indigenous health

Conclusion: Despite the potential for expansion of the role of the pharmacist in Indigenous health, the majority of participants in this study were reluctant to commit themselves more than at present unless the financial barriers were removed. In addition, although they expressed an openness to undergoing training in cultural safety, and a willingness to have a greater understanding of Indigenous culture, they were very conscious of a lack of time to do so, a situation generally resulting from a shortage of pharmacists. Their awareness of and current interactions with AHWs were limited, but all participants could see the potential value of working more closely with these important members of the healthcare team. If the proposed extension of Section 100 of the Australian Pharmaceutical Benefits Scheme goes ahead and financial barriers are removed, it then remains for pharmacists to take up the challenge to increase their own understanding of Indigenous health issues and form collaborative partnerships with their AHW counterparts. Then a real change for the better in mainstream pharmacy services may be achieved.

Existing evidence suggests indigenous health education is an emerging pedagogy, and studies have raised concerns about the quality of teaching and assessment of indigen- ous health [14]. Institutional and educational barriers may exist that impact on the value that students and clinical teachers place on indigenous curricula. These barriers in- clude a focus on science rather than humanities, and a lack of opportunity for indigenous faculty leadership, resulting in inadequate resourcing of indigenous content within health education. The work outlined by this re- search provides an educational schema to support the de- velopment of learners and faculty awareness of indigenous health disparities and a way to respond that engages train- ing clinicians. The program described in this study has identified methods that enable students to value an Indi- genous health curriculum as an equal part of their medical education. The program provides a framework that ad- dresses both the institutional and educational barriers identified by similar studies such as limited institutional support and/or understanding of the critical importance of an Indigenous health curricula to support clinical train- ing [22] (Fig. 3). Future work would include exploration of the impact of the curriculum on objective measurements of clinical competencies.

Additionally, it is important to understand indigenous behaviors and knowledge around cancer. Cancer inci- dence has risen in First Nations people of Canada, and additional research has noted that a lack of culturally ap- propriate education and expertise, inadequate access to services, poor understanding of prevention and treat- ment and a mistrust in the current health system all contribute to poor cancer journeys for the Canadian in- digenous. Subsequent planning has led to a strategic government partnership agenda to address inequities and disparities [5]. Additionally, research has indicated suboptimal knowledge, attitudes and beliefs on cancer screening among indigenous communities. Greater un- derstanding of barriers and interventions for cancer screening among indigenous communities has been rec- ommended [40]. Additionally, cultural differences in in- digenous point to necessary research in palliative care, hospice and survivorship components to cancer. A re- cent survivorship study recommended tailored, specific approaches to indigenous cancer survivors based on needs, preferences and barriers. Research within specific indigenous and Pan-American groups could advance health equity in cancer survivorship, palliative and hos- pice care even further [11]. Cancer is multifaceted, with continued unknowns in genetics and environmental cor- relations, and delivery of care is just as complex. Oppor- tunities in research are noted due to a spotlight on indigenous health focus on cancer.

The objective of this study was to verify health actions and services directed to the Guama Tocantins Indigenous Special Health District included in the Health Care Networks (RAS-Redes de Atenção à Saúde) of the state of Para,evaluating the perception of the coordinators of the health care networks as well as of the indigenous health managers of Para, on the implementation of these actions and services in the regional plans of the four RAS (stork, urgency and emergency, psychosocial and people with disabilities) seven health regions, which encompass the Guama-Tocantins DSEI. The study was developed based on a qualitative and descriptive research using content analysis, based on semi-structured interviews with the state actors involved in the implementation and implementation of RAS and the federal managers responsible for the indigenous health policy in the Sanitary District Indigenous Special (DSEI - Distrito Sanitário Especial Indígena) Guama - Tocantins (GUATOC) of the State of Para. The obtained results express the absence of actions and services that guarantee the equity of the access to the natives in the RAS. Thus, there is an urgent need to qualify professionals for health care that respects the ethnic and cultural aspects of these peoples and especially that there is integration between the RAS managers and the DSEI managers in the planning and implementation of the actions and services, continuity of care from basic care to medium and high complexity.

