Pathways to Poor Health (health injustice) for Indigenous Peoples
August 2023
Authors: Charlotte Kemp & Araceli Camargo
Introduction
There are disproportionately high rates of psychological and psychological distress and health disparities among Indigenous Peoples. That is, regardless of their geographical location or sociopolitical situation, health indicators are always poorer for Indigenous Peoples than for non Indigenous ones.
The pathways to poor health outcomes for Indigenous Peoples are multifaceted and interconnected. They stem from, and are upheld by, a combination of historical, social, economic, and environmental factors.
Here, we provide a brief overview of some of the mechanisms by which the devastating effects of colonisation, forced assimilation, displacement, and systemic oppression contribute to health disparities of indigenous peoples.
The purpose of this work is not to give a comprehensive overview of the multitude of interconnected factors, but to highlight that the determinants of the poor health outcomes experienced by Indigenous Peoples are deep-rooted, complex and related to the actions of supremacy structures. Accordingly, it is clear that addressing the health challenges faced by Indigenous Peoples requires a comprehensive approach that recognises their rights, acknowledges historical as well as persistent injustices, and incorporates indigenous knowledge and practices into healthcare systems.
This work is the start of our journey, as we continue to uncover more Indigenous and Land-Kinned specific poor health pathways. This is necessary for our own health sovereignty, so we can advocate more strategically across policies and laws that influence urban planning. Additionally, we will use these Knowledges so we can learn to adapt our Traditional Knowledges to these evolving health challenges. The intention is to health ourselves through our Kinship with the urbanised Land that is also in need of healing and dignity.
Indigeneity, Urbanisation and Poor Health Outcomes - a brief summary
The link between urban systems and the health of Indigenous Peoples is complex and multifaceted. Urbanization often leads to the migration of Indigenous Peoples from rural or remote areas to urban centres in search of economic opportunities or due to displacement.
The transition to urban environments can have detrimental effects on Indigenous health. Urban systems can contribute to the erasure of Traditional Indigenous Knowledges and cultural practices, leading to a loss of physical connection to Land, community, and traditional healing methods. This loss, combined with factors such as inadequate housing, limited access to clean water, food insecurity, and exposure to pollution, can contribute to poor physical and mental health outcomes for Indigenous peoples in urban settings.
Moreover, urban systems may not adequately address the specific health needs and cultural sensitivities of Indigenous and Land-Kinned Peoples. Barriers to accessing culturally appropriate healthcare, language barriers, discrimination, and systemic inequalities can further exacerbate health disparities.
To promote the health of Indigenous and Land-Kinned Peoples in urban settings, it is crucial to involve Indigenous Peoples in decision-making processes, ensure culturally sensitive healthcare services, provide access to traditional healing practices, address social determinants of health, and support Indigenous-led initiatives that acknowledge Indigenous Wisdoms and Knowledges.
A simplified representation of pathways to poor health for Indigenous Peoples
Detailed Pathways to Poor Health
Indigenous historical trauma (IHT) is distinguished by its emphasis on ancestral adversity that is intergenerationally transmitted in ways that compromise descendent well-being. The legacy of colonization, forced assimilation, and cultural disruption has resulted in deep-rooted trauma, which can impact mental, emotional, and physical well-being across generations. Higher indicators of IHT have been associated with adverse health outcomes.
Social Determinants of Health: Indigenous Peoples often face systemic barriers such as poverty, inadequate housing, limited access to education and employment opportunities, food insecurity, and discrimination. These social determinants of health significantly impact overall well-being.
Displacement and Loss of Land: Many Indigenous Peoples have been forcibly and violently displaced from their Ancestral lands, leading to a loss of cultural connection, traditional practices, and community cohesion. This disruption can contribute to a sense of loss, identity, and decreased overall health.
Environmental Injustice: Indigenous Peoples often face disproportionate exposure to environmental hazards, such as pollution, contaminated water sources, and degraded ecosystems. These factors can lead to increased risks of respiratory illnesses, waterborne diseases, and other health problems.
Inadequate Healthcare Access: Indigenous and Land- Kinned Peoples may encounter challenges in accessing culturally appropriate healthcare services, including language barriers, geographic remoteness, underfunding of healthcare facilities, and a lack of healthcare professionals trained in Indigenous health risks. Furthermore, displacement can often lead to Indigenous Peoples not being able to access Ancestral healing practices and methods. This can leave many Indigenous Peoples both unable to health themselves and over-dependent on healthcare systems that are not able to provide adequate healing .
Cultural discontinuity and oppression: The erosion of cultural practices, languages, and traditional healing methods due to assimilation efforts and oppression can lead to a loss of cultural identity and contribute to poor mental health outcomes. Marginalisation and discrimination further compound these issues.
Gut-brain axis/ micro-biome: Forced displacement and associated loss of access to nutrition and microbiota that support physical and mental health.
Pervasive supremacy epistemologies: Supremacy epistemologies seen throughout urban systems (e.g. healthcare, mobility, housing education) contribute to marginalisation and further erasure of Indigenous and Land Kinned Peoples. In cities across the “Americas”, Indigenous Peoples are pushed to live in areas with the highest levels of contamination, deprivation and areas at higher risk for flooding, urban heat island, and other risks related to the crisis being driven by poor governmental strategies against climatic events. Additionally, we are erased, as we are seen as an undesired Peoples amongst the wealthy white European areas of the city. All of this contributes to poor health outcomes.
Sources & further reading
Braginsky, N., Kataoka-Yahiro, M., & Inouye, J. (2016). The lived experience of Pacific Island women with a “big body” size. Asian/Pacific Island Nursing Journal, 1(2), 10-23.
Dialogue – Decolonizing Wellness: Indigenous Women’s Perspectives on Healthcare
Gone, J. P., Hartmann, W. E., Pomerville, A., Wendt, D. C., Klem, S. H., & Burrage, R. L. (2019). The impact of historical trauma on health outcomes for indigenous populations in the USA and Canada: A systematic review. American Psychologist, 74(1), 20.
Journal Description: AlterNative: An International Journal of Indigenous Peoples
Turpel-Lafond, M. E., & Johnson, H. (2021). In plain sight: Addressing Indigenous-specific racism and discrimination in BC health care. BC Studies: The British Columbian Quarterly, (209), 7-17.
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