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      Educating for Indigenous Health Equity: An International Consensus Statement

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          Abstract

          The determinants of health inequities between Indigenous and non-Indigenous populations include factors amenable to medical education’s influence—for example, the competence of the medical workforce to provide effective and equitable care to Indigenous populations. Medical education institutions have an important role to play in eliminating these inequities. However, there is evidence that medical education is not adequately fulfilling this role and, in fact, may be complicit in perpetuating inequities.

          This article seeks to examine the factors underpinning medical education’s role in Indigenous health inequity, to inform interventions to address these factors. The authors developed a consensus statement that synthesizes evidence from research, evaluation, and the collective experience of an international research collaboration including experts in Indigenous medical education. The statement describes foundational processes that limit Indigenous health development in medical education and articulates key principles that can be applied at multiple levels to advance Indigenous health equity.

          The authors recognize colonization, racism, and privilege as fundamental determinants of Indigenous health that are also deeply embedded in Western medical education. To contribute effectively to Indigenous health development, medical education institutions must engage in decolonization processes and address racism and privilege at curricular and institutional levels. Indigenous health curricula must be formalized and comprehensive, and must be consistently reinforced in all educational environments. Institutions’ responsibilities extend to advocacy for health system and broader societal reform to reduce and eliminate health inequities. These activities must be adequately resourced and underpinned by investment in infrastructure and Indigenous leadership.

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          Most cited references48

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          The concepts and principles of equity and health.

          In 1984, the 32 member states of the World Health Organization European Region took a remarkable step forward in agreeing unanimously on 38 targets for a common health policy for the Region. Not only was equity the subject of the first of these targets, but it was also seen as a fundamental theme running right through the policy as a whole. However, equity can mean different things to different people. This article looks at the concepts and principles of equity as understood in the context of the World Health Organization's Health for All policy. After considering the possible causes of the differences in health observed in populations--some of them inevitable and some unnecessary and unfair--the author discusses equity in relation to health care, concentrating on issues of access to care, utilization, and quality. Lastly, seven principles for action are outlined, stemming from these concepts, to be borne in mind when designing or implementing policies, so that greater equity in health and health care can be promoted.
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            Colonisation, racism and indigenous health

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              Medical professionalism in the new millennium: a physician charter.

              , , (2015)

                Author and article information

                Journal
                Acad Med
                Acad Med
                ACM
                Academic Medicine
                Published for the Association of American Medical Colleges by Lippincott Williams & Wilkins
                1040-2446
                1938-808X
                April 2019
                01 October 2018
                : 94
                : 4
                : 512-519
                Affiliations
                [1 ] R. Jones is senior lecturer, Te Kupenga Hauora Maori, University of Auckland, Auckland, New Zealand.
                [2 ] L. Crowshoe is associate professor, Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada.
                [3 ] P. Reid is professor and Tumuaki, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
                [4 ] B. Calam is associate professor, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.
                [5 ] E. Curtis is associate professor, Te Kupenga Hauora Maori, University of Auckland, Auckland, New Zealand.
                [6 ] M. Green is professor and head, Department of Family Medicine, Queen’s University, Kingston, Ontario, Canada.
                [7 ] T. Huria is senior lecturer, Maori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand.
                [8 ] K. Jacklin is professor, Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minnesota, and professor, Human Sciences Division, Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada.
                [9 ] M. Kamaka is associate professor, Department of Native Hawaiian Health, University of Hawai‘i at Manoa John A. Burns School of Medicine, Honolulu, Hawai‘i.
                [10 ] C. Lacey is senior lecturer, Maori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand.
                [11 ] J. Milroy is professor, School of Indigenous Studies, University of Western Australia, Perth, Western Australia, Australia.
                [12 ] D. Paul is professor, School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia.
                [13 ] S. Pitama is associate professor, Maori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand.
                [14 ] L. Walker is associate director, Centre for Excellence in Indigenous Health, University of British Columbia, Vancouver, British Columbia, Canada.
                [15 ] G. Webb is associate professor, Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia.
                [16 ] S. Ewen is professor and director, Melbourne Poche Centre for Indigenous Health, and pro vice chancellor (Indigenous), University of Melbourne, Melbourne, Victoria, Australia.
                Author notes
                Correspondence should be addressed to Rhys Jones, Te Kupenga Hauora Maori, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; telephone: (+64) 9-923-6278; e-mail: rg.jones@ 123456auckland.ac.nz ; Twitter: @rg_jones.
                Article
                00028
                10.1097/ACM.0000000000002476
                6445615
                30277958
                0f2093b9-45b4-4225-a245-ee0d88eaa5f7
                Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Association of American Medical Colleges.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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