Educating for Indigenous Health Equity: An International Consensus Statement

doi:10.1097/ACM.0000000000002476

. 2019 Apr;94(4):512-519.

doi: 10.1097/ACM.0000000000002476.

Educating for Indigenous Health Equity: An International Consensus Statement

Rhys Jones¹, Lynden Crowshoe, Papaarangi Reid, Betty Calam, Elana Curtis, Michael Green, Tania Huria, Kristen Jacklin, Martina Kamaka, Cameron Lacey, Jill Milroy, David Paul, Suzanne Pitama, Leah Walker, Gillian Webb, Shaun Ewen

Affiliations

Affiliation

¹ R. Jones is senior lecturer, Te Kupenga Hauora Maori, University of Auckland, Auckland, New Zealand. L. Crowshoe is associate professor, Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada. P. Reid is professor and Tumuaki, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. B. Calam is associate professor, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada. E. Curtis is associate professor, Te Kupenga Hauora Maori, University of Auckland, Auckland, New Zealand. M. Green is professor and head, Department of Family Medicine, Queen's University, Kingston, Ontario, Canada. T. Huria is senior lecturer, Maori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand. 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. 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. C. Lacey is senior lecturer, Maori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand. J. Milroy is professor, School of Indigenous Studies, University of Western Australia, Perth, Western Australia, Australia. D. Paul is professor, School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia. S. Pitama is associate professor, Maori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand. L. Walker is associate director, Centre for Excellence in Indigenous Health, University of British Columbia, Vancouver, British Columbia, Canada. G. Webb is associate professor, Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia. S. Ewen is professor and director, Melbourne Poche Centre for Indigenous Health, and pro vice chancellor (Indigenous), University of Melbourne, Melbourne, Victoria, Australia.

PMID: 30277958
PMCID: PMC6445615
DOI: 10.1097/ACM.0000000000002476

Educating for Indigenous Health Equity: An International Consensus Statement

Rhys Jones et al. Acad Med. 2019 Apr.

. 2019 Apr;94(4):512-519.

doi: 10.1097/ACM.0000000000002476.

Authors

Affiliation

¹ R. Jones is senior lecturer, Te Kupenga Hauora Maori, University of Auckland, Auckland, New Zealand. L. Crowshoe is associate professor, Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada. P. Reid is professor and Tumuaki, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. B. Calam is associate professor, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada. E. Curtis is associate professor, Te Kupenga Hauora Maori, University of Auckland, Auckland, New Zealand. M. Green is professor and head, Department of Family Medicine, Queen's University, Kingston, Ontario, Canada. T. Huria is senior lecturer, Maori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand. 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. 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. C. Lacey is senior lecturer, Maori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand. J. Milroy is professor, School of Indigenous Studies, University of Western Australia, Perth, Western Australia, Australia. D. Paul is professor, School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia. S. Pitama is associate professor, Maori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand. L. Walker is associate director, Centre for Excellence in Indigenous Health, University of British Columbia, Vancouver, British Columbia, Canada. G. Webb is associate professor, Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia. S. Ewen is professor and director, Melbourne Poche Centre for Indigenous Health, and pro vice chancellor (Indigenous), University of Melbourne, Melbourne, Victoria, Australia.

PMID: 30277958
PMCID: PMC6445615
DOI: 10.1097/ACM.0000000000002476

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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References

1. Anderson I, Crengle S, Kamaka ML, Chen TH, Palafox N, Jackson-Pulver L. Indigenous health in Australia, New Zealand, and the Pacific. Lancet. 2006;367:1775–1785. - PubMed
1. Gracey M, King M. Indigenous health part 1: Determinants and disease patterns. Lancet. 2009;374:65–75. - PubMed
1. King M, Smith A, Gracey M. Indigenous health part 2: The underlying causes of the health gap. Lancet. 2009;374:76–85. - PubMed
1. Anderson I, Robson B, Connolly M, et al. Indigenous and tribal peoples’ health (the Lancet-Lowitja Institute Global Collaboration): A population study. Lancet. 2016;388:131–157. - PubMed
1. Whitehead M. The concepts and principles of equity and health. Health Promot Int. 1991;6:217–228. - PubMed

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[1] Anderson I, Crengle S, Kamaka ML, Chen TH, Palafox N, Jackson-Pulver L. Indigenous health in Australia, New Zealand, and the Pacific. Lancet. 2006;367:1775–1785. - PubMed

[2] Anderson I, Crengle S, Kamaka ML, Chen TH, Palafox N, Jackson-Pulver L. Indigenous health in Australia, New Zealand, and the Pacific. Lancet. 2006;367:1775–1785. - PubMed

[3] Gracey M, King M. Indigenous health part 1: Determinants and disease patterns. Lancet. 2009;374:65–75. - PubMed

[4] Gracey M, King M. Indigenous health part 1: Determinants and disease patterns. Lancet. 2009;374:65–75. - PubMed

[5] King M, Smith A, Gracey M. Indigenous health part 2: The underlying causes of the health gap. Lancet. 2009;374:76–85. - PubMed

[6] King M, Smith A, Gracey M. Indigenous health part 2: The underlying causes of the health gap. Lancet. 2009;374:76–85. - PubMed

[7] Anderson I, Robson B, Connolly M, et al. Indigenous and tribal peoples’ health (the Lancet-Lowitja Institute Global Collaboration): A population study. Lancet. 2016;388:131–157. - PubMed

[8] Anderson I, Robson B, Connolly M, et al. Indigenous and tribal peoples’ health (the Lancet-Lowitja Institute Global Collaboration): A population study. Lancet. 2016;388:131–157. - PubMed

[9] Whitehead M. The concepts and principles of equity and health. Health Promot Int. 1991;6:217–228. - PubMed

[10] Whitehead M. The concepts and principles of equity and health. Health Promot Int. 1991;6:217–228. - PubMed

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Educating for Indigenous Health Equity: An International Consensus Statement

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Educating for Indigenous Health Equity: An International Consensus Statement

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