Public Health and Indigenous Peoples: North America, Australia, and New Zealand

by

Margo L. Greenwood, Regine Halseth, Nicole Lindsay, Hilary McGregor, Sarah de Leeuw, Donna Atkinson, Deborah Keahey

• LAST REVIEWED: 26 July 2017
• LAST MODIFIED: 26 July 2017
• DOI: 10.1093/obo/9780199756797-0071

Introduction

Indigenous peoples around the world experience a disproportionate burden of disease, mortality, and ill-health when compared to non-indigenous peoples. This is an important global public health issue. The various manifestations of these health disparities and their drivers—although complex, interactive, co-constitutive, dynamic, and always changing—can be most usefully understood within a social determinants of health (SDOH) framework, as demonstrated by the growing bodies of research and evidence explored in the sections of this article. Many international SDOH frameworks are anchored in the 1986 Ottawa Charter for Health Promotion, which is understood as a global milestone in conceptualizing health inequities and disparities. On an international level, the UN has established the right to health in numerous conventions and comments. These documents form an important background for considering the health of indigenous peoples around the world. Indigenous health is an emerging field of research but is seriously limited by a lack of reliable and accurate data in all but a few regions of the world; namely, Canada, Australia, the United States, and New Zealand. As well, much of the existing academic literature about indigenous health is published in English. These geographical and linguistic limitations are reflected in this article. There has been increased attention to research on indigenous health disparities, and, encouragingly, a growing number of new and emerging studies are being led by indigenous researchers and directed by the needs and priorities of indigenous communities. Although research on indigenous health is growing rapidly, and many regions are committing considerable resources and efforts toward improving policies around health promotion and provision of health care for indigenous peoples, progress in improving the life circumstances of indigenous peoples has been slow, and health outcomes in indigenous communities continue to lag behind those in non-indigenous communities.

General Overviews

This section presents general overviews of indigenous health, on the basis of a social determinants of health (SDOH) framework. Social determinants of health are the economic and social conditions that shape the health of individuals and communities. Access to resources and services have a significant impact on health, and a growing body of research confirms the reality that lower socioeconomic status is related to poorer health and wellness outcomes. Given that indigenous peoples in all parts of the world experience disproportionate levels of poverty and social exclusion, SDOH approaches are highly relevant to understanding the health outcomes of indigenous peoples (Carson, et al. 2007; Waldram, et al. 2006). Two complementary articles, Gracey and King 2009 and King, et al. 2009, provide a detailed picture of patterns of health disparities experienced by indigenous peoples around the world and the causes of these disparities. Mitrou, et al. 2014 examines socioeconomic trends among indigenous and non-indigenous populations in three high-income countries to determine whether progress has been made in closing gaps. To date, there have been few indigenous authors published in SDOH academic literature. Reading and Wien 2009 and Greenwood, et al. 2015 are included here to address this gap, providing a uniquely indigenous perspective on the determinants of indigenous peoples’ health. Landmark documents such as Canada’s Royal Commission on Aboriginal Peoples 1996 and the Truth and Reconciliation Commission of Canada 2015 focus on ways in which colonialism, economic marginalization, and social exclusion have negatively affected the health of indigenous peoples and have far-reaching policy implications.

• Carson, Bronwyn, Terry Dunbar, Richard D. Chenhall, and Ross Bailie. 2007. Social determinants of indigenous health. Crows Nest, Australia: Allen & Unwin Academic.

  This book contains contributions from researchers on SDOHs for indigenous peoples in Australia. Chapters focus on defining health, applying health models to indigenous health, history of colonization and indigenous health, racism, poverty and social class, social capital, education, employment and welfare, indigenous relationships to place and country, housing, policy processes, human rights, and interventions and sustainable programs.

• Gracey, Michael, and Malcolm King. 2009. Indigenous health part 1: Determinants and disease patterns. The Lancet 374.9683: 65–75.

