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Muslin C. Addressing the burden of cervical cancer for Indigenous women in Latin America and the Caribbean: a call for action. Front Public Health 2024; 12:1376748. [PMID: 38807996 PMCID: PMC11130434 DOI: 10.3389/fpubh.2024.1376748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/24/2024] [Indexed: 05/30/2024] Open
Abstract
Cervical cancer, primarily caused by human papillomavirus (HPV) infection, poses a significant global health challenge. Due to higher levels of poverty and health inequities, Indigenous women worldwide are more vulnerable to cervical cancer than their non-Indigenous counterparts. However, despite constituting nearly 10% of the population in Latin America and the Caribbean (LAC), the true extent of the burden of cervical cancer among Indigenous people in this region remains largely unknown. This article reviews the available information on cervical cancer incidence and mortality, as well as HPV infection prevalence, among Indigenous women in LAC. The limited existing data suggest that Indigenous women in this region face a heightened risk of cervical cancer incidence and mortality compared to non-Indigenous women. Nevertheless, a substantial knowledge gap persists that must be addressed to comprehensively assess the burden of cervical cancer among Indigenous populations, especially through enhancing cancer surveillance across LAC countries. Numerous structural, social and cultural barriers hindering Indigenous women's access to HPV vaccination and cervical cancer screening worldwide have been identified and are reviewed in this article. The discussion highlights the critical role of culturally sensitive education, community engagement, and empowerment strategies in overcoming those barriers. Drawing insights from the success of targeted strategies in certain high-income countries, the present article advocates for research, policies and healthcare interventions tailored to the unique context of LAC countries.
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Affiliation(s)
- Claire Muslin
- One Health Research Group, Faculty of Health Sciences, Universidad de las Américas, Quito, Ecuador
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2
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Sehgal A, Henderson R, Murry A, Crowshoe LL, Barnabe C. Advancing health equity for Indigenous peoples in Canada: development of a patient complexity assessment framework. BMC PRIMARY CARE 2024; 25:144. [PMID: 38684966 PMCID: PMC11057171 DOI: 10.1186/s12875-024-02362-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 04/03/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Indigenous patients often present with complex health needs in clinical settings due to factors rooted in a legacy of colonization. Healthcare systems and providers are not equipped to identify the underlying causes nor enact solutions for this complexity. This study aimed to develop an Indigenous-centered patient complexity assessment framework for urban Indigenous patients in Canada. METHODS A multi-phased approach was used which was initiated with a review of literature surrounding complexity, followed by interviews with Indigenous patients to embed their lived experiences of complexity, and concluded with a modified e-Delphi consensus building process with a panel of 14 healthcare experts within the field of Indigenous health to identify the domains and concepts contributing to health complexity for inclusion in an Indigenous-centered patient complexity assessment framework. This study details the final phase of the research. RESULTS A total of 27 concepts spanning 9 domains, including those from biological, social, health literacy, psychological, functioning, healthcare access, adverse life experiences, resilience and culture, and healthcare violence domains were included in the final version of the Indigenous-centered patient complexity assessment framework. CONCLUSIONS The proposed framework outlines critical components that indicate the presence of health complexity among Indigenous patients. The framework serves as a source of reference for healthcare providers to inform their delivery of care with Indigenous patients. This framework will advance scholarship in patient complexity assessment tools through the addition of domains not commonly seen, as well as extending the application of these tools to potentially mitigate racism experienced by underserved populations such as Indigenous peoples.
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Affiliation(s)
- Anika Sehgal
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
| | - Rita Henderson
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Adam Murry
- Department of Psychology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Lynden Lindsay Crowshoe
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
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3
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Marchand T, Squires K, Daodu O, Brindle ME. Improving Indigenous health equity within the emergency department: a global review of interventions. CAN J EMERG MED 2024:10.1007/s43678-024-00687-3. [PMID: 38683290 DOI: 10.1007/s43678-024-00687-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/27/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION Indigenous health equity interventions situated within emergency care settings remain underexplored, despite their potential to influence patient care satisfaction and empowerment. This study aimed to systematically review and identify Indigenous equity interventions and their outcomes within acute care settings, which can potentially be utilized to improve equity within Canadian healthcare for Indigenous patients. METHODS A database search was completed of Medline, PubMed, Embase, Google Scholar, Scopus and CINAHL from inception to April 2023. For inclusion in the review, articles were interventional and encompassed program descriptions, evaluations, or theoretical frameworks within acute care settings for Indigenous patients. We evaluated the methodological quality using both the Joanna Briggs Institute checklist and the Ways Tried and True framework. RESULTS Our literature search generated 122 publications. 11 articles were selected for full-text review, with five included in the final analysis. Two focusing on Canadian First Nations populations and three on Aboriginal Australians. The main intervention strategies included cultural safety training, integration of Indigenous knowledge into care models, optimizing waiting-room environments, and emphasizing sustainable evaluation methodologies. The quality of the interventions was varied, with the most promising studies including Indigenous perspectives and partnerships with local Indigenous organizations. CONCLUSIONS Acute care settings, serving as the primary point of access to health care for many Indigenous populations, are well-positioned to implement health equity interventions such as cultural safety training, Indigenous knowledge integration, and optimization of waiting room environments, combined with sustainable evaluation methods. Participatory discussions with Indigenous communities are needed to advance this area of research and determine which interventions are relevant and appropriate for their local context.
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Affiliation(s)
- Tyara Marchand
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Kaitlyn Squires
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Oluwatomilayo Daodu
- Surgery, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Mary E Brindle
- Surgery and Community Health Sciences, Cumming School of Medicine, Calgary, AB, Canada
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Mulqueeney A, Battin M, McKillop A, Stott NS, Allermo-Fletcher A, Williams SA. A prospective assessment of readiness to implement an early detection of cerebral palsy pathway in a neonatal intensive care setting using the PARIHS framework. Implement Sci Commun 2024; 5:46. [PMID: 38654322 PMCID: PMC11036598 DOI: 10.1186/s43058-024-00581-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 04/06/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Early detection of cerebral palsy (CP) is possible through targeted use of assessment tools. Changes in practice are needed to facilitate this shift towards earlier diagnosis of CP in New Zealand. The aim of this study was to prospectively evaluate readiness to implement an early detection of CP pathway within a level 3 neonatal intensive care unit (NICU) setting prior to any implementation taking place. The PARIHS (Promoting Action on Research Implementation in Health Services) framework was engaged to assess readiness by highlighting determinants that influence implementation outcomes as either barriers or enablers. METHODS A mixed methods approach was used. Firstly, an online staff survey assessed PARIHS sub-elements using Likert scores and free text with the intent to develop a baseline understanding of staff views. Secondly, focus groups were conducted to gain deeper understanding of barriers and enablers to implementation. Participants included health professionals involved in the first 6 months of life. Data were analysed to outline the barriers and enablers of implementation under the Evidence and Context constructs of the PARIHS framework. RESULTS Twenty-seven participants completed the survey, and 20 participants participated in eight focus groups and two individual interviews. Quantitative (survey) findings found 65% agreement around the usefulness of research evidence on early CP detection; however, ≤ 45% felt current resources (i.e. human, financial and IT) were sufficient for implementation. Qualitative findings (survey and focus groups) highlighted key staff concerns around resources, family impact (creating unnecessary stress), and equity (barriers to participation). Staff wanted information regarding how international evidence translates to the local context and availability of timely follow-up services. Sub-elements within the Evidence and Context constructs were rated as either mixed or low (except for Evidence - Research, rated as high), overall indicating that Auckland NICU is at the early stages of readiness to implement the early CP detection pathway. CONCLUSION This work may resonate with other neonatal services preparing to implement CP early detection pathways. Resourcing has a major role in facilitating implementation of pathways and uncertainty about resources is a barrier to implementation. Ongoing focus on building consensus and funding is required to ensure optimal uptake.
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Affiliation(s)
- Amy Mulqueeney
- Newborn Services, Starship Child Health, Te Toka Tumai - Auckland, Te Whatu Ora, Auckland, New Zealand
| | - Malcolm Battin
- Newborn Services, Starship Child Health, Te Toka Tumai - Auckland, Te Whatu Ora, Auckland, New Zealand.
- Faculty of Medical and Health Sciences, Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand.
| | - Ann McKillop
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - N Susan Stott
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | | | - Sîan A Williams
- School of Allied Health, Curtin University, Perth, Australia
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Sheftel MG, Heiland FW. The Role of Place of Birth and Residence in Puerto Rican Health Disparities: Evidence From Disability Prevalence Among Archipelago- Vs. Mainland-Born Puerto Ricans. J Aging Health 2024; 36:67-84. [PMID: 37115825 PMCID: PMC10693743 DOI: 10.1177/08982643231172643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Objectives: This paper provides new estimates of disability prevalence for the archipelago and mainland-residing Puerto Rican populations ages 40 and above and compares disability by place of birth and place of residence to investigate drivers of middle and older age health. Methods: Large nationally representative samples from 2013 to 2017 American Community Survey and Puerto Rico Community Survey data are used to estimate age-specific disability prevalence for archipelago-born/archipelago-residing, archipelago-born/mainland-residing, mainland-born/mainland-residing Puerto Ricans. Results: Mainland-born/mainland-residing Puerto Ricans have the lowest age-adjusted disability rates and archipelago-born/archipelago-residing Puerto Ricans have the highest rates. Differences in education explain part of this disparity. Discussion: Similarities in disability prevalence are strongest based on where one was born as opposed to current residence, pointing to early life as a critical period in the disablement process for later-life health. Early life socio-economic disadvantage on the archipelago may have an enduring impact on later-life disability prevalence for archipelago-born Puerto Ricans.
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Affiliation(s)
- Mara Getz Sheftel
- Population Research Institute, Pennsylvania State University, University Park¸ PA, USA
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Newport R, Grey C, Dicker B, Ameratunga S, Harwood M. Ethnic differences of the care pathway following an out-of-hospital cardiac event: A systematic review. Resuscitation 2023; 193:110017. [PMID: 37890578 DOI: 10.1016/j.resuscitation.2023.110017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/25/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023]
Abstract
AIM This systematic review aimed to determine to what extent and why the care pathways for acute cardiac events in the community might differ for minoritised ethnic populations compared to non-minoritised populations. It also sought to identify the barriers and enablers that could influence variations in access to care for minoritised populations. METHODS A multi-database search was conducted for articles published between 1 January 2000 and 1 January 2023. A combination of MeSH terms and keywords was used. Inclusion criteria for papers were published in English, adult population, the primary health condition was an acute cardiac event, and the primary outcomes were disaggregated by ethnicity or race. A narrative review of extracted data was performed, and findings were reported according to the PRISMA 2020 guidelines. RESULTS Of the 3552 articles identified using the search strategy, 40 were deemed eligible for the review. Studies identified a range of variables in the care pathway that differed by ethnicity or race. These could be grouped as time to care, transportation, event related-variables, EMS interactions and symptoms. A meta-analysis was not performed due to heterogeneity across the studies. CONCLUSION The extent and reasons for differences in cardiac care pathways are considerable. There are several remediable barriers and enablers that require attention to achieve equitable access to care for minoritised populations.
