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Cordes A, Bak M, Lyndon M, Hudson M, Fiske A, Celi LA, McLennan S. Competing interests: digital health and indigenous data sovereignty. NPJ Digit Med 2024; 7:178. [PMID: 38965365 PMCID: PMC11224364 DOI: 10.1038/s41746-024-01171-z] [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: 04/17/2024] [Accepted: 06/14/2024] [Indexed: 07/06/2024] Open
Abstract
Digital health is increasingly promoting open health data. Although this open approach promises a number of benefits, it also leads to tensions with Indigenous data sovereignty movements led by Indigenous peoples around the world who are asserting control over the use of health data as a part of self-determination. Digital health has a role in improving access to services and delivering improved health outcomes for Indigenous communities. However, we argue that in order to be effective and ethical, it is essential that the field engages more with Indigenous peoples´ rights and interests. We discuss challenges and possible improvements for data acquisition, management, analysis, and integration as they pertain to the health of Indigenous communities around the world.
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Affiliation(s)
- Ashley Cordes
- Environmental Studies Program and Department of Data Science, University of Oregon, Eugene, OR, USA
| | - Marieke Bak
- Institute of History and Ethics in Medicine, Department of Preclinical Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Department of Ethics, Law and Humanities, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mataroria Lyndon
- Centre for Medical and Health Sciences Education, School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Maui Hudson
- Te Kotahi Research Institute, University of Waikato, Hamilton, New Zealand
| | - Amelia Fiske
- Institute of History and Ethics in Medicine, Department of Preclinical Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Leo Anthony Celi
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Stuart McLennan
- Institute of History and Ethics in Medicine, Department of Preclinical Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany.
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.
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Gray M, Williams K, Oster RT, Bruno G, Cooper A, Healy C, Rich R, Scott Claringbold S, Teare G, Wessel S, Henderson RI. Indigenous identity identification in administrative health care data globally: A scoping review. J Health Serv Res Policy 2024; 29:210-221. [PMID: 38099443 PMCID: PMC11151709 DOI: 10.1177/13558196231219955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
OBJECTIVE Both Indigenous and non-Indigenous governments and organizations have increasingly called for improved Indigenous health data in order to improve health equity among Indigenous peoples. This scoping review identifies best practices, potential consequences and barriers for advancing Indigenous health data and Indigenous data sovereignty globally. METHODS A scoping review was conducted to capture the breadth and nature of the academic and grey literature. We searched academic databases for academic records published between 2000 and 2021. We used Google to conduct a review of the grey literature. We applied Harfield's Aboriginal and Torres Strait Islander Quality Appraisal Tool (QAT) to all original research articles included in the review to assess the quality of health information from an Indigenous perspective. RESULTS In total, 77 academic articles and 49 grey literature records were included. Much of the academic literature was published in the last 12 years, demonstrating a more recent interest in Indigenous health data. Overall, we identified two ways for Indigenous health data to be retrieved. The first approach is health care organizations asking clients to voluntarily self-identify as Indigenous. The other approach is through data linkage. Both approaches to improving Indigenous health data require awareness of the intergenerational consequences of settler colonialism along with a general mistrust in health care systems among Indigenous peoples. This context also presents special considerations for health care systems that wish to engage with Indigenous communities around the intention, purpose, and uses of the identification of Indigenous status in administrative databases and in health care settings. Partnerships with local Indigenous nations should be developed prior to the systematic collection of Indigenous identifiers in health administrative data. The QAT revealed that many research articles do not include adequate information to describe how Indigenous communities and stakeholders have been involved in this research. CONCLUSION There is consensus within the academic literature that improving Indigenous health should be of high priority for health care systems globally. To address data disparities, governments and health organizations are encouraged to work in collaboration with local Indigenous nations and stakeholders at every step from conceptualization, data collection, analysis, to ownership. This finding highlights the need for future research to provide transparent explanation of how meaningful Indigenous collaboration is achieved in their research.
