STATE OF THE WORLD's INDIGENOUs PEOpLEs - CINU

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EMBARGOED UNTIL 14 January 2010STATE OF THE WORLD’S INDIGENOUS PEOPLESNot for distributionPoor nutrition is one of the health issues that most affects indigenous peoples around the world. In additionto circumstances of extreme poverty, indigenous peoples suffer from malnutrition because of environmentaldegradation and contamination of the ecosystems in which indigenous communities have traditionally lived,loss of land and territory, and a decline in abundance or accessibility of traditional food sources. These changesin traditional diet, combined with other changes in lifestyle, have resulted in widespread malnutrition amongindigenous peoples. The World Bank has reported that “the rate of stunting [height/age] for Guatemala overallis 44 percent, but for indigenous children the rate is 58 percent, higher than either Yemen or Bangladesh, andalmost twice the rate for non-indigenous children. In Ecuador, chronic malnutrition is more than twice as high inindigenous as compared to non-indigenous communities”. 26 In El Salvador, an estimated 40 per cent of indigenouschildren under age five are malnourished, compared to the national average of 23 per cent, and in Honduras anestimated 95 per cent of indigenous children under age 14 suffer from malnutrition. 27However, this malnutrition manifests itself differently depending on the local circumstances. Whilst in someparts of the world malnutrition affects maternal and infant health and child development, in other regionsit contributes to an increasing prevalence of non-communicable diseases such as obesity, diabetes andcardiovascular disease among indigenous peoples. In the State of Arizona in the United States, for example,the Pima Indian tribe has the highest rate of diabetes in the world, as “some 50 per cent of the Pima betweenthe ages of 30 and 64 have diabetes.” 28Indigenous people and diabetesIndigenous people are particularly vulnerable to diabetes due to a combination of environmental, geneticand socio-economic factors. The contamination and destruction of natural habitats and the disappearanceof wildlife plants and animals have resulted in the erosion of traditional food systems and decreased foodsecurity. This has led to increasing reliance upon imported processed foods that have little nutritionalvalue but are often high in sodium and fat, causing obesity and diabetes.The genetic selection processes that may have been advantageous when food was in short supply andhad to be obtained through hard physical effort make indigenous people highly vulnerable to diabetesat the time of the rapid transition to a high-calorie diet and low levels of physical activity. The situationis aggravated by indigenous peoples’ lack of access to health care. Most indigenous people are neverdiagnosed or treated for diabetes. Others are diagnosed too late to prevent the dramatic impact of thedisease on the eyes, kidneys, nerves and circulation.Because of economic constraints and lack of knowledge about healthy eating, many families chooseaffordability over nutritional value. In Tonga, for example, traditional low-fat sources of protein, such asfish, cost between 15 per cent and 50 per cent more than either lamb flaps or imported chicken parts. Thelocal taro plant costs more than imported starches such as bread and rice. Thus, “not only are the healthconsequences of these imported foods detrimental, but the availability of these cheap imports is alsoconstraining the development of domestic markets”.There is little research into diabetes prevalence in indigenous populations. However, available healthstatistics indicate that, in some indigenous communities, diabetes has reached epidemic proportions and26Hall and Patrinos (2006), 14.27PAHO (2002a), 181.28PAHO (2002), 182.HEALTH | 163
EMBARGOED UNTIL 14 January 2010STATE OF THE WORLD’S INDIGENOUS PEOPLESNot for distributionplaces the very existence of indigenous groups at risk. In the Pacific, diabetes is present in 44 per cent ofthe Torres Strait Islanders of Australia, 28 per cent of the residents of the Kingdom of Tonga and 22 per centof the residents of Nauru. In Australia, the estimated number of indigenous adults with type 2 diabetes isup to four times higher than that of Australians of European descent, and ten times higher than the nationalprevalence among 25- to 50-year-olds. In other areas of the world, diabetes prevalence is also high amongNative North Americans, Inuit people of the Canadian Arctic and Greenland, and indigenous people inAsia. In Canada, diabetes prevalence among certain aboriginal peoples is three to five times higher thanthat of the general population in the same age group. Worldwide, over 50 per cent of indigenous adultsover age 35 have type 2 diabetes, and these numbers are predicted to rise.It is essential to recognize the severity of diabetes in indigenous people. A number of successful initiativeshave been undertaken in order to protect traditional food systems in the Pacific region. Vanuatu declared2001 as Yia Blong Aelan Kakae, or the Year of Island Food, to encourage the revival of traditional methodsof food cultivation and consumption. Fiji banned the import of lamb flaps from New Zealand because ofthe proven links with obesity. Such initiatives need to be supported with research that will foster a betterunderstanding of diabetes in indigenous communities. Furthermore, it is important to step up efforts todevelop culturally appropriate methods of education, prevention and care within indigenous populationsas part of broader efforts to improve the health of indigenous communities around the world.Sources: International Diabetes Federation (2007); World Health Organization (2001); Nicolaisen (2006).Infant, child and maternal mortality rates are good indicators of the general health status, as they are affected by arange of factors, most important of which are malnutrition and poor access to health care, which are preventable.Although the gap has narrowed in recent decades in most countries that collect disaggregated data, these ratescontinue to be significantly higher among indigenous peoples, compared to the non-indigenous populations.Child mortality (years 1-4) rates in 2005, for example, were twice as high for American Indian and Alaska Nativesthan for the total population in the United States, 29 while in Australia for the period 1999-2003, the indigenousinfant mortality rates were almost three times that of non-indigenous infants, and child mortality twice as high. 30Infant mortality rates in New Zealand are 1.5 times higher for the indigenous Maori than for non-Maori, whilstsimilar trends are visible in Canada. 31In Latin America, where disaggregated data is readily available, indigenous infant mortality rates are alwayshigher than those of the total population, ranging from 1.11 times higher in Chile to 3.09 times higher than thegeneral population in Panama. 32 “In Bolivia, Ecuador, Guatemala, México and Panama, which have collectedinformation on ethnic group and mother’s area of residence (i.e., urban vs. rural), infant mortality rates areconsistently higher among rural indigenous populations than among their non-indigenous rural peers as well asamong urban indigenous populations”. 33Where disaggregated data is unavailable, it is sometimes helpful to look at regional differences, and the regionswhere indigenous peoples predominantly live tend to fare worse than other regions. In Ratankiri, the northeast29DeVoe, J.F. and Darling-Churchill, K.E. (2008), 34.30Trewin, D. & Madden, R. (2005), 88.31Although these differences in these rich countries are striking, the gap has narrowed substantially in recent years.32ECLAC (2007) 190.33PAHO (2007) 32.164 | CHAPTER V
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STATE OF THE WORLD's INDIGENOUs PEOpLEs - CINU

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