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Affiliation(s)
- Rochelle Newport
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, New Zealand.
| | - Corina Grey
- Health New Zealand; Honorary Academic, Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, New Zealand
| | - Bridget Dicker
- Clinical Audit and Research, Hato Hone St John New Zealand, Auckland, New Zealand; Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
| | - Shanthi Ameratunga
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, New Zealand; Section of Epidemiology & Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Matire Harwood
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, New Zealand
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Sethi S, Santiago PHR, Soares GH, Ju X, Antonsson A, Canfell K, Smith M, Garvey G, Hedges J, Jamieson L. Development and validation of an HPV infection knowledge assessment scale among Aboriginal and Torres Strait Islander Peoples. Vaccine X 2023; 14:100317. [PMID: 37288370 PMCID: PMC10241973 DOI: 10.1016/j.jvacx.2023.100317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 06/09/2023] Open
Abstract
Background An increased incidence of Human Papillomavirus (HPV) infection and its related cancers has been observed in recent years. Correct knowledge about HPV infection can lead to a significant decrease in transmission and a subsequent increase in vaccine uptake. Awareness and behavioural perception towards HPV infections are critical for improving HPV vaccination rates among Aboriginal and/or Torres Strait Islander Peoples. However, to the best of our knowledge, there has been no instrument designed to measure knowledge about HPV infection that is culturally appropriate and validated among Aboriginal and/or Torres Strait Islander People. Aim To address this research gap, this paper aims to examine the psychometric properties of the HPV Knowledge Tool (HPV-KT) in an Indigenous population sample from South Australia. Methodology Data from 747 Indigenous Australian Adults who participated in the 12-month follow-up of the HPV and Oropharyngeal Carcinoma in Indigenous Australians Study was utilised for this study. The psychometric properties examined included1) dimensionality and item redundancy; (2) network loadings; (3) model fit; (4) criterion validity; and (5) reliability. The network model was estimated using the Graphical Least Absolute Shrinkage and Selector Operator (GLASSO). Evaluation of the HPV-KT (10 items) dimensionality and item redundancy was conducted within the framework of Exploratory Graph Analysis (EGA). Reliability was evaluated with the McDonald's Omega (ω) coefficient. Results After the exclusion of two items, the HPV-KT exhibited good psychometric properties for Aboriginal and/or Torres Strait Islander Peoples. The two dimensions of "General HPV Knowledge" and "Commonness of HPV" were identified. The dimension of "Commonness of HPV" displayed poor reliability, so a sum score for this subscale is not recommended (i.e. the items can still be used individually) The network model of the 7-item HPV-KT was fitted in the validation sample and model fit was adequate (x2 (7) = 17.17, p < 0.016; CFI = 0.980; TLI = 0.94; RMSEA = 0.063, 90% CI = 0.025-0.010). Furthermore, the reliability of the "General HPV Knowledge" subscale (ω = 0.76, 95% CI: 0.72-0.79), while the reliability of the "Commonness of HPV" subscale (ω = 0.58, 95% CI0.58-0.88) was poor. Conclusion The HPV-KT was adapted for an Aboriginal and/or Torres Strait Islander population and is readily available for future use in Australia. The addition of items assessing specifications of HPV infection, natural history and behaviour will improve the reliability and usability to assess the level of accurate knowledge about HPV infection. Future studies should investigate the possibility of developing new items for the dimension 'Commonness of HPV'.
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Affiliation(s)
- Sneha Sethi
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Pedro Henrique Ribeiro Santiago
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Gustavo Hermes Soares
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Xiangqun Ju
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | | | - Karen Canfell
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW
| | - Megan Smith
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
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8
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Greaves LM, Lindsay Latimer C, Li E, Hamley L. Well-being and cultural identity for Māori: Knowledge of iwi (tribal) affiliations does not strongly relate to health and social service outcomes. Soc Sci Med 2023; 329:116028. [PMID: 37336121 DOI: 10.1016/j.socscimed.2023.116028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 06/21/2023]
Abstract
Research indicates that experiences in health and social services vary depending on identity. For Indigenous groups, identity and affiliation is complex. This paper explores ethnicity and knowledge of tribal (iwi) affiliations for Māori (the Indigenous peoples of Aotearoa New Zealand), and links this to health and social service outcomes in administrative data, the national Census, and Māori social survey data. While many initiatives have sought to connect Māori to iwi - where such knowledge has been severed by colonization - we find surprisingly few differences in data between those who named tribal affiliations and those who did not, across sole- and mixed-Māori ethnicity groups. Those who did not name an iwi were less likely to live in overcrowded homes, but were less likely to own that home, and more likely to be a smoker. Unsurprisingly, those who did not name tribal affiliations were less likely to find Māori culture as important, although many still did. These groups also had slightly less contact with social networks and support, plus felt lonelier. The results also point to sole-ethnic identification as Māori as a key marker of experiences of inequity and suggest that connections to tribal affiliations are more complicated than a binary of "connected" or "disconnected". However, in some indicator areas, affiliation differences should be followed up with future work. We argue these results give further weight to the need for good quality data and indicators designed with Māori populations in mind to measure and monitor inequity.
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Affiliation(s)
- Lara M Greaves
- Political Science and International Relations, Victoria University of Wellington, Wellington, New Zealand.
| | | | - Eileen Li
- COMPASS Research Centre, University of Auckland, Auckland, New Zealand
| | - Logan Hamley
- Te Kura Whatu Oho Mauri/School of Psychology, University of Waikato, Hamilton, New Zealand
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Marchand T, Daodu O, MacRobie A, Green-Dowden S, Brindle M. Examining Indigenous emergency care equity projects: a scoping review protocol. BMJ Open 2023; 13:e068618. [PMID: 37015788 PMCID: PMC10083800 DOI: 10.1136/bmjopen-2022-068618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
INTRODUCTION Indigenous peoples across the globe face inequitable access to high-quality care. Emergency departments are the first point of access for many Indigenous peoples and are the interface between the individual and the healthcare system. There is a reliance on emergency services due to a lack of primary healthcare, a history of mistreatment from providers and increased disease complexity. As such, a potential place for health equity reform is within these departments and other acute care settings. It is the purpose of this review to determine what projects have occurred that address emergency care inequities in four countries such as Australia, Canada, New Zealand and the USA and explore their successes and failures. METHODS AND ANALYSIS Using search strategies developed with a research librarian, publications will be identified from indexed databases including Medline, Embase, Web of Science, Cochrane Central, CINAHL and Scopus. Grey literature will also be searched and scanned for inclusion. To be included in the review, articles must describe interventions developed to address Indigenous health equity occurring within emergency care settings. Articles will include both programme descriptions and programme evaluations and be quality appraised by analysing study design and Indigenous research methodologies. ETHICS AND DISSEMINATION This review does not require ethics approval. This protocol describes a review that attempts to map Indigenous health equity interventions taking place within emergency care settings. It will contribute to Indigenous health scholarship and equity research. Results will be made available in multiple dissemination methods to ensure accessibility by researchers and community members.
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Affiliation(s)
- Tyara Marchand
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Surgery, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | | | - Ali MacRobie
- Surgery, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | | | - Mary Brindle
- Surgery, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Ariadne Labs, Boston, Massachusetts, USA
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Maddox R, Drummond A, Kennedy M, Martinez SA, Waa A, Nez Henderson P, Clark H, Upton P, Lee JP, Hardy BJ, Tautolo ES, Bradbrook S, Calma T, Whop LJ. Ethical publishing in 'Indigenous' contexts. Tob Control 2023:tc-2022-057702. [PMID: 36781227 DOI: 10.1136/tc-2022-057702] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/27/2023] [Indexed: 02/15/2023]
Abstract
Ethical publishing practices are vital to tobacco control research practice, particularly research involving Indigenous (Indigenous peoples: For the purposes of this Special Communication, we use the term Indigenous people(s) to include self-identified individuals and communities who frequently have historical continuity with precolonial/presettler societies; are strongly linked to the land on which they or their societies reside; and often maintain their own distinct language(s), belief and social-political systems, economies and sciences. The authors humbly acknowledge, respect and value that Indigenous peoples are diverse and constitute many nations, cultures and language groups. Many Indigenous peoples also exist as governments in treaty relations with settler-colonial societies, and all Indigenous peoples have inherent rights under international law. The language and terminology used should reflect the local context(s) and could include, but are not limited to, terms such as Aboriginal, Bagumani, Cherokee, First Peoples, First Nations, Inuit, Iwaidja, Kungarakan, Lakota, Māori, Mѐtis, American Indian, Navajo, Wagadagam, Wiradjuri, Yurok, etc) people. These practices can minimise, correct and address biases that tend to privilege Euro-Western perspectives. Ethical publishing practices can minimise and address harms, such as appropriation and misuse of knowledges; strengthen mechanisms of accountability to Indigenous peoples and communities; ensure that tobacco control research is beneficial and meaningful to Indigenous peoples and communities; and support Indigenous agency, sovereignty and self-determination. To ensure ethical practice in tobacco control, the research methodology and methods must incorporate tangible mechanisms to include and engage those Indigenous peoples that the research concerns, affects and impacts.Tobacco Control is currently missing an ethical research and evaluation publishing protocol to help uphold ethical practice. The supporters of this Special Communication call on Tobacco Control to adopt publication practice that explicitly upholds ethical research and evaluation practices, particularly in Indigenous contexts. We encourage researchers, editors, peer reviewers, funding bodies and those publishing in Tobacco Control to reflect on their conduct and decision-making when working, developing and undertaking research and evaluation of relevance to Indigenous peoples.Tobacco Control and other publishers, funding bodies, institutions and research teams have a fundamental role in ensuring that the right peoples are doing the right work in the right way. We call for Tobacco Control to recognise, value and support ethical principles, processes and practices that underpin high-quality, culturally safe and priority-driven research, evaluation and science that will move us to a future that is commercial tobacco and nicotine free.
