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Saturday 23 August 2003

BMJ

BMJ: first published as 10.1136/bmj.327.7412.403 on 21 August 2003. Downloaded from https://www.bmj.com/ on 6 January 2025 by guest. Protected by copyright.
Indigenous by definition, experience, or world view
Links between people, their land, and culture need to be acknowledged


I
ndigenous” has a number of usages that differ reaching within through meditation and other
from “to be born in a specific place,” which is practices; and an indigenous view, which sees people as
how the Concise Oxford Dictionary defines it.1 integral to the world, with humans having a seamless
These usages tend to define indigenous by the experi- relationship with nature which includes seas, land, riv-
ences shared by a group of people who have inhabited ers, mountains, flora, and fauna.
a country for thousands of years, which often contrast If we accept that indigenous people have an
with those of other groups of people who reside in the integral association with nature, then it is easy to see
same country for a few hundred years. A number of the validity of an argument presented by many people,
alternative terms are preferred to indigenous. For including Foliaki and Pearce (p 437). This states that
example, in Australia, Aboriginal and Torres Strait the dislocation of most indigenous peoples from their
Islander is appropriate and acceptable. In Canada and lands through colonisation has contributed to the
the United States, the term First Nations is used to effects of newly introduced diseases on their health
describe the Indian, Métis, and Inuit populations, (figure). The direct linkages between the current health
whereas in Hawaii, native Hawaiian finds favour. Many status of Australian Aboriginal and Torres Strait
groups prefer their own language. The Maori of New Islanders and the various practices that followed
Zealand use “Tangata Whenua” or “people of the land” invasion and colonisation and the removal of people
in preference to Maori used by the colonising from land and culture are well established.4
Victorian English who, unaware of its meaning Indigenous peoples around the Pacific rim, such as
(ordinary or common), ironically deemed the indig- Australian Aboriginal and Torres Strait Islanders,
enous population to be the ordinary inhabitants, Kanaka Maoli of Hawaii, Samoan, Tongan, Tuvaluan,
rendering themselves extraordinary in the process.2 and other Pacific First Nations peoples, and the Maori
Te Ahukaramu Charles Royal, a recent Maori of New Zealand, have a disturbingly similar pattern of
recipient of the Churchill fellowship for overseas study, health and social status. These patterns contrast with
offers an attractive definition of indigenous based on those of the dominant populations in their countries.
what he calls world views—indigenous is used for those As Ring and Brown mention in this issue (p 404), it is
cultures whose world views place special significance the Australian Aboriginal and Torres Strait Islanders
on the idea of the unification of the humans with the for whom the greatest differences exist. Yet even in
natural world.3 Royal contrasts three major world countries where indigenous people fare better, such as
views—a Western (Judaeo-Christian) view which sees in Canada, the United States, and New Zealand, differ-
God as external and in heaven “above”; an Eastern entials persist, with the New Zealand pakeha or
BMJ 2003;327:403–4 view, which focuses internally and concentrates on European population continuing to make gains in life
and health expectancy.6
Cultural genocide COLONISATION Many indigenous populations now have a diverse
Stolen children profile,7 although the level of integration with other
Loss of hunter- populations varies greatly. While the First Nations
gatherer lifestyle,
loss of culture
peoples of North America have been concentrated on
reservations, Aboriginal and Torres Strait Islanders
Marginalisation from white society, Fixed settlements, fringe and Maori are considerably more integrated within the
poor communication, camps, urban ghettoes
discrimination populations of their countries. Many Pacific nations are
still dominated by their indigenous populations within
Poor nutrition Poor housing, poor
Unemployment, poverty, hygiene, overcrowding, their island states. Yet diversity, and distance (both geo-
poor education infectious disease graphic and genealogical), do not lessen the attach-
Low birth weight, ment of indigenous peoples to their lands and their
Alcohol and substance abuse diabetes mellitis, Respiratory disease, world views. Neither is their distinctiveness lessened;
hypertension, ear disease, many groups assert their difference, and a renaissance
cardiovascular rheumatic heart disease,
Domestic violence, accidents, disease renal disease of language and culture is occurring—for example, in
deaths in custody the education system in New Zealand from preschool
(kohanga reo) through to university (wananga).8 Sadly,
this is not the case in some areas of Australia, with
Impact of white colonisation on Aboriginal health today. Modified from Mathews5 frightening evidence emerging that the culture and

BMJ VOLUME 327 23 AUGUST 2003 bmj.com 403


Editorials

language of the Aboriginal and Torres Strait Islander all colonised indigenous groups is one reason for hav-
people is disappearing or has disappeared. ing a theme issue devoted to their health. This issue is

