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


METHODS
Collaborators with expertise in Indigenous health data systems were identified for each country. Data were obtained for population, life expectancy at birth, infant mortality, low and high birthweight, maternal mortality, nutritional status, educational attainment, and economic status. Data sources consisted of governmental data, data from non-governmental organisations such as UNICEF, and other research. Absolute and relative differences were calculated.


RESULTS
Our data (23 countries, 28 populations) provide evidence of poorer health and social outcomes for Indigenous peoples than for non-Indigenous populations. However, this is not uniformly the case, and the size of the rate difference varies. We document poorer outcomes for Indigenous populations for: life expectancy at birth for 16 of 18 populations with a difference greater than 1 year in 15 populations; infant mortality rate for 18 of 19 populations with a rate difference greater than one per 1000 livebirths in 16 populations; maternal mortality in ten populations; low birthweight with the rate difference greater than 2% in three populations; high birthweight with the rate difference greater than 2% in one population; child malnutrition for ten of 16 populations with a difference greater than 10% in five populations; child obesity for eight of 12 populations with a difference greater than 5% in four populations; adult obesity for seven of 13 populations with a difference greater than 10% in four populations; educational attainment for 26 of 27 populations with a difference greater than 1% in 24 populations; and economic status for 15 of 18 populations with a difference greater than 1% in 14 populations.


CONCLUSIONS
We systematically collated data across a broader sample of countries and indicators than done in previous studies. Taking into account the UN Sustainable Development Goals, we recommend that national governments develop targeted policy responses to Indigenous health, improving access to health services, and Indigenous data within national surveillance systems.


