Indigenous People and Health Inequalities

- Dr Yadav Gurung


The concept of indigeneity is complex and the prevailing view today is that no formal universal definition of the Indigenous people is necessary (Carolyn, John, Clive, & Ruth, 2006; Kuper, 2005). Though United Nations has not adopted an official definition of indigenous people, for practical purposes, the understanding or definition of the term commonly accepted is the one provided in Jose R. Martinez Cobo’s study on the Problems of Discrimination on Indigenous Populations (United Nations, 2009). Indigenous communities, peoples and nations are those which, having a historical continuity with pre-invasion and pre-colonial societies that developed on their territories consider themselves distinct from other sectors of the societies now prevailing on those territories or parts of them (Cobo, 1983; cited in Carolyn et al., 2006).

Gurung, an Indigenous people of Nepal, performing a traditional dance

The fifth session of UN Permanent Forum on Indigenous Issues developed a modern understanding of indigenous peoples which is based on the common ideas: identify themselves and are recognized and accepted by their community as indigenous; demonstrate historical continuity with pre-colonial and/or pre-settler societies; have strong links to territories and surrounding natural resources; have a distinct social, economic or political systems; maintain distinct languages, cultures and beliefs; from non-dominant groups of society; and resolve to maintain and reproduce their ancestral environments and systems as distinctive peoples and communities (United Nations Permanent Forum on Indigenous Issues [UNPFII], 2006). Indigenous populations are communities that live within, or are attached to, geographically distinct traditional habitats or ancestral territories, and who identify themselves as being part of a distinct cultural group, descended from groups present in the area before modern states were created and current borders defined (WHO, 2013).

In some countries or regions, there may be frequent use of other terms such as tribes, first people/nations, aboriginals, ethnic groups, adivasi or janajati. The term indigenous is used in some contexts to refer to the aboriginal population those who were the first recorded human inhabitants (Carolyn et al., 2006). In some countries such as New Zealand, Australia, North America, Canada and Latin America, definition of indigenous is distinctly clear between native people and European colonial settlers (Anderson et al., 2006; Montenegro & Stephens, 2006). In Nepal and India, the term used for Indigenous people is Adivasi or Janajati, which indicates people living in tribal communities characterised by distinct culture and dialect, geographical isolation, and pre-literate people living in forests and hills, sharing a symbolic relationship with nature (Carolyn et al., 2006; Government of Nepal, 2002).

It is estimated that there are more than 370 million indigenous people spread across 70 countries worldwide (UNPFII, 2006). They represent a rich diversity of cultures, religions, traditions, languages and histories but they are still among the world’s most marginalized population groups (WHO, 2007).

Though data do exist and indigenous people have worse health; in some regions, they are unrecognized and uncounted (Carolyn et al., 2006). In some parts of the world, indigenous people are easily recognised: they are Native Americans, the aboriginal people of Australia, or the Maori in New Zealand who occupied the land before the arrival of European settlers (International Work Group for Indigenous Affairs [IWGIA], 2006).

Health inequalities among Indigenous people

Indigenous peoples suffer from poorer health, more likely to experience disability and reduced quality of life and ultimately die younger than non-indigenous counterparts (Department of Economic and Social Affairs [DESA], 2009). The gap in life expectancy between indigenous and non-indigenous people in years is: Guatemala 13; Panama 10; Mexico 6; Nepal 20; Australia 20; Canada 7; New Zealand 11 (UNPFII, 2010). Indigenous people remain on the margins of society: they are poorer, less educated, die at a younger age, are much more to commit suicide; and are generally in worse health than the rest of the population (IWGIA, 2006). The present epidemiological profile of the indigenous population is associated with high poverty indices, unemployment, illiteracy, migration, excluded from the mainstream society, destruction of the ecosystem, alteration of the dynamic of life, and unmet basic needs (DESA, 2009). Children born into indigenous communities often live in remote areas where government does not invest in basic social services; and indigenous youth and children have limited access or no access to health care, quality education, justice and participation (UNPFII, 2006).

