Disappearing, displaced, and undervalued: a call to action for Indigenous health worldwide

doi:10.1016/S0140-6736(06)68892-2

The Lancet

Volume 367, Issue 9527, 17–23 June 2006, Pages 2019-2028

https://doi.org/10.1016/S0140-6736(06)68892-2 Get rights and content

Summary

“What sets worlds in motion is the interplay of differences, their attractions and repulsions. Life is plurality, death is uniformity. By suppressing differences and peculiarities, by eliminating different civilisations and cultures, progress weakens life and favours death. The ideal of a single civilisation for everyone implicit in the cult of progress and technique, impoverishes and mutilates us. Every view of the world that becomes extinct, every culture that disappears, diminishes a possibility of life!”¹

Section snippets

Definition of Indigenous

The notion of indigeneity is complex, and highly contested.⁷ After all, are we all not, in some sense, Indigenous to the lands where we were born? Two main areas of debate exist: how does one define what the idea of being Indigenous is, and who is Indigenous in any particular setting? Anthropologists disagree on the answers to these questions, and Indigenous peoples themselves have differing views.

The term Indigenous is used in some contexts to refer to the aboriginal population of a nation or

Indigenous health

In some countries, specifically Canada, Australia, and New Zealand, a large amount of reliable data on Indigenous health exists. In recent years these data have not solely been about Indigenous peoples, but have been gathered and published by Indigenous researchers. Internationally, peer-reviewed studies are scarce, and for some regions we searched for studies from non-governmental organisations, both local and international, and other unpublished sources. Some of these are sources from

Addressing underlying causes

The reviews in this series show that at best the health situation of Indigenous peoples mirrors that of the world's very poorest, but is made worse by their social and cultural marginalisation. For example, in 1999–2000 around 25% of India's total population were living below the poverty line, but for the Scheduled Tribes living in rural areas this figure was 46%.⁵⁷ Even in wealthier countries, most Indigenous peoples live in worse socioeconomic conditions than their non-Indigenous counterparts.

New research approaches

We have, in theory, entered a new decade of Indigenous peoples, and a real need for information related to their conditions and wellbeing remains.¹¹ The populations might be small within their countries and regions, but Indigenous peoples contribute largely to the world's cultural, linguistic, and intellectual diversity. Such information should also be seen in the context of their absence from most calls for action on international health. There cannot be improved advocacy for international

Health services

Indigenous people do not have easy access to basic western health care when needed.65, 66, 67 Access is constrained by financial, geographic, and cultural barriers. Indigenous people are low on governments' priority lists, especially when they live in remote areas where services are difficult and costly to provide. Where services are available, Indigenous people are often reluctant or afraid to use them because staff can be insensitive, discriminatory, and unfriendly.68, 69

All papers in this

The importance of Indigenous knowledge

Our final call to action is for all health professionals to respect Indigenous peoples for their wisdom, not argue for them as though they are problematic victims. As Reading notes “in the past and in the present, research studies and media reports have focused on pathology and dysfunction in aboriginal communities.”⁶³ Yet Indigenous peoples are the guardians of the natural world, protecting many of the plants that form the basis of our most important medicines. Indigenous peoples have

Call to action

This second International Decade needs new policies for Indigenous health, all with a stronger emphasis on Indigenous rights.59, 97 Only then will governments be held to account for continued exploitation of Indigenous peoples' lands. A key conclusion of the 2004 international conference on Indigenous Peoples Rights to Health was that “the right to land and a healthy environment is an indispensable part of Indigenous peoples health and well-being and should be recognised.”⁹⁸

Political rights

References (101)

I Anderson et al.
Indigenous health in Australia, New Zealand, and the Pacific
Lancet
(2006)
R Montenegro et al.
Indigenous health in Latin America and the Caribbean
Lancet
(2006)
No Ohenjo et al.
Indigenous Health in Africa
Lancet
(2006)
A Kuper
Indigenous people: an unhealthy category
Lancet
(2005)
VF Andrade-Neto et al.
Antimalarial activity of Cinchona-like plants used to treat fever and malaria in Brazil
J Ethnopharmacol
(2003)
MA Maciel et al.
Ethnopharmacology, phytochemistry and pharmacology: a successful combination in the study of Croton cajucara
J Ethnopharmacol
(2000)
J Van Oostdam et al.
Human health implications of environmental contaminants in Arctic Canada: a review
Sci Total Environ
(1999)
RE Black et al.
Where and why are 10 million children dying every year?
Lancet
(2003)
JE Lawn et al.
4 million neonatal deaths: when? Where? Why?
Lancet
(2005)
CG Victora et al.
Applying an equity lens to child health and mortality: more of the same is not enough
Lancet
(2003)

I Rudan et al.