BMJ: first published as 10.1136/bmj.327.7412.403 on 21 August 2003. Downloaded from https://www.bmj.com/ on 6 January 2025 by guest. Protected by copyright.
In Australia, there is currently a debate about sym- an opportunity to share these similarities and
bolic versus practical reconciliation—the latter differences and to learn from the ways used to improve
approach suggesting that it is best not to acknowledge outcomes. This sharing of experiences needs to be
the history and its influence on current outcomes, and transferred among nations to move rhetoric into
that to move forward to improve living conditions and urgently needed action.
other activities that enhance wellbeing is in effect
Chris Cunningham director of health research
ignoring the root causes.9 10 However, evidence shows
School of Maori Studies at Massey University, Private Bag 756,
that the most effective programmes are those which
Wellington, New Zealand ([email protected])
acknowledge the devastating impact of removing
people from their land, removing children from their Fiona Stanley director
families and from their culture, and marginalising Telethon Institute for Child Health Research, PO Box 855, West Perth,
WA 6872, Australia
people so that they cannot access any of the
advantages of the dominant culture, such as education Competing interest: None declared.
and employment, which would have enabled them to
participate and control their own lives.11–13 This is 1 Allen RE, ed. Concise Oxford Dictionary of Current English. London: Claren-
evidence of the importance of the social determinants don, 1990.
2 Williams HW. Dictionary of the Mäori language. 7th ed. Wellington:
of health and how they have had an impact on genera- Government Print Publications, 1994.
tions of these populations—seen repeatedly in all colo- 3 Royal TAC. Indigenous worldviews—a comparative study. Wellington: Te
Wananga-o-Raukawa, 2003.
nised indigenous groups. We believe that sustainable 4 Preparatory Committee for World Conference. Indigenous peoples and
solutions to indigenous health problems must address racism: the report of the regional meeting of indigenous peoples of Aus-
tralia, New Zealand, Canada, Hawaii and the United States held at
and acknowledge this history and the links these Sydney, Australia, 20-22 February 2001. http://racismconference.com/
people have with nature. 2001/report.html (accessed 19 Aug 2003).
5 Mathews JD. Historical, social and biological understanding is needed to
Increasingly, we witness approaches to health improve Aboriginal health. Recent Adv Microbiol 1997;5:257-334.
research and health service provision led by indig- 6 Ajwani S, Blakely T, Robson B, Tobias M, Bonne M. Decades of disparity—
ethnic mortality trends in New Zealand 1980–1999. Wellington: Ministry of
enous people and based on indigenous methodologies Health, 2003.
and world views. Some approaches incorporate many 7 Durie MH. Ngä Matatini Mäori: Diverse Mäori realities. A paper prepared for
the Ministry of Health. Palmerston North: Department of Maori Studies,
contemporary and Western developments; still others Massey University, 1995.
prefer a return to more authentic cultural delivery, 8 Durie MH. Te Mana, Te Käwanatanga: The politics of Mäori self-
using traditional medicines and practices such as spir- determination. Auckland: Oxford University Press, 1998.
9 Council for Aboriginal Reconciliation. Roadmap for reconciliation. 1999.
itual and traditional healing approaches. www.austlii.edu.au/au/other/IndigLRes/car/2000/10/ (accessed 15
August 2004 will mark the end of the United Aug 2003).
10 Jackie Huggins: the symbolic and the practical [editorial]. The Australian
Nations decade for indigenous people, and a recent 30 July 2003:ii.
report reflects the views of less well researched 11 Human Rights and Equal Opportunity Commission. Bringing them home:
report of the National Enquiry into the Separation of Aboriginal and Torres
indigenous peoples from Laos, Cambodia, Guatemala, Strait Islander Children From Their Families. Sydney: Human Rights and
Burma, and Namibia.14 Unfortunately, it concludes: Equal Opportunity Commission, 1997.
12 Gordon S, Hallahan K, Henry D. Putting the picture together, inquiry into
“Very little has been achieved on the ground, and [our] response by government agencies to complaints of family violence and child abuse
experience is that the threats to indigenous people are in Aboriginal communities. Perth: Department of Premier and Cabinet,
2002.
growing rather than diminishing.” 13 Aboriginal Affairs Planning Committee. Royal Commission into Aboriginal
The indigenous experience is distinct yet diverse; deaths in custody: Government of Western Australia implementation report.
Perth: Government of Western Australia, 1993.
many similarities are obvious yet significant differences 14 Health Unlimited. Utz´ Wach´il: health and well being among indigenous
can be identified. That this pattern is so similar across peoples. London: Health Unlimited; 2003.

The health status of indigenous peoples and others


The gap is narrowing in the United States, Canada, and New Zealand, but a lot
more is needed

I
ndigenous populations differ in levels, patterns, morbidity through high quality primary healthcare
and trends of health. What is common is the services for prevention and early treatment.
unacceptably large differences between the health The gap in life expectancy between indigenous and
of indigenous and non-indigenous populations in non-indigenous populations is estimated to be 19-21
developed nations. Durie recently outlined the years in Australia, 8 years in New Zealand, 5-7 years in
explanations for these disparities and proposed a Canada, and 4-5 years in the United States.2–5 These
broad spectrum of interventions to improve the continuing disparities in health are a matter of major
health of indigenous people.1 Within that spectrum, concern, but it is none the less important to recognise
health professionals can have a major role in con- the substantial narrowing of the gap in health between
tributing to dramatic reductions in mortality and indigenous and non-indigenous people in the United BMJ 2003;327:404–5

404 BMJ VOLUME 327 23 AUGUST 2003 bmj.com

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