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Affiliation(s)
- Raglan Maddox
- Bagumani (Modewa) Clan, Milne Bay, Papua New Guinea
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Ali Drummond
- Meriam and Wuthathi, Torres Strait, Queensland, Australia
- Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, Canberra, Australian Capital Territory, Australia
| | - Michelle Kennedy
- Wiradjuri, New South Wales, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, The University of Newcastle College of Health, Medicine and Wellbeing, Callaghan, New South Wales, Australia
- College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Sydney A Martinez
- Cherokee Nation Citizen, Tahlequah, Oklahoma, USA
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Andrew Waa
- Ngāti Hine/Ngāpuhi, Wellington, New Zealand
- Eru Pomare Māori Health Research Unit, University of Otago, Wellington, New Zealand
| | - Patricia Nez Henderson
- Navajo Nation (Diné), South Dakota, South Dakota, USA
- Black Hills Center for American Indian Health, Rapid City, South Dakota, USA
| | - Hershel Clark
- Navajo Nation (Diné), South Dakota, South Dakota, USA
- Black Hills Center for American Indian Health, Rapid City, South Dakota, USA
| | - Penney Upton
- University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Juliet P Lee
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California, USA
| | - Billie-Jo Hardy
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, Waakebiness-Bryce Institute for Indigenous Health, University of Toronto, Toronto, Ontario, Canada
- Well Living House, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - El-Shadan Tautolo
- Samoa/Ngāti Tapuniu, Auckland, New Zealand
- Pacific Health Research Centre, Auckland University of Technology, Auckland, New Zealand
| | - Shane Bradbrook
- Ngāi Tāmanuhiri, Rongowhakaata, Ngāti Kahungunu, Aotearoa, New Zealand
| | - Tom Calma
- Elder from the Kungarakan tribal group and a member of the Iwaidja tribal group, Northern Territory, Northern Territory, Australia
- Indigenous tobacco control advocate, Canberra, Australian Capital Territory, Australia
| | - Lisa J Whop
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
- Wagadagam, Gumulgal, Torres Strait, Queensland, Australia
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11
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Brown H, Bryder L. Universal healthcare for all? Māori health inequalities in Aotearoa New Zealand, 1975-2000. Soc Sci Med 2023; 319:115315. [PMID: 36089552 DOI: 10.1016/j.socscimed.2022.115315] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 07/29/2022] [Accepted: 08/25/2022] [Indexed: 11/22/2022]
Abstract
Despite establishing a so-called universal, taxpayer funded health system from 1938, New Zealand's health system has never delivered equitable health outcomes for its indigenous population, the Māori people. This article, using a case study approach focusing on Māori, documents these historic inequalities and discusses policy attempts to address them from the 1970s when the principles of the Treaty of Waitangi were first introduced in legislation. This period is one of increasing self-determination for Māori, but notwithstanding this, Māori continued to have significantly shorter life expectancy than the population as a whole and suffered poor health at much higher rates. Neo-liberal policies were introduced and expanded during the 1980s and 1990s in New Zealand, including in healthcare from the early 1990s. The introduction of the purchaser-provider split in health services and the focus on devolving responsibility to communities provided an opportunity for Māori health providers to be established. However, the neo-liberal economic and social welfare policies implemented during this time also worked against Māori and adversely affected their health. By analysing attempts to reduce inequity in health outcomes for Māori, we explore why these collective attempts, including by Māori themselves, did not result in overall improved health and increased life expectancy for Māori. There was often a significant gap between government rhetoric and action, and we suggest that a predominantly universal healthcare system did not accommodate cultural and ethnic differences, and this is a potential explanation for the failure to reduce inequities. While this is true for all minority ethnic groups it is even more crucial for Māori as New Zealand's tangata whenua (first people) who had been progressively disadvantaged under colonialism. However, the seeds of ideas around Māori-led healthcare were planted in this period and have become part of the current Labour Government's policy on health reform.
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Affiliation(s)
- Hayley Brown
- London School of Hygiene and Tropical Medicine, 15-17, Tavistock Place, London WC1H 9SH, United Kingdom.
| | - Linda Bryder
- University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
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Brockie T, Clark TC, Best O, Power T, Bourque Bearskin L, Kurtz DLM, Lowe J, Wilson D. Indigenous social exclusion to inclusion: Case studies on Indigenous nursing leadership in four high income countries. J Clin Nurs 2023; 32:610-624. [PMID: 33942940 DOI: 10.1111/jocn.15801] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/21/2021] [Accepted: 03/29/2021] [Indexed: 01/17/2023]
Abstract
AIMS AND OBJECTIVES This discursive paper provides a call to action from an international collective of Indigenous nurse academics from Australia, Canada, Aotearoa New Zealand and the USA, for nurses to be allies in supporting policies and resources necessary to equitably promote Indigenous health outcomes. BACKGROUND Indigenous Peoples with experiences of colonisation have poorer health compared to other groups, as health systems have failed to address their needs and preferences. Achieving health equity will require leadership from Indigenous nurses to develop and implement new systems of care delivery. However, little is known about how Indigenous nurses influence health systems as levers for change. DESIGN A Kaupapa Māori case study design. METHODS Using a Kaupapa Māori case study methodology, coupled with expert Indigenous nursing knowledge, we developed a consensus on key themes. Themes were derived from three questions posed across the four countries. Themes were collated to illustrate how Indigenous nurses have provided nursing leadership to redress colonial injustices, contribute to models of care and enhance the Indigenous workforce. RESULTS These case studies highlight Indigenous nurses provide strong leadership to influence outcomes for Indigenous Peoples. Five strategies were noted across the four countries: (1) Indigenous nationhood and reconciliation as levers for change, (2) Indigenous nursing leadership, (3) Indigenous workforce strategies, (4) Development of culturally safe practice and Indigenous models of care and (5) Indigenous nurse activism. CONCLUSIONS In light of 2020 declared International Year of the Nurse and Midwife, we assert Indigenous nurses' work must be visible to support development of strategic approaches for improving health outcomes, including resources for workforce expansion and for implementing new care models. RELEVANCE TO CLINICAL PRACTICE Curating strategies to promote Indigenous nurse leaders around the world is essential for improving models of healthcare delivery and health outcomes for Indigenous Peoples.
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Affiliation(s)
- Teresa Brockie
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Center for American Indian Health, Baltimore, MD, USA
| | | | - Odette Best
- University of Southern Queensland - Ipswich Campus, Ipswich, Qld, Australia
| | - Tamara Power
- Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, NSW, Australia
| | | | - Donna L M Kurtz
- University of British Columbia School of Nursing, Vancouver, BC, Canada
| | - John Lowe
- University of Texas at Austin School of Nursing, Austin, TX, USA
| | - Denise Wilson
- Faculty of Health and Environmental Sciences, Taupua Waiora Māori Research Centre, Auckland University of Technology, Auckland, New Zealand
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Yu D, Osuagwu UL, Pickering K, Baker J, Cutfield R, Wang Z, Cai Y, Orr-Walker BJ, Sundborn G, Zhao Z, Simmons D. Adverse Clinical Outcomes Attributable to Socioeconomic and Ethnic Disparities Among People with Type 2 Diabetes in New Zealand Between 1994-2018: A Multiple Linked Cohort Study. Clin Epidemiol 2023; 15:511-523. [PMID: 37153075 PMCID: PMC10162107 DOI: 10.2147/clep.s402307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/17/2023] [Indexed: 05/09/2023] Open
Abstract
Purpose The study aimed to examine the separate population-level contributions of the ethnic and socioeconomic disparities among people with type 2 diabetes mellitus (T2DM) and residence in New Zealand (NZ). Patients and Methods A prospective cohort enrolled T2DM patients from 01/01/1994 into the Diabetes Care Support Service, a primary care audit program in Auckland, NZ. The cohort was linked to national registry databases (socioeconomic status, pharmaceutical claim, hospitalization, and death registration). Each cohort member was followed up till death or the study end time (31/12/2019), whichever came first. Incident clinical events (stroke, myocardial infarction (MI), heart failure (HF), end-stage renal disease (ESRD), and premature mortality (PM)) were used as outcomes. The attributable fractions (AFs) were estimated for the whole population and for specific population with NZ Europeans (NZE) and/or least deprived population as reference, both unadjusted and with adjustment for covariables by Cox Regression models. Results Among 36,267 patients, adjusted population AFs indicated 6.6(-30.8-33.3)% of PM, 17.1(5.8-27.0)% of MI, 35.3(22.6-46.0)% of stroke, 14.3(3.2-24.2)% of HF, and 15.9(6.7-24.2)% of ESRD could be attributed to deprivation; while 14.3(3.3-25.4)% of PM, -3.3(-8.3-1.5)% of MI, -0.5(-6.7-5.3)% of stroke, 4.7(0.3-8.8)% of HF, 13.3(9.9-16.6)% of ESRD could be attributed to ethnicity. Deprivation contributed a significant AF to stroke, while ethnicity was important for ESRD. Gradient of AF for deprivation indicated NZE and Asians were most affected by deprivation across outcomes. Conversely, Māori, with the highest AFs for ethnicity of PM and ESRD, were unaffected by deprivation. At same deprivations, the AFs of MI and stroke were greatest among NZE compared with other ethnic groups; the AF of ESRD was greatest among Māori and Pasifika. Conclusion Both socioeconomic deprivation and ethnicity are strongly associated with outcomes in patients with T2DM in NZ, although the extent of the deprivation gradient is greatest among NZE and Asians, and least among Māori.
