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From an ethno-gerontological perspective, new models are needed to fulfill the health needs of the indigenous older adult population in Mexico. In this paper we developed a comprehensive healthcare model, interculturally appropriate, designed to meet the needs of Mexican indigenous older adults. The model was constructed using a qualitative design with semi-structured interviews of older adults, health providers, and available health resources in three Mexican indigenous regions. An ethnographical review was carried out to contextually characterize these communities. At the same time, a comprehensive bibliographic revision was made to identify socio-demographic markers. Results pointed out that Mexican indigenous older adults are not covered by any type of social health insurance program. Their health problems tend in large part to be chronic in nature due to the lack of early diagnosis and treatment. There is a need for trained human resources in the field of gerontology encompassing the sociocultural context of the indigenous groups. The geographical location of these communities limits the permanent presence of healthcare givers and thus limits access to continuous care. Traditional healthcare givers, able to speak the native language, are a great asset allowing the invaluable possibility of direct verbal communication. Based upon the data gathered from indigenous older adults and service providers, in tandem with evidence from the literature, we identified key elements for successful intervention and designed an intervention model. We concluded that indigenous older adults are a more vulnerable group, given that aside from being elderly in a country where the health needs of these populations exceed the capacity of existing healthcare services, their ethnicity serves as an added barrier preventing their access to the limited available healthcare resources. To achieve uniformity in providing health care, today's health systems need to address intercultural and participative aspects of healthcare models. [ABSTRACT FROM AUTHOR]

Objective. The objective of this paper is to explore the discourse of ‘community’ and its offshoots, ‘social capital’ and ‘community capacity building’, in the contexts of health service delivery to, and the health status of, Indigenous people in the Northern Territory of Australia, and to link this discourse to the wider context of social control and the management of diversity in a multicultural society. Design. The discourse is subjected to critical theoretical and historical analysis and comparisons are drawn between this and similar discourses in the immigration and settlement area. Results/conclusions. The constitution of Indigenous society as a series of ‘communities’ and the orientation of primary health care policy towards ‘capacity building’ has the effect, if not the intention, of depoliticising Indigenous health, whilst reproducing, legitimising and mystifying relations of white dominance and permitting the maintenance of a health service delivery system for Indigenous people which, in relation to need, is grotesquely underfunded and incapable of making serious inroads into the appalling health problems of the Indigenous population. [ABSTRACT FROM AUTHOR]

Objectives.New Zealand has a unique tool, Te Tiriti o Waitangi, the Treaty of Waitangi, for addressing health disparities. Indigenous Māori have compromised health status compared to other groups. This paper investigates ways in which public health units (PHUs) and non-governmental organisations (NGOs) use Te Tiriti o Waitangi in service delivery to Māori. Design.A nationwide telephone survey of primary health providers (n=162) was conducted in 2014-15. Participants were asked about effectiveness and monitoring of their service delivery to Māori. Results.PHUs reported actively working with Māori, and Te Tiriti o Waitangi to reduce health disparities. Direct Māori engagement with development and delivery of programmes was viewed as essential. Strategies included designated PHU staff in positions of responsibility, formal partnerships with Māori, and providing operational and strategic guidance. Some PHUs supported development of cultural competencies. NGO responsiveness to Māori was variable. Some NGOs described prioritising service delivery and programmes for Māori. Others reported the focus of their service was European or other non-Māori ethnicities. Lack of resources or past difficulties engaging with Māori were barriers. Conclusion.Public health has an ethical commitment to reduce health disparities. Advancing Te Tiriti obligations in everyday practice has the potential to address inequalities. [ABSTRACT FROM AUTHOR]

