of water source (p < 0.001), and educational level (p = 0.026) were associated with seropositivity. Logistic regression showed that indigenous seropositivity was associated with eating game meat (p = 0.002), drinking water from rivers (p < 0.001), and inversely proportional to the educational level. According to univariate analysis for non-indigenous HP, age (p = 0.005), frequency of visits to the indigenous populations (p < 0.001), consumption of water at the indigenous communities (p < 0.001), and ingestion of raw meat (p = 0.023) were associated with T. gondii seropositivity. Logistic regression revealed living outdoors (p = 0.042), habit of hunting (p = 0.008), and drinking river water (p = 0.007) as risk factors associated to seropositivity in dogs. In addition, indigenous communities lacking water treatment had higher seroprevalence for all groups including indigenous persons (GLMM; z = −7.153; p < 0.001), their dogs (GLMM; z = −2.405; p = 0.0162), and all HPs (GLMM; z = −2.420; p = 0.0155). Human seropositivity was associated with that of their dogs (p < 0.001). A single soil sample, out of 270 (0.37%), was positive for T. gondii by PCR. Our results indicate water source is a risk for human and dog toxoplasmosis in indigenous communities; both share similar exposure. Moreover, quality water access was shown to be crucial to prevent toxoplasmosis in both total and non-indigenous HPs who work in these indigenous communities.

Estimating the Prevalence of Hypercholesterolemia in Indigenous Populations: A Systematic Review and Meta-Analysis

BackgroundHypercholesterolemia is a common condition characterized by elevated levels of low-density lipoprotein cholesterol (LDL-C) and increased risk of atherosclerotic cardiovascular disease (ASCVD). Indigenous populations experience disproportionate rates of ASCVD, however, the extent to which hypercholesterolemia contributes to this burden is unknown. ObjectivesThis study aimed to estimate the prevalence of hypercholesterolemia, severe hypercholesterolemia, and familial hypercholesterolemia (FH) in Indigenous populations in Canada, the United States, Australia, and New Zealand. MethodsWe searched MEDLINE, EMBASE, Web of Science, Native Health Database, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews for peer-reviewed studies reporting on hypercholesterolemia and elevated LDL-C in Indigenous populations. All diagnostic criteria used to classify hypercholesterolemia were included. Pooled prevalence and 95% CIs were calculated using a random-effects model. ResultsThere were no studies reporting the prevalence of FH and one study reporting the prevalence of severe hypercholesterolemia in Indigenous populations. The pooled prevalence of hypercholesterolemia was 28.9% or ∼1 in 3 to 1 in 4 individuals (95% CI: 22.4%-36.4%) and 12.6% (95% CI: 7.7%-19.9%) using an LDL-C cutoff of ≥3.5 mmol/L (135 mg/dL). The pooled prevalence in Indigenous populations in North America was 24.3% (95% CI: 17.1%-33.3%) compared with 40.0% (95% CI: 31.3%-49.3%) in Australia. Meta-regression showed diabetes had a significant effect on prevalence (P = 0.022). ConclusionsHypercholesterolemia is prevalent in Indigenous communities and may contribute to the high burden of ASCVD these populations face. There is insufficient research on FH and severe hypercholesterolemia in Indigenous populations worldwide.

The methods of improving cultural sensitivity of depression scales for use among global indigenous populations: a systematic scoping review.

