We searched a combination of sources, including PubMed, concentrating on original publications and reviews from the preceding 10 years. The search was not confined to the English language. Keywords used included: “Indigenous”, “Aboriginal”, or “Aborigines”, linked with “health”, “nutrition”, “malnutrition”, “growth”, “infants”, “children”, “pregnancy”, “maternal health”, “adolescents”, “infections”, “parasites”, “hypertension”, “cardiovascular disease”, “diabetes”, “renal disease”,
ReviewIndigenous health part 1: determinants and disease patterns
Introduction
There are more than 370 million Indigenous people worldwide and they live in countries on every inhabited continent.1, 2 The definition of Indigenous can be difficult, even contentious;2, 3 panel 1 shows criteria that can be used to this end. Some Indigenous groups are easily identified, such as native Americans, Australia's Aboriginal people, Mãori in New Zealand, and the original inhabitants of Pacific Ocean nations who were present long before Europeans.3 Indigenous peoples are variously called Indigenous, Aboriginal, tribal, or minority groups or peoples.3 Poor definition of Indigenous identification contributes to the groups' marginalisation and inadequate data for their numbers, health, and socioeconomic circumstances.3 Most countries do not officially recognise their Indigenous groups, and have inaccurate or no published statistical data for these peoples. Therefore, systematic information about health, morbidity, and mortality is sparse.2, 3 Most reports relate to specific conditions and small groups. In this Review we discuss issues of worldwide importance and draw on Australian Indigenous experience as an example. Despite great diversity of Indigenous peoples, many similarities in their health and illnesses and their determinants exist.
Indigenous people come from thousands of cultures and are over-represented among the poor and disadvantaged. Overall, their health compares unfavourably with their non-Indigenous counterparts.3 Their susceptibility to disease is exacerbated by poor living conditions and water supplies, often with restricted access to fresh and nutritious food, and inadequate health services. Panel 2 summarises their main health problems.
Section snippets
Effects of colonisation
Common to many Indigenous groups are the powerful effects of colonisation on their people and their lands by outsiders who later dominated societies and alienated them from their own ways of life. This colonisation adversely affected physical, social, emotional, and mental health and wellbeing in traditional societies. Extrapolation between different groups is unwise because local circumstances differ greatly.
We need to understand how colonisation affected the lives of Indigenous peoples to
Health of children and mothers
Poor living conditions, inadequate nutrition, and exposure to high rates of infection cause a heavy burden of disease in infants and children.11, 12, 13 These diseases are mainly skin infections, acute and chronic ear disease, dental caries, trachoma, diarrhoeal diseases, parasite infestations, upper and lower respiratory tract infections, urinary tract infections, and viral and bacterial infections affecting the nervous system. Indigenous children have high rates of low birthweight and being
Burden of infectious disease
Indigenous people have much higher rates of infection than do their non-Indigenous counterparts, and these infections are likely to be more severe or more frequently fatal in Indigenous groups. The nature, frequency, and severity of infection depends on age, nutritional status, impaired immunity, presence of diabetes, personal living conditions and hygiene, exposure to infections and disease-carrying vectors, immunisation status, geography, and climate.
Skin infections are very common,
Urbanisation and upsurge of lifestyle diseases
Urbanisation has had a profound effect in the past century. The process of urbanisation is usually regarded as the growth of cities and rural-to-urban migration. Millions of Indigenous people now live in urban or periurban areas. The effects of urbanisation are virtually worldwide and are not confined to large groups. These effects are caused by increasing commercialism, acculturation, and rapidly changing lifestyles. They include modern high-calorie, high-fat, high-salt, and low-fibre diets,
Changing patterns of Indigenous health
Major difficulties, trends, and factors that affect Indigenous health are summarised in panel 5. Clearly, Indigenous people should have better health than they do at present, which will depend on recognition of the problems and resolute action to overcome them. Approaches should relate to local circumstances, interaction between Indigenous and non-Indigenous parts of society, and provision of improved health-related services.
Is Indigenous health changing? This important but sweeping question
Conclusions
When considering Indigenous health worldwide, one can feel overwhelmed and discouraged by the great disparities in health and disease statistics. Using Indigenous Australians as an example,90 we see that Indigenous peoples have higher rates of physical, mental, and emotional illness, injuries, disability, and earlier and higher mortality than do their non-Indigenous counterparts. The mortality gap between Indigenous and other Australians is considerably greater than the disability gap—ie, when
Search strategy and selection criteria
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