Objectives.Cancer is the second biggest killer of Aboriginal Australians. For some cancers, the mortality rate is more than three times higher in Aboriginal people than for non-Aboriginal people. The Aboriginal Patterns of Cancer Care Study explored barriers to and facilitators of cancer diagnosis and treatment among Aboriginal and Torres Strait Islander people in New South Wales. Design.Our team – which includes both Aboriginal and non-Aboriginal researchers – conducted in-depth interviews between 2009 and 2010 with Aboriginal people with cancer, their carers and health professionals who care for them. In this paper, we identify recurrent patterns of ‘discursive framing’ in the 16 interviews with health care professionals. We are particularly interested in how these frames assisted participants in constructing a professional position on what ‘cultural difference’ means for the design and delivery of cancer care services to Aboriginal people. Results.Despite geographical, organisational, disciplinary and cultural diversity, these interview participants consistently drew upon six discursive frames, which we have interpreted as eitherelidinga discussion ofdifference(‘everyone is the same’ and ‘everyone is different’) orfacilitatingthat discussion (‘different priorities,’ ‘different practices’ and ‘making difference safe’). An additional strategy appeared to actively resist either of these positions but then tended to ultimately prioritise the eliding frames. Conclusions.While none of our participants were dismissive of the idea that cultural identity might matter to Aboriginal people, their reliance upon familiar narratives about what that means for cancer care services has the potential to both symbolically and practically exclude the voices of a group of people who may already feel disenfranchised from the mainstream health care system. Critically unpacking the ‘taken for granted’ assumptions behind how health care professionals make sense of cultural difference can enrich our understanding of and response to the care needs of indigenous people affected by cancer. [ABSTRACT FROM PUBLISHER]

Action Research can be a powerful tool for change and improvement in health services for indigenous people when utilised within an appropriate framework. The project Maori Utilisation & Experience of Ischaemic Heart Disease Management illustrates this convergence in its use of Kaupapa Maori Action Research methods in its efforts to improve the health and well-being of Maori within the northern region of Aotearoa/New Zealand. We outline the research processes and outcomes obtained through the application of 'by Maori for Maori' approaches to understanding Maori pathways and barriers to care for ischaemic heart disease. Maori understandings of their illness and experiences of treatment, and healthcare providers' perspectives on care of Maori with ischaemic heart disease, were combined into Maori-led actions to improve service provision. The paper examines critical factors in an action research approach to health service innovations and implications for efforts to reduce entrenched health disparities. [ABSTRACT FROM AUTHOR]

Objective Methodological criteria that characterise ethically sound community-based studies are often described in overviews but are rarely documented in clinical studies. Research investigating the health of Aboriginal Australians is often small-scale, descriptive and largely driven by non-Indigenous people. The ‘community-controlled’ model of research relating to Aboriginal peoples health is a form of ‘participatory’ research that shifts the balance of control towards those being researched. This paper describes the methodological issues and principles that underpin community-controlled health research; their practical application; and encourages their adoption in research involving Indigenous populations.Design Descriptive report of the methods used to conduct the landmark Aboriginal community-controlled multi-centre double-blind randomised controlled clinical ear trial investigating ototopical treatments for chronic suppurative otitis media.Results The characteristics of the community-controlled research model are illustrated under the headings of: setting the research agenda; research project planning and approval; conduct of research; and analysis, dissemination and application of findings.Conclusion The 22 methodological elements which defined the community-controlled design of the ear trial may assist community groups, external research bodies and funding agencies to improve the acceptability, quality and scope of research involving Indigenous peoples. Aboriginal community-controlled organisations are well placed to lead research, which can be interventional and of a high scientific standard without compromising the values and principles of those being researched. With over 120 Aboriginal community-controlled health services (ACCHSs) across Australia, the potential exists for these services to engage in multi-centre research to realise solutions to health problems faced by Indigenous Australians. [ABSTRACT FROM AUTHOR]

Mexico's indigenous communities continue to experience higher levels of mortality and poorer access to health care services than non-indigenous regions, a pattern that is repeated across the globe. We conducted a two-year ethnographic study of pregnancies and childbirth in an indigenous Wixárika community to explore the structural causes of this excess mortality. In the process we also identified major differences between official infant mortality rates, and the numbers of infants born to women in our sample who did not survive. We interviewed 67 women during pregnancy and followed-up after the birth of their child. At baseline, socio-demographic data was collected as well as information regarding birthing intentions. In depth-interviews and semi-structured interviews were conducted with 62 of these women after the birth of their child, using a checklist of questions. Women were asked about choices regarding, and experiences of childbirth. Of the 62 women we interviewed at follow-up 33 gave birth at home without skilled attendance and five gave birth completely alone in their homes. Five neonates died during labour or the perinatal period. Concerns about human resources, the structure of service delivery and unwanted interventions during childbirth all appear to contribute to the low institutional childbirth rate. Our data also suggests a low rate of death registration, with the custom of burying infants where they die. This excess mortality, occurring in the context of unnecessary lone and unassisted childbirth are structurally generated forms of violence. [ABSTRACT FROM AUTHOR]

Objectives.To describe levels of risky sexual behaviour, HIV testing and HIV knowledge among men and women in Guatemala by ethnic group and to identify adjusted associations between ethnicity and these outcomes. Design.Data on 16,205 women aged 15–49 and 6822 men aged 15–59 from the 2008–2009Encuesta Nacional de Salud Materno Infantilwere used to describe ethnic group differences in sexual behaviour, HIV knowledge and testing. We then controlled for age, education, wealth and other socio-demographic factors in a multivariate logistic regression model to examine the effects of ethnicity on outcomes related to age at sexual debut, number of lifetime sex partners, comprehensive HIV knowledge, HIV testing and lifetime sex worker patronage (men only). Results.The data show low levels of risky sexual behaviour and low levels of HIV knowledge among indigenous women and men, compared to other respondents. Controlling for demographic factors, indigenous women were more likely than other women never to have been tested for HIV and to lack comprehensive HIV knowledge. They were less likely to report early sexual debut and three or more lifetime sexual partners. Indigenous men were more likely than other men to lack comprehensive HIV knowledge and demonstrated lower odds of early sexual debut, 10 or more lifetime sexual partners and sex worker patronage. Conclusions.The Mayan indigenous population in Guatemala, while broadly socially vulnerable, does not appear to be at elevated risk for HIV based on this analysis of selected risk factors. Nonetheless, low rates of HIV knowledge and testing may be cause for concern. Programmes working in indigenous communities should focus on HIV education and reducing barriers to testing. Further research into the factors that underlie ethnic self-identity and perceived ethnicity could help clarify the relative significance of these measures for HIV risk and other health outcomes. [ABSTRACT FROM PUBLISHER]

Objective. Few empirical studies have specifically examined the relationship between socio-economic status (SES) and health in Indigenous populations of Australia. We sought to provide insights into the nature of this relationship by examining socio-economic disparities in physical health outcomes among Aboriginal and Torres Strait Islander children in Western Australia. Design. We used a diverse set of health and SES indicators from a representative survey conducted in 2000–2002 on the health and development of 5289 Indigenous children aged 0–17 years in Western Australia. Analysis was conducted using multivariate logistic regression within a multilevel framework. Results. After controlling for age and sex, we found statistically significant socio-economic disparities in health in almost half of the associations that were investigated, although the direction, shape and magnitude of associations differed. For ear infections, recurring chest infections and sensory function problems, the patterns were generally consistent with a positive socio-economic gradient – where better health was associated with higher SES. The reverse pattern was found for asthma, accidents and injuries, and oral health problems, although this was primarily observed for area-level SES indicators. Conclusion. Conventional notions of social position and class have some influence on the physical health of Indigenous children, although the diversity of results implies that there are other ways of conceptualising and measuring SES that are important for Indigenous populations. We need to consider factors that relate specifically to Indigenous circumstances and culture in the past and present day, and give more thought to how we measure social position in the Indigenous community, to gain a better understanding of the pathways from SES to Indigenous child health. [ABSTRACT FROM PUBLISHER]

Introduction. Although opportunities exist for positive experiences in research, Maori in New Zealand, like other indigenous people colonised by Europeans in the nineteenth century, have also been subject to research and associated policies that have had long-lasting negative consequences. Researchers have subsequently been challenged by Maori to conduct research that is acceptable, accountable and relevant. Much of this debate has taken place within the framework of the Treaty of Waitangi, a treaty of cession signed between Maori and British Crown representatives in 1840. Nowadays, health and health research statutes exist that require researchers to respond to the 'principles' of the Treaty. Few practical examples of how health researchers have undertaken this have been published. Aims. We examine how, in developing a national study of injury outcomes, we responded to the Treaty. Our study, the Prospective Outcomes of Injury Study, aims to quantitatively identify predictors of disability following injury and to qualitatively explore experiences and perceptions of injury outcomes. Discussion. Responses to the Treaty included: consultation with Maori groups, translation of the questionnaire into te reo Maori, appointment of interviewers fluent in te reo Maori, sufficient numbers of Maori participants to allow Maori-specific analyses and the inclusion of a Maori-specific qualitative component. While this article is located within the New Zealand context, we believe it will resonate with, and be of relevance to, health researchers in other former settler societies. We do not contend this project represents an 'ideal' model for undertaking population-based research. Instead, we hope that by describing our efforts at responding to the Treaty, we can prompt wider debate of the complex realities of the research environment, one which is scientifically, ethically and culturally located. [ABSTRACT FROM AUTHOR]

Background. Diabetes is associated with lower socioeconomic status (SES) in developed countries, but the reverse is true in developing countries. Little is known about the relationship between SES and diabetes among Indigenous populations in developed countries. Design. We examined the relationship between measures of SES and the prevalence of diabetes in the DRUID Study, a cross-sectional study of urban Indigenous Australian volunteers in the Darwin region. Results. Among 777 participants aged 15-64 years included in the analysis, 17.1% had diabetes, ranging from 2.0% among those aged 15-24 years to 50.8% of those aged 55-64 years. After adjusting for age and sex, diabetes was significantly more common among those of lower SES, whether measured by housing tenure, household income, or employment status. For example, compared with those living in a household that was owned/being purchased by its occupants, the relative odds of diabetes was 2.66 (95% confidence interval 1.71-4.15) for those living in rented/other accommodation. The inverse relationship between SES and diabetes was present even among those who had not previously been diagnosed with diabetes. The relationship between disadvantage and diabetes was not mediated to any great degree by obesity. Conclusions. The relationship between SES and diabetes among Indigenous Australians in this study is consistent with the patterns observed in developed countries, rather than those in some developing countries. [ABSTRACT FROM AUTHOR]

Objectives. To explore the prevalence and severity of Indigenous and non-Indigenous child dental disease in relation to age, sex, residential location and socio-economic status in three Australian states and territories.Design. Children aged 4–14 years who were enrolled in a school dental or screening service in New South Wales, South Australia and the Northern Territory, Australia, were randomly selected to take part in this cross-sectional study. Bivariate and multivariate analyses were used to assess outcomes.Results. A total of 328,042 children were included, of which 10,517 (3.2%) were Indigenous. Some 67.1% of Indigenous children lived in rural areas and 47.3% lived in areas of high disadvantage. About 37.5% of 4- to 10-year-old Indigenous children had no experience of dental disease in the primary dentition while 70.7% of 6- to 14-year-old Indigenous children had caries-free permanent dentitions. The mean number of decayed, missing and filled primary teeth (dmft) of Indigenous 4- to 10-year-old children was 2.9 (SD; 3.4) while the mean DMFT of Indigenous 6- to 14-year-old children was 0.8 (SD; 1.6). Across all age-groups, Indigenous children living in the most deprived areas had higher dmft and DMFT levels than their more socially advantaged counterparts, while rural-dwelling Indigenous children had higher levels of dental disease experience than metropolitan-dwelling Indigenous children. After adjusting for potential confounding, Indigenous children aged 4–10 years were over twice as likely to have caries in the deciduous dentition than similarly aged non-Indigenous children (OR: 2.25, CI: 2.14–2.36), and 6- to 14-year-old Indigenous children were over one and a half times more likely to have decay in the permanent dentition (OR: 1.68, CI: 1.60–1.77) than their non-Indigenous counterparts.Conclusion. Indigenous children experienced higher caries prevalence and severity than non-Indigenous children, irrespective of other socio-demographic factors. Factors concerning Indigenous social capital may have influenced our findings. [ABSTRACT FROM AUTHOR]

Objectives: To examine ethnic and gender differences in the prevalence of cigarette smoking among indigenous Sami, ethnocultural Kven and majority Norwegian adolescents, and ethnic-specific gender differences in smoking. Design: 'The North Norwegian Youth Study' was a longitudinal epidemiological study. It collected data at two time points at a three-year interval (1994/95 and 1997/98). It was based on student self-reports (10-12th grade) from 21 state schools in North Norway. The initial analysis included 2997 students aged 15-19 years (response rate (RR): 85%) and 1533 responders at follow-up (RR: 55%). The sample consisted of 12% Kvens, 23% Sami and 65% Norwegians. Results: Baseline (follow-up) smoking rates were; 38% (35%) never smokers, 29% (29%) current regular smokers, 11% (12%) current irregular smokers and 23% (24%) former smokers. Ethnic differences in cigarette smoking were minor and found at baseline only. Sami students reported a lower proportion of current irregular smokers (8%) and a higher rate of former smokers (26%). Gender differences were most pronounced at baseline with females more involved in cigarette smoking than their male peers. However, males were more likely to be heavy smokers at both time points. Conclusions: Cigarette smoking among adolescents and young people in North Norway was generally independent of the ethnicity of the respondents. There were no ethnic differences in smoking rates at follow-up. Sami youth were not at higher risk of cigarette smoking than their non-indigenous peers. This finding contrasts with findings among other Arctic indigenous youth. [ABSTRACT FROM AUTHOR]