Gap in life expectancy between indigenous and non-indigenous people [in years], (UNPFII, 2010)
Guatemala Panama Mexico Nepal Australia Canada New Zealand
13 10 6 20 20 7 11

Many studies report that indigenous people have higher rates of non-communicable disease which has significantly increased inequalities within and across these diverse populations (The NCD Alliance, 2012). More than 50 percent of indigenous adults over 35 years have type two diabetes (DESA, 2009). A study conducted in Canada shows 43 percent of Aboriginal people suffered from arthritis or rheumatism, 35 percent had heart diseases, 24 percent had chronic obstructive pulmonary disease, and 22 percent had diabetes (Anand et al., 2001; Steer & Carapetis, 2009)

The lower standard of health of Indigenous people compared to non-Indigenous people may be partly due to their higher exposure to health risk factors. Health risk factors such as the use of tobacco, alcohol and other drugs, as well as inadequate diet and nutrition have great impact on indigenous people’s health (Gracey & King, 2009).

For indigenous people, access to health services is a substantial problem, and for indigenous communities in rural areas, access is impeded by distance from facilities and the lack of trained staff and services (The Commission on Social Determinants of Health [CSDH], 2007). Indigenous People have their own traditional health systems, but they face a myriad of obstacles to accessing health care systems including economic, geographic, linguistic, educational and socio-cultural and religious barrier (The NCD Alliance, 2012). For example, in Guatemala, health services only reach 54 percent of the total indigenous population, and in rural areas, access drops to 25 percent (IWGIA, 2012). The health inequality that results in indigenous people suffering poorer health, being more likely to experience disability and ultimately dying at younger ages than non-indigenous counterparts is an extreme violation of the human right to health (The NCD Alliance, 2012).

Major health problems of Indigenous peoples Persistent problems of Indigenous People
  • High infant and young child mortality
  • High maternal morbidity and mortality
  • Heavy infectious disease burdens
  • Malnutrition and retarded growth
  • Shortened life expectancy at birth
  • Diseases and deaths associated with cigarette smoking
  • Social problems, illnesses, and deaths linked to misuse of alcohol and other drugs
  • Obesity, diabetes, hypertension, cardiovascular disease, and chronic renal disease (lifestyle diseases)
  • Injury and Violence


  • Poverty, hunger, environmental contamination, frequent infections, and parasites
  • Infant and child malnutrition and growth failure
  • High infant and young child mortality
  • Maternal ill-health and high mortality
  • Chronic ill-health and disabilities
  • Shortened life expectancy
  • Poor understanding of the complexities of Indigenous health by health professionals
  • Widespread prejudice about perceived inadequacies of Indigenous people
  • False expectations that medical strategies alone can overcome Indigenous health problems
  • Government’s preoccupation with sickness services rather than wellness strategies
  • Insufficient chances for Indigenous people to be trained and take part in their health care
  • Inadequate systematic data to allow surveillance and improvement of Indigenous health care
  • Government indifference, ignorance, neglect, and denial about the poor state of Indigenous health

Adapted from Gracey & King (2009); King, Smith & Gracey (2009)

Social determinants of Indigenous health

Social determinants of health are the political, economic, social and cultural structures that shape health and health patterns (Birn, Pillay, Holtz, & Basch, 2009, p. 310). The factors contributing to the poor health status of Indigenous people should be seen within the broader context of the social determinants of health. These determinants which are complex and interrelated, include income, education, employment, social networks and support, social exclusion, working and living conditions, gender and behavioural aspects (Gracey & King, 2009).

Indigenous peoples are widely believed to be among the world’s poorest. Though Indigenous people account only 4 percent of the total population, they account 10 percent of the world’s poor. Moreover, one third of indigenous people are very poor (The World Bank, 2010).

Poor nutrition is one of the health issues that most affects indigenous peoples. In addition to circumstances of extreme poverty, indigenous peoples suffer from malnutrition because of environmental degradation and contamination of the ecosystems in which indigenous communities have traditionally lived, loss of land and territory, and a decline in abundance or accessibility of traditional food sources (DESA, 2009, p. 163). Poor housing, lack of education, inability to find work, where it found, low wages and hazardous working environments put their lives and health at risk. Indigenous people may live to some extent outside of the monetary economy, and have a different understanding of education and health; conventional social indicators may not be reliable or valid.

Fundamental health determinant which is responsible for poor health is the disruption or severance of ties of indigenous people to their land, weakening or destroying closely associated cultural practices and participation in the traditional economy essential health and well being (CSDH, 2007). In many instances, researchers ends up blaming communities for their ill health through wrong behaviours, poor knowledge, non-compliance and ignorance without examining the social determinants that limit individual choices or practices (CSDH, 2007).