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Affiliation(s)
- Dahai Yu
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, People’s Republic of China
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Uchechukwu Levi Osuagwu
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, NSW, Australia
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | | | - John Baker
- Diabetes Foundation Aotearoa, Auckland, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, Auckland, New Zealand
| | - Richard Cutfield
- Diabetes Foundation Aotearoa, Auckland, New Zealand
- Department of Diabetes and Endocrinology, Waitemata District Health Board, Auckland, New Zealand
| | - Zheng Wang
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, People’s Republic of China
| | - Yamei Cai
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, People’s Republic of China
| | - Brandon J Orr-Walker
- Diabetes Foundation Aotearoa, Auckland, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, Auckland, New Zealand
| | - Gerhard Sundborn
- Section of Pacific Health, The University of Auckland, Auckland, New Zealand
| | - Zhanzheng Zhao
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, People’s Republic of China
| | - David Simmons
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, People’s Republic of China
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, NSW, Australia
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
- Correspondence: David Simmons; Zhanzheng Zhao, Department of Nephrology, The First Affiliated Hospital Zhengzhou University, Zhengzhou, 450052, People’s Republic of China, Tel +61 2 4620 3899; +86 139 3852 5666, Fax +61 2 4620 3890; +86 371 6698 8753, Email ;
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Mangoyana C, March S, Lalloo R, Walsh LJ. Positive oral health outcomes: A partnership model improves care in a rural Indigenous community. Aust J Rural Health 2022. [PMID: 36583508 DOI: 10.1111/ajr.12960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 11/30/2022] [Accepted: 12/10/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The purpose of this study was to explore the benefits of a partnership between a university dental school and a Community Controlled Health Service, specifically in relation to improving the oral health of an underserved rural Indigenous community. We sought community opinions on health and social outcomes arising from the service provided by the dental student clinical outplacement. SETTING In Dalby, Queensland. PARTICIPANTS In total, 38 participants in five focus groups were representative of local Indigenous community Elders, community health support group members and management and staff. DESIGN A descriptive qualitative study employing semi-structured audio-recorded focus group discussions conducted with purposefully selected Indigenous community groups to explore participant views and experience of the partnership model. Qualitative data were analysed using thematic content analysis. RESULTS The Indigenous community representatives expressed positive benefit in both their general and oral health awareness, in improved access to dental care provided in their own safe space, while they were pleased to assist with students' learning. They viewed the partnership as mutually beneficial. Suggestions for enhancement of the oral health service were also offered. CONCLUSION This partnership between a university and a Community Controlled Health Service provides sustainable positive social and health benefits for the targeted Indigenous community and for the wider local population, while simultaneously providing enhanced educational benefits for students on clinical outplacement. Translation and uptake of this successful model of care would benefit both underserved communities and dental and other health care professional educators worldwide.
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Affiliation(s)
- Clare Mangoyana
- School of Dentistry, Oral Health Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Sandra March
- School of Dentistry, Oral Health Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Ratilal Lalloo
- School of Dentistry, Oral Health Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Laurence J Walsh
- School of Dentistry, Oral Health Centre, The University of Queensland, Brisbane, Queensland, Australia
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Collen EJ, Johar AS, Teixeira JC, Llamas B. The immunogenetic impact of European colonization in the Americas. Front Genet 2022; 13:918227. [PMID: 35991555 PMCID: PMC9388791 DOI: 10.3389/fgene.2022.918227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
The introduction of pathogens originating from Eurasia into the Americas during early European contact has been associated with high mortality rates among Indigenous peoples, likely contributing to their historical and precipitous population decline. However, the biological impacts of imported infectious diseases and resulting epidemics, especially in terms of pathogenic effects on the Indigenous immunity, remain poorly understood and highly contentious to this day. Here, we examine multidisciplinary evidence underpinning colonization-related immune genetic change, providing contextualization from anthropological studies, paleomicrobiological evidence of contrasting host-pathogen coevolutionary histories, and the timings of disease emergence. We further summarize current studies examining genetic signals reflecting post-contact Indigenous population bottlenecks, admixture with European and other populations, and the putative effects of natural selection, with a focus on ancient DNA studies and immunity-related findings. Considering current genetic evidence, together with a population genetics theoretical approach, we show that post-contact Indigenous immune adaptation, possibly influenced by selection exerted by introduced pathogens, is highly complex and likely to be affected by multifactorial causes. Disentangling putative adaptive signals from those of genetic drift thus remains a significant challenge, highlighting the need for the implementation of population genetic approaches that model the short time spans and complex demographic histories under consideration. This review adds to current understandings of post-contact immunity evolution in Indigenous peoples of America, with important implications for bettering our understanding of human adaptation in the face of emerging infectious diseases.
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Affiliation(s)
- Evelyn Jane Collen
- Australian Centre for Ancient DNA, School of Biological Sciences, University of Adelaide, Adelaide, SA, Australia
- *Correspondence: Evelyn Jane Collen, ; Bastien Llamas,
| | - Angad Singh Johar
- Australian Centre for Ancient DNA, School of Biological Sciences, University of Adelaide, Adelaide, SA, Australia
- School of Mathematics and Statistics, The University of Melbourne, Parkville, VIC, Australia
| | - João C. Teixeira
- Australian Centre for Ancient DNA, School of Biological Sciences, University of Adelaide, Adelaide, SA, Australia
- School of Culture History and Language, The Australian National University, Canberra, ACT, Australia
- Centre of Excellence for Australian Biodiversity and Heritage (CABAH), School of Biological Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Bastien Llamas
- Australian Centre for Ancient DNA, School of Biological Sciences, University of Adelaide, Adelaide, SA, Australia
- Centre of Excellence for Australian Biodiversity and Heritage (CABAH), School of Biological Sciences, University of Adelaide, Adelaide, SA, Australia
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT, Australia
- Telethon Kids Institute, Indigenous Genomics Research Group, Adelaide, SA, Australia
- *Correspondence: Evelyn Jane Collen, ; Bastien Llamas,
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Speight J, Baptista S, Lee C, Sher L, Skinner TC, Brown A. The Social and Emotional Well-being of Indigenous Peoples Living With Diabetes: A Systematic Review Protocol. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:902395. [PMID: 36992776 PMCID: PMC10012064 DOI: 10.3389/fcdhc.2022.902395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022]
Abstract
IntroductionGlobally, Indigenous people have a greater incidence and earlier onset of diabetes than the general population and have higher documented rates of emotional distress and mental illness. This systematic review will provide a synthesis and critical appraisal of the evidence focused on the social and emotional well-being of Indigenous peoples living with diabetes, including prevalence, impact, moderators, and the efficacy of interventions.MethodsWe will search MEDLINE Complete, EMBASE, APA PsycINFO, and CINAHL Complete from inception until late April 2021. Search strategies will include keywords related to Indigenous peoples, diabetes, and social and emotional well-being. All abstracts will be rated independently by two researchers against specified inclusion criteria. Eligible studies will report social and emotional well-being data for Indigenous people with diabetes, and/or report on the efficacy of interventions designed to address social and emotional well-being in this population. For each eligible study, quality will be rated using standard checklists to appraise each study’s internal validity, to be determined based on study type. Any discrepancies will be resolved through discussions and consultation with other investigators as needed. We expect to present a narrative synthesis of the evidence.DiscussionThe findings of the systematic review will enable greater understanding of the impact of relationships between diabetes and emotional well-being among Indigenous peoples to inform research, policy and practice. The findings will be accessible to Indigenous people affected by diabetes through a summary published in plain language on our research centre’s website.Systematic Review RegistrationPROSPERO registration number: CRD42021246560.
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Affiliation(s)
- Jane Speight
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Shaira Baptista
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
- *Correspondence: Shaira Baptista,
| | - Christopher Lee
- First Nations Diabetes consumer and advocate, Melbourne, VIC, Australia
| | - Louisa Sher
- Library, Deakin University, Geelong, VIC, Australia
| | - Timothy C. Skinner
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
- LaTrobe University, Melbourne, VIC, Australia
| | - Alex Brown
- College of Health & Medicine, Australian National University, Canberra, ACT, Australia
- Telethon Kids Institute, Perth, WA, Australia
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Reclaiming Indigenous Health in the US: Moving beyond the Social Determinants of Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127495. [PMID: 35742745 PMCID: PMC9223447 DOI: 10.3390/ijerph19127495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 02/01/2023]
Abstract
The lack of literature on Indigenous conceptions of health and the social determinants of health (SDH) for US Indigenous communities limits available information for Indigenous nations as they set policy and allocate resources to improve the health of their citizens. In 2015, eight scholars from tribal communities and mainstream educational institutions convened to examine: the limitations of applying the World Health Organization’s (WHO) SDH framework in Indigenous communities; Indigenizing the WHO SDH framework; and Indigenous conceptions of a healthy community. Participants critiqued the assumptions within the WHO SDH framework that did not cohere with Indigenous knowledges and epistemologies and created a schematic for conceptualizing health and categorizing its determinants. As Indigenous nations pursue a policy role in health and seek to improve the health and wellness of their nations’ citizens, definitions of Indigenous health and well-being should be community-driven and Indigenous-nation based. Policies and practices for Indigenous nations and Indigenous communities should reflect and arise from sovereignty and a comprehensive understanding of the nations and communities’ conceptions of health and its determinants beyond the SDH.
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Hika K, Harwood M, Ritchie S, Chan AHY. Māori Experiences and Beliefs about Antibiotics and Antimicrobial Resistance for Acute Upper Respiratory Tract Symptoms: A Qualitative Study. Antibiotics (Basel) 2022; 11:antibiotics11060714. [PMID: 35740121 PMCID: PMC9220347 DOI: 10.3390/antibiotics11060714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 02/01/2023] Open
Abstract
Antimicrobial resistance (AMR) is a threat to public health. Addressing unnecessary antibiotic use provides an opportunity to reduce antibiotic consumption and to slow AMR. Understanding people’s beliefs is important for informing antimicrobial stewardship (AMS) initiatives. Within New Zealand, health inequities exist between Māori and non-Māori; however, no research has examined Māori beliefs about antibiotics and AMR. The aim of this study was to explore the experiences related to antibiotic use of Māori in New Zealand. In-depth, semi-structured interviews were conducted with 30 Māori adults recruited from primary care to explore the experiences, perceptions and beliefs that Māori have about antibiotics, and about AMR. Overall, 30 Māori adults (23% male; age range from 20 to 77 years) participated. Three themes emerged: systemic-, social-, and individual-related factors. From these themes, seven subthemes explained the factors that influenced antibiotic use and their perceptions of AMR in Māori: general practitioner (GP) times and ratios, effect of colonisation, lack of knowledge and information, access and poverty barriers, relationship with health professionals, illness perceptions, treatment beliefs and Whaakaro (thoughts), and beliefs pertaining to natural (rongoā) and Western medicine. Participants identified potential solutions to improve antibiotic use such as cultural support and involving Te Ao Māori; recognising these can inform future AMS initiatives.