Cultural adaptation of psychometric measures has become a process aimed at increasing acceptance, reliability, and validity among specific Indigenous populations. We present a systematic scoping review to: (1) identify the depression scales that have been culturally adapted for use among Indigenous populations worldwide, (2) globally report on the methods used in the cultural adaptation of those scales, and (3) describe the main features of those cultural adaptation methods. We included articles published from inception to April 2021, including 3 levels of search terms: Psychometrics, Indigenous, and Depression. The search was carried out in the Ovid Medline, PubMed, Embase, Global Health, PsycINFO, and CINAHL databases, following PRISMA guidelines. We identified 34 reports on processes of cultural adaptation that met the criteria. The scales were adapted for use among Indigenous populations from Africa, Australia, Asia, North America, and Latin America. The most common scales that underwent adaptation were the Patient Health Questionnaire (PHQ-9), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Edinburgh Postnatal Depression Scale (EPDS). Methods of adaptation involved a revision of the measures' cultural appropriateness, standard/transcultural translation, revision of the administration process, and inclusion of visual supports. Culturally safe administration of scales was reported in some studies. To come to a consensus on most appropriate methods of improving cultural safety of psychometric measurement, most studies utilized qualitative methods or mixed methods to understand the specific community's needs. Revision of linguistic equivalence and cultural relevance of content, culturally safe administration procedures, qualitative methods, and participatory research were key features of developing safe culturally adapted measures for depressive symptoms among Indigenous populations. While for comparability, uniform scales would be ideal as mental health evaluations, an understanding of the cultural impact of measurements and local depression expressions would benefit the process of developing culturally sensitive psychometric scales. PROSPERO registration ID: CRD42023391439.

Exploring Traditional Healing and Medicine in Dementia Care for Indigenous Populations in North America, Australia, and New Zealand: A Policy Advocacy and Practice

AbstractBackgroundAccess to culturally‐safe dementia assessment, diagnosis, and care in Indigenous populations worldwide is an emerging challenge. In 2018, the World Health Organization recognized traditional healers as stakeholders in dementia care and prevention globally. Traditional healers contribute to dementia assessment, diagnosis, and care in unique ways, and play a catalytic role in the process of culturally‐safe dementia care planning and assessment with health care providers at the community level. The purpose of this scoping review was to understand the roles and experiences of traditional healers, to evaluate strategies for integration between Indigenous traditional healing and western dementia care approaches, and to examine the policy barriers and research gaps in North America, Australia, and New Zealand.MethodThe scoping review methodology used was the Joanna Briggs Institute (JBI) approach that included six steps: protocol development based on participants, content and context framework, development of a search strategy, selection of relevant studies, charting of relevant data, synthesis, and reporting of results, and conducting stakeholder consultation.ResultSearched English literature in select bibliographic databases, including CINAHL, EMBASE, Medline and PsycINFO. The initial search identified 516 papers published between 2000 and 2020 that met the search criteria. After 164 duplicates were removed, we screened 352 titles and abstracts, excluding the 209 that did not meet the inclusion criteria. The second stage review of 143 full‐text studies resulted in the further exclusion of 141 studies. Only two studies from Canada met all inclusion criteria for this study and explored the potential integration of traditional healing in dementia care and the roles, perceptions, and experiences of traditional healers.ConclusionThis study emphasizes the inclusion of traditional healers, knowledge‐holders, and Grandmother groups that can contribute to building an evidence‐based dementia care decision‐making process for Indigenous people with dementia. Integration of Indigenous traditional healing and medicine in dementia care is a path to culturally‐safe dementia care and assessment. diagnosis. The study has policy implications for health care provider education and advocacy needs to engage with traditional healers in dementia care. It recommends two community‐based models to establish culturally‐safe dementia care between traditional healers and healthcare providers in a seamless collaboration.

Consumption and Preferences for Wild and Domestic Meat in Indigenous Communities in the Brazilian Atlantic Forest

Wild animals have traditionally been the main sources of protein available, if not the only, to numerous indigenous populations worldwide. However, greater access to markets, reduced availability or access to wildlife, and policies in support of agricultural development, have shifted food habits toward domestic and industrial sources of protein. In this study, we evaluated consumption patterns and preferences/avoidances for wild animals (wildmeat, crustaceans, and fish) in comparison to domestic sources of protein among the Potiguara living on the Brazilian coast. Using data from 843 semi-structured interviews applied to students from 28 indigenous villages, we found that domestic meats were more consumed and preferred as compared to wild animals (aquatic and game animals), despite the high abundance of fish and crustacean resources in the surveyed area. Consumption and preference for game were higher among male students while avoidance was higher among female students. The avoidance of domestic meats and fish was low for both genders. The occupation of the fathers affected students’ food habits, in those nature-related occupations (farmer, fisherman/woman, sugarcane worker) conditioned greater consumption of wildmeat and fish, while non-nature related occupations lead to greater consumption of protein from domestic sources. The consumption of protein from all sources increased with the distance between villages and a protected area. Our results indicate that the younger generation of Potiguaras does not regularly consume wildmeat and fish and their preference for domestic sources of protein is shaped by the socio-environmental context, access to different types of meat, and taste preferences.

