Elsevier

The Lancet

Volume 367, Issue 9524, 27 May–2 June 2006, Pages 1775-1785
The Lancet

Series
Indigenous health in Australia, New Zealand, and the Pacific

https://doi.org/10.1016/S0140-6736(06)68773-4Get rights and content

Summary

We survey Indigenous health issues across the Pacific with a case study approach that focuses on Australia, New Zealand, Hawai‘i, and US Associated Micronesia. For each case study, we provide an overview of the Indigenous population, its colonial history, and current health and social outcomes. In the discussion that follows, we flag some of the key policy initiatives that have been developed to address Indigenous health disadvantage, albeit within the context of continuing debates about Indigenous rights and policy.

Introduction

The Pacific Ocean covers roughly 28% of the globe. This ocean is larger than the total land area of the world, and stretches between the Southern Ocean, Asia, Australia, and North and South America.1 Thousands of islands are spread across this expanse, which adds to the region's considerable geographical, cultural, and linguistic diversity. This vast expanse provides the backdrop to our survey of Indigenous health.

There is