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Affiliation(s)
- Kayla Hika
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand;
| | - Matire Harwood
- General Practice and Primary Healthcare, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand;
| | - Stephen Ritchie
- Molecular Medicine and Pathology, School of Medical Science, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand;
- Auckland District Health Board, Auckland 1023, New Zealand
| | - Amy Hai Yan Chan
- Auckland District Health Board, Auckland 1023, New Zealand
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand
- Correspondence:
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King PT, Cormack D. ‘It feels special when you’re Māori’—voices of mokopuna Māori aged 6 to 13 years. J R Soc N Z 2022. [DOI: 10.1080/03036758.2022.2064520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Paula Toko King
- Te Rōpū Rangahau Hauora a Eru Pōmare, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Donna Cormack
- Te Rōpū Rangahau Hauora a Eru Pōmare, Department of Public Health, University of Otago, Wellington, New Zealand
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Ouellet L, Grandisson M, Fletcher C. Development of rehabilitation services in an Inuit sociocultural context: challenges, strategies and considerations for the future. Int J Circumpolar Health 2022; 81:2058694. [PMID: 35354359 PMCID: PMC8973344 DOI: 10.1080/22423982.2022.2058694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
In recent years, a new rehabilitation programme has been developed on the Hudson Bay coast of Nunavik. The purpose of this article is to reflect on the experience of an occupational and physical therapy programme development in an Inuit sociocultural context. To do so, the challenges encountered during the first years following the implementation of rehabilitation services and the strategies implemented by the professionals to overcome them were identified, examined in the light of the literature, and discussed with members of the rehabilitation team. The challenges encountered and strategies implemented were divided into 10 major themes: (1) diverse clinical needs; (2) communication issues; (3) acquisition of cross-cultural interaction and population-specific knowledge; (4) adaptation of clinical practice to Nunavimmiut; (5) client engagement in rehabilitation; (6) professional isolation; (7) lack of awareness around the objectives and scope of rehabilitation practice; (8) use of culturally safe assessment tools; (9) staff turnover; (10) large geographic area to be served. This exercise highlighted the need to adapt clinical rehabilitation practices to Nunavimmiut’s worldviews and culture, as well as to adopt a reflective practice in order to improve the quality, relevance and effectiveness of rehabilitation services.
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Affiliation(s)
- Lauriane Ouellet
- Département de réadaptation, Centre de santé Inuulitsivik, Nunavik, QC, Canada.,Département de médecine sociale et préventive, Université Laval, Québec, QC, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, QC, Canada.,Axe santé des populations et pratiques optimales en santé, Centre de recherche du Centre hospitalier universitaire de Québec, Université Laval, Québec, QC, Canada
| | - Marie Grandisson
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, QC, Canada.,Département de réadaptation, Université Laval, Québec, QC, Canada
| | - Christopher Fletcher
- Département de médecine sociale et préventive, Université Laval, Québec, QC, Canada.,Axe santé des populations et pratiques optimales en santé, Centre de recherche du Centre hospitalier universitaire de Québec, Université Laval, Québec, QC, Canada
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Kawakami KL, Muneoka S, Burrage RL, Tanoue L, Haitsuka K, Braun KL. The Lives of Native Hawaiian Elders and Their Experiences With Healthcare: A Qualitative Analysis. Front Public Health 2022; 10:787215. [PMID: 35273936 PMCID: PMC8902069 DOI: 10.3389/fpubh.2022.787215] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/19/2022] [Indexed: 11/15/2022] Open
Abstract
Native Hawaiians are proud and resilient people who have endured significant impacts from colonization. Despite being in a time of vibrant cultural revitalization, Native Hawaiians have a shorter life expectancy than other racial and ethnic groups in Hawai'i. The primary aim of this paper was to share data from the first year of a 5-year study with Native Hawaiian kūpuna (elders) on their experiences with healthcare, along with barriers to accessing healthcare. Ten kūpuna living in rural areas of Hawai'i participated in three interviews each, which were held in an informal, talk-story style. The first interview focused on establishing rapport. The second interview focused on the kūpuna's strengths, resiliencies, and what they would like to pass to the next generation. The third interview focused on the elders' experiences with healthcare, which is the focus of this paper. All ten kūpuna reported growing up with limited access to Western healthcare; rather, their families successfully treated many illnesses and injuries with lā'au lapa'au (Hawaiian herbal medicine) and other traditional healing practices, as they had done for generations. As Western medicine became more prevalent and accessible, they used both, but many preferred holistic treatments such as prayer, a return to the traditional diet, and lā'au lapa'au. As a group, the kūpuna rated their health as fair to good; two had diabetes, two had cardiovascular disease, four had neuropathies, and five were cancer survivors. The kūpuna reported high turnover among providers in rural communities. Limited access to specialists often required them to travel to Honolulu for care, which was costly and especially difficult during coronavirus disease 2019 (COVID-19). Regardless of provider ethnicity, the kūpuna appreciated those who took the time to get to know them as people and respected Hawaiian cultural practices. They advised that Western providers speak honestly and directly, have compassion, and build connections to patients and their communities.
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Affiliation(s)
- Keilyn Leina‘ala Kawakami
- Hā Kūpuna National Resource Center for Native Hawaiian Elders, Thompson School of Social Work & Public Health, University of Hawai‘i at Mānoa, Honolulu, HI, United States
| | - Shelley Muneoka
- Hā Kūpuna National Resource Center for Native Hawaiian Elders, Thompson School of Social Work & Public Health, University of Hawai‘i at Mānoa, Honolulu, HI, United States
| | - Rachel L. Burrage
- Department of Social Work and Hā Kūpuna National Resource Center for Native Hawaiian Elders, Thompson School of Social Work & Public Health, University of Hawai‘i at Mānoa, Honolulu, HI, United States
| | | | - Kilohana Haitsuka
- Hā Kūpuna National Resource Center for Native Hawaiian Elders, Thompson School of Social Work & Public Health, University of Hawai‘i at Mānoa, Honolulu, HI, United States
| | - Kathryn L. Braun
- Office of Public Health Studies, Principal Investigator, Hā Kūpuna National Resource Center for Native Hawaiian Elders, Thompson School of Social Work & Public Health, University of Hawai‘i at Mānoa, Honolulu, HI, United States
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Redvers N, Wilkinson M, Fischer C. Colorectal cancer community engagement: a qualitative exploration of American Indian voices from North Dakota. BMC Cancer 2022; 22:158. [PMID: 35139807 PMCID: PMC8827199 DOI: 10.1186/s12885-021-09119-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background American Indians (AI) in North Dakota present with higher rates of advanced-stage disease for screening detectable colorectal cancers and have lower overall baseline colorectal cancer screening rates than non-AIs. We sought to identify the perceived barriers and facilitators for the engagement with colorectal cancer prevention within North Dakota tribal communities. Methods Twelve semi-structured interviews were carried out across four tribal reservation communities in the state of North Dakota with American Indian adults between the ages of 30 and 75 years. We utilized purposive sampling to ensure maximum variation in age, sex, and tribal community until data saturation was achieved. The interviews were transcribed, and thematic analysis was carried out to identify consistent themes rooted within the data. Ethical approval was gained for this project from all relevant institutional review boards. Results Four main themes were identified as barriers for the engagement with colorectal cancer prevention, including: colorectal cancer screening barriers, focused on other health problems, lack of colorectal cancer tailored health promotion, and socio-cultural factors affecting colorectal cancer prevention. Three main themes were identified as facilitators for the engagement with colorectal cancer prevention, including: reasons for getting colorectal cancer screening, role of culture, and getting out into the community. Conclusion There is need for more community-rooted, strengths-based approaches to colorectal cancer prevention activities in AI communities in North Dakota. Socio-cultural factors, such as the use of storytelling, and the use of traditional knowledge have been demonstrated to be an important element of consideration for colorectal cancer tribal community engagement and prevention planning in the state. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-09119-2.
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Affiliation(s)
- Nicole Redvers
- Department of Family & Community Medicine, University of North Dakota School of Medicine & Health Sciences, ND, Grand Forks, USA. .,Department of Indigenous Health, University of North Dakota School of Medicine & Health Sciences, ND, Grand Forks, USA.
| | - Mia Wilkinson
- Department of Indigenous Health, University of North Dakota School of Medicine & Health Sciences, ND, Grand Forks, USA
| | - Courtney Fischer
- Department of Indigenous Health, University of North Dakota School of Medicine & Health Sciences, ND, Grand Forks, USA
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The Health and Wellbeing of Indigenous and Tribal Peoples around the Globe: Ensuring and Promoting Best Practice in Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010261. [PMID: 35010521 PMCID: PMC8751189 DOI: 10.3390/ijerph19010261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 11/30/2022]
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Sethi S, Ju X, Antonsson A, Canfell K, Smith MA, Garvey G, Hedges J, Jamieson L. Oral HPV infection among Indigenous Australians; incidence, persistence and clearance at 12-months follow-up. Cancer Epidemiol Biomarkers Prev 2021; 31:604-613. [PMID: 34937792 DOI: 10.1158/1055-9965.epi-21-1056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/19/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Persistent oral human papillomavirus (HPV) infection is a risk factor for oropharyngeal squamous cell carcinoma (OPSCC). Indigenous Australians have a higher rate of OPSCC than non-Indigenous Australians. Risk factors for oral HPV persistence among Indigenous Australians are poorly understood. METHODS Participants provided information on socio-demographic characteristics, health-related behaviours including tobacco and alcohol use and sexual history. Participants additionally provided saliva samples for microbial genotyping. Negative log binomial regression models were used to evaluate indicators on incident, persistent and cleared oral HPV infection at 12 months follow-up. RESULTS Of the 1,011 participants recruited at baseline, 321 (35.3%) testing positive for any oral HPV infection. At 12-month follow up, saliva samples were obtained from 743 participants (73.5%). Among the 584 participants, 24 (42.6%) had no oral HPV infection at both time points, 130 (22.2%) had new (incident) oral HPV infection at 12 months, 130 (22.2%) had persistent oral HPV infection (i.e. present at both baseline and 12-months), and 75 (12.8%) had oral HPV infection clearance from baseline to 12-months. Rural location of residence and ever received oral sex were significantly associated with persistence of oral HPV infection. CONCLUSIONS The incidence of oral HPV infection at both baseline and 12-month follow-up was high. IMPACT There are currently no studies available which have assessed oral HPV infection incidence, persistence and clearance amongst Indigenous populations in Australia or even at a global level. The study has been able to identify risk factors associated with potential malignant changes in the oropharynx among Indigenous Australians.