Understanding Sociocultural Influences on Physical Activity in Relation to Overweight and Obesity in a Rural Indigenous Community of Fiji Islands

IntroductionGiven health disparities and increased rates of obesity and non-communicable diseases seen in Indigenous populations worldwide and the evidence connecting sociocultural knowledge with physical activity, health, and wellbeing, this research was undertaken to understand the social and cultural components contributing to obesity in the Indigenous Fijian rural areas.MethodsThis research is a community-based participatory research (CBPR) project, which engaged community members from a rural iTaukei village in the Fiji Islands. Data collection was carried out through community consultation and semi-structured interviews. The data was analysed using descriptive thematic analysis.ResultsFour major themes emerged associated with sociocultural, economic, political, and physical environmental factors. Males emphasised sports and working on farmlands as preferred types of physical activity, while females focused on family activities and daily activities and support for females’ separate playgrounds. There was a focus on previous health promotion programs that did not incorporate the cultural values, cultural competence beliefs, and traditional ways of the rural Indigenous Fijian community.ConclusionThe healthcare providers and policymakers need to recognise the iTaukei community culture and appreciate traditional methods to promote equitable community participation in decision-making for health promotion. These findings should inform future research and community-based health programs to address the physical activity levels of the rural Indigenous community and may be relevant to other Indigenous peoples.

Differentiated Primary Healthcare in the Pataxó Indigenous Communities in Bahia, Brazil: Polyphonic Ethnography of Healthcare Practices from an Intercultural Perspective

A lack of culturally appropriate healthcare is a common problem for colonial nations, and this can explain the different patterns of health in indigenous populations worldwide. Our study is the first ethnography realized with the neglected Pataxó indigenous people from the south of the state of Bahia, Brazil, that analyzes the representations and practices of “differentiated” public healthcare. The polysemic conceptualization and polymorphism of the healthcare practices highlight some spontaneous intercultural competences, particularly those of the indigenous professionals, within the hegemony of non-indigenous health knowledge and the lack of awareness of intercultural healthcare. Intercultural training and empowerment still remain a priority.

ADAPTIVE STRATEGIES OF INDIGENOUS LOTHA COMMUNITY: A STUDY OF DOYANG DAM RESETTLEMENT AREA IN NAGALAND

Development-induced displacement resulted in the disruption of age-old ecological conditions among the indigenous populations worldwide. Indigenous communities who cherish a symbiotic relationship with their natural habitat were forced to evict due to the exploitation of rich natural resources in hydro-electric projects to cater to human beings’ modern needs. The present study focuses on the Lotha-Nagas, from the state of Nagaland in India, who belong to the Doyang Hydro-electric project’s resettled population in Wokha district, Nagaland. The study uses Michael Cernea’s Impoverishment Risks and Reconstruction (IRR) model to analyse the adaptation process of the Lotha tribe in the resettlement area. The study’s findings reveal that the displaced community faced challenges in terms of loss of livelihood opportunities in agriculture, imbalance in ecology, and poor transport and education facilities. This paper argues that in the process of resettlement, few elite families have become the most significant beneficiaries. In contrast, the ordinary people struggled in the resettled area, which further led to the community disarticulation despite occasional visits to their ancestral homes.

Traditional healing and medicine in dementia care for indigenous populations in North America, Australia, and New Zealand: A scoping review protocol

