The groundbreaking Lancet-Lowitja Institute Global Collaboration had its genesis 10 years ago following a call for action by the fifth session of the UN Permanent Forum on Indigenous Issues.
The interest of The Lancet was spiked and the medical journal commissioned and published two series of articles highlighting the poor health status of Indigenous populations worldwide, the first in 2006 and a subsequent series of reviews in 2009.
Indigenous health specialist, Professor Ian Anderson, was a contributing author to the earlier series, co-publishing with colleagues from across the Pacific an article titled ‘Indigenous health in Australia, New Zealand, and the Pacific’.
Launching a new initiative
Looking to institute an investigation that would go beyond previous studies which had investigated health and social outcomes for Indigenous and tribal populations – but only across two or more countries – The Lancet ultimately commissioned Melbourne-based Professor Ian Anderson and the Lowitja Institute to conduct a rigorous and systematic research project never before attempted on an international scale.
In the lead-up to becoming Pro Vice-Chancellor at the University of Melbourne and its foundation Chair in Indigenous Education, Professor Anderson had seen first-hand the challenges that Indigenous communities face. He has studied and worked over an extended period in a variety of medically-related roles to improve the conditions and prospects of Australian and Torres Strait Islander people across the country.
After moving to Bendigo from Tasmania Professor Anderson became one of the first of his family to graduate from high school and the first Aboriginal medical graduate of the University of Melbourne. He has worked as an Aboriginal health worker, a clinician in general practice, as an administrator at the Victorian Aboriginal Health Service and medical adviser on Aboriginal and Torres Strait Islander Health for the Australian government.
“Having Ian Anderson as the lead of the project, someone who has a close association and continues to support the Lowitja Institute, is crucial,” says Chief Executive Officer, Romlie Mokak, a Djugun man from Western Australia.
“For a small Indigenous organisation at the bottom end of the world to be collaborating with The Lancet is recognition of the importance and relevance of our work and mission.”
The Lowitja Institute takes its name from senior Elder, Lowitja O’Donoghue, and is the only national research organisation in Australia solely focused on the health and wellbeing of Aboriginal and Torres Strait Islander people.
“In saying that, we are also members of the global Indigenous family and extend our purpose to all Indigenous peoples of the world, our brothers, sisters, cousins,” Mr Mokak says.
Like Professor Anderson, Lowitja O’Donoghue is a trailblazer, being the first Aboriginal nurse at the Royal Adelaide Hospital, and going on to become a renowned public administrator and leader, teacher and mentor to her people.
Project process and scale
Accounting for approximately half the global population of Indigenous and tribal peoples in 23 countries and 28 individual populations, the Lancet-Lowitja Global Collaboration, led by Professor Anderson and funded by the Lowitja Institute, set about to systematically and comprehensively collect reliable data available within these populations to monitor health outcomes and develop policy and service responses.
Participating countries included Australia, Brazil, Cameroon, Canada, Chile, China, Colombia, Denmark, India, Kenya, Myanmar, New Zealand, Nigeria, Norway, Pakistan, Panama, Peru, Russia, Sweden, Thailand, the United States, and Venezuela.
“The objective was to describe health and social status relative to benchmark populations, but without attempting to make any comparisons between Indigenous populations,” Professor Anderson says.
“Our approach differs from previous studies in attempting to find data systematically across major themes.”
As with previous studies, the new research provides evidence of poorer health and social outcomes for Indigenous and tribal peoples but, importantly, highlights that there are exceptions and that the size of differences varies.
“We were particularly keen to make sure this was not just another study that looked at populations in Canada, the United States, New Zealand and Australia,” says Professor Anderson, “countries where there are generally better developed Indigenous data systems.
“We needed to talk to a much wider cohort and describe issues from a global perspective.’’
Professor Anderson initially drew on his professional networks to enlist a nucleus of 11 experts in Indigenous health who in turn helped identify additional collaborators. Accordingly, a team of over 65 locally-based collaborators with expertise in Indigenous health data systems worked individually and collaboratively to collate basic population data, data on life expectancy at birth, on infant mortality, low and high birth weight, maternal mortality, nutritional status, educational attainment and economic status.
“In the first phases it was largely a collation exercise, followed by a sustained period where we reviewed the data contributions,” Professor Anderson says. “The next phase involved calculation and rigorous analysis of the differences thrown up by the data.
“The involvement of contributors from each country was absolutely critical, because it’s only at a country level, when you really know what data sources are available and can test the quality of the data, that a project of this scale and with a focus this intensive can be attempted.”
In Professor Anderson’s estimation, this approach – identifying and working with over 65 qualified collaborators throughout the world – significantly extended the reach of previous studies, was critical to its success, and has led to the framing of solid recommendations for global sustainable development.
Project findings found generally poorer outcomes for Indigenous populations across all indicators, with some significant exceptions and variations in size of rate differences.
For example, for life expectancy at birth across the 18 populations for which data was available, rate differences were found to be greater than one year in 15 of the populations investigated, while available data on infant mortality rates in 19 populations revealed a difference greater than one per 1000 live births in 16 populations.
“It is interesting that in a few countries – including Australia – nutritional outcomes are poorer across all indicators,” Professor Anderson says. “In these cases there is a higher rate of child malnutrition, a higher rate of child obesity, and a higher rate of adult obesity.”
Romlie Mokak agrees with Professor Anderson’s call for Indigenous engagement early and fully in any future process.
“Indigenous knowledges the world over go hand-in-hand with sustainability,” he says. “It’s part of our Indigenous DNA to be thinking not only of the present but honouring our ancestors and fulfilling those obligations to the future.”
Finally, the Lancet-Lowitja Insititute study highlights the need for a concerted effort to ensure that reliable and high quality data is collected on Indigenous status across all data systems in order to monitor change and inform policy and service delivery.
“We are not going to succeed globally in implementing sustainable development goals without action on health and social outcomes for Indigenous and tribal peoples,” Professor Anderson says.
“And we are not going to get successful action if we continue to fail to include Indigenous peoples in a meaningful way in both global processes and, particularly, in new forms of governance in relationship to the development of data.”
Explore the Lancet-Lowitja Report in more detail, including an interview with Ian Anderson and Romlie Mokak, and an infographic illustrating the status of Indigenous population health worldwide.
Banner image: internally displaced Indigenous children in Colombia/Flickr