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Affiliation(s)
- Sneha Sethi
- Adelaide Dental School, University of Adelaide
| | - Xiangqun Ju
- Adelaide Dental School, University of Adelaide
| | | | - Karen Canfell
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, University of Sydney
| | | | - Gail Garvey
- School of Public Health, University of Queensland
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Galovič R. Revelation of the Continents of Imagination. ANTHROPOLOGY OF CONSCIOUSNESS 2021. [DOI: 10.1111/anoc.12145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sethi S, Poirier B, Canfell K, Smith M, Garvey G, Hedges J, Ju X, Jamieson LM. Working towards a comprehensive understanding of HPV and cervical cancer among Indigenous women: a qualitative systematic review. BMJ Open 2021; 11:e050113. [PMID: 34193502 PMCID: PMC8246376 DOI: 10.1136/bmjopen-2021-050113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Indigenous peoples carry a disproportionate burden of infectious diseases and cancers and are over-represented among the socially disadvantaged of most countries. Human papillomavirus (HPV) is a risk factor and causative agent of cervical, oropharyngeal and other cancers. Recent literature shows evidence of Indigenous populations being at increased risk of HPV infections and its associated cancers. OBJECTIVE This is a qualitative systematic review. The objective of this study was to explore the experiences and barriers Indigenous women face in relation to HPV awareness, knowledge and cervical screening, in order to better understand factors that may mitigate against or facilitate prevention efforts for HPV infection and associated cancers. METHODS Two investigators independently searched MEDLINE, PubMed, SCOPUS and Web of Science databases (for articles published from inception until 30 June 2020) using a prespecified search strategy to identify qualitative studies on narratives of Indigenous women regarding HPV infection awareness, knowledge and cervical screening, across all geographic and income-level settings. Using a 'meta-study' approach, a social ecological model of cervical screening, infection and associated cancer prevention among Indigenous populations was formulated. RESULTS Five core themes were identified and formulated within the social ecological model; intrapersonal factors, interpersonal factors, institutional/organisational factors, sociocultural/community factors and public policy. These collectively formed the proposed social ecological model of HPV infection awareness and cervical cancer prevention among Indigenous women. This model has been synthesised by taking into account personal stories of Indigenous women and healthcare workers, thus offering a more nuanced, organised, structured and culturally sensitive approach to policy translation. CONCLUSION The social ecological model of HPV infection awareness and cervical cancer prevention among Indigenous women offers a holistic and practical approach for Indigenous health policy makers. It clearly addresses the high risk of Indigenous populations at a global level in experience of both HPV infection and HPV-related cancers. PROSPERO REGISTRATION NUMBER CRD42020207643.
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Affiliation(s)
- Sneha Sethi
- Australian Research Centre for Population Oral Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Brianna Poirier
- Australian Research Centre for Population Oral Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia
| | - Megan Smith
- Cancer Research Division, Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia
| | - Gail Garvey
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research Brisbane Office, Brisbane, Queensland, Australia
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Xiangqun Ju
- Australian Research Centre for Population Oral Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lisa M Jamieson
- Australian Research Centre for Population Oral Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Te Karu L, Dalbeth N, Stamp LK. Inequities in people with gout: a focus on Māori (Indigenous People) of Aotearoa New Zealand. Ther Adv Musculoskelet Dis 2021; 13:1759720X211028007. [PMID: 34262623 PMCID: PMC8252336 DOI: 10.1177/1759720x211028007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/08/2021] [Indexed: 11/15/2022] Open
Abstract
Health equity can be defined as the absence of systematic disparities in health between more and less advantaged social groups. Gout is one of the most common forms of arthritis and disproportionally affects Indigenous peoples, including Māori in Aotearoa New Zealand. Inequities in gout management are well documented and clearly evidenced in Indigenous populations. For example, while gout occurs at a younger age and is more severe in Māori, there is less regular dispensing of urate-lowering therapies. Indigenous peoples are also under-represented in clinical trials. Herein, we will review inequities in gout using Aoteoaroa New Zealand as an example. We will explore reasons for health inequities and challenges that need to be faced to achieve health equity.
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Affiliation(s)
- Leanne Te Karu
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Nicola Dalbeth
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lisa K Stamp
- Department of Medicine, University of Otago Christchurch, 2 Riccarton Ave, PO Box 4345, Christchurch 8011, New Zealand
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Nath S, Poirier BF, Ju X, Kapellas K, Haag DG, Ribeiro Santiago PH, Jamieson LM. Dental Health Inequalities among Indigenous Populations: A Systematic Review and Meta-Analysis. Caries Res 2021; 55:268-287. [PMID: 34107490 PMCID: PMC8491513 DOI: 10.1159/000516137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/21/2021] [Indexed: 11/19/2022] Open
Abstract
The aim of this systematic review and meta-analysis was to document the disparity in dental caries experiences among indigenous and nonindigenous populations globally by measuring dental caries prevalence and severity. An electronic database (MEDLINE) was initially searched using relevant keywords. This was followed by use of the search string in the following electronic databases: Scopus, EBSCOhost, Cochrane, and Open Grey. Two independent reviewers conducted the study search and screening, quality assessment, and data extraction, which was facilitated using JBI SUMARI software. The primary outcome was the decayed missing filled teeth (DMFT) score and dental caries prevalence. Subgroup analysis was done by country of publication to identify causes of heterogeneity. Forest plots were used with the standardized mean difference (SMD) and publication bias was assessed using the Egger test with funnel plot construction. For the final review, 43 articles were selected and 34 were meta-analyzed. The pooled mean DMFT for both the permanent dentition (SMD = 0.26; 95% CI 0.13-0.39) and deciduous dentition (SMD = 0.67; 95% CI 0.47-0.87) was higher for the Indigenous population than for the general population. Indigenous populations experienced more decayed teeth (SMD = 0.44; 95% CI 0.25-0.62), a slightly higher number of missing teeth (SMD = 0.11< 95% CI -0.05 to 0.26), and lesser filled teeth (SMD = -0.04; 95% CI -0.20 to 0.13) than their nonindigenous counterparts. The prevalence of dental caries (SMD = 0.27; 95% CI 0.13-0.41) was higher among indigenous people. Globally, indigenous populations have a higher caries prevalence and severity than nonindigenous populations. The factors which have led to such inequities need to be examined.
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Affiliation(s)
- Sonia Nath
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
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Sethi S, Ali A, Ju X, Antonsson A, Logan R, Canfell K, Smith M, Garvey G, Hedges J, Jamieson L. A systematic review and meta-analysis of the prevalence of human papillomavirus infection in Indigenous populations - A Global Picture. J Oral Pathol Med 2021; 50:843-854. [PMID: 34008187 DOI: 10.1111/jop.13201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIM Recent trends have shown a decline in the rates of human papillomavirus (HPV)-associated cervical cancer in the vaccinated population but there has been a spike in the HPV-associated oropharyngeal, anal and penile cancers in the majority of the unvaccinated population which are young and middle-aged males. Indigenous populations at an international level carry a disproportionate burden of most diseases. The aim of this meta-analysis was to ascertain the worldwide prevalence of HPV infection in Indigenous populations stratified by sex and site and to document the most commonly reported HPV types. METHODS Published articles on HPV infection in Indigenous populations from PubMed, Scopus, EMBASE and Web of Science were systematically searched from inception until 23 December 2019. RESULTS A total of 41 studies were included in the final analysis. The pooled worldwide prevalence of HPV infection (for both oral and genital sites, both males and females) in Indigenous populations was 34.2% (95% CI: 28.9%-39.8%). Subgroup analysis (geographical) showed that the pooled prevalence for African Indigenous, American Indigenous and Asian-Oceanic Indigenous populations were 33.0% (95% CI: 12.8%-57.1%), 33.0% (95% CI: 27.4%-38.9%) and 33.3% (95% CI: 0.17.5%-51.3%), respectively. CONCLUSION There are not enough data on the burden of the infection carried by males especially with respect to highly suspicious sites like oropharynx. Also, we conclude an overall high prevalence of HPV infection in the Indigenous populations and increasing their susceptibility to benign and malignant manifestations of HPV.
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Affiliation(s)
- Sneha Sethi
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, SA, Australia
| | - Anna Ali
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Xiangqun Ju
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, SA, Australia
| | - Annika Antonsson
- QIMR Berghofer Medical Research Institute, QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia
| | - Richard Logan
- Adelaide Dental School, University of Adelaide, Adelaide, SA, Australia
| | - Karen Canfell
- Cancer Council of New South Wales, Sydney, NSW, Australia
| | - Megan Smith
- Cancer Council of New South Wales, Sydney, NSW, Australia
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, SA, Australia
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, SA, Australia
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First Nations emergency care in Alberta: descriptive results of a retrospective cohort study. BMC Health Serv Res 2021; 21:423. [PMID: 33947385 PMCID: PMC8096356 DOI: 10.1186/s12913-021-06415-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
Background Worse health outcomes are consistently reported for First Nations people in Canada. Social, political and economic inequities as well as inequities in health care are major contributing factors to these health disparities. Emergency care is an important health services resource for First Nations people. First Nations partners, academic researchers, and health authority staff are collaborating to examine emergency care visit characteristics for First Nations and non-First Nations people in the province of Alberta. Methods We conducted a population-based retrospective cohort study examining all Alberta emergency care visits from April 1, 2012 to March 31, 2017 by linking administrative data. Patient demographics and emergency care visit characteristics for status First Nations persons in Alberta, and non-First Nations persons, are reported. Frequencies and percentages (%) describe patients and visits by categorical variables (e.g., Canadian Triage and Acuity Scale). Means, medians, standard deviations and interquartile ranges describe continuous variables (e.g., age). Results The dataset contains 11,686,288 emergency care visits by 3,024,491 unique persons. First Nations people make up 4% of the provincial population and 9.4% of provincial emergency visits. The population rate of emergency visits is nearly 3 times higher for First Nations persons than non-First Nations persons. First Nations women utilize emergency care more than non-First Nations women (54.2% of First Nations visits are by women compared to 50.9% of non-First Nations visits). More First Nations visits end in leaving without completing treatment (6.7% v. 3.6%). Conclusions Further research is needed on the impact of First Nations identity on emergency care drivers and outcomes, and on emergency care for First Nations women. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06415-2.
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Balabanski AH, Dos Santos A, Woods JA, Thrift AG, Kleinig TJ, Suchy-Dicey A, Siri SR, Boden-Albala B, Krishnamurthi R, Feigin VL, Buchwald D, Ranta A, Mienna CS, Zavaleta C, Churilov L, Burchill L, Zion D, Longstreth WT, Tirschwell DL, Anand S, Parsons MW, Brown A, Warne DK, Harwood M, Katzenellenbogen JM. The Incidence of Stroke in Indigenous Populations of Countries With a Very High Human Development Index: A Systematic Review Protocol. Front Neurol 2021; 12:661570. [PMID: 33967945 PMCID: PMC8100239 DOI: 10.3389/fneur.2021.661570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Aims: Despite known Indigenous health and socioeconomic disadvantage in countries with a Very High Human Development Index, data on the incidence of stroke in these populations are sparse. With oversight from an Indigenous Advisory Board, we will undertake a systematic review of the incidence of stroke in Indigenous populations of developed countries or regions, with comparisons between Indigenous and non-Indigenous populations of the same region, though not between different Indigenous populations. Methods: Using PubMed, OVID-EMBASE, and Global Health databases, we will examine population-based incidence studies of stroke in Indigenous adult populations of developed countries published 1990-current, without language restriction. Non-peer-reviewed sources, studies including <10 Indigenous People, or with insufficient data to determine incidence, will be excluded. Two reviewers will independently validate the search strategies, screen titles and abstracts, and record reasons for rejection. Relevant articles will undergo full-text screening, with standard data extracted for all studies included. Quality assessment will include Sudlow and Warlow's criteria for population-based stroke incidence studies, the Newcastle-Ottawa Scale for risk of bias, and the CONSIDER checklist for Indigenous research. Results: Primary outcomes include crude, age-specific and/or age-standardized incidence of stroke. Secondary outcomes include overall stroke rates, incidence rate ratio and case-fatality. Results will be synthesized in figures and tables, describing data sources, populations, methodology, and findings. Within-population meta-analysis will be performed if, and where, methodologically sound and comparable studies allow this. Conclusion: We will undertake the first systematic review assessing disparities in stroke incidence in Indigenous populations of developed countries. Data outputs will be disseminated to relevant Indigenous stakeholders to inform public health and policy research.
