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Developing Responsive Indicators of Indigenous Community Health

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ABSTRACT

How health is defined and assessed is a priority concern for Indigenous peoples due to considerable health risks faced from environmental impacts to homelands, and because what is “at risk” is often determined without their input or approval. Many health assessments by government agencies, industry, and researchers from outside the communities fail to include Indigenous definitions of health and omit basic methodological guidance on how to evaluate Indigenous health, thus compromising the quality and consistency of results. Native Coast Salish communities (Washington State, USA) developed and pilot-tested a set of Indigenous Health Indicators (IHI) that reflect non-physiological aspects of health (community connection, natural resources security, cultural use, education, self-determination, resilience) on a community scale, using constructed measures that allow for concerns and priorities to be clearly articulated without releasing proprietary knowledge. Based on initial results from pilot-tests of the IHI with the Swinomish Indian Tribal Community (Washington State, USA), we argue that incorporation of IHIs into health assessments will provide a more comprehensive understanding of Indigenous health concerns, and assist Indigenous peoples to control their own health evaluations.

No MeSH data available.


Workshop participants’ views on the status of community health using the Indigenous Health Indicators. (NRS = natural resources security; RE = resilience; SD = self-determination; ED = education; CU = cultural use; CC = community connection).
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ijerph-13-00899-f002: Workshop participants’ views on the status of community health using the Indigenous Health Indicators. (NRS = natural resources security; RE = resilience; SD = self-determination; ED = education; CU = cultural use; CC = community connection).

Mentions: The workshop data and participants’ comments demonstrate that the IHIs help depict key non-physiological health priorities and concerns. An overview of the results are presented here to illustrate the usefulness of the methods; detailed data are not given because the results are not representative of the Tribe and the authors do not want to misrepresent the current health status of the community. For the “Where are we now?” health status questions, the collated results depicted respondents’ views that each of the IHIs are in a unique position in on the continuum of poor health to excellent health. None of the IHIs were uniformly ranked as “very bad” or “great”, and none of the IHIs were ranked as having the same status. The distinctions between the status of each of the indicators, as well as differences in how they were ranked by the workshop participants, points to the efficacy of the IHIs representing unique aspects of health that are of importance to participants. Figure 2 illustrates a summary of the “where are we now?” health status results. To determine the summary statistics, the ranking results for all measures were added for one of the IHI, then the IHIs were compared. For example, for natural resources security, the descriptive rankings (i.e., “we are doing great, looking pretty good, not very good, and things are very bad”) were summed for the three measures: quality, access, and safety. The majority of respondents chose “not very good” as the status of all three measures (access, abundance, sharing) in differing percentages. The total number of “not very good” rankings, versus the total number of the other three rankings, reflects a general snapshot of workshop participants’ beliefs regarding the health status of the natural resources security IHI, thus putting natural resources security in the “not very good” category overall. While this method obscures the measures of the individual measures for natural resource security, which are important in an actual evaluation, the individual measure results are not integral to test whether the method works. Figure 2 depicts natural resources security as the IHI with the lowest health status on the health continuum.


Developing Responsive Indicators of Indigenous Community Health
Workshop participants’ views on the status of community health using the Indigenous Health Indicators. (NRS = natural resources security; RE = resilience; SD = self-determination; ED = education; CU = cultural use; CC = community connection).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036732&req=5

ijerph-13-00899-f002: Workshop participants’ views on the status of community health using the Indigenous Health Indicators. (NRS = natural resources security; RE = resilience; SD = self-determination; ED = education; CU = cultural use; CC = community connection).
Mentions: The workshop data and participants’ comments demonstrate that the IHIs help depict key non-physiological health priorities and concerns. An overview of the results are presented here to illustrate the usefulness of the methods; detailed data are not given because the results are not representative of the Tribe and the authors do not want to misrepresent the current health status of the community. For the “Where are we now?” health status questions, the collated results depicted respondents’ views that each of the IHIs are in a unique position in on the continuum of poor health to excellent health. None of the IHIs were uniformly ranked as “very bad” or “great”, and none of the IHIs were ranked as having the same status. The distinctions between the status of each of the indicators, as well as differences in how they were ranked by the workshop participants, points to the efficacy of the IHIs representing unique aspects of health that are of importance to participants. Figure 2 illustrates a summary of the “where are we now?” health status results. To determine the summary statistics, the ranking results for all measures were added for one of the IHI, then the IHIs were compared. For example, for natural resources security, the descriptive rankings (i.e., “we are doing great, looking pretty good, not very good, and things are very bad”) were summed for the three measures: quality, access, and safety. The majority of respondents chose “not very good” as the status of all three measures (access, abundance, sharing) in differing percentages. The total number of “not very good” rankings, versus the total number of the other three rankings, reflects a general snapshot of workshop participants’ beliefs regarding the health status of the natural resources security IHI, thus putting natural resources security in the “not very good” category overall. While this method obscures the measures of the individual measures for natural resource security, which are important in an actual evaluation, the individual measure results are not integral to test whether the method works. Figure 2 depicts natural resources security as the IHI with the lowest health status on the health continuum.

View Article: PubMed Central - PubMed

ABSTRACT

How health is defined and assessed is a priority concern for Indigenous peoples due to considerable health risks faced from environmental impacts to homelands, and because what is “at risk” is often determined without their input or approval. Many health assessments by government agencies, industry, and researchers from outside the communities fail to include Indigenous definitions of health and omit basic methodological guidance on how to evaluate Indigenous health, thus compromising the quality and consistency of results. Native Coast Salish communities (Washington State, USA) developed and pilot-tested a set of Indigenous Health Indicators (IHI) that reflect non-physiological aspects of health (community connection, natural resources security, cultural use, education, self-determination, resilience) on a community scale, using constructed measures that allow for concerns and priorities to be clearly articulated without releasing proprietary knowledge. Based on initial results from pilot-tests of the IHI with the Swinomish Indian Tribal Community (Washington State, USA), we argue that incorporation of IHIs into health assessments will provide a more comprehensive understanding of Indigenous health concerns, and assist Indigenous peoples to control their own health evaluations.

No MeSH data available.