Educating for Indigenous health equity: An international consensus statement

The determinants of health inequities between Indigenous and non-Indigenous populations include factors amenable to medical education’s influence, for example, the competence of the medical workforce to provide effective and equitable care to Indigenous populations. Medical education institutions have an important role to play in eliminating these inequities. However, there is evidence that medical education is not adequately fulfilling this role, and in fact may be complicit in perpetuating inequities. This article seeks to examine the factors underpinning medical education’s role in Indigenous health inequity, in order to inform interventions to address these factors. The authors developed a consensus statement that synthesizes evidence from research, evaluation, and the collective experience of an international research collaboration including experts in Indigenous medical education. The statement describes foundational processes that limit Indigenous health development in medical education and articulates key principles that can be applied at multiple levels to advance Indigenous health equity. The authors recognize colonization, racism, and privilege as fundamental determinants of Indigenous health that are also deeply embedded in Western medical education. In order to contribute effectively to Indigenous health development, medical education institutions must engage in decolonization processes and address racism and privilege at curricular and institutional levels. Indigenous health curricula must be formalized and comprehensive, and must be consistently reinforced in all educational environments. Institutions’ responsibilities extend to advocacy for health system and broader societal reform to reduce and eliminate health inequities. These activities must be adequately resourced and underpinned by investment in infrastructure and Indigenous leadership

What works? A review of actions addressing the social and economic determinants of Indigenous health

Introduction: The purpose of this paper is to review evidence relating to ‘what works’ to influence the social and economic determinants of Indigenous health, in order to reduce health inequities, and ultimately contribute to closing the life expectancy gap between Indigenous and non-Indigenous Australians. We outline a conceptual framework for understanding how social and economic determinants influence health and wellbeing, and identify a number of key determinants of health. We review evidence relating to how each determinant is associated with Indigenous health and wellbeing, and then consider specific actions designed to improve Indigenous outcomes in each of these areas in order to determine the characteristics of successful initiatives. Based on our conceptual framework, we link successful actions which result in positive outcomes for Indigenous Australians in each of the key determinants to ultimately improving health and wellbeing and contributing towards ‘closing the gap’ in health and wellbeing. We note that many actions we consider only aim to improve the situation for Indigenous Australians in regard to that specific area (for example, education, housing) and were not devised to take direct action to improve health, even though the evidence indicates that those actions may be likely to contribute to improved health over the longer term

Best Practices in Intercultural Health

This paper presents some of the background research that contributed to the discussions within the Inter-American Development Bank's policy and strategy regarding indigenous health issues. The paper's conceptual approach and good practice research helped focus the discussion on the importance of intercultural health practices to promote indigenous peoples' access to allopathic health as well as to strengthen those traditional health practices based on indigenous peoples' own knowledge, culture, social networks, institutions and ways of life, that have shown their effectiveness. The paper presents five intercultural health experiences (in Suriname, Guatemala, Chile, Ecuador and Colombia) that are considered best practices in the field. Although poorly financed, these experiences highlight the significance to indigenous peoples of health models that bridge the gap between state-financed allopathic health services and their own indigenous health systems. This study however, does not represent a medical trial on the efficacy or efficiency of intercultural health models.Afro Descendents & Indigenous Peoples, Health Care, intercultural health, health care, indigenous peoples, health care services

Indigenous youth peer-led health promotion in Canada, New Zealand, Australia, and the United States: A systematic review of the approaches, study designs, and effectiveness