Indigenous notion of health and community development

Indigenous people have been the guardians of our environment and its medicines for thousands of years, built on a holistic communal view of humanity and its links to ecosystem. Research into Indigenous health has been largely focused on non-indigenous, rather than the indigenous notion of health (King et al., 2009). Indigenous people define wellbeing far more broadly than merely physical health

Maori, an Indigenous people of New Zealand

or the absence of disease. The indigenous Peoples’ concept of health and survival is both a collective and an individual inter-generational continuum encompassing a holistic perspective incorporating four distinct shared dimensions of life. These dimensions are spiritual, the intellectual, physical and emotional. These four elements are instricately woven together and interact to support a strong and healthy person (Wilson, 2003). Balance extends beyond the individual realm so that good health and healing also require that an individual live in harmony with others, their community and spirit worlds (King et al., 2009). Connections, relations, and family are among the many essential components of wellbeing as in the Maori concept of whanau or family (Anderson et al., 2006). Land, food and health are key components of being alive well for indigenous people (King et al., 2009). Belonging to own family and community and connected is a major determinant of indigenous health. Health for indigenous people is not merely absence of ill health, but also a state of spiritual, communal and ecosystem equilibrium and wellbeing. Similarly, Indigenous knowledge is a basis for today’s modern development in many sectors. Indigenous people have sophisticated and well established systems of traditional medicine with tried and trusted remedies developed over centuries. Indigenous wisdom about these traditional remedies is not only valuable to Indigenous communities, but is also the foundation of many western pharmaceutical discoveries (Carolyn et al., 2006; King et al., 2009). The devastations that followed from the colonisation resulted breakdown of bond in with the land and the environment, and the community and disappearance of indigenous knowledge.

Holistic vision for Community development actions is essential so that cultural identity, language, connection in family and community, bond with the land and the environment can be restored. At the personal level this means each other enjoys health and wellness in body, mind, heart and spirit, Within the family context, this means mutual support of each other while from a community perspective, it means leadership committed to whole health, empowerment, sensitivity to the interrelatedness of past, present future possibilities and connected between cultures (King et al., 2009).

Indigenous policies and rights

The indigenous social movements that emerged across the world from the late 1960s have resulted the greater recognition of the civil rights of Indigenous people (Anderson et al., 2006). International human rights instruments such as the Universal Declaration of Human Rights, the International Covenant on Economic, Social and Cultural Rights, the Convention on the Elimination of All Forms of Discrimination against Women and the Convention on the Rights of Child have provided the legal framework the foundation of international human rights, including the right to health with some specifically recognising the right of individual from marginalised populations, including indigenous people and ethnic minorities. The United Nations Declaration on the Rights of Indigenous Peoples by the General Assembly in 2007 states that “Indigenous people have an equal right to the enjoyment of the highest attainable standard of physical and mental health. The states shall take the necessary steps with a view to achieving progressively the full realization of this right. Indigenous people have the right to their traditional medicines and to maintain their health practices, including the conservation of their vital medicinal plants, animals and minerals. Indigenous individual also has the right to access, without any discrimination, to all social and health services (United Nations, 2009, p. 46).”

The Convention on Indigenous and Tribal Peoples of the International Labour Organization (ILO no. 169) held in September 2007 is the primary international legal instrument for protecting the rights of Indigenous populations. This includes the right to exercise control over their own institutions and natural resources, ways of life and economic development and to develop and maintain their identities (Center for Constitutional Dialogue [CDC], 2009).

Recognition of indigenous health issues as a policy priority has been growing in many countries as they have recognized indigenous population as vulnerable communities. However, still a few countries fail to recognize their own populations who are still marginalized and excluded.


Health standards of indigenous people are unacceptably poor. When we see the status of indigenous health, we can feel overwhelmed by the great disparities and inequalities. Indigenous people have higher rates of physical, mental and emotional illness, injuries, disability and earlier and higher mortality. Health of indigenous people is complex as it is associated with literacy, poverty, culture, behavioural practices, nutrition, and exposure to risk factors. To address indigenous health crisis, holistic vision of health research and health intervention that are more upstream, more integrated, and socio-culturally appropriate for these communities is essential. A holistic approach should address the overall community development of the indigenous population with their emotional, intellectual, mental and physical well being and their bond with the land and nature.

In accordance with international human rights instruments which state the right to health, the state should ensure equal access to quality health care including through efforts to eliminate the discrimination and marginalisation faced by indigenous people. To improve the health situation of indigenous people around the world, it is critical to recognize their health and wellbeing are inextricably linked to their collective rights, such as rights to land and natural resources and to conserve and practice traditional knowledge.


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