BACKGROUND
The Lowitja Institute.
The University of Melbourne, Melbourne, Australia. Electronic address: i.anderson@unimelb.edu.au.
Ian
I
Anderson
Te Rōpū Rangahau Hauora a Eru Pōmare, University of Otago, Dunedin, New Zealand.
Bridget
B
Robson
International Group on Indigenous Health Measurement, USA.
Michele
M
Connolly
Indigenous and Children's Group, Australian Institute of Health and Welfare, Canberra, Australia.
Fadwa
F
Al-Yaman
University of Oslo, Institute of Health and Society, Department of Community Medicine, Oslo, Norway.
Espen
E
Bjertness
Simon Fraser University, Burnaby, BC, Canada.
Alexandra
A
King
The Lowitja Institute, Melbourne, Australia.
Michael
M
Tynan
The University of Sydney, Sydney, Australia.
Richard
R
Madden
Society for Education, Action and Research in Community Health, Gadchiroli, Maharashtra, India.
Abhay
A
Bang
Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Carlos E A
CE
Coimbra
Salud Sin Límites Perú, Lima, Peru; Center for Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
Maria Amalia
MA
Pesantes
Universidad de Chile, Santiago, Chile.
Hugo
H
Amigo
Scientific Research Centre of the Arctic, Salekhard, Russia.
Sergei
S
Andronov
The Gorgas Memorial Institute for Health Studies, Universidad Interamericana de Panamá, Panama City, Panama.
Blas
B
Armien
Departamento Administrativo Nacional de Estadística, Bogotá, Colombia.
Daniel Ayala
DA
Obando
Centre for Sami Research, Umeå University, Umeå, Sweden.
Per
P
Axelsson
Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan.
Zaid Shakoor
ZS
Bhatti
Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan; SickKids Center for Global Child Health, Toronto, Canada.
Zulfiqar Ahmed
ZA
Bhutta
National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
Peter
P
Bjerregaard
University of Oslo, Institute of Health and Society, Department of Community Medicine, Oslo, Norway.
Marius B
MB
Bjertness
LACSO, Social Science Laboratory, Central University of Venezuela, Caracas, Venezuela.
Roberto
R
Briceno-Leon
Centre for Sami Health Research, Faculty of Health, UiT The Arctic University of Norway, Tromsø, Norway.
Ann Ragnhild
AR
Broderstad
Universidad de Chile, Santiago, Chile.
Patricia
P
Bustos
Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Virasakdi
V
Chongsuvivatwong
Institute of Medical Biology, Chinese Academy of Medical Sciences, Kunming, China.
Jiayou
J
Chu
Department of Preventive Medicine, Tibet University Medical College, Lhasa, Tibet, China.
Deji
International Institute for Population Sciences, Deemed University, Mumbai, India.
Jitendra
J
Gouda
National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India.
Rachakulla
R
Harikumar
Ministry of Health, Nay Pyi Taw, Myanmar.
Thein Thein
TT
Htay
University of Oslo, Institute of Health and Society, Department of Community Medicine, Oslo, Norway; Ministry of Health, Nay Pyi Taw, Myanmar.
Aung Soe
AS
Htet
Population Dynamics and Reproductive Health Program, African Population and Health Research Center, Nairobi, Kenya.
Chimaraoke
C
Izugbara
Department of Native Hawaiian Health, John A Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
Martina
M
Kamaka
CIHR-Institute of Aboriginal Peoples' Health, Simon Fraser University, Burnaby, BC, Canada.
Malcolm
M
King
National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India.
Mallikharjuna Rao
MR
Kodavanti
Universidad de Chile, Santiago, Chile.
Macarena
M
Lara
National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India.
Avula
A
Laxmaiah
Salud Sin Límites Perú, Lima, Peru.
Claudia
C
Lema
Ministerio de Salud y Protección Social, Bogotá, Colombia.
Ana María León
AM
Taborda
Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Tippawan
T
Liabsuetrakul
Scientific Research Centre of the Arctic, Salekhard, Russia.
Andrey
A
Lobanov
Centre for Sami Health Research, Faculty of Health, UiT The Arctic University of Norway, Tromsø, Norway.
Marita
M
Melhus
National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India.
Indrapal
I
Meshram
Center for Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
J Jaime
JJ
Miranda
Ministry of Health, Nay Pyi Taw, Myanmar.
Thet Thet
TT
Mu
National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India.
Balkrishna
B
Nagalla
National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India.
Arlappa
A
Nimmathota
Scientific Research Centre of the Arctic, Salekhard, Russia.
Andrey Ivanovich
AI
Popov
Ministerio de Salud y Protección Social, Bogotá, Colombia.
Ana María Peñuela
AM
Poveda
International Institute for Population Sciences, Deemed University, Mumbai, India.
Faujdar
F
Ram
The University of Melbourne, Melbourne, Australia.
Hannah
H
Reich
Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Ricardo V
RV
Santos
Ministry of Health, Nay Pyi Taw, Myanmar.
Aye Aye
AA
Sein
International Institute for Population Sciences, Deemed University, Mumbai, India.
Chander
C
Shekhar
University of Oslo, Institute of Health and Society, Department of Community Medicine, Oslo, Norway.
Lhamo Y
LY
Sherpa
Arctic Research Centre, Umeå University, Umeå, Sweden.
Peter
P
Skold
School of Business and Economy, Umeå University, Umeå, Sweden.
Sofia
S
Tano
Cameroon Centre for Evidence-Based Health Care, Yaounde, Cameroon.
Asahngwa
A
Tanywe
Department of Sociology/Anthropology, University of Nigeria, Nsukka, Nigeria.
Chidi
C
Ugwu
Department of Psychology, Federal University, Ndufu-Alike, Nigeria.
Fabian
F
Ugwu
Institute for Population and Social Research, Mahidol University Salaya, Phuttamonton, Nakhon Pathom, Thailand.
Patama
P
Vapattanawong
Institute of Basic Medical Sciences at Chinese Academy of Medical Sciences & School of Basic Medicine at Peking Union Medical College, Beijing, China.
Xia
X
Wan
Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
James R
JR
Welch
Institute of Basic Medical Sciences at Chinese Academy of Medical Sciences & School of Basic Medicine at Peking Union Medical College, Beijing, China.
Gonghuan
G
Yang
Institute of Medical Biology, Chinese Academy of Medical Sciences, Kunming, China.
Zhaoqing
Z
Yang
Native Hawaiian Center of Excellence, John A Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
Leslie
L
Yap
D000328:Adult; D002648:Child; D015362:Child Nutrition Disorders / Q000208:ethnology*; D004522:Educational Status; D005320:Fetal Macrosomia / Q000208:ethnology*; D014943:Global Health; D054624:Health Status Disparities; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000208:ethnology*; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008017:Life Expectancy / Q000208:ethnology*; D008428:Maternal Mortality / Q000208:ethnology*; D009765:Obesity / Q000208:ethnology; D063766:Pediatric Obesity / Q000208:ethnology*; D044382:Population Groups / Q000208:ethnology* / Q000706:statistics & numerical data; D011203:Poverty / Q000208:ethnology*; D012959:Socioeconomic Factors