AbstractObjectiveIn this scoping review we aim to explore approaches to the integration of traditional healing and medicine in dementia care for Indigenous communities in North America, Australia, and New Zealand. We aim to understand the roles and experiences of traditional healers, strategies and their evaluation, and the barriers and opportunities for integration of Indigenous and western dementia care approaches. Introduction: Access to culturally safe geriatric care and dementia assessment, diagnosis, and care in Indigenous populations worldwide is an emerging challenge. The World Health Organization recognizes traditional healers as stakeholders in dementia care. Traditional healers can provide dementia assessment and care in unique ways and play a catalytic role in the process of dementia care planning. This scoping review will inform Indigenous health service providers about the potential integration of traditional healing and medicine into dementia care and support systems. Inclusion criteria: This review will include all types of study designs, that examine the integration of Indigenous approaches and traditional healers in dementia care in Indigenous communities in North America (Canada and U.S.), Australia and New Zealand.MethodsIn close collaboration with Indigenous community advisors, we will search for OVID MEDLINE, PsycINFO, CINAHL and EMBASE include English literature from 1990 to 2020. After two independent screens of title and abstract, and then full text, we will extract the study population, participants, intervention type, aims, methods, key findings, and knowledge gaps. The results will be summarized and presented to Indigenous community advisors for contextual interpretation and validation prior to being finalized.ResultsOur initial search of CINAHL, Embase, Medline and PsycINFO identified 516 records published between 2000 and 2020 that met our search criteria. After 164 duplicates were removed, we screened 352 titles and abstracts and excluded 209 that did not meet inclusion criteria. Our second stage review of 143 full text studies resulted in the further exclusion of 113 studies. Of these, 84 studies did not include traditional medicine and 13 did not involve Indigenous populations or meet our study design criteria. Results were extracted from the 30 eligible and relevant studies that were included in the final scoping review.

Changing language input following market integration in a Yucatec Mayan community.

Like many indigenous populations worldwide, Yucatec Maya communities are rapidly undergoing change as they become more connected with urban centers and access to formal education, wage labour, and market goods became more accessible to their inhabitants. However, little is known about how these changes affect children's language input. Here, we provide the first systematic assessment of the quantity, type, source, and language of the input received by 29 Yucatec Maya infants born six years apart in communities where increased contact with urban centres has resulted in a greater exposure to the dominant surrounding language, Spanish. Results show that infants from the second cohort received less directed input than infants in the first and, when directly addressed, most of their input was in Spanish. To investigate the mechanisms driving the observed patterns, we interviewed 126 adults from the communities. Against common assumptions, we showed that reductions in Mayan input did not simply result from speakers devaluing the Maya language. Instead, changes in input could be attributed to changes in childcare practices, as well as caregiver ethnotheories regarding the relative acquisition difficulty of each of the languages. Our study highlights the need for understanding the drivers of individual behaviour in the face of socio-demographic and economic changes as it is key for determining the fate of linguistic diversity.

From Artificial Intelligence Bias to Inequality in the Time of COVID-19

As secretary general of the United Nations, Antonio Guterres said during the 2020 Nelson Mandela Annual Lecture, “COVID-19 has been likened to an X-ray, revealing fractures in the fragile skeleton of the societies we have built.” Without a doubt, the COVID-19 pandemic has exposed and exacerbated existing global inequalities. Whether at the local, national, or international scale, the gap between the privileged and the vulnerable is growing wider, resulting in a broad increase in inequality across all dimensions of society. The disease has strained health systems, social support programs, and the economy as a whole, drawing an ever-widening distinction between those with access to treatment, services, and job opportunities and those without. Global lockdown restrictions have led to increases in childcare and housework responsibilities, and most of the burden has fallen on women, further increasing existing gender inequality [1], [2]. Indigenous populations worldwide find themselves more vulnerable to infection, many times with less access to health services or hygiene measures and limited updated scientific information about the virus and measures that can be taken to mitigate it [3]. Inequality has also pervaded the education sector, with only a subset of students able to attend safe in-person schooling or access online education when needed.

