COVID-19 adds to a list of risk factors that make indigenous populations a vulnerable group within society. Colonisation and racism continue to impact indigenous people’s health resulting in poorer health and social outcomes. Increased rates of poverty, longstanding discrimination, and inequality commonly result in the exclusion of indigenous people from health programs and policies that affect their lives.
Here, we list some of the reasons why indigenous populations are often left out of outbreak responses or health programming:
Not prioritised in outbreak response: Although it is well established that there are major health inequities affecting indigenous populations, they are often left behind in the response to COVID-19, as they have been from previous outbreak responses. For example, during the Spanish Influenza Pandemic of 1918, the exclusion of indigenous people in outbreak response had detrimental effects. The Māori people of New Zealand and First Nations in Canada were respectively seven and eight times more likely to die compared to non-indigenous people. During the H1N1 influenza outbreak in 2009, indigenous people in the Americas and the Pacific had 3-6 times higher risk of developing severe disease and death. Aboriginals and Torres Strait Islanders in Australia represented 12.9% of hospitalised cases of the H1N1 virus, even though they make up 3% of the Australian population. There are indications that the current lack of consideration for indigenous populations within the COVID-19 response may result in similar outcomes. For example, nearly half the population of Bolivia is considered to be of indigenous origin, but one study reported that no specific considerations or plans had been developed for combating coronavirus in native communal territories.
Lack of disaggregated data: When reporting on demographic data, indigenous people often do not have an option to select their race or ethnicity, rendering them unseen. Racial misclassification triggers the exclusion of populations from health service responses and coverage. As a result, the impact of COVID-19 on vulnerable populations may go unnoticed. In April 2020, 80% of US state health departments released racial demographic data on COVID-19, but less than half of these reported explicitly on the impact of the pandemic on Native Americans.
Response programmes not delivered in indigenous languages and culturally appropriate ways: A major contributor to the racist marginalisation of indigenous groups is the lack of culturally and linguistically appropriate information about the pandemic. Inadequate information on infectious disease prevention and health care access is already a widespread contributor to poor health among indigenous people, and more so during the COVID-19 pandemic. This can be a particular challenge for indigenous populations who have moved from their traditional lands and now reside in urban areas. While coverage of health care services may be higher in urban areas, the lack of culturally and linguistically appropriate information can still be a barrier for indigenous people living in these settings. Ensuring respect for traditional health knowledge and worldviews is vital for successful COVID-19 response in indigenous communities.
Cross border living: Indigenous territories are regularly split by international borders and therefore the health needs of indigenous communities in these areas come under the responsibility of two or more countries. In cases such as these, collaboration across borders is recommended to ensure the needs of the populations are met.
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Editor's note
Author: Astrid Hasund Thorseth
Reviewers: Delmo Roncarati Vilela, Bethany Caruso, Susannah Mayhew, Sian White
Last update: 28.10.20