In Victoria, for example, Indigenous health funding submissions normally go through two key separate fund- ing categories. The first is through the ‘whole of govern- ment’ funding such as housing, correctional services, employment and others. This submission goes through the head of the Ministerial Task Force on Indigenous Af- fairs. The second submission involves the mainstream pool of programs in which Indigenous health is treated as part of the mainstream population. When such a sub- mission goes through the mainstream programs, it is treated as part of the departmental structure. In either case, the funding submission has to be backed by evi- dence. This evidence may be in the form of epidemi- ology data, economic evaluation evidence, or political incentives. Once the funding has been secured, the decision-makers then allocate it to specific services based on implicit reasons/criteria behind the govern- ment priority setting process. This is one of the reasons it is important to understand the government process of priority setting. Priority setting can be defined as a non- market-based process of making choices in the face of scarcity [11].

Note that if assignments are submitted in the after-hours slot in SMAH Central or via post, the receipt must be filled out and left attached to the coversheet. The receipt will be stamped and retained under the counter at SMAH Central for later collection during business hours. You must collect your receipt personally and you will be required to show your student card at the counter of SMAH Central to obtain your receipt. Any assignments received without the coversheet attached, receipt section completed in full or receipt missing will not be receipted. Hard copy is the only accepted format for submission of assignments. The School of Nursing, Midwifery & Indigenous Health does not normally accept email, online, faxed or mailed copies of assignments. Some specific subjects, however, include electronic assignment submission as part of eLearning.

• The Closing the Gap Statement of Intent goals and health equality targets and subsequent budget and program initiatives, including the formation of the National Aboriginal and Torres Strait Islander Health Equality Council (NATSIHEC) formerly the National Indigenous Health Equality Council (NIHEC). NATSIHEC advises the government on the development and monitoring of health related goals and targets to support the commitments to ‘closing the gap’ and, as a first priority, to consider strategies to boost the participation of Aboriginal and Torres Strait Islander peoples in the health workforce.

· universalistic and anthropological particularistic models of causation' .10 In writing a history of disease, health and healing among indigenous people in Western Australia and Queensl[r]

Indigenous people globally have been over-researched and inappropriately researched, with culturally respectful methodologies often disregarded or overlooked within Western research paradigms (Bessarab & Ng’andu, 2010; Smith, 1999). This has also been the case historically in Australia too, with indigenous peoples being actively involved in defining principals for researching indigenous issues and concerns (Rigney, 2001). This is particularly evident in health research. In Australia, despite an ever-increasing volume of indigenous health research, there remains little change in the health disparities faced by indigenous Australians when compared with non-

The Cultural Respect Framework was informed by international developments around the notions of ‘cultural safety’ (New Zealand) and ‘cultural competence’ (United States). It was developed and endorsed for action by health ministers of all Australian jurisdictions with the intent ‘to ensure that Indigenous peoples enjoy a healthy life equal to that of the general population that is enriched by a strong living culture, dignity and justice’ (NATSIHC 2003:7). Cultural respect is defined by the Australian Health Ministers’ Conference as ‘ensuring that the cultural diversity, rights, views, values and expectations of Indigenous peoples are respected in the delivery of culturally appropriate health services’ (NATSIHC 2003:2). Key responses to this type of criterion have been to develop capacity of Indigenous Australians in the workforce, for example by training health workers, and providing cultural awareness training for those already working in Indigenous health care. See Appendix A for an expansion of the nomenclature around cultural competency.

The systematic review was completed using PRISMA guidelines [38] (see Additional file 1 for the checklist). Our primary research question was the following: How are the four elements of the HPW Implementation Framework reflected in studies involving the implemen- tation of a non-communicable disease health interven- tion in an Indigenous community? This question relies on the post hoc application of the HPW framework to studies that did not directly use it. The rationale for this choice is that there is not an existing framework guiding implementation science of Indigenous health interven- tions. The HPW framework was recently developed and has a strong theoretical and empirical basis and its post hoc application enables us to examine whether these key elements are being used by researchers and implemen- ters; if so, they can help identify promising practices for researchers and practitioners working in similar commu- nities. If they are not being used, it may illustrate im- portant directions for future research and practice. The

