Indigenous people across the globe are custodians of a wide range of biologically diverse areas and hold the responsibility of contributing towards the cultural and linguistic diversity of the world. These group of people are often subjected to marginalisation, discrimination and conflict in socio-economic context. Their way of life has been put under threat against urbanisation and globalisation, and the social inequalities they suffer have been reflected repeatedly in the health issues arising within he population (Gibson et al. 2015). The present report aims to critically analyse the social as well as economic influences on health outcomes of the indigenous populations. The health issue selected for the paper is diabetes which is being examined within the context of two indigenous population, the Maoris of New Zealand, a developed country, and the Adivasis of India, a developing country. The paper compares and contrasts how the social determinants of health influence this problem in both populations. How the social determinants been addressed in an intervention aimed at combatting the problem is also discussed.
Though the ethnic composition of the population of New Zealand is predominantly of European descent, the indigenous population of the country comprises of the Maori population and other indigenous groups. The prevalence of diabetes among the Maori population is high, with distinct differences in statistics between the two. With the increase in ageing population and rapid demographic changes, the incidence of type 2 diabetes is also on the rise. The Maori population are known to suffer from high rate of diabetic nephropathy and in comparison to the non-indigenous population they have increased chances of developing renal failure due to diabetes. Self-reported prevalence of diabetes among this population, as reported in the year 2013/14, is almost twice that of the non-Maori population. Research shows that a much higher level of disparities between the M?ori and non-M?ori is prevalent for diabetes complications (Atlantis et al. 2017). In India, the high prevalence of diabetes among the common population has grabbed the attention of public health departments to immediately take necessary actions. This is specially true for the indigenous population of the country, referring to the ‘adivasi’ community. Studies identify that indigenous population of the country develop diabetes at least ten years earlier than the non-indigenous population. The medical complications arising within this population as a result of diabetes is nephropathy, chronic glomerulonephritis and chronic interstitial nephritis (Harris et al. 2016).
The predisposition for indigenous population to develop diabetes is indicated to have a relation with young age at the onset of diabetes and socio-economic as well as cultural factors leading to insufficient access to medical care (Zimmet et al. 2014). Income is considered to be the most vital determinant of health as there is a correlation between low income and poor health outcomes. In India, the indigenous people have a high risk of suffering from diabetes without proper care regimen due to low income. This can be understood well in light of the fact that India is a developing country and there is economic instability across the different areas. However, the impact of this determinant of health is similar in New Zealand, which is a developed country. The Maoris experience a financial crisis that has a direct impact on their health. Poverty in New Zealand has become a topic of public discussion over the last few years. Patients suffering from diabetes as a result of poverty are not in a condition to treat this issue with required eating habits. Likewise, in India, the scenario is somewhat similar to most of the indigenous population living in poverty, unable to afford the nutrients required to combat diabetes. Education level is critical in determining the economic and social position and therefore health status. The Maori population is known to attain a high level of educational participation through a high level of literacy. In contrast, indigenous people in India have low education levels. As a result of low education levels, the patients suffering diabetes are not in the position to understand the adverse implications of diabetes. The knowledge base they have regarding diabetes is less, and it is difficult to make them understand the importance of adhering to a strict management plan (Holt et al. 2016).
Cultural and ethnicity play a pivotal role in the health outcomes of the indigenous population. The concept of culture in the broad sense is the norms and accepted patterns of behaviour in a group within the society. As indicated, the tendency to adhere to traditional beliefs and customs regarding health is the man cause of poor adherence to treatment procedures. In India, the indigenous people prefer referring their traditional and cultural remedies for diabetes that are not appropriate under many circumstances (Kaveeshwar and Cornwall 2014. Likewise, within the Maoris, culture is central to their well-being and how they perceive diabetes. Cultural inequalities are the underlying socioeconomic determinants of health (Farmer 2015).
Maori leadership has been identified to be a key tool for developing health promotion within the Maori community. The intervention that has proved to be effective in addressing the social determinants of health among the Maori population is health care delivery through Maori health care providers. This approach has been important to bring changes in the health behaviours of the vulnerable population through creating a social connect. Use of Maori models of health promotion is a key philosophy underpinning the primary health outcomes of the patients. Maori specific services have been crucial to developing a bond between the care providers and thereby bringing changes in the way this population perceive their healthcare. These care providers work mainly with the families who suffer from the adverse impacts of low socio-economic factors and drive the changes that can be brought within this context. The providers address the issues such as low health literacy and educational levels so that there is an increased knowledge about the risk factors for diabetes and the management practices. However, it is too soon for assessing the impact of major provider health organisations on addressing the social determinants of health (Cram 2014).
In India, cultural safety education has been implemented in parallel with other interventions to improve access to the indigenous population to mainstream services of healthcare in order to combat the socioeconomic determinant. Cultural safety acts as a framework for education imparted regarding diabetes prevention and management. The initiatives of cultural safety include the teaching of the advantages and disadvantages of traditional care practices in relation to health. In addition, it strives to identify the social and cultural attitudes impacting the perception of individuals. The community is given a chance to reflect on their view and expression regarding diabetes and share their cultural experiences governing them. Self-awareness is constantly being promoted, and healthcare professionals are advocating cultural non-immersion approach. Along with confronting and understanding the issue of cultural health practices, a critical component of the education is to achieve an overall improvement in the socio-economic determinants of health in an indirect manner (Farmer et al. 2016).
Coming to the end of this report it can be concluded that prevalence of diabetes among the indigenous population of both developing and developed countries are continually compelling public health departments to implement strategies to address this health issue. Though much progress has been made as these strategies address the social and economic determinants of heath, there is scope for improvement in this area. This can only be achieved through research and involvement of the population in health decision making.
Atlantis, E., Joshy, G., Williams, M. and Simmons, D., 2017. Diabetes Among M?ori and Other Ethnic Groups in New Zealand. In Diabetes Mellitus in Developing Countries and Underserved Communities (pp. 165-190). Springer International Publishing.
Cram, F., 2014. Improving M?ori access to cancer, diabetes and cardiovascular health care: Key informant interviews. Auckland: Katoa Ltd.
Farmer, A., 2015. A Community Based Participatory Research Approach to Create a Diabetes Prevention Documentary for M?ori.
Farmer, A., Gage, J., Kirk, R. and Edgar, T., 2016. Applying Community-Based Participatory Research to Create a Diabetes Prevention Documentary with New Zealand M?ori. Progress in Community Health Partnerships: Research, Education, and Action, 10(3), pp.383-390.
Gibson, O., Lisy, K., Davy, C., Aromataris, E., Kite, E., Lockwood, C., Riitano, D., McBride, K. and Brown, A., 2015. Enablers and barriers to the implementation of primary health care interventions for Indigenous people with chronic diseases: a systematic review. Implementation Science, 10(1), p.71.
Harris, S.B., Tompkins, J.W. and TeHiwi, B., 2016. Call to Action: A New Path for Improving Diabetes Care for Indigenous Peoples, a Global Review. Diabetes Research and Clinical Practice.
Holt, R.I., Cockram, C., Flyvbjerg, A. and Goldstein, B.J. eds., 2016. Textbook of diabetes. John Wiley & Sons.
Kaveeshwar, S.A. and Cornwall, J., 2014. The current state of diabetes mellitus in India. The Australasian medical journal, 7(1), p.45.
Zimmet, P.Z., Magliano, D.J., Herman, W.H. and Shaw, J.E., 2014. Diabetes: a 21st century challenge. The lancet Diabetes & endocrinology, 2(1), pp.56-64.
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