Tamara Power|Denise Wilson|Odette Best|Teresa Brockie|Lisa Bourque Bearskin|Eugenia Millender|John Lowe
COVID?19 and Indigenous Peoples: An imperative for action
University of Technology Sydney|Auckland University of Technology|University of Southern Queensland|Johns Hopkins University|Thompson Rivers University|Florida State University|Florida State University
acknowledge traditional custodians country across world continuing relationship culture community land waters sky honour children born yet pay respects elders past present future every person earth affected way coronavirus disease covid19 pandemic however marked inequity impact threat disease 370 million indigenous peoples worldwide honouring diversity peoples cultures editorial written collaborative indigenous nurses australia aotearoa new zealand canada united states america central america explores contemporary issues raised indigenous communities latest public health emergency please note may describe situation specific indigenous group readers assured issues raise endemic across colonised indigenous communities globally pandemics indigenous peoples suffer higher infection rates severe symptoms death general population powerful forces social cultural determinants health lack political power 1918 spanish influenza pandemic mori died rate seven times european population likely underestimation undocumented mori deaths summers baker wilson 2018 first nations people canada eight times likely die compared nonfirst nations kelm 1999 although covid19 infection rates currently low 2009 h1n1 influenza pandemic aboriginal people central australia experienced rates five times higher nonindigenous population mousseau 2013 pacific island mori people seven times likely hospitalised europeans three half times likely die mousseau 2013 mortality american indian alaska natives h1n1 four times higher people ethnicities combined centers disease control prevention 2009 canada first nations people three times likely hospitalised six half times likely admitted intensive care unit boggild yuan low mcgeer 2011 indigenous peoples experience significant burden noncommunicable infectious diseases generally related social health inequities stemming invasion subsequent colonisation colonisations legacy indigenous peoples includes intergenerational concentrated poverty poor physical mental health transport housing issues increased rates domestic family violence shorter life expectancy inadequate access culturally safe care allan smylie 2015 braveman et al 2011 colonisation known negative effect social determinants health greenwood de leeuw lindsay 2018 sherwood 2018 cultural determinants health salmon et al 2019 canada australia new zealand americas invasion subsequent colonisation brought disproportionate inequities detrimentally affect indigenous peoples compared groups respective countries indigenous peoples colonised nations share similar histories invasion displacement traditional lands relocation onto missions reservations stolen generations forced assimilation genocide decimation introduced infectious diseases attempted erasure culture banning languages cultural practices sherwood 2018 central american countries like guatemala panama indigenous peoples endured centuries war internal violence exile marginalisation genocide trauma existence imposed trauma decimation began spaniards invaded panama early 16th century central intelligence agency 2020 despite world class universal healthcare systems available canada australia indigenous populations continue experience much poorer health outcomes due legacies intersections colonialism racism allan smylie 2015 indigenous peoples increased vulnerability disease unquestionable evident shorter life expectancies also lower age become vulnerable australia health department advice australians aged 70 years aged 65 years chronic medical conditions stay home avoid contact people however indigenous peoples recommendation aged 50 years department health 2020b regretfully highlight danger comorbidities several governments neglected explicitly recognise premature mortality indigenous peoples advice vulnerability covid19 centers disease control prevention 2020 new zealand government 2020b public health agency canada 2020 historical data demonstrated poor health poverty positively correlate pandemic severity clay lewis severnini 2019 poverty impacts indigenous peoples capacity respond covid19 multiple levels current crisis health outcomes determined levels secure housing employment comorbidities functional literacy health insurance food security access running water access health care technology onesizefitsall response covid19 ignores roles privilege affluence racism perpetuating inequities therefore ability provide culturally safe care best 2018 globally many indigenous peoples live missions reserves many missions reserves geographically rural remote among 574 tribes usa navajo nation third highest population nation per capita infections new york new jersey 22nd may 2020 navajo nation 4253 positive cases 146 deaths covid19 navajo department health 2020a older age multigenerational housing lack running water communal wells increased chronic disease poverty increased impact covid19 forty per cent navajo households access running water thirty per cent electricity digdeep us water alliance 2020 lack access running water makes difficult comply handwashing recommendations additionally many native american tribes lumbee tribe north carolina eligible receive federal funds provide health care maynor lowery 2009 2018 marginalisation segregation discrimination tribes negatively impacting health wellbeing covid19 situation tribes relying upon resources address tribal community needs likewise central america many indigenous groups live low middleincome countries lacking fundamental basic human needs clean water environment live resulting higher rates infectious disease covid19 babyar 2019 help curb spread covid19 navajo department health ordered members within 17millionacre reservationjurisdiction age 2 years wear masks public instituted isolation measures including weekend curfews unnecessary travel punishable 30 days incarceration 1000 usd fine navajo department health 2020b similar lockdowns evident across globe australia enactment biosecurity act 2015 given federal minister health extraordinary powers maclean elphick 2020 26th march 2020 minister invoked biosecurity travel restrictions remote areas people wishing enter remote communities must selfisolate 14 days prior entry national indigenous australians agency niaa 2020 assurances governments support people appropriate alternate arrangements selfisolate trusted niaa 2020 communities hundreds kilometres many hours away regional centres people would accommodated clear furthermore support evident aboriginal people media reports rough sleepers camps broken police possessions thrown garbage trucks hirini 2020 central tension exists food security affordability closing missions reservations communities keep indigenous peoples safe virus prepandemic one three adult aboriginal people lived remotely australia reported running food unable afford rogers ferguson ritchie van den boogaard brimblecombe 2018 many remote