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

被引:38
作者
Hernandez, Alison [1 ]
Ruano, Ana Lorena [1 ,2 ]
Marchal, Bruno [3 ]
San Sebastian, Miguel [4 ]
Flores, Walter [1 ]
机构
[1] Ctr Study Equ & Governance Hlth Syst CEGSS, Guatemala City, Guatemala
[2] Univ Bergen, Ctr Int Hlth, Bergen, Norway
[3] Inst Trop Med ITM, Antwerp, Belgium
[4] Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden
基金
英国医学研究理事会;
关键词
Indigenous people; Systems thinking; Health systems; Equity; Indigenous health; Guatemala; Accountability; COVERAGE; CARE;
D O I
10.1186/s12939-017-0521-2
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
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.
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收藏
页数:5
相关论文
共 30 条
[1]   Indigenous and tribal peoples' health (The Lancet-Lowitja Institute Global Collaboration): a population study [J].
Anderson, Ian ;
Robson, Bridget ;
Connolly, Michele ;
Al-Yaman, Fadwa ;
Bjertness, Espen ;
King, Alexandra ;
Tynan, Michael ;
Madden, Richard ;
Bang, Abhay ;
Coimbra, Carlos E. A., Jr. ;
Pesantes, Maria Amalia ;
Amigo, Hugo ;
Andronov, Sergei ;
Armien, Blas ;
Obando, Daniel Ayala ;
Axelsson, Per ;
Bhatti, Zaid Shakoor ;
Bhutta, Zulfi Qar Ahmed ;
Bjerregaard, Peter ;
Bjertness, Marius B. ;
Briceno-Leon, Roberto ;
Broderstad, Ann Ragnhild ;
Bustos, Patricia ;
Chongsuvivatwong, Virasakdi ;
Chu, Jiayou ;
Deji ;
Gouda, Jitendra ;
Harikumar, Rachakulla ;
Htay, Thein Thein ;
Htet, Aung Soe ;
Izugbara, Chimaraoke ;
Kamaka, Martina ;
King, Malcolm ;
Kodavanti, Mallikharjuna Rao ;
Lara, Macarena ;
Laxmaiah, Avula ;
Lema, Claudia ;
Taborda, Ana Maria Leon ;
Liabsuetrakul, Tippawan ;
Lobanov, Andrey ;
Melhus, Marita ;
Meshram, Indrapal ;
Miranda, J. Jaime ;
Mu, Thet Thet ;
Nagalla, Balkrishna ;
Nimmathota, Arlappa ;
Popov, Andrey Ivanovich ;
Poveda, Ana Maria Penuela ;
Ram, Faujdar ;
Reich, Hannah .
LANCET, 2016, 388 (10040) :131-157
[2]  
[Anonymous], 2009, STAT WORLDS IND PEOP
[3]  
Bosmans M, 2016, STUDIES HLTH SERVICE
[4]  
Castro A, 2015, REV PANAM SALUD PUBL, V38, P96
[5]  
Ceron A, 2016, INT J EQUITY HEALTH, V15, P1
[6]  
CHECKLAND P, 1985, J OPER RES SOC, V36, P757, DOI 10.2307/2582164
[7]  
Coronado Gabriela, 2005, Anthropol Med, V12, P165, DOI 10.1080/13648470500140047
[8]  
Crivelli V., 2013, STATE WORLDS MINORIT, P26
[9]  
Flores Walter, 2009, Health Hum Rights, V11, P37
[10]   Implementation and progress of an inclusive primary health care model in Guatemala: coverage, quality, and utilization [J].
Fort, Meredith P. ;
Grembowski, David E. ;
Verdugo, Juan C. ;
Morales, Lidia C. ;
Arriaga, Carmen A. ;
Mercer, Mary A. ;
Lim, Stephen S. .
REVISTA PANAMERICANA DE SALUD PUBLICA-PAN AMERICAN JOURNAL OF PUBLIC HEALTH, 2011, 30 (03) :217-224