Turning the gaze to the privileged requires rethinking the focus of care, critically reflecting on whether policies and practices support or undermine Indigenous health, and engaging Indigenous people in the process. Applying main- stream solutions to a non-mainstream problem has done little to reduce health disparities between Indigenous and other Australians [57] despite the culturally blind “univer- sal” approach to health care (epitomised in the often repeated comment “I treat everyone the same”) which has been found wanting. While considering alternative strat- egies in mainstream health settings to reflect principles of equity and respect to respond to the Indigenous health issue [57], a step forward is to engage and keep Indigenous stakeholders at the table to co-construct policies and pro- grams that are adequately resourced, where both Indigen- ous and non-Indigenous people are accountable for translating them to practice and evaluating their short and long-term effectiveness in improving health outcomes. This also requires that health practitioners establish and build long-term partnerships with Indigenous communi- ties, developing their capacity to improve health by offering a more collaborative, sustained framework that recognises and respects Indigenous ontology epistemology and axiol- ogy. This approach repositions more equitably the role and power of White people in decolonising institutional prac- tices that discriminate against Indigenous Australians and instead implementing those that improve health outcomes. This devolution of power is appropriate and necessary for solutions to the complex circumstances that created the disparities that exist, and enables Indigenous and non- Indigenous people to come together as ‘individuals, as a society and as a health system to form true and equitable partnerships’ in the healing process [80: 498].

Since the Canadian government relies on Census data to fund social and health programs across the nation (Walter & Andersen, 2013) and these national statistics are under-representative of the actual Indigenous population (Chandler & Dunlop, 2015; Rotondi et al., 2017), it is assumed that social and health programs for Indigenous people may be underfunded. Given that Census data does not assess health or social wellbeing of Indigenous peoples living on-reserve and offers a significant under-representation of urban Indigenous peoples, the Canadian government needs to consider data sources that are Indigenous-led and governed because the current funding system for Indigenous health is faulty. When available, the Canadian government and provincial governments should refer to regional-level data when funding Indigenous-specific services to ensure that adequate resources are being allocated to meet the needs of urban Indigenous peoples because they are commonly left out of the funding equation at different governing levels. For example, in Ontario, Chiefs of Ontario (COO) are the regional representatives for First Nations. COO advocates for Provincial Territorial Organizations (PTOs), who are also mandated to work with First Nations communities (i.e. mostly on-reserve). A funding model that is more inclusive of First Nations, Inuit, and Métis at all governing levels is needed to ensure the health and wellbeing of urban First Nations, Inuit, and Métis are a priority as well. This proposed model is not to counter the existing funding model for health services on-reserve; rather, it is an addition to be more inclusive of Indigenous populations residing in urban settings. It is imperative to ensure both urban and on-reserve Indigenous communities have access to the necessary health and social services because many Indigenous people have strong connections to both reserve and urban settings. Therefore, this new model should increase to be inclusive of the needed

The research team would like to thank the Indigenous Health Services involved in the study (Ngati Porou Hauroa, Te Hononga O Tamaki Me Hoturoa, Victorian Aboriginal Health Service and De Dwa Da Dehs-Nye > s - Aboriginal Health Centre). We make special mention of their management teams who supported the study and those health services employees who filled critical roles in the research team including Research Coordinators and Local Investigators Jennie Harré Hindmarsh, Marion Hakaraia, Conrad Prince, and Mary Belfrage; Research Nurses - Julia Brooking, Lisa Sami, Taomiau Teremoana and Athena Weber; Community Health Worker - Jade Young and Community Research Support - Lesley Williams, Connie Mc Knight, Alan Brown and Tracy Williams. Additional research team members who contributed to the study development include Marcia Anderson, Nancy Cooper and Matire Harwood. We also acknowledge the support of all the participants and their families/whanau who took the time to be involved in this project. We thank the funders of this project the Health Research Council of New Zealand, the National Health and Medical Research Council (Australia), and the Canadian Institutes of Health Research. Dr. Smylie was funded by a CIHR new investigator award in knowledge translation at the time of the study.

by increasing primary care effectiveness and reducing the use of costly emergency and crisis-oriented services. This study’s findings strongly support the TRC call to action to include Indigenous Elders in the treatment of Indigenous patients within the Canadian health care system. Dr Tu is a family physician at the Urban Indigenous Health and Healing Cooperative, the Lu’ma Medical Centre, and St Paul’s Hospital in Vancouver, BC, and Clinical Assistant Professor in the Department of Family Practice at the University of British Columbia (UBC). Dr Hadjipavlou is a psychiatrist at the BC Operational Stress Injury Clinic, and with the UBC Hotel Study, and Clinical Assistant Professor in the Department of Psychiatry at UBC. Mrs Dehoney is a physiotherapist and wellness coach with the Urban Indigenous Health and Healing Cooperative and a member of the Missanabie Cree First Nation. Elder Price is a member of the Snuneymuxw and Cowichan Nations; a mother of 4 and grandmother to 6 children; Indigenous Elder for the Richmond, Delta, and Burnaby School Districts, as well as for the Indigenous Elder Visiting Program for BC Women’s and Children’s Hospital in Vancouver; Elder Advisor and Research Partner for UBC School of Nursing; and Elder Advisor for the Department of Family Practice at UBC. Mr Dusdal is a medical student at UBC. Dr Browne is Full Professor in the School of Nursing at UBC. Dr Varcoe is Full Professor in the School of Nursing at UBC. Acknowledgment