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Affiliation(s)
- Mandi Gray
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kienan Williams
- Indigenous Wellness Core, Alberta Health Services, Canada, Edmonton, AB, Canada
| | - Richard T. Oster
- Indigenous Wellness Core, Alberta Health Services, Canada, Edmonton, AB, Canada
| | - Grant Bruno
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Annelies Cooper
- Indigenous Health and Environmental Justice, Critical Health and Social Action Lab., University of Toronto, Toronto, ON, Canada
| | - Chyloe Healy
- Blackfoot Confederacy Tribal Council, Calgary, AB, Canada
| | | | - Shayla Scott Claringbold
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Gary Teare
- Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Samara Wessel
- Counselling Psychology, Department of Educational Psychology, University of Calgary, Calgary, AB, Canada
| | - Rita I. Henderson
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Ring IT, Griffiths K. Life expectancy for Indigenous people is improving, but closing the gap remains unacceptably slow. Med J Aust 2022; 217:26-27. [DOI: 10.5694/mja2.51606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 05/22/2022] [Indexed: 11/17/2022]
Affiliation(s)
| | - Kalinda Griffiths
- Centre for Big Data Research in Health University of New South Wales Sydney NSW
- Centre For Health Equity the University of Melbourne Melbourne VIC
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Madden R, Fortune N, Gordon J. Health Statistics in Australia: What We Know and Do Not Know. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19094959. [PMID: 35564353 PMCID: PMC9099714 DOI: 10.3390/ijerph19094959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/21/2022] [Accepted: 02/02/2022] [Indexed: 01/18/2023]
Abstract
Australia is a federation of six states and two territories (the States). These eight governmental entities share responsibility for health and health services with the Australian Government. Mortality statistics, including causes of death, have been collected since the late 19th century, with national data produced by the (now) Australian Bureau of Statistics (ABS) from 1907. Each State introduced hospital in-patient statistics, assisted by State offices of the ABS. Beginning in the 1970s, the ABS conducts regular health surveys, including specific collections on Aboriginal and Torres Strait Islander peoples. Overall, Australia now has a comprehensive array of health statistics, published regularly without political or commercial interference. Privacy and confidentiality are guaranteed by legislation. Data linkage has grown and become widespread. However, there are gaps, as papers in this issue demonstrate. Most notably, data on primary care patients and encounters reveal stark gaps. This paper accompanies a range of papers from expert authors across the health statistics spectrum in Australia. It is hoped that the collection of papers will inform interested readers and stand as a comprehensive review of the strengths and weaknesses of Australian health statistics in the early 2020s.
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Affiliation(s)
- Richard Madden
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Correspondence:
| | - Nicola Fortune
- Centre for Disability Research and Policy, University of Sydney, Sydney, NSW 2006, Australia;
- Centre of Research Excellence in Disability and Health, University of Melbourne, Carlton, VIC 3053, Australia
| | - Julie Gordon
- WHO Collaborating Centre for Strengthening Rehabilitation Capacity in Health Systems, University of Sydney, Sydney, NSW 2006, Australia;
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Trudgett S, Griffiths K, Farnbach S, Shakeshaft A. A framework for operationalising Aboriginal and Torres Strait Islander data sovereignty in Australia: Results of a systematic literature review of published studies. EClinicalMedicine 2022; 45:101302. [PMID: 35243269 PMCID: PMC8861650 DOI: 10.1016/j.eclinm.2022.101302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/17/2022] [Accepted: 01/25/2022] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Racial health disparities are only likely to be meaningfully improved by tailoring public health and clinical interventions to the specific needs of Indigenous people and their communities. Accurate tailoring relies on the availability of high-quality Indigenous-specific data. The potential benefits of increased availability of Indigenous data need to be balanced by efforts to ensure those data are collected and used appropriately. This paper identifies characteristics of Indigenous Data Sovereignty (IDS) principles and considers a framework for operationalisation. METHODS A PRISMA compliant search of the literature was undertaken, using methods detailed in the Cochrane Collaboration Handbook on Systematic Reviews of Health Promotion and Public Health Interventions (1). The search strategy comprised two steps: a search of 11 scientific electronic databases and five grey literature sources. The search was limited by date of publication (1 January 2000 to 1 December 2021). The following keywords and subject heading terms were used: (exp Aboriginal and Torres Strait Islander or Aborigin* or Torres Strait Island* or, Oceanic ancestry group) and (exp research or biomedical research or population surveillance or translational medical research or, research design) and (exp data or datasets or data collection or data management or health surveys or information dissemination or, intellectual property) and (exp self-determination or ownership or control or access or possession or OCAP or sovereignty or, ethics) and, (exp Australia). IDS principles: (i) ownership; (ii) control; (iii) accessibility; (iv) custodianship; (v) accountability to Indigenous people; (vi) amplify Community voice; (vii) relevant and reciprocal; and (viii) sustainably self-determining. Using standard data extraction forms, we examined relevant Australian studies to identify key characteristics and frequency with which they cited IDS principles. These findings were consolidated into an operationalisation framework. FINDINGS 34 relevant Australian published studies were identified. The most frequently cited IDS principles were Accountability to Aboriginal and Torres Strait Islander peoples and sustainably self-determining. The least frequently cited principle was Access. A framework to operationalise IDS principles is proposed that is both standardised internationally and able to be tailored to the diverse contexts of Indigenous peoples. INTERPRETATION IDS is emergent in Australia and there is a clear need to establish an agreed set of International IDS principles and a framework for their operationalisation and contextualisation across diverse Indigenous communities and contexts. FUNDING This research project is funded through an Australian Research Council (ARC) Discovery Grant from 2017 to 2022. The National Drug and Alcohol Research Centre (NDARC) is funded by the Australian Government Department of Health. The 1st author (ST) is supported by a scholarship co-funded by NDARC and the Lowitja Institute.
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Affiliation(s)
- Skye Trudgett
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia
- Corresponding author.
| | - Kalinda Griffiths
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Australia
- School of Health Sciences, University of Sydney, Sydney, Australia
| | - Sara Farnbach
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia
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