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Affiliation(s)
- Anna H. Balabanski
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash Universit, Melbourne, VIC, Australia,Department of Medicine and Neurology, Melbourne Brain Centre at Royal Melbourne, Melbourne, VIC, Australia,*Correspondence: Anna H. Balabanski
| | - Angela Dos Santos
- Department of Medicine and Neurology, Melbourne Brain Centre at Royal Melbourne, Melbourne, VIC, Australia
| | - John A. Woods
- Western Australian Centre for Rural Health, School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Amanda G. Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash Universit, Melbourne, VIC, Australia
| | - Timothy J. Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Astrid Suchy-Dicey
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Susanna Ragnhild Siri
- Department of Community Medicine, Faculty of Health Sciences, Centre for Sami Health Research, UiT the Arctic University of Norway, Tromso, Norway
| | - Bernadette Boden-Albala
- Department of Population Health and Disease Prevention, Department of Epidemiology, University of California, Irvine, Irvine, CA, United States
| | - Rita Krishnamurthi
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Valery L. Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, United States
| | - Annemarei Ranta
- Department of Medicine, University of Otago, Wellington, New Zealand
| | | | - Carol Zavaleta
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Leonid Churilov
- Department of Medicine and Neurology, Melbourne Brain Centre at Royal Melbourne, Melbourne, VIC, Australia
| | - Luke Burchill
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Deborah Zion
- Human Research Ethics Committee, Victoria University, Melbourne, VIC, Australia
| | - W. T. Longstreth
- Departments of Neurology and Epidemiology, University of Washington, Seattle, WA, United States
| | - David L. Tirschwell
- Departments of Neurology and Epidemiology, University of Washington, Seattle, WA, United States
| | - Sonia Anand
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Mark W. Parsons
- Department of Medicine and Neurology, Melbourne Brain Centre at Royal Melbourne, Melbourne, VIC, Australia,University of New South Wales (UNSW) South Western Sydney Clinical School, Liverpool, NSW, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Donald K. Warne
- School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, United States
| | - Matire Harwood
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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McLane P, Bill L, Barnabe C. First Nations members' emergency department experiences in Alberta: a qualitative study. CAN J EMERG MED 2020; 23:63-74. [PMID: 33683609 DOI: 10.1007/s43678-020-00009-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/16/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES In Alberta, First Nations members visit Emergency Departments (EDs) at almost double the rate of non-First Nations persons. Previous publications demonstrate differences in ED experience for First Nations members, compared to the general population. The Alberta First Nations Information Governance Centre (AFNIGC), First Nations organizations, Universities, and Alberta Health Services conducted this research to better understand First Nations members' ED experiences and expectations. METHODS This was a participatory research project. Elders selected topics of focus through discussion with the research team, and approved our method of data collection. Sharing circles were held in February 2018 with Elders, First Nations patients, healthcare providers and health administrators from across Alberta. We analyzed data using the Western approach of thematic analysis, with review by two Indigenous team members. AFNIGC is custodian of the research data on behalf of Alberta First Nations, and approves publication of this work. RESULTS Forty-six persons participated in four sharing circles lasting between one and a half and three hours. Findings included First Nations patients' understandings of ED work, limited access to primary care services driving ED use, expectations of different treatment in ED based on race, experiences of racism, concerns about interactions with Children's Services, healthcare avoidance, and avoiding specific hospitals. Equity approaches were identified as key to improving First Nations patients' ED experiences. CONCLUSIONS Bringing First Nations perspectives to Western understandings of ED care is an important step toward identifying required improvements in the health system for better patient experiences and outcomes.
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Affiliation(s)
- Patrick McLane
- Emergency Strategic Clinical Network, Alberta Health Services, 2-033 10030 107 Street, Edmonton, AB, T5J 3E4, Canada. .,Department of Emergency Medicine, University of Alberta, Edmonton, Canada.
| | - Lea Bill
- Alberta First Nations Information Governance Centre, Calgary, Canada
| | - Cheryl Barnabe
- Cumming School of Medicine, University of Calgary, Calgary, Canada
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Bussalleu A, Di-Liberto A, Carcamo C, Carrasco-Escobar G, Zavaleta-Cortijo C, King M, Berrang-Ford L, Maurtua D, Llanos-Cuentas A. Cultural Values and the Coliform Bacterial Load of "Masato," an Amazon Indigenous Beverage. ECOHEALTH 2020; 17:370-380. [PMID: 33216234 PMCID: PMC7719114 DOI: 10.1007/s10393-020-01498-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/28/2020] [Accepted: 09/27/2020] [Indexed: 06/11/2023]
Abstract
Access to safe drinking water is limited in many isolated areas, such as the Amazon where Indigenous peoples frequently reside. Identifying safe forms of drinking water accepted by the communities could have positive health benefits for Indigenous peoples. Many Amazon Indigenous peoples traditionally prepare and consume a fermented beverage called masato, which is frequently the only form of water consumption. Despite its widespread consumption and evidence of the health benefits of fermentation, masato remains poorly investigated. We partnered with a Shawi Indigenous community in the Peruvian Amazon to conduct participatory photography to research masato preparation, and to characterize key cultural features and to assess the presence of total and fecal coliform bacteria by using a membrane filter technique. Pictures show that masato preparation is a key part of cultural practices and that there are clear gender roles in the preparation process. We found that 100% of communal water sources (26/26) were contaminated with coliform bacteria; by contrast, fewer, 18% of masato samples (2/11), were positive for coliform. This exploratory study suggests that fermented beverages like masato merit further investigation as they represent an Indigenous method to improve water quality in Amazonian communities where water safety cannot be assured.
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Affiliation(s)
- Alejandra Bussalleu
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru
| | - Aldo Di-Liberto
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru
| | - Cesar Carcamo
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru
| | - Gabriel Carrasco-Escobar
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru
- Division of Infectious Diseases, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Carol Zavaleta-Cortijo
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada.
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru.
| | - Matthew King
- Geography Department, McGill University, Burnside Hall Building, Room 705, 805 Sherbrooke Street West, Montreal, QC, H3A0B9, Canada
| | - Lea Berrang-Ford
- Priestley International Centre for Climate, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | - Dora Maurtua
- Laboratorio de Bacteriología de los Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru
| | - Alejandro Llanos-Cuentas
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru
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Storm Mienna C, Axelsson P. Somatic health in the Indigenous Sami population - a systematic review. Int J Circumpolar Health 2020; 78:1638195. [PMID: 31262241 PMCID: PMC6610513 DOI: 10.1080/22423982.2019.1638195] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The objective of this systematic review was to survey the current scientific knowledge regarding the state of somatic health among the Indigenous Sami people in Norway, Finland, Sweden and the Kola Peninsula in Russia; and assess the quality of the identified studies. A systematic search in the databases Pubmed, EBSCOhost (AMED, Medline, Cinahl) and Svemed was conducted from January 2000, through December 2017. This systematic search identified 399 articles. After screening abstracts, 93 articles were reviewed in full text, 32 of which met the inclusion criteria. The scientific quality of the evidence was rated according to the Newcastle–Ottawa scale. Based on the studies with moderate to high scientific quality, there is evidence for stating that the majority of the Sami included in this review experience good health. Mortality and life expectancy are similar, with only minor differences, to those of a non-Sami population. The cancer risk rate among Sami was lower than that of the general population of Norway, Sweden and Finland. Self-reported myocardial infarction prevalence was similar between Sami and non-Sami, but Angina pectoris was more prevalent among Sami. In Sweden, cardiovascular disease rates were similar between Sami and non-Sami. Musculoskeletal pain symptoms are common among the Sami population, as are obesity and overweight. To conclude, there are knowledge gaps in regard to the somatic health situation of the Indigenous Sami in the circumpolar area, especially in Russia, Finland and Sweden; as current knowledge is mainly based on publications from the SAMINOR study in Norway. No study obtained the highest quality score, suggesting a need to implement longitudinal prospective studies.
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Affiliation(s)
- Christina Storm Mienna
- a Department of Odontology/Clinical Oral Physiology , Umeå University , Umeå , Sweden.,b Vaartoe-Centre for Sami Research , Umeå University , Umeå , Sweden
| | - Per Axelsson
- b Vaartoe-Centre for Sami Research , Umeå University , Umeå , Sweden.,c Department of historical, philosophical and religious studies , Umeå University , Umeå , Sweden
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Voaklander B, Rowe S, Sanni O, Campbell S, Eurich D, Ospina MB. Prevalence of diabetes in pregnancy among Indigenous women in Australia, Canada, New Zealand, and the USA: a systematic review and meta-analysis. LANCET GLOBAL HEALTH 2020; 8:e681-e698. [DOI: 10.1016/s2214-109x(20)30046-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 01/28/2020] [Accepted: 02/05/2020] [Indexed: 12/19/2022]
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Larson S, Stoeckl N, Jarvis D, Addison J, Grainger D, Watkin Lui F. Indigenous Land and Sea Management Programs (ILSMPs) Enhance the Wellbeing of Indigenous Australians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010125. [PMID: 31878049 PMCID: PMC6981778 DOI: 10.3390/ijerph17010125] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/24/2019] [Accepted: 12/20/2019] [Indexed: 11/28/2022]
Abstract
Conservation and environmental management have been reported as offering opportunities to substantially improve the wellbeing of Indigenous people. Using the holistic wellbeing impact evaluation (W-IE) approach—well suited for use in Indigenous communities—we interviewed 190 Indigenous Australians across four communities. All communities were involved in the Indigenous land and sea management programs (ILSMPs). Our study explored the conceptualisation of ‘wellbeing’ by participants. In particular, we were interested in the aspects of wellbeing perceived to be affected by ILSMPs. Out of the 26 wellbeing factors explored, ‘Health centres’; ‘Language’; ‘Schools’; and ‘Safe community’ emerged as being of highest importance to the largest percentage of the respondents. When grouped using principle components analysis (PCA), the ‘Community and society’ domain emerged as the most important; accounting for 52% of the overall importance of all wellbeing factors. The second most important domain was the ‘Country and culture’, contributing 31%. Lastly, ‘Economic aspects’ contributed only 17%. Respondents believed that ILSMPs have played a considerable causal role in improving wellbeing, by positively changing factors most important to them. Specifically, 73% of perceived causal links were related to improvements in the ‘Country and Culture’ and 23% to ‘Community and Society’ domain. We thus conclude that land management for Indigenous people is much more than ecological or environmental management with ILSMPs, perceived to cause a wide range of cultural and social benefits. We also propose ways in which the future design of such programs could be improved to further increase benefits.