  DOI: 10.1016/S0140-6736(09)60914-4

  This article considers the patterns of disease and ill health among indigenous peoples. It highlights the adverse effects of colonization on indigenous peoples, as well as major health issues such as maternal and child health, the burden of infectious disease, and urbanization and lifestyle diseases on changing patterns of indigenous health.

• Greenwood, Margo, Sarah de Leeuw, Nicole M. Lindsay, and Charlotte Reading, eds. 2015. Determinants of indigenous peoples’ health in Canada: Beyond the social. Toronto: Canadian Scholars’ Press.

  With contributions from primarily First Nations, Inuit, and Métis authors across Canada, this book presents a broader perspective on determinants of indigenous peoples’ health inequalities that goes beyond a focus on strictly social determinants, including colonialism, geography, biology, and culture, and identity, among others. The book makes a unique contribution to the literature because it reflects indigenous worldviews that are holistic and collectivist and embrace culture and language as integral to improved health and well-being, as well as indigenous ways of transmitting knowledge.

• King, Malcolm, Alexandra Smith, and Michael Gracey. 2009. Indigenous health part 2: The underlying causes of the health gap. The Lancet 374.9683: 76–85.

  DOI: 10.1016/S0140-6736(09)60827-8

  As a companion piece to Gracey and King 2009, this article explores the underlying causes of indigenous health disparities, drawing from indigenous perspectives on health and wellness to highlight the colonial disruption of relationships among identity, culture, and the natural world that have resulted in health disparities.

• Mitrou, Francis, Martin Cooke, David Lawrence, et al. 2014. Gaps in indigenous disadvantage not closing: A census cohort study of social determinants of health in Australia, Canada, and New Zealand from 1981–2006. BMC Public Health 14:201.

  DOI: 10.1186/1471-2458-14-201

  This article compares socioeconomic outcomes (income, employment, and education) between indigenous and non-indigenous—twenty-five- to twenty-nine-year-olds from three developed nations, using census data from 1981 to 2006. All three countries showed large socioeconomic gaps between both population groups over this period, with no significant reductions being made with respect to income and employment and a widening gap in education.

• Reading, Charlotte, and Fred Wien. 2009. Health inequalities and the social determinants of aboriginal peoples’ health. Prince George, BC: National Collaborating Centre for Aboriginal Health.

  This well-cited report describes the health inequalities experienced by diverse aboriginal peoples in Canada, taking a holistic, life-course approach to account for the proximal, intermediate, and distal determinants affecting their health.

• Royal Commission on Aboriginal Peoples. 1996. Report of the Royal Commission on Aboriginal Peoples. Vol. 3, Gathering strength. Ottawa, ON: Canada Communication Group.

  In 1996, the Royal Commission on Aboriginal Peoples (RCAP) released a comprehensive five-volume final report that sets out a twenty-year agenda for implementing changes aimed at improving indigenous peoples’ lives in Canada. Vol. 3 provides the context for health and well-being for indigenous peoples, including current problems in family life, health and healing, housing, education, and cultural policy. The report makes recommendations for addressing these problems.

• Truth and Reconciliation Commission of Canada. 2015. Honouring the truth, reconciling for the future: Summary of the final report of the Truth and Reconciliation Commission of Canada. Winnipeg, MB: Truth and Reconciliation Commission of Canada.

  This report documents the truth about Indian Residential Schools in Canada and their impacts on the health and well-being of individuals, families, communities, and nations through the stories of survivors and their families. It presents a framework for reconciliation that includes recommendations for Canada’s political and legal systems, educational and religious institutions, the corporate sector, and civil society.

• Waldram, James B., D. Ann Herring, and T. Kue Young. 2006. Aboriginal health in Canada: Historical, cultural, and epidemiological perspectives. 2d ed. Toronto: Univ. of Toronto Press.

  The second edition of this seminal book serves as a general introduction to the topic, combining epidemiological, historical, and anthropological methodologies and perspectives in a broad overview of indigenous health in Canada.