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Rapid Responses: Rapid Responses published:
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Australian Aboriginal Health
- Thomas J P Verberne (7 March 2003)
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Indigenous health – inequality frameworks and identity construction should be addressed
- Niyi Awofeso, NA (11 March 2003)
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Who are we?
- Guillermo A Herrera Taracena (19 March 2003)
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Re: Australian Aboriginal Health
- Judie Gade (3 May 2003)
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Health of indigenous people
- Ibrahim M Zardawi, J Rode (14 May 2003)
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Thomas J P Verberne, nil n. a.
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In his editorial, "The health of indigenous peoples" (BMJ, 2003;326:510-511), Durie writes: "While communicable diseases continue to affect large indigenous populations, vulnerability to injury, alcohol and drug misuse, cancer, ischaemic heart disease, kidney disease, obesity, suicide, and diabetes have become the modern indigenous health hazards." The reference behind this statement is to Cunningham and Condon's 1996 Med J Aust article. This is somewhat puzzling because alcohol and drug misuse, cancer, obesity, diabetes, kidney disease, and suicide are not included amongst "the most important causes of premature death" listed in that article. Thomas J P Verberne Competing interests: None declared |
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Niyi Awofeso, Public Health Officer (Surveillance), New South Wales Corrections Health Service New South wales Corrections Health Service, Long Bay Correctional Centre, Matraville 2036, Australia, NA
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Indigenous health inequality frameworks and identity construction should be addressed Professor Durie’s timely and thought-provoking article on indigenous health1 is rather thin on two important issues; first, even in more egalitarian societies, not all health inequalities are a result of inequities, i.e. unjust and remediable factors. Genetic factors or disability, for example might lead to health inequalities even in egalitarian societies. Furthermore, most benchmarks of inequality measure how well an apparently disadvantaged group is doing in relation to an advantaged group. In post-apartheid South Africa, for example, aggregate decreases in health inequality nationally might signal a reversal of previous improvements of the health status of the white population, while the health profile of blacks may be static or declining at a relatively slower rate. This, paradoxically. is bad news. Thus, it is important to measure the levels and trends of the absolute health status of indigenous people. 2 The Diffusion of Innovation Theory framwork3 may be profitably applied to a range of health problems (e.g. access, socioeconomic and macro-political disadvantages) and interventions concerning indigenous people. Second, the social construction of identities is an ongoing process of assertion, imposition and negotiation between actors and institutions with different capacities to make their accounts and categorizations “count” or “stick”, and with different capacities to control the flow of information about themselves and others. Racialized stereotypes of Aboriginal people as “backward” or “subhuman” are not restricted to early colonialists (as inferred by Durie); such clichés permeate many aspects of contemporary inter-racial relations. For instance, the depiction of individuals’ images on nations’ coins not only represents such individuals, it expresses something about them. The metaphorical and numismatic exemplification implicit in the current Australian $2 coin suggests a racialized national identity of Aboriginal Australians, which is deeply rooted in the history of colonization.4 Racialized negative identity stereotypes have been shown to contribute to poor indigenous health, and to violence a major threat to public health.5 References 1) Durie MH. The health of indigenous peoples: depends on genetics, politics, and socioeconomic factors. BMJ, 2003; 326: 510-1. 2) Feachem RGA. Poverty and inequity: a proper focus for the new century. Bull. WHO. 2000; 78(1): 1- 2. 3) Ferrence R. Using diffusion theory in health promotion: the case for tobacco. Can. J. Public Health, 1996; 87 (supplement 2): S24-7. 4) Awofeso N., Green S. Numismatics, Australian two-dollar coin, and Aboriginal identity. J. Mundane behavior. 2001, 2(3): 343-54. URL: http://mundanebehavior.org/issues/v2n3/awofeso- green.htm 5) McKenzie K. Racism and health: antiracism is an important health issue. BMJ, 2003; 326: 65-6. Competing interests: None declared |
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Guillermo A Herrera Taracena, Medical Epidemiologist Ozvatan Sokak, Teras Evler 17/2, Ankara, Turkey.
