Indigenous health part 1: determinants and disease patterns

Summary

The world's almost 400 million Indigenous people have low standards of health. This poor health is associated with poverty, malnutrition, overcrowding, poor hygiene, environmental contamination, and prevalent infections. Inadequate clinical care and health promotion, and poor disease prevention services aggravate this situation. Some Indigenous groups, as they move from traditional to transitional and modern lifestyles, are rapidly acquiring lifestyle diseases, such as obesity, cardiovascular disease, and type 2 diabetes, and physical, social, and mental disorders linked to misuse of alcohol and of other drugs. Correction of these inequities needs increased awareness, political commitment, and recognition rather than governmental denial and neglect of these serious and complex problems. Indigenous people should be encouraged, trained, and enabled to become increasingly involved in overcoming these challenges.

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.