Of the four questionnaires applied in the National Survey (village, household, woman, child), the data used in this paper derive from the first three. Questions in Portuguese addressed sociodemographic conditions, sanitation, do- mestic economy, access to health services, and mater- nal characteristics, among others. Local Indigenous translators (often Indigenous health agents or primary education teachers) were used for interviews with non- Portuguese speaking respondents. For the assessment of hemoglobin, one drop of capillary blood was obtained with one-way lancets fitted to an Accu-Chek lancing de- vice by Roche (Mannheim, Germany) and analyzed using portable hemoglobinometer, model HemoCue Hb 201+ (Ängelholm, Sweden). Body weight was measured to the nearest 100 g with a portable digital scale (Seca model 872, Hamburg, Germany), with participants wearing minimal clothing and barefoot. Standing height was measured with an AlturaExata portable anthropometer (Belo Horizonte, Brazil) and recorded to the nearest 0.1 cm. Previously trained and standardized field re- searchers carried out anthropometric measurements. A detailed description of the methods used in the National Survey is presented elsewhere [16].

Workshops were held to train multidisciplinary field teams in research and anthropometric measurement procedures [20]. To guarantee the precision and reliabil- ity of field measurements, designated anthropometrists participated in training exercises to standardize their use of equipment and calculate within and between observer variability of height and weight measurements. The standard deviation of replicate measurements between observers and within observers was less than 5 mm [37]. In selected households, several questionnaires (domicile, mother, child) were applied in participating households. Questions in Portuguese addressed sociodemographic conditions, sanitation, domestic economy, access to health services, maternal characteristics, infant feeding, and mor- bidity [20]. The mothers or caretakers of all children < 5 years of age were interviewed. Children whose mothers self-identified as indigenous and children who were iden- tified as indigenous by a caretaker or non-indigenous mother were included in the study. Local indigenous translators (often indigenous health agents or primary education teachers) were used for interviews with non- Portuguese speakers.

Different aspects of the Grossman model may be useful in the study of factors contributing to Indigenous health. Among Indigenous people in Australia the initial stock of health may be less than that of non-Indigenous people. This is in contrast to Muurinen and Grand’s (1985) expansion of the Grossman model which hypothesised that although all components of stocks are unequally distributed between social classes, the inequality in inherited health may be less than in other inherited stocks because of its distinctive, genetic component. Evidence shows that Indigenous babies are more than twice as likely to be born premature or underweight (less than 2.5 kg) as non-Indigenous babies (AMA 2005). Major causes of low birth weight babies include smoking, alcohol and substance abuse, sexually transmitted diseases and malnutrition in the mother. This projects the importance of social issues such as dispossession, Stolen Generation, racism, social exclusion, poor socio-economic conditions and other stressful life events that have trans- generational impacts on Indigenous people and consequently affect their initial stock of health and the rate of depreciation of their health stock. These issues again hinder the subsequent efficiency in the production of good health.

This article examines the causes associated with health disparities in AIAN populations, paying particular interest to political and social determinants. Further, it will examine the role of the Indian Self-Determination and Education Assistance Act (ISDEAA) of 1975 and the Indian Health Care Improvement Act of 1976 – which enabled some tribes to assume greater autonomy in the services they provide – in not only the health status of AIAN, but also how this law alleviates some of the unique burdens that AIANs carry, via feelings of ownership and empowerment. Lastly, an evaluation of community-based and community-run indigenous health services from both the United States and abroad, will illustrate that, although the access to health has seemingly improved for tribes via the implementation of new programs and new facilities as discussed by current IHS director Yvette Roubideaux 1 , a crack still remains in the

Despite the declining HIV-related mortality rates demonstrated in this study, indigenous patients might still be at increased risk of dying compared with others, as shown by the significantly higher all-cause mortality. This high mortality rate in this study could be owing to differences between the 2 groups. For example, indig- enous people are more likely to be younger, and thus possibly exposed earlier to the associated risks; they are more likely to be women, another known risk factor in this context 8 ; and they are less likely to be taking HAART