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- Are we civilized? - I thought for a moment and look at my seven year old who had just entered home back from another day in school. My answer was to ask back the same question –Are we? – I think it is hard for my daughter to study Native Americans and hear what we were supposed to be or do and what has become of us. – Do we live in a reservation back in America? – Another question that raised my eyes. - No, we do not - I replied taking a deep breath. – Can we live in one? I want to help my people – Who are we? If to be indigenous means to have “an ancient relationship with a defined territory and ethnic distinctiveness” (1) then Mayas, Mexicas, English, French, Turks, Maoris, etc. are all indigenous. However, white Europeans are not indigenous to the American continent although they have been there long enough to have displaced or mixed with the “original people.” How long do we need to live in a defined geographic area to become indigenous? Is two or three or maybe five hundred years enough? What made us “indigenous” is to have had our property, land, and natural resources repossessed and our social, cultural, and historical identity repressed, as well as our language, by another people or nation. The end process is assimilation, integration, or annihilation by the newcomers. In other cases, “indigenous people” were assigned new “homelands” or “reservations” so that they could be safely ignored and, when necessary, taken care of by the self appointed “protectors”. “And as I observed their ill will toward the service of his Majesty, and for the good benefit of this country, I burned them and ordered that the city be burned to its foundations” Pedro de Alvarado letter to Carlos V of Spain. (2) Historical events made us “indigenous” and the perpetuation of those events is what is keeping “indigenous people” from achieving full potential as global citizens. To say that our “social structures and lifestyles have suffered the repercussions of modern development” (3), is to reinforce the profile of victims who cannot aspire to a better future because development, technology, and globalization will always be a threat and utopia to us. The same goes for “cultural alienation” as “an important consideration for effective health care”. (1, 4) “The enemy is not destroyed in battle. You win over him by destroying his mind, his intelligence, and his will”; military poster in Peten, Guatemala.(2) Cultural alienation is a loss of identity and a reinforcement of beliefs, values, and attitudes imposed by the dominant group. Mayas and many other nations and groups have endured “cultural alienation” for more than 500 years. Studies have shown that acculturation might be detrimental to health and economic achievement.(5) Also, factors like poor housing, low education, unemployment, inadequate incomes are not exclusive to “indigenous people”; they do not discriminate based on race, ethnicity, or religion. It is us, human beings, in the predominant majority or the dominant minority, regardless of how "indigenous or non indigenous" we are, who impose unnecessary suffering and hardship on other human beings. Thus, “the health of indigenous people” depends on how “backward or forward thinking” we are as a society or a nation. Finally, what came first? Was it genetics or historical, political, and socioeconomic factors? If genetics were first, there should be a history of alcoholism, diabetes, obesity, and cancer in our families, dating generations. However, what we can find in our “genetic” three is a history of discrimination, alienation, poverty, domination, lack of educational opportunities, etc. We used to die of diarrheal diseases, upper respiratory infections, ad vaccine preventable diseases, mainly. Now, modernization, vaccines, and a change in diet are allowing us to live longer and experience diabetes, cancer, and obesity. Alcoholism is utilized to “drawn reality” while suicide is a faster and less painful way to escape it. So it may well be that, faced with so many insults, genetically we have changed to survive. We are today what we were yesterday and what we would like to be tomorrow. 1. Durie M. The health of indigenous peoples. BMJ 2003; 326: 510- 511. 2. Perera V. Unfinished conquest: the Guatemalan tragedy. Berkeley: University of California Press, 1993:1,52. 3. United Nations. Statement by the president of the general assembly at the commencement of the international decade of the world’s indigenous people. New York: UN Information Co-ordinator GA/8842, 9 December 1994. 4. Duran E, Duran B. Native American post-colonial psychology. Albany: State University of New York, 1995:93-156. 5. Anderson LM, Wood DL, Sherbourne CD. Maternal acculturation and childhood immunization levels among children in Latino families. Am J Public Health 1997;87:2018-21. Competing interests: None declared |