Background: Youth peer-led interventions have become a popular way of sharing health information with young people and appear well suited to Indigenous community contexts. However, no systematic reviews focusing on Indigenous youth have been published. We conducted a systematic review to understand the range and characteristics of Indigenous youth-led health promotion projects implemented and their effectiveness. Methods: A systematic search of Medline, Embase, and ProQuest Social Sciences databases was conducted, supplemented by gray literature searches. Included studies focused on interventions where young Indigenous people delivered health information to age-matched peers. Results: Twenty-four studies were identified for inclusion, based on 20 interventions (9 Australian, 4 Canadian, and 7 from the United States of America). Only one intervention was evaluated using a randomized controlled study design. The majority of evaluations took the form of pre–post studies. Methodological limitations were identified in a majority of studies. Study outcomes included improved knowledge, attitude, and behaviors. Conclusion: Currently, there is limited high quality evidence for the effectiveness of peer-led health interventions with Indigenous young people, and the literature is dominated by Australian-based sexual health interventions. More systematic research investigating the effectiveness of peer-led inventions is required, specifically with Indigenous populations. To improve health outcomes for Indigenous youth, greater knowledge of the mechanisms and context under which peer-delivered health promotion is effective in comparison to other methods of health promotion is needed

The Health Status of Indigenous and Non-Indigenous Australians

We use unique survey data to examine the determinants of self-assessed health of Indigenous and non-Indigenous Australians. We explore the degree to which differences in health are due to differences in socio-economic factors, and examine the sensitivity of our results to the inclusion of ‘objective’ health measures. Our results reveal that there is a significant gap in the health status of Indigenous and non-Indigenous Australians, with the former characterised by significantly worse health. These findings are robust to alternative estimation methods and measures of health. Although between one third and one half of the health gap can be explained by differences in socio-economic status - such as income, employment status and education - there remains a large unexplained component. These findings have important policy implications. They suggest that, in order to reduce the gap in health status between Indigenous and non-Indigenous Australians, it is important to address disparities in socio-economic factors such as education. The findings also suggest that there are disparities in access to health services and in health behaviour. These issues need to be tackled before Australia can truly claim to have 100% health-care coverage and high levels of health and life expectancy for all of its population.self-assessed health, Indigenous health

The contribution of sleep to ‘Closing the Gap’ in the health of Indigenous children: a methodological approach

Examination of the sleep of Australian Indigenous children presents some unique challenges, particularly in terms of community input, study design and in the collection of relevant data. Abstract Objectives: Research on Indigenous children’s sleep quality is likely to play a significant part in ‘Closing the Gap’ between Indigenous and non-Indigenous children’s health, academic performance and social outcomes. However, examination of the sleep of Australian Indigenous children presents some unique challenges, particularly in terms of community input, study design and in the collection of relevant data. Methods: The current literature on Indigenous sleep research is reviewed and includes factors such as mental and physical health, socioeconomic disadvantage, and their relationships to sleep. Challenges encountered in researching Indigenous sleep and strategies for best practice are explored. Conclusion: Many challenges exist in researching sleep in Indigenous children, but the imperative of undertaking this task is clear. An assessment of the sleep of Australian Indigenous children requires a thorough evaluation of factors that contribute to sleep health such as co-morbid disease, regional factors and social disadvantage. Methodological issues include appropriate assessment tools, affordable and objective sleep quality measures, accounting for differing cultural beliefs and practices and timekeeping associated with bedtimes and get-up times

Education programs for Indigenous Australians about sexually transmitted infections and bloodborne viruses

As a group, Indigenous Australians experience poorer health outcomes than other Australians, including in the area of sexual health. Indigenous Australians have substantially higher rates of STIs, BBVs and teen pregnancy than non-Indigenous Australians, particularly for chlamydia, gonorrhoea, infectious syphilis, hepatitis B and hepatitis C. Efforts to reduce these high rates are compounded by the historical and social context of Indigenous Australians. Although many Australians may experience elements of shame and embarrassment when they access health services for STIs and BBVs, for many Indigenous Australians there also exists a mistrust of ‘mainstream’ (non-Indigenous specific) health services as a result of past injustices and racially differentiated treatment (Arabena 2006). Historically, Indigenous Australians diagnosed with an STI were segregated and placed into privately run hospitals (‘lock hospitals’) that were in poor condition (Hunter 1998)

Impressions of Interculturality and Health Care in Bolivia: Three Cases from Cochabamba

