23
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Engaging with complexity to improve the health of indigenous people: a call for the use of systems thinking to tackle health inequity

      editorial

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          The 400 million indigenous people worldwide represent a wealth of linguistic and cultural diversity, as well as traditional knowledge and sustainable practices that are invaluable resources for human development. However, indigenous people remain on the margins of society in high, middle and low-income countries, and they bear a disproportionate burden of poverty, disease, and mortality compared to the general population. These inequalities have persisted, and in some countries have even worsened, despite the overall improvements in health indicators in relation to the 15-year push to meet the Millennium Development Goals. As we enter the Sustainable Development Goals (SDGs) era, there is growing consensus that efforts to achieve Universal Health Coverage (UHC) and promote sustainable development should be guided by the moral imperative to improve equity. To achieve this, we need to move beyond the reductionist tendency to frame indigenous health as a problem of poor health indicators to be solved through targeted service delivery tactics and move towards holistic, integrated approaches that address the causes of inequalities both inside and outside the health sector. To meet the challenge of engaging with the conditions underlying inequalities and promoting transformational change, equity-oriented research and practice in the field of indigenous health requires: engaging power, context-adapted strategies to improve service delivery, and mobilizing networks of collective action. The application of systems thinking approaches offers a pathway for the evolution of equity-oriented research and practice in collaborative, politically informed and mutually enhancing efforts to understand and transform the systems that generate and reproduce inequities in indigenous health. These approaches hold the potential to strengthen practice through the development of more nuanced, context-sensitive strategies for redressing power imbalances, reshaping the service delivery environment and fostering the dynamics of collective action for political reform.

          Related collections

          Most cited references30

          • Record: found
          • Abstract: found
          • Article: not found

          Indigenous and tribal peoples' health (The Lancet-Lowitja Institute Global Collaboration): a population study.

          International studies of the health of Indigenous and tribal peoples provide important public health insights. Reliable data are required for the development of policy and health services. Previous studies document poorer outcomes for Indigenous peoples compared with benchmark populations, but have been restricted in their coverage of countries or the range of health indicators. Our objective is to describe the health and social status of Indigenous and tribal peoples relative to benchmark populations from a sample of countries.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Indigenous health part 1: determinants and disease patterns.

            The world's almost 400 million Indigenous people have low standards of health. This poor health is associated with poverty, malnutrition, overcrowding, poor hygiene, environmental contamination, and prevalent infections. Inadequate clinical care and health promotion, and poor disease prevention services aggravate this situation. Some Indigenous groups, as they move from traditional to transitional and modern lifestyles, are rapidly acquiring lifestyle diseases, such as obesity, cardiovascular disease, and type 2 diabetes, and physical, social, and mental disorders linked to misuse of alcohol and of other drugs. Correction of these inequities needs increased awareness, political commitment, and recognition rather than governmental denial and neglect of these serious and complex problems. Indigenous people should be encouraged, trained, and enabled to become increasingly involved in overcoming these challenges.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Rethinking health systems strengthening: key systems thinking tools and strategies for transformational change.

              While reaching consensus on future plans to address current global health challenges is far from easy, there is broad agreement that reductionist approaches that suggest a limited set of targeted interventions to improve health around the world are inadequate. We argue that a comprehensive systems perspective should guide health practice, education, research and policy. We propose key 'systems thinking' tools and strategies that have the potential for transformational change in health systems. Three overarching themes span these tools and strategies: collaboration across disciplines, sectors and organizations; ongoing, iterative learning; and transformational leadership. The proposed tools and strategies in this paper can be applied, in varying degrees, to every organization within health systems, from families and communities to national ministries of health. While our categorization is necessarily incomplete, this initial effort will provide a valuable contribution to the health systems strengthening debate, as the need for a more systemic, rigorous perspective in health has never been greater.
                Bookmark

                Author and article information

                Contributors
                ana.lorena.ruano@cih.uib.no
                Journal
                Int J Equity Health
                Int J Equity Health
                International Journal for Equity in Health
                BioMed Central (London )
                1475-9276
                21 February 2017
                21 February 2017
                2017
                : 16
                : 26
                Affiliations
                [1 ]Center for the Study of Equity and Governance in Health Systems (CEGSS), Guatemala, Guatemala
                [2 ]ISNI 0000 0004 1936 7443, GRID grid.7914.b, Center for International Health, , University of Bergen, ; Bergen, Norway
                [3 ]GRID grid.11505.30, , Institute of Tropical Medicine (ITM), ; Antwerp, Belgium
                [4 ]ISNI 0000 0001 1034 3451, GRID grid.12650.30, Department of Public Health and Clinical Medicine, , Umeå University, ; Umeå, Sweden
                Author information
                http://orcid.org/0000-0003-3913-4228
                Article
                521
                10.1186/s12939-017-0521-2
                5319053
                28219429
                3ccd9c60-168b-42a1-ae17-b3408b90bb8f
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 6 January 2017
                : 10 January 2017
                Categories
                Commentary
                Custom metadata
                © The Author(s) 2017

                Health & Social care
                indigenous people,systems thinking,health systems,equity,indigenous health,guatemala,accountability

                Comments

                Comment on this article