Geographic Accessibility to Radiotherapy in Canada and Greenland for Indigenous Populations: A Quantitative Approach to Highlighting Inequities and Exploring Solutions

A high cancer burden exists among indigenous populations worldwide. Providing equitable delivery of cancer services can be challenging in Canada and Greenland given their geography. We sought to describe geographic access to radiotherapy for indigenous populations in Canada and Greenland. We used geospatial analyses to calculate distance and travel-time from indigenous communities in Canada and Greenland to the nearest radiotherapy center. In Canada, we calculated the proportion of indigenous communities and populations residing within a 1 and 2-hour drive of a radiotherapy center, and compared the proportion of indigenous versus non-indigenous populations residing within each drive-time area. We also calculated the potential distance and travel-time saved if radiotherapy was available in northern Canada (Yellowknife and Iqaluit), and Greenland (Nuuk). This took into consideration several assumptions, including that the new radiotherapy centers here would be similarly utilized and could offer all the same types of treatments available as in the current referral tertiary centers. We also assumed that patients would choose to receive radiotherapy within their own respective regions. Median one-way travel from indigenous communities to nearest radiotherapy center in Canada was 268 km (3 hours by plane or road), and 4,111 km (6 hours by plane) in Greenland. In Canada, 84% and 68% of indigenous communities were outside a 1 and 2-hour drive from a radiotherapy center, respectively. Only 2% of the total population in Canada resided outside a 2-hour drive from a radiotherapy center. However, indigenous peoples were 336 times more likely to live more than a 2-hour drive away, compared to non-indigenous peoples. Nearly 3 million km and 4,000 hours of travel could be saved for 1,000 patients with newly diagnosed cancers over a 10-year period in Canada, and 7 million km and 10,000 hours for 1,020 patients in Greenland, if radiotherapy was available in Yellowknife, Iqaluit, and Nuuk. Disparities in geographic access to radiotherapy exist between indigenous and non-indigenous peoples in Canada. Geospatial analyses can help highlight inequities in access to inform radiotherapy service planning, such as in Canada and Greenland where geography is an important potential barrier. Future work should involve a detailed economic evaluation involving the current costs associated with travelling, versus the implementation of local radiotherapy units.

Community-associated MRSA among Indigenous children in remote settings: Best practices for NPs.

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is a major public health concern for Indigenous pediatric populations worldwide. It is the leading cause of skin and soft tissue infections in this demographic. This article reviews the literature and presents an evidence-based algorithm for the assessment and management of CA-MRSA among Indigenous children in remote settings.

Model of Engaging Communities Collaboratively

The Model of Engaging Communities Collaboratively was developed with the integration of literature reviews in cultural adaptation approaches, engagement and implementation approaches; and international Indigenous feedback to inform the processes of implementing evidence-based practices (EBP) with Indigenous populations. This model synthesises the collective strengths of these approaches and feedback and provides checklists for practicality of use by researchers, service providers and global Indigenous populations alike. This article describes the process of the theoretical development of the MECC and the feedback that refined it into a functional model for working with Indigenous populations worldwide.

Generating protective immunity to severe influenza disease in Indigenous Australians

Abstract The 2009 influenza pandemic caused generally mild infections due, at least partially, to broadly cross-reactive pre-existing CD8+ T cell immunity. In contrast, severe disease was observed in Indigenous populations worldwide, as shown by disproportionate hospitalisation rates. Human leukocyte antigen-I (HLA-I) molecules present viral peptides to CD8+ T cells, eliciting anti-viral responses that contribute to accelerated viral clearance. We identified several HLA-I alleles which are highly prevalent in Indigenous Australians (HLA-A*11:01, A*24:02, A*34:01, B*13:01 and B*15:21) but largely understudied. Using specific HLA-allomorph expressing C1R cell lines, we identified influenza A and B immunopeptidomes by mass spectrometry. A total of 653 influenza peptides derived from various viral proteins were presented during infection by different HLA-Is. Using virus-specific PBMC expansions, we screened these peptides for their potential to reactivate influenza-specific memory CD8+ T cells. We identified on average 4.6 (2–8) immunogenic epitopes per HLA-I for influenza A and B. We defined epitope-specific CD8+ T cells ex vivo across different human tissues and determined their memory subsets, phenotype and activation in healthy donors and influenza-infected patients. Overall, our approach is effective in detection of immunogenic epitopes and understanding CD8+ T cell pools in Indigenous populations, thus providing potential vaccine targets to protect Indigenous populations globally, from severe influenza disease. This is the first study to identify hallmarks of immunogenic responses and reveal key targets of an effective CD8+ T cell vaccine in Indigenous people.

Good Spirit, Good Life: A Quality of Life Tool and Framework for Older Aboriginal Peoples.