Considerable health disparities exist that result in both poorer health outcomes and relatively low accessibility of health care for the world’s indigenous populations. States and global/international health organizations have prioritized indigenous health. Intercultural health care plays a pivotal role in this prioritization. Recent governmental changes in Bolivia, a country in which two thirds of the population self-identify as indigenous, have resulted in state discourse centered on decolonization and interculturality that advocates indigenous rights as well as economic and popular democracy. Research that focuses on how intercultural policies are practiced on the ground or on how individuals are experiencing these policies is lacking. Using qualitative data gathered from semi-structured interviews of three individuals living in and around Cochabamba, Bolivia, this thesis explores participants’ thoughts and experiences of interculturality, health, and the Bolivian healthcare system. Results are contextualized 1) through a discussion of the intercultural health care literature based on Latin American examples and 2) according to two health behavior theories: Social Cognitive Theory and the Structural-Ecological Model. The results presented here raise concerns about the implementation and effectiveness of intercultural healthcare policies. Participants have noticed very little change as a result of new polices and are skeptical of the motivations driving interculturality. Additional factors, such as substantial financial barriers, impede intercultural health care. Research that investigates how intercultural health care functions on the ground and in practice in Bolivia has repercussions for health policy on a global scale. The research presented here is of public health importance because, if the goal is to improve the health of indigenous peoples worldwide, a more critical consideration of the implementation of intercultural healthcare efforts, of which this thesis is part, is necessary

Ten principles relevant to health research among Indigenous Australian populations

As committed Indigenous health researchers in Australia, these researchers aim to provide the answers to key questions relating to health that might enable Indigenous Australians to live the lives that they would choose to live. Working with Indigenous communities towards research that is relevant, effective and culturally respectful Writing in the Journal about Indigenous health in 2011, Sir Michael Marmot suggested that the challenge was to conduct research, and to ultimately apply findings from that research, to enable Indigenous Australians to lead more flourishing lives that they would have reason to value.1 As committed Indigenous health researchers in Australia, we reflect Marmot’s ideal — to provide the answers to key questions relating to health that might enable Indigenous Australians to live the lives that they would choose to live. As a group, we have over 120 collective years’ experience in Indigenous health research. Over this time, particularly in recent years as ethical guidelines have come into play, there have been many examples of research done well. However, as the pool of researchers is constantly replenished, we hold persisting concerns that some emerging researchers may not be well versed in the principles of best practice regarding research among Indigenous Australian populations. Implementing any research methodology among Indigenous Australian groups will work best when the following 10 principles are met. These principles are reflected in the many documents related to working and researching with Indigenous Australians; for example, the National Health and Medical Research Council (NHMRC) ethical guidelines for research among Aboriginal and Torres Strait Islander people.2 In this article, we set out these principles in one short, accessible document.   Download PDF Authors: Lisa M Jamieson, Yin C Paradies, Sandra Eades, Alwin Chong, Louise Maple-Brown, Peter Morris, Ross Bailie, Alan Cass, Kaye Roberts-Thomson and Alex Brown. Image: OpalMirror / flick

“Because we have really unique art”: Decolonizing Research with Indigenous Youth Using the Arts

Indigenous communities in Canada share a common history of colonial oppression. As a result, many Indigenous populations are disproportionately burdened with poor health outcomes, including HIV. Conventional public health approaches have not yet been successful in reversing this trend. For this study, a team of community- and university-based researchers came together to imagine new possibilities for health promotion with Indigenous youth. A strengths-based approach was taken that relied on using the energies and talents of Indigenous youth as a leadership resource. Art-making workshops were held in six different Indigenous communities across Canada in which youth could explore the links between community, culture, colonization, and HIV. Twenty artists and more than 85 youth participated in the workshops. Afterwards, youth participants reflected on their experiences in individual in-depth interviews. Youth participants viewed the process of making art as fun, participatory, and empowering; they felt that their art pieces instilled pride, conveyed information, raised awareness, and constituted a tangible achievement. Youth participants found that both the process and products of arts-based methods were important. Findings from this project support the notion that arts-based approaches to the development of HIV-prevention knowledge and Indigenous youth leadership are helping to involve a diverse cross-section of youth in a critical dialogue about health. Arts-based approaches represent one way to assist with decolonization for future generations