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Indigenous health
ОглавлениеThere are about 370 million indigenous people from thousands of different cultures in all continents of the planet (United Nations, 2017). While indigenous communities cannot be encapsulated within a single definition, the United Nations (2009) used Martinez Cobo’s (1987) conceptualization of indigenous groups as:
peoples and nations which, having a historical continuity with pre-invasion and pre-colonial societies that developed on their territories, consider themselves distinct from other sectors of the societies now prevailing on those territories, or parts of them. They form at present non-dominant sectors of society and are determined to preserve, develop and transmit to future generations their ancestral territories, and their ethnic identity, as the basis of their continued existence as peoples, in accordance with their own cultural patterns, social institutions and legal system. (United Nations, 2009: 4)
Globally, indigenous peoples experience poorer health outcomes, reduced quality of life and higher mortality rates from specific diseases, such as heart disease, tuberculosis, cancer, respiratory disease, stroke and diabetes, than their non-indigenous counterparts. Indigenous populations are six times more likely to die from injuries and are disproportionately more affected by forced displacement caused by natural disasters, armed conflict and loss of their ancestral domains. They also have worse access to education, health care and social services. This trend can be observed among indigenous groups around the world, including those in North America (Ramraj et al., 2016), Australia (Marmot, 2016), New Zealand and the Pacific (Anderson et al., 2006), Latin America and the Caribbean (Montenegro and Stephens, 2006) and Africa (Ohenjo et al., 2006).
The alleged health profile of indigenous groups has been distorted by racism and racial stereotypes. This is illustrated by the alleged alcoholism rates of Australian Aboriginals (Box 6.1). Similar stereotyping occurs regarding the alcohol use of Native Americans. Direct comparisons to published alcohol consumption data from other US populations indicated that American Indians in two reservation samples may be less likely to use alcohol than are others in the USA. However, among American Indian drinkers, more alcohol was consumed per drinking occasion (Beals et al., 2003).
Governmental efforts aim to address inequalities that disadvantage indigenous communities, but in some instances these efforts are tokenistic or symbolic in nature. Living with a legacy of conquest and culture, they may even continue to subjugate indigenous people to unjust and unfair economic and educational systems (Fredericks et al., 2014). It is important to recognize indigenous ways of knowing and to value indigenous stories and narratives within their socio-cultural context to bring to the surface knowledge that is relevant, insightful and meaningful for community members. Participatory action research can be used to facilitate this process (see Chapters 7 and 16). Genuine participation, instead of tokenistic participation, can foster a sense of ownership for community members and can strengthen personal and community capabilities.
For example, Thompson et al. (2013) facilitated an arts-based participatory action research project to explore the experiences and meaning of physical activity in two remote Northern Territory communities in Australia. Semi-structured interviews were conducted with community members (n = 23) and supplemented by five commissioned paintings by community-based artists and ethnographic observations. Physical activities were often linked with work, diet, social relationships and being active ‘on country’. They also were associated with educating younger generations about indigenous traditions.
Culturally appropriate physical activities such as bush walking, dancing and art making contribute to health promotion of the community. It is important that indigenous beliefs, knowledge and traditions are considered in the process. Furthermore, social and political issues, including those that are related to racism and discrimination, need to be taken into account since these may compound experiences and access to health care and promotion (Denison et al., 2014).