The lack of appropriate quality of life (QoL) measures is a major barrier to planning and delivering health and aged care services for older Indigenous peoples worldwide. QoL is dependent on cultural values and priorities may vary between age groups. This project aims to develop a QoL tool for older Aboriginal Australians. The study was completed with Aboriginal Australians aged over 45 years living in Perth and Melbourne, Australia. Participatory Action Research methods were applied with an Indigenous research paradigm. Semistructured interviews were undertaken to identify the factors important to having a good life. Factors were further explored in yarning groups with older Aboriginal peoples to develop the draft QoL tool questions. Face validity of the tool was completed in two regions. The participants preferred the term "a good life" to QoL. Having a good spirit is at the core of having a good life. The protective factors for a good life were family and friends, health, culture, Elder role, respect, Country, spirituality, services and supports, community, future plans, safety and security, and basic needs. Twelve factors were identified and developed into key questions for the Good Spirit, Good Life tool. The draft tool will undergo quantitative validity testing, prior to embedding in service provision to inform care for older Aboriginal peoples. With local adaptation, the tool, accompanying framework, and participatory methods for development may have wider applicability to other Indigenous populations worldwide.

Examining geographic accessibility to radiotherapy in Canada and Greenland for indigenous populations: Measuring inequities to inform solutions

BackgroundA high cancer burden exists among indigenous populations worldwide. Canada and Greenland have similar geographic features that make health service delivery challenging. We sought to describe geographic access to radiotherapy for indigenous populations in both regions. MethodsWe used geospatial analyses to calculate distance and travel-time from indigenous communities in Canada and Greenland to the nearest radiotherapy center. We calculated the proportion of indigenous communities and populations residing within a 1 and 2-hour drive of a radiotherapy center in Canada, and compared the proportion of indigenous versus non-indigenous populations residing within each drive-time area. We calculated the potential distance and travel-time saved if radiotherapy was available in northern Canada (Yellowknife and Iqaluit), and Greenland (Nuuk). ResultsMedian one-way travel from indigenous communities to nearest radiotherapy center in Canada was 268 km (3 h when considering any transportation mode), and 4111 km (6 h by plane) in Greenland. In Canada, 84% and 68% of indigenous communities were outside a 1 and 2-hour drive from a radiotherapy center, respectively. Only 2% of the total population in Canada resided outside a 2-hour drive from a radiotherapy center. However, indigenous peoples were 336 times more likely to live more than a 2-hour drive away, compared to non-indigenous peoples. Nearly 3 million km and 4000 h of travel could be saved over a 10-year period for patients with newly diagnosed cancers in Canada, and 7 million km and 10,000 h in Greenland, if radiotherapy was available in Yellowknife, Iqaluit and Nuuk. ConclusionsGeography is an important barrier to accessing radiotherapy for indigenous populations in Canada and Greenland. A significant disparity exists between indigenous and non-indigenous peoples in Canada. Geospatial analyses can help highlight disparities in access to inform radiotherapy service planning.

‘Desculturización,’ urbanization, and nutrition transition among urban Kichwas Indigenous communities residing in the Andes highlands of Ecuador

BackgroundThe nutrition transition continues to affect populations throughout the world. The added impact of market integration and urbanization exacerbates the impact of the nutrition transition upon Indigenous populations worldwide. ObjectivesThis study aims to explore the nutritional concerns of the urban Kichwas community residing in the Andes highlands of Ecuador. Study designThis is a qualitative study. MethodsEight focus groups were conducted with Kichwas men and women in November 2015 in the Imbabura province of the Andes in Ecuador. Data analysisApplied thematic analysis was used to analyze findings regarding nutrition. ResultsThe participants shared concerns regarding increased intake of fast food, poor meal timing, and a shift in the child's food preferences that rejects traditional foods. They attributed these concerns to urbanization resulting from an increase in dual-income households and a loss of cultural identity. ConclusionsSynergistic cultural factors are related to nutritional concerns voiced by the urban Kichwas community. Public health implicationsSyndemic theory is a useful interpretive lens regarding nutritional trends within the Kichwas communities as they relate to the increased risk of chronic disease.