Gaps in policy-relevant information on burden of disease in children: a systematic review

Lancet

(2005)

JD Sachs et al.

The Millennium Project: a plan for meeting the Millennium Development Goals

Lancet

(2005)

J Cunningham

Comparing indigenous health status across regions: a numerical example of uncertainty

Aust N Z J Public Health

(2002)

JW Lee

Child survival: a global health challenge

Lancet

(2003)

S Venis

Child survival

Lancet

(2003)

L Cavalli-Sforza et al.

Call for a worldwide survey of human genetic diversity: a vanishing opportunity for the Human Genome Project

Genomics

(1991)

CA Louw et al.

Medicinal bulbous plants of South Africa and their traditional relevance in the control of infectious diseases

J Ethnopharmacol

(2002)

SR King et al.

Biological diversity, indigenous knowledge, drug discovery and intellectual property rights: creating reciprocity and maintaining relationships

J Ethnopharmacol

(1996)

PD Mail et al.

Expanding practice horizons: learning from American Indian patients

Patient Educ Couns

(1989)

CR Janes

The health transition, global modernity and the crisis of traditional medicine: the Tibetan case

Soc Sci Med

(1999)

MC Duarte et al.

Anti-Candida activity of Brazilian medicinal plants

J Ethnopharmacol

(2005)

FF Perazzo et al.

Anti-inflammatory and analgesic properties of water-ethanolic extract from Pothomorphe umbellata (Piperaceae) aerial parts

J Ethnopharmacol

(2005)

NL Etkin et al.

Seeking a transdisciplinary and culturally germane science: The future of ethnopharmacology

J Ethnopharmacol

(2005)

O Paz

The Labyrinth of Solitude

(1985)

F Bristow et al.

Utz W'achil: Health and wellbeing among Indigenous peoples

(2003)

United Nations General Assembly. Draft programme of action for the Second Internation Decade of the World's Indigenous...

R Sylvain

Land, Water and Truth

Am Anthropol

(2002)

African Commission on Human and Peoples' Rights (ACHPR). Report of the African Commission's Working Group on Indigenous...

The Constitution of India

(1949)

United Nations. The concept of indigenous peoples: background paper prepared by the Secretariat of the Permanent Forum...

World Bank. HRO Dissemination Notes Number 8, June 7, 1993: Human Resources Development and Operations Policy,...

The Indigenous world 2000/2001

(2001)

Ethnologue: Languages of the World, Fifteenth edition

(2005)

D Napolitano et al.

La salud de los pueblos indígenas y el Proyecto de Gas de Camisea Informe para la AIDESEP

(2003)

R Witzig et al.

The road to indigenous extinction: case study of resource exportation, disease importation, and human rights violations against the Urarina in the Peruvian Amazon

Health Hum Rights

(1999)

R Sylvain

San Women Today: inequality and dependency in a post-foraging world

Indigenous Affairs

(2002)

M Pineros-Petersen et al.

[Demographic aspects in indigenous communities of 3 regions of Colombia]

Salud Publica Mex

(1998)

R Pennington

Hunter-gatherer demography

JF Peters

The Shirishana of the Yanomami: a demographic study

Soc Biol

(1980)

RH Jackson

[The creation and changing definitions of demographic knowledge: the case of mestizos in the indigenous communities of the Valle Bajo of Cochabamba, Bolivia]

Cah Que Demogr

(1996)

J Suzman

An Introduction to the Regional Assessment of the San in Southern Africa

(2001)

HJ Hsu

[Incidence of tuberculosis in the hunting tribe E-Lun-Chun in Northeast China]

Pneumologie

(1990)

D Bramley et al.

Indigenous disparities in disease-specific mortality, a cross-country comparison: New Zealand, Australia, Canada, and the United States

N Z Med J

(2004)

C Smeja et al.

Tuberculosis infection in an Aboriginal (First Nations) population of Canada

Int J Tuberc Lung Dis

(2000)

LM Alessandri et al.

Cumulative mortality in children aged 1 to 6 years born in Western Australia from 1980–89

Arch Dis Child

(1999)

LM Alessandri et al.

Perinatal and postneonatal mortality among Indigenous and non-Indigenous infants born in Western Australia, 1980–1998

Med J Aust

(2001)

ZC Luo et al.