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Judie Gade, student 3199
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Although "the most important causes of premature death" may be "suicide...alcohol and drug misuse..." another cause that has not been mentioned could be ADHD (Attention Deficit Hyperactivity/ Disorder). Impulsivity, risk taking, addictive personalities & distractibility being major traits of the disorder could explain the high suicide rate (acting before thinking) & alcohol/drug dependency (self medication) amongst indigenous populations in particular those from hunting societies. Perhaps the "modern indigenous health hazards" are governments that do not empower indigenous societies with information regarding funding, governements that instil a white societie's values on aboriginals and not taking the time to find the social determinants that are the root causes of the problems. Treat the cause, not the symptom. Competing interests: None declared |
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Ibrahim M Zardawi, Medical Director Mayne Health, Laverty Pathology, Newcastle Laboratory, PO box 801, Newcastle, NSW 2300, J Rode
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We read with interest the Editorial on the health of indigenous peoples by Durie in the Journal1 and would like to highlight some pathological aspects of aboriginal health in the Northern Territory of Australia. A wide range of unusual infections, precancers and cancers are encountered in indigenous Australians in the Territory. We attribute the predisposition to these diseases to the possible presence of subtle genetic immune deficiencies in socioeconomically disadvantaged individuals. Ill-health and poor housing are likely to compound the immunological impairment and hinder complete recovery from potentially oncogenic infections, allowing persistence and in some instances progression to pre-malignancy or even to frank cancer.2 Conditions such as invasive amoebiasis and malakoplakia, attributed to either impaired or abnormal immune responses are not uncommon in the Northern Territory. We have recently published our experience with invasive amoebiasis and have described 6 cases of amoebic appendicitis, which we encountered in a little over a year in indigenous Australians mainly from remote communities.3 We are in the process of reporting 6 cases of malakoplakia of the urinary bladder, collected over a 4 year period from a remote Aboriginal community in North East Arnhem Land with a total population of 9697.4 Deficiencies in immune surveillance have emerged as important factors in the process of carcinogenesis. In a partly retrospective study we have found a high prevalence of Human Papilloma Virus related intraepithelial neoplasia and squamous cell carcinomas of the vulva in young indigenous women in the Northern Territory.5 In a previous study we also demonstrated the high prevalence of a number of mucocutaneous precancers and cancers in aboriginal Australians. Compared to the rest of Australia, the age-adjusted death rate from these cancers is 3-4 times higher in the indigenous population.2 We are therefore in agreement with Durie about the importance of socioeconomic factors and genetic vulnerability in predisposition to disease and injury. References 1. Durie MH. The health of indigenous peoples depends on genetics, politics and socioeconomic factors. BMJ 2003;326(7388):510-511. 2. Kattampallil J, Mathew R, Zardawi I, Rode J. Mucocutaneous cancer and Human Papilloma Virus in the Top End of Australia. Pathology International 2001;51:Suppl A7. 3. Zardawi IM, Katampillal J, Rode J. Amoebic appendicitis. Med J Aust 2003;178(10):523-524. 4. Zardawi IM, Katampillal J, Rode J. Malakoplakia in the Top End of Australia. In press (Pathology). 5. Zardawi IM, Rode J. Vulval cancer in the Northern Territory. Submitted (Pathology). Ibrahim M Zardawi, J Rode Dr Ibrahim M Zardawi is the Medical Director of Mayne Health, Laverty Pathology, Newcastle Laboratory Professor J Rode is Professor of Anatomical Pathology at the Royal Darwin Hospital and the Northern Territory Clinical School of Flinders University of South Australia. Competing interests: None declared |
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