This article has been reviewed according to Science X's editorial process and policies. Editors have highlighted the following attributes while ensuring the content's credibility: How health is defined, measured and addressed by Indigenous communities doesn't match Western frameworks, leading health systems to fall short in caring for vulnerable communities, a University of Otago—Ōtākou Whakaihu Waka–led study has found. Lead author Laura Gemmell-Sinnott (Ngāti Kahungunu, Ngāti Tūwharetoa, Raukawa, Ngaruāhine, Waikato), a Ph.D. candidate at Kōhatu Centre for Hauora Māori, says how health systems set priorities and the definitions used to do so need to be challenged and reoriented.
"The World Health Organization's definition of health—a state of complete physical, mental and social well-being, not just the absence of illness—is the most internationally influential framework governing how health systems are designed, funded and evaluated. "The definition hasn't changed in 80 years, but the global understanding of the burden of disease has transformed, the evidence base for structural determinants of health has grown substantially, and international human rights frameworks have been reoriented toward self-determination. "It also doesn't reflect how Indigenous people define and view health.
Indigenous peoples have their own knowledge systems, ways of thinking, priorities and needs, and our health systems don't account for them well, which has serious implications for equity," she says. The study, published in SSM—Qualitative Research in Health, explored how Indigenous peoples in Aotearoa, Australia, Canada, the mainland U.S. and Hawai'i define health. Five themes were identified: holistic well-being, cultural knowledge, connection to land, relationships and self-determination.
"These themes demonstrate that Indigenous understandings of health are distinct knowledge systems, with depth and breadth, and need to be recognized as such. "Colonization still shapes the knowledge systems that our health care approaches are built on. We need to move beyond that and build genuine partnerships that work in Indigenous communities' interests, as they are still impacted by that history." She would like to see health frameworks that are community-driven and culturally driven to best support Indigenous self-determination and drive more sustainable, culturally responsive health solutions.
"In practice, this means health systems need to move beyond clinical measures of health and develop culturally driven indicators that reflect what Indigenous people themselves identify as central to their well-being. "This is not about whose knowledge is more valid, but a recognition that not all people understand or experience health and well-being through the same lens." She believes there is an opportunity for health systems to support Indigenous communities in determining health for themselves. "The importance of health equity has long been recognized, yet Indigenous populations continue to experience persistent and preventable health inequities.
Closing this gap requires systems that are genuinely built with, and accountable to, the communities they serve. "I would like to see Indigenous peoples leading the representation, partnership and decision-making about health care for their own communities. How can we make fair and accurate decisions about communities we don't fully understand?
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