Infant mortality among First Nations versus non-First Nations in British Columbia: temporal trends in rural versus urban areas, 1981–2000

Int J Epidemiol

(2004)

LJ Kirmayer et al.

The mental health of Aboriginal peoples: transformations of identity and community

Can J Psychiatry

(2000)

E Hunter et al.

Indigenous suicide in Australia, New Zealand, Canada, and the United States

Emerg Med (Fremantle)

(2002)

D Macdonald et al.

From pleasure to pain: a social history of Baswara alcohol use in Botswana

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Assessing child development scores among minority and Indigenous language versus dominant language speakers: a cross-sectional analysis of national Multiple Indicator Cluster Surveys
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Multiple studies have highlighted the inequities minority and Indigenous children face when accessing health care. Health and wellbeing are positively impacted when Indigenous children are educated and receive care in their maternal language. However, less is known about the association between minority or Indigenous language use and child development risks and outcomes. In this study, we provide global estimates of development risks and assess the associations between minority or Indigenous language status and early child development using the ten-item Early Child Development Index (ECDI), a tool widely used for global population assessments in children aged 3–4 years.
We did a secondary analysis of cross-sectional data from 65 UNICEF Multiple Indicator Cluster Surveys (MICS) containing the ECDI from 2009–19 (waves 4–6). We included individual-level data for children aged 2–4 years (23–60 months) from datasets with ECDI modules, for surveys that captured the language of the respondent, interview, or head of household. The Expanded Graded Intergenerational Disruption Scale was used to classify household languages as dominant versus minority or Indigenous at the country level. Our primary outcome was on-track overall development, defined per UNICEF's guidelines as development being on track for at least three of the four ECDI domains (literacy–numeracy, learning, physical, and socioemotional). We performed logistic regression of pooled, weighted ECDI scores, aggregated by language status and adjusting for the covariables of child sex, child nutritional status (stunting), household wealth, maternal education, developmental support by an adult caregiver, and country-level early child education proportion. Regression analyses were done for all children aged 3–4 years with ECDI results, and separately for children with functional disabilities and ECDI results.
65 MICS datasets were included. 186 393 children aged 3–4 years had ECDI and language data, corresponding to an estimated represented population of 34 714 992 individuals. Estimated prevalence of on-track overall development as measured by ECDI scores was 65·7% (95% CI 64·2–67·2) for children from a minority or Indigenous language-speaking household, and 76·6% (75·7–77·4) for those from a dominant language-speaking household. After adjustment, dominant language status was associated with increased odds of on-track overall development (adjusted OR 1·54, 95% CI 1·40–1·71), which appeared to be largely driven by significantly increased odds of on-track development in the literacy–numeracy and socioemotional domains. For the represented population aged 2–4 years (n=11 465 601), the estimated prevalence of family-reported functional disability was 3·6% (95% CI 3·0–4·4). For the represented population aged 3–4 years with a functional disability (n=292 691), language status was not associated with on-track overall development (adjusted OR 1·02, 95% CI 0·43–2·45).
In a global dataset, children speaking a minority or Indigenous language were less likely to have on-track ECDI scores than those speaking a dominant language. Given the strong positive benefits of speaking an Indigenous language on the health and development of Indigenous children, this disparity is likely to reflect the sociolinguistic marginalisation faced by speakers of minority or Indigenous languages as well as differences in the performance of ECDI in these languages. Global efforts should consider performance of measures and monitor developmental data disaggregated by language status to stimulate efforts to address this disparity.
None.
For the Spanish, Kaqchikel and K'iche' translations of the abstract see Supplementary Materials section.
Breastfeeding rates of Aboriginal and Torres Strait Islander women in Australia: a systematic review and narrative analysis
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Australian Aboriginal and Torres Strait Islander (referred to hereafter as Aboriginal) women breastfeed at lower rates than non-Aboriginal women, and rates vary across and within Aboriginal populations.
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CINAHL, Medline, EMBASE, SCOPUS, PsycINFO, and the Cochrane library were searched for peer-reviewed literature published between 1995 and 2021. Quantitative studies written in English and reporting breastfeeding for Aboriginal women or women having an Aboriginal infant were included. Screening and quality assessment included co-screening 10% of papers. Two reviewers completed data extraction. A proportional meta-analysis was undertaken for breastfeeding initiation and narrative data synthesis used to summarise breastfeeding maintenance.
The initial search identified 12,091 records, with 31 full text studies retrieved, and 27 reports from 22 studies met inclusion criteria. Breastfeeding initiation was 78% (95% CI 0.71, 0.84), however, rates were lower than non-Aboriginal women. Maintenance ranged between one week and five years. Rates and definitions varied significantly between studies, with inconsistencies in government collection and reporting of breastfeeding.
Significant variation in definitions and reporting make comparisons difficult. Breastfeeding rates were below recommended targets. Future pattern and trend analyses require standardised measures and definitions. Current collection and reporting of breastfeeding data, particularly routinely collected state-based data, is inadequate to present an accurate picture of current breastfeeding in Australia for Aboriginal women and infants, and to effectively inform interventions and policies.
Impact of social networks on the choice of place of delivery among ethnic women in Bangladesh
2021, Sexual and Reproductive Healthcare
This study aims at exploring the present situation of the delivery place and the impact of social networks on the choice of delivery place among the ethnic women in Bangladesh.
Data were collected through face to face interviews using a structured questionnaire from a sample of 205 married ethnic - Garo and Mandai - women in Madhupur Upazilla of Tangail district. A stepwise binary logistic regression analysis is run to explain the impact of social networks on the choice of delivery place (the place where the women actually did deliver a baby) of ethnic women in Bangladesh.
Descriptive statistics show that of the total deliveries 37.7% among Garo- and 13% among Mandai women take place in institutions (hospitals and clinics). The regression model reveals that next to ethnicity and husband's occupation, network size has a significant positive relationship, while reproductive health-related constraints have a significant negative relationship with the choice of delivery place of ethnic women. Based on these, this study suggests that if the social networks of ethnic women increase, the probability of their institutional delivery may increase.
The personal social networks of ethnic women may motivate them on their choice of institutional delivery in Bangladesh. This finding may contribute to the development of pathways to stimulate ethnic women's reproductive health behaviour in the developing countries context.
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SeriesDisappearing, displaced, and undervalued: a call to action for Indigenous health worldwide