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Affiliation(s)
- Silva Larson
- College of Business, Law and Governance, James Cook University and the Cairns Institute, Townsville, QLD 4811, Australia
- Correspondence:
| | - Natalie Stoeckl
- College of Business and Economics, University of Tasmania, Hobart, TAS 7005, Australia
| | - Diane Jarvis
- College of Business, Law and Governance, James Cook University and CSIRO Land and Water, Townsville, QLD 4811, Australia; (D.J.); (J.A.)
| | - Jane Addison
- College of Business, Law and Governance, James Cook University and CSIRO Land and Water, Townsville, QLD 4811, Australia; (D.J.); (J.A.)
| | - Daniel Grainger
- College of Business, Law and Governance and the Indigenous Education and Research Centre, James Cook University, Townsville, QLD 4811, Australia;
| | - Felecia Watkin Lui
- Indigenous Education and Research Centre, James Cook University and the Cairns Institute, Cairns, QLD 4870, Australia;
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Carson SL, Kentatchime F, Sinai C, Van Dyne EA, Nana ED, Cole BL, Godwin HA. Health Challenges and Assets of Forest-Dependent Populations in Cameroon. ECOHEALTH 2019; 16:287-297. [PMID: 31114945 DOI: 10.1007/s10393-019-01411-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 03/27/2019] [Accepted: 04/01/2019] [Indexed: 05/25/2023]
Abstract
Indigenous populations often have poorer health outcomes than the general population. Marginalization, colonization, and migration from traditional lands have all affected traditional medicine usage, health access, and indigenous health equity. An in-depth understanding of health for specific populations is essential to develop actionable insights into contributing factors to poor indigenous health. To develop a more complete, nuanced understanding of indigenous health status, we conducted first-person interviews with both the indigenous Baka and neighboring Bantu villagers (the reference population in the region), as well as local clinicians in Southern Cameroon. These interviews elucidated perspectives on the most pressing challenges to health and assets to health for both groups, including access to health services, causes of illness, the uses and values of traditional versus modern medicine, and community resilience during severe health events. Baka interviewees, in particular, reported facing health challenges due to affordability and discrimination in public health centers, health effects due to migration from their traditional lands, and a lack of culturally appropriate public health services.
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Affiliation(s)
- Savanna L Carson
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA.
| | - Fabrice Kentatchime
- Higher Institute of Environmental Sciences - IBAY Sup, Nkolbisson, Yaounde, Cameroon
| | - Cyrus Sinai
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA
| | - Elizabeth A Van Dyne
- Department of Pediatrics, Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, CA, USA
| | - Eric Djomo Nana
- Higher Institute of Environmental Sciences - IBAY Sup, Nkolbisson, Yaounde, Cameroon
| | - Brian L Cole
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Hilary A Godwin
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA
- Center for Tropical Research, Institute of the Environment and Sustainability, University of California, Los Angeles, Los Angeles, CA, 90039, USA
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Heaslip V, Wilson D, Jackson D. Are Gypsy Roma Traveller communities indigenous and would identification as such better address their public health needs? Public Health 2019; 176:43-49. [PMID: 31079879 DOI: 10.1016/j.puhe.2019.02.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/01/2018] [Accepted: 02/25/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Across Europe, large numbers of Gypsy Roma Traveller communities experience significant health inequities such as higher morbidity, mortality and infant mortality. This health inequity is perpetuated by wider determinants such as a lower social status, lower educational attainment and substandard accommodation. This is not dissimilar to other indigenous peoples, even though many Gypsy Roma Traveller communities are not identified as indigenous. METHODS This article presents contemporary literature and research alongside the internationally agreed principles of indigenous peoples, examining similarities between Gypsy Roma Traveller communities and other indigenous peoples. RESULTS We argue that Gypsy Roma Traveller communities could be recognised as indigenous in terms of the internationally agreed principles of indigeneity and shared experiences of health inequity, colonisation and cultural genocide. Doing so would enable a more robust public health strategy and development of public health guidelines that take into account their cultural views and practices. CONCLUSION Recognising Gypsy Roma Traveller communities in this way is important, especially concerning public health, as formal recognition of indigeneity provides certain rights and protection that can be used to develop appropriate public health strategies. Included within this are more nuanced approaches to promoting health, which focus on strengths and assets rather than deficit constructs that can perpetuate problematising of these communities.
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Affiliation(s)
- V Heaslip
- Principal Academic Department of Nursing and Clinical Science, Faculty of Health and Social Science, Bournemouth University, UK; Department of Social Studies, University of Stavanger, Norway.
| | - D Wilson
- Māori Health, Taupua Waiora Centre for Māori Health Research, Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand
| | - D Jackson
- Nursing, Faculty of Health, University of Technology, Sydney (UTS), Australia
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Jones R, Crowshoe L, Reid P, Calam B, Curtis E, Green M, Huria T, Jacklin K, Kamaka M, Lacey C, Milroy J, Paul D, Pitama S, Walker L, Webb G, Ewen S. Educating for Indigenous Health Equity: An International Consensus Statement. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:512-519. [PMID: 30277958 PMCID: PMC6445615 DOI: 10.1097/acm.0000000000002476] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
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, 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. 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.
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Affiliation(s)
- Rhys Jones
- R. Jones is senior lecturer, Te Kupenga Hauora Maori, University of Auckland, Auckland, New Zealand
| | - Lynden Crowshoe
- L. Crowshoe is associate professor, Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Papaarangi Reid
- P. Reid is professor and Tumuaki, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Betty Calam
- B. Calam is associate professor, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elana Curtis
- E. Curtis is associate professor, Te Kupenga Hauora Maori, University of Auckland, Auckland, New Zealand
| | - Michael Green
- M. Green is professor and head, Department of Family Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Tania Huria
- T. Huria is senior lecturer, Maori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Kristen Jacklin
- K. Jacklin is professor, Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minnesota, and professor, Human Sciences Division, Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada
| | - Martina Kamaka
- M. Kamaka is associate professor, Department of Native Hawaiian Health, University of Hawai‘i at Manoa John A. Burns School of Medicine, Honolulu, Hawai‘i
| | - Cameron Lacey
- C. Lacey is senior lecturer, Maori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Jill Milroy
- J. Milroy is professor, School of Indigenous Studies, University of Western Australia, Perth, Western Australia, Australia
| | - David Paul
- D. Paul is professor, School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Suzanne Pitama
- S. Pitama is associate professor, Maori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Leah Walker
- L. Walker is associate director, Centre for Excellence in Indigenous Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gillian Webb
- G. Webb is associate professor, Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Shaun Ewen
- S. Ewen is professor and director, Melbourne Poche Centre for Indigenous Health, and pro vice chancellor (Indigenous), University of Melbourne, Melbourne, Victoria, Australia
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Tomas I. Equity for Indigenous peoples in the emergency department: A Māori perspective. Emerg Med Australas 2018; 30:859-861. [PMID: 30456791 DOI: 10.1111/1742-6723.13196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Inia Tomas
- Emergency Department, Middlemore Hospital, Auckland, New Zealand
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Disney G, Teng A, Atkinson J, Wilson N, Blakely T. Changing ethnic inequalities in mortality in New Zealand over 30 years: linked cohort studies with 68.9 million person-years of follow-up. Popul Health Metr 2017; 15:15. [PMID: 28446238 PMCID: PMC5406924 DOI: 10.1186/s12963-017-0132-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 04/12/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Internationally, ethnic inequalities in mortality within countries are increasingly recognized as a public health concern. But few countries have data to monitor such inequalities. We aimed to provide a detailed description of ethnic inequalities (Māori [indigenous], Pacific, and European/Other) in mortality for a country with high quality ethnicity data, using both standard and novel visualization methods. METHODS Cohort studies of the entire New Zealand population were conducted, using probabilistically-linked Census and mortality data from 1981 to 2011 (68.9 million person years). Absolute (standardized rate difference) and relative (standardized rate ratio) inequalities were calculated, in 1-74-year-olds, for Māori and Pacific peoples in comparison to European/Other. RESULTS All-cause mortality rates were highest for Māori, followed by Pacific peoples then European/Other, and declined in all three ethnic groups over time. Pacific peoples experienced the slowest annual percentage fall in mortality rates, then Māori, with European/Other having the highest percentage falls - resulting in widening relative inequalities. Absolute inequalities, however, for both Māori and Pacific males compared to European/Other have been falling since 1996. But for females, only Māori absolute inequalities (compared with European/Other) have been falling. Regarding cause of death, cancer is becoming a more important contributor than cardiovascular disease (CVD) to absolute inequalities, especially for Māori females. CONCLUSIONS We found declines in all-cause mortality rates, over time, for each ethnic group of interest. Ethnic mortality inequalities are generally stable or even falling in absolute terms, but have increased on a relative scale. The drivers of these inequalities in mortality are transitioning over time, away from CVD to cancer and diabetes; such transitions are likely in other countries, and warrant further research. To address these inequalities, policymakers need to enhance prevention activities and health care delivery, but also support wider improvements in educational achievement and socioeconomic position for highest need populations.
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Affiliation(s)
- George Disney
- University of Otago, 23a Mein Street, Wellington, New Zealand.
| | - Andrea Teng
- University of Otago, 23a Mein Street, Wellington, New Zealand
| | - June Atkinson
- University of Otago, 23a Mein Street, Wellington, New Zealand
| | - Nick Wilson
- University of Otago, 23a Mein Street, Wellington, New Zealand
| | - Tony Blakely
- University of Otago, 23a Mein Street, Wellington, New Zealand
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