communities one store buy food prices exorbitant due transport access issues rogers et al 2018 cases pricegouging evident central land council 2020 food costing sixty per cent remote communities many aboriginal people prefer travel regional towns shopping central land council 2020 biosecurity lockdowns effect longer possible covid19 exacerbates food insecurity unexpected increases unemployment halts tourism people unable leave communities hunt participate cultural determinants health also demonstrates one unique differences globally among indigenous populations locking communities within australia indigenous peoples history confined designated areas called missions reserves government policy approximately 1890s 1970s australian institute aboriginal torres strait islander studies aiatsis 2019 global indigenous populations locking selfdetermined process within australia question triggering episodes posttraumatic stress arisen older indigenous peoples still live missions reserves locked due government intervention legislation early 1970s state queensland still lived experiences number indigenous australians characteristics crises like pandemics include rapid increase rape sexual assault violence peterman et al 2020 indigenous people worldwide already increased risk family violence consequence colonisation historical trauma wilson mikaherehall sherwood cootes jackson 2019 prevalence rates 57 80 found lifetime violence among whine mori women wilson et al 2019 p 15 aboriginal women australia 32 times likely hospitalised family violence nonaboriginal women andrews 2020 para 3 canada first nations inuit mtis women two half times likely experience violence nonindigenous women klingspohn 2018 national inquiry missing murdered indigenous women girls nimmiwg 2019 canada sexual physical abuse murder indigenous women girls ongoing generations labelled genocide native american women sustain rates violent victimisation rape sexual assault robbery aggravated assault simple assault rates two times higher african americans two half times hispanics two half times caucasians four times asians morgan oudekerk 2019 current covid19 crisis seen reports australia brazil china united states suggesting sudden rise violence women children peterman et al 2020 p 3 compounding sudden increase violence pandemic intersecting forms stressors stemming sudden rise economic emotional physical pressures enforced proximity lockdowns reduced access support systems health care first responders peterman et al 2020 preexisting trauma stress triggered disasters also corresponding rise harmful alcohol substance abuse macauley 2020 families faced stressors associated covid19 may see violence occurring first time factors culminate indigenous women children affected violence longer able enact strategies could take keep children safe also difficult seek help outside homes covid19 crisis seen unprecedented disruption cultural practices normal relational collective practices indigenous peoples detrimental empirically proven cultural determinants health overwhelmingly positive impact health indigenous peoples bourke et al 2018 many aboriginal torres strait islander people australia travel frequently communities attend sorry business funerals grieving department health 2020a current environment lockdowns social distancing indigenous people difficulties reconciling coronavirus restrictions relationally based cultural obligations mourning taking precedence wainwright 2020 mori aotearoa also forced reconsider undertake cultural practices involved farewell someone passed away support older people high needs traditional greetings hongi pressing noses greeting harir shaking hands rhui temporary prohibition suspending practices breach social distancing regulations new zealand government 2020a prepandemic governments already failing efforts reduce inequities social determinants health outcomes indigenous nonindigenous citizens indigenous peoples generally underresourced responding current crisis 2019 report health security across 195 countries found majority countries illequipped prevent detect respond health emergencies nalabandian et al 2019 instance estimated 100 ventilators available guatemala haiti burki 2020 furthermore algorithms triaging access intensive care facilities likely exclude indigenous peoples comorbid conditions may indigenous peoples known survive historical contemporary adversities demonstrating resourcefulness resilience adversity despite marginalisation indigenous peoples countries covid19 responses indigenous communities instituting measures presence universal approaches managing spread covid19 addressing needs borne poverty housing food insecurity aotearoa iwi tribal nations distributing food parcels older people cannot leave homes whanau family rather expecting people make way food bank remote areas iwi monitoring comes goes rohe iwi region roadblocks canada first nation populations gathering bundles medicine food birthing death developing innovative ways protect making protective facemasks wright 2020 although allied media reporting initiatives information strategies indigenous peoples implemented pandemics routinely collected acknowledged zavaleta 2020 date despite known vulnerability high mortality rates little information related rates covid19 indigenous peoples obtainable even testing available data rarely disaggregated ethnicity united nations 2020 yet data essential understand true impact covid19 communities justify demand resources like food personal protection equipment ppe allow service access delivery ensure already existing inequities worsen phelan 2020 indigenous communities across canada urging provincial federal health leaders disclose covid statistics nations reporting numbers help nations prepare respond appropriately potential outbreaks central america statistical transparency among indigenous groups related previous pandemics health outcomes lacking perpetuating lack indigenous voice increasing health disparity gap babyar 2019 failure recognise differences morbidity mortality among indigenous peoples contributes inequities lack information sharing delay funding support nations growing jurisdictional disputes provide services intensified response covid pandemic planning ever time acknowledge need collect accurate ethnicity data disseminate adequate resources address health disparities among indigenous people globally time needs indigenous peoples must made visible subsumed instead generalised universal response strategies editorial drawn attention existing health social justice inequities stemming colonisation discussed devastating effects pandemics health capacity practice culture medicine asked reader consider desperate situation peoples face recognise indigenousled solutions enacted demand governments recognise harm hurt drastically increased morbidity mortality communities pandemic legacies failing address historical ongoing inequities cultural determinants health must recognised remedy built health policy practice research going forward data need meticulously document damage naming us countries communities clans tribes next time disease sweeps planet know weaknesses know strengths informed empowered prevail next neo colonial wave