Summary

Section snippets

Definition of Indigenous

Indigenous health

Addressing underlying causes

New research approaches

Health services

The importance of Indigenous knowledge

Call to action

Lancet

Lancet

Lancet

Lancet

J Ethnopharmacol

J Ethnopharmacol

Sci Total Environ

Lancet

Lancet

Lancet

Lancet

Lancet

Aust N Z J Public Health

Lancet

Lancet

Genomics

J Ethnopharmacol

J Ethnopharmacol

Patient Educ Couns

Soc Sci Med

J Ethnopharmacol

J Ethnopharmacol

J Ethnopharmacol

The Labyrinth of Solitude

Utz W'achil: Health and wellbeing among Indigenous peoples

Land, Water and Truth

Am Anthropol

The Constitution of India

The Indigenous world 2000/2001

Ethnologue: Languages of the World, Fifteenth edition

La salud de los pueblos indígenas y el Proyecto de Gas de Camisea Informe para la AIDESEP

The road to indigenous extinction: case study of resource exportation, disease importation, and human rights violations against the Urarina in the Peruvian Amazon

Health Hum Rights

San Women Today: inequality and dependency in a post-foraging world

Indigenous Affairs

[Demographic aspects in indigenous communities of 3 regions of Colombia]

Salud Publica Mex

Hunter-gatherer demography

The Shirishana of the Yanomami: a demographic study

Soc Biol

[The creation and changing definitions of demographic knowledge: the case of mestizos in the indigenous communities of the Valle Bajo of Cochabamba, Bolivia]

Cah Que Demogr

An Introduction to the Regional Assessment of the San in Southern Africa

[Incidence of tuberculosis in the hunting tribe E-Lun-Chun in Northeast China]

Pneumologie

Indigenous disparities in disease-specific mortality, a cross-country comparison: New Zealand, Australia, Canada, and the United States

N Z Med J

Tuberculosis infection in an Aboriginal (First Nations) population of Canada

Int J Tuberc Lung Dis

Cumulative mortality in children aged 1 to 6 years born in Western Australia from 1980–89

Arch Dis Child

Perinatal and postneonatal mortality among Indigenous and non-Indigenous infants born in Western Australia, 1980–1998

Med J Aust

Infant mortality among First Nations versus non-First Nations in British Columbia: temporal trends in rural versus urban areas, 1981–2000

Int J Epidemiol

The mental health of Aboriginal peoples: transformations of identity and community

Can J Psychiatry

Indigenous suicide in Australia, New Zealand, Canada, and the United States

Emerg Med (Fremantle)

From pleasure to pain: a social history of Baswara alcohol use in Botswana

Series
Disappearing, displaced, and undervalued: a call to action for Indigenous health worldwide