In considering indigenous, or aboriginal, populations the terms "indigenous" and "aboriginal" must be framed within a larger context of human adaptation, migration, and colonization. Despite controversy over human origins, many paleoanthropologists uphold the "Out of Africa hypothesis," which states that contemporary humans are descendants from a single line of Homo sapiens that developed in Southeast Africa between 50,000 and 100,000 years ago. From Africa human populations migrated to many areas of the world, sometimes settling among other hominid groups that had arrived earlier. This migration occurred approximately 40,000 years ago for Northwest Africa; 30,000 years ago for western Europe and Australia; and 20,000 years ago for North America (Foley, 1991). Human populations since these first migrations have been highly mobile and exogamous, thus confounding any simple notion of "original" or "native" inhabitants.
Accepted usage of "indigenous" and "aboriginal" refers to an individual or a people whose ancestors inhabited a region before the arrival of colonists in a period starting close to 1400 C.E., corresponding to the beginnings of European imperialism and colonialism. This definition includes peoples of North America, such as American Indians and Alaska Natives, Canadian Indians (First Nations) and Inuit, and Mexican Indians. It also includes but is not limited to Native Hawaiians, South Pacific Islanders, New Zealand Maoris, Australian Aborigines, peoples of Latin America, and tribal peoples of India. These are broad descriptors, used to simplify communication. It is conceded that the appropriateness of any given term falls to the groups being discussed, and therein lie many group and individual differences.
HEALTH STATUS DISPARITIES
Controversy about origins and nomenclature does not extend to dispute over the health status of indigenous people, now numbering some 300 million worldwide. Indigenous populations, relative to nonindigenous populations as well as other disadvantaged minority groups, have more of just about every category of disease. Disparities in health are widening in many regions. Relative to national population averages, indigenous people die ten to thirty years earlier, have infant mortality rates two to three times greater, and experience significantly greater morbidity and mortality from infectious and noncommunicable diseases. Patterns of health and sickness have shifted in indigenous populations in industrialized countries from acute, infectious disease to that of a chronic and degenerative nature (Young, 1994). A high prevalence of risk factors for disease and a greater rate of development of disease and conditions with a substantial behavioral component (e.g., diabetes, hypertension, and some cancers) need to be framed in the context of social risk conditions that affect the expression of individual-level risk factors.
The health issues confronting indigenous populations did not rise out of an historical vacuum (Campbell, 1989). Under the hegemony of European colonization, indigenous populations underwent rapid environmental changes through which their cultures were diluted by and made dependent on "western" ways of living and external resources incompatible with traditional patterns. Political, economic, and social subjugation, along with warfare and genocide, led to voluntary and
IMPROVING INDIGENOUS HEALTH
Poverty, limited education, cultural barriers, discrimination, jurisdictional problems, and power imbalances with historic precedents are the basis of the health and social problems facing indigenous people at the start of the twenty-first century. Means for improving indigenous health require the development of personal skills and individual and collective capacities and the strengthening of community action at local and national levels. This means supporting the aspirations of indigenous people for self-determination together with attempts to change behavior at the individual level and by organizational and environmental support for behavioral interventions. Culture is of great importance to such initiatives. Indigenous logics often recognize a reciprocal relationship between the health of individuals and communities. Individual health is perceived as a state in which the entire being—spirit, mind, and body—is in balance, with sickness seen as an outcome of disharmony, lack of holism, or imbalance. Cultural values, beliefs, and attitudes can be drawn upon and used by public health initiatives as powerful influences on health and reciprocal determinants of change in behavior and environment.
G. FLETCHER LINDER
Campbell, G. R. (1989). "The Changing Dimension of Native American Health Care: A Critical Understanding of Contemporary Native American Health Issues." American Indian Culture and Research Journal 13(3, 4):1–20.
Foley, R. (1991). Another Unique Species: Patterns in Human Evolutionary Ecology. Essex: Longman Scientific and Technical.
Young, T. K. (1994). The Health of Native Americans: Towards a Biocultural Epidemiology. Toronto: Oxford University Press.