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Opinion Piece
Nursing Partnerships in Indigenous Health
Tzu-I Tsai
National Yang Ming University, Faculty of Nursing, Taipei, Taiwan
Keywords
Maori, CVA, Indigenous health, caring, Whanau
Article Text
Numerous international studies have identified striking health disparities and inequalities among Indigenous communities (Reading 2003; Sanderson 2000). There is no exception for Taiwan's Indigenous people. Comprising only two per cent of the total population in Taiwan, Indigenous people profoundly represent an ethnic minority who were ignored for decades. Due to the social transition and multicultural awareness in recent years, Indigenous health-related issues have become one of the most important national healthcare priorities.
Earlier studies identified that economic and geographic disadvantage, as well as personal lifestyle, were crucial risk factors contributing to the health disparities and inequities among Taiwan Indigenous people (Hong, Lin, Peno & Lyu 2002). Accordingly, various health policies and strategies have been implemented by the Taiwan government to increase health service accessibility for Indigenous people. However, there has been limited success in reducing the health disparities in Indigenous populations as a result of these newly implemented policies and strategies. Instead, the evidence shows the health gap between Taiwan Indigenous and non-Indigenous populations is even widening. For example: Life expectancy is six to 14 years less for Aboriginal males and four to seven years less for Aboriginal females than that of the general populations of Taiwan in both urban and rural remote regions.
The infant mortality rate is two times greater, with a noticeably increasing gap between Indigenous and general populations from 2001 to 2003. The leading causes of death also shed light on the different health problems and needs of Taiwan Indigenous populations. By 2004, accidents continued to count as the first leading cause of death for Indigenous peoples but were the fifth leading cause of death for the general population. Chronic liver disease and cirrhosis are the fourth leading cause of death, reflecting problem drinking and the prevalence of hepatitis among Taiwan Indigenous people. In addition, mental health problems, in terms of depression and suicide, teenage pregnancy, domestic violence, as well as TB, and gout consistently demonstrate higher rates in Indigenous communities (Council of Indigenous Peoples 2004).
Deficits in health care delivery and limited improvement in the health of Indigenous people are continuously reported throughout the world (Reading 2003; Sanderson 2000). Too often Indigenous people are passive subjects rather than active participants, their voices are disdained, and their lifestyles and health behaviors are blamed by a majority of researchers and policy makers who are the cultural outsiders. Accumulated international research on Indigenous communities suggests that culturally tailored and community-based participatory approaches are essential elements to develop Indigenous health programs. For example, Palafox and colleagues (2002) proposed an Indigenous-people-centered model of research which requires an understanding and application of Indigenous peoples' paradigms of health knowledge, science and research. Kirmayer and colleagues (2000) suggest that cultural identity is an important component in promoting the mental health and well-being of Indigenous populations. Evidence demonstrates that cultural discontinuity and oppression are strongly related to mental health problems in terms of depression, alcoholism, suicide and violence among many North American native communities. Similarly, in Fejo and Rae's (1996) study, we recognize that a great sense of pride and ownership in empowering cultural communities and individuals is a very powerful foundation for improvement and maintenance of Indigenous health. Yet, until recently, only a small number of healthcare professionals in Taiwan admitted to the dearth of a cultural framework and participatory action in Indigenous healthcare policies and strategies as key barriers to resolving Taiwanese Indigenous health-related issues (Hong et al 2002).
All over the world, the need to close the health gap between Indigenous and non-Indigenous groups is urgent. Traditional biomedical models alone appear insufficient to explain and eliminate the health disparities in Indigenous communities. Ecological and socio-cultural determinants profoundly demonstrate the effects of disparities in healthcare delivery and health outcome. It is time that the nursing profession took a more active role in improving the health status of Indigenous populations. In particular, greater attention is needed in the rural and remote regions of countries where low levels of health professionals and facilities exist. These challenges must be undertaken by the nursing profession in order to eliminate the health status inequities and inequalities of the Indigenous people. From the aspect of health service delivery, we need to acknowledge the irreplaceable role of community nurses who continue to provide primary healthcare, health education information and home visits for Indigenous communities, within limited and inadequate public infrastructures. Meanwhile, as Bushy (2002) suggests, we may consider expanding their professional roles and practices to strengthen their autonomy and dignity. Moreover, the community-nursing profession could expand its role by establishing long-term partner relationships with Indigenous communities and assisting those Indigenous communities in terms of reviving cultural identity, mobilizing community resources, and empowering people - and thus building cultural capacity.
As in the education sector, too often health professionals experience difficulties in service delivery due to differences in cultural backgrounds between healthcare professions and Indigenous communities. More effort should be made to educate nursing students and clinical and community nursing professionals to build their knowledge and understanding, and to respect the diversity and uniqueness of cultural minority groups, and to create the capability to integrate cultural respect and sensitivity in their healthcare delivery. Nursing curricula may also provide opportunities for nursing students during their training to involve healthcare services and establish a partnership in Indigenous communities. Finally, in the area of research, health policies on training, recruitment and retention of nursing professionals to work in Indigenous communities is still limited, and needs more exploration and investment. With these premises and insights, we may create a new hope and pathway to enhance the health outcomes for, and sense of wellbeing in, Indigenous populations.
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