Book Details

Advances in Contemporary Indigenous Health Care

Concerns about Indigenous health status are linked not only to the deprivation and socio-economic positioning many experience, but to the access and use of health services. Indigenous health is shrouded in politics at the level of Indigenous communities up to the level of the government where policy and resource decisions are made.

As registered nurses we are invariably mandated to implement policy and service delivery decisions that affect Indigenous people and their communities. Tension arises when health services are not always accessible to, and appropriate or acceptable for Indigenous users of health services, and outcomes are not realised. Disparities arise through differential access to essential determinants of health (such as housing, education, income, and nutrition) and health services, and cracks in the quality of services available. In Aotearoa New Zealand during 2004 and 2005, 'race based' politics attacked the provision of services targeted for Maori that aimed to reduce the disparities in the health status they experienced compared to others living in New Zealand. This political groundswell associated with Maori health services moved the focus of service provision from 'race' to 'need', further marginalising Maori health needs and access to vital resources required to reduce the inequalities by making invisible race and ethnicity-determinants of health. Australia, Canada and New Zealand have all recognised the imperative to improve the inexcusable health status of their Indigenous populations.

The burden of disease and ill-health experienced by colonised Indigenous populations globally is greater when compared to other groups within their nations. Globally, these Indigenous populations have been forced to move from being socio-economically healthy pre-colonisation to being socially marginalised and socio-economically deprived. Globally, Indigenous peoples have diverse historical and socio-political contexts and differ demographically, geographically and politically. For example, New Zealand Maori are unique in having the Treaty of Waitangi that establishes their rights and the nature of their relationship with the government. The Indigenous peoples of Australia, Canada, United States and New Zealand also differ demographically in their population composition.

The relatively low numbers of Indigenous people impacts on their efficacy to politically affect changes to address their health status and service issues, compounded by the utilitarian approach to rationalising and allocating resources for health service delivery by diverting essential resources away from Indigenous health need to those with less need and health risk. The rurality and geographical isolation also experienced by some Indigenous groups in Australia and Canada also presents issues that differ from those in Aotearoa New Zealand. Diversity among, and within, contemporary Indigenous groups as a result of colonising experiences, inter-ethnic marriages, urbanisation, rurality, socio-economic status, educational experiences, capitalism, and technological advances also need to be considered.

Similarities also exist for Indigenous populations with histories of colonisation. The colonising agenda to civilise 'savages' and re-create Indigenous peoples in the effigy of their colonisers was aided by policies of assimilation and integration, and legislation banning language and many cultural practices. The resultant loss of people, land, language, socio-economic viability and cultural practices, along with changes in social structure and roles imposed a legacy on Indigenous people that survives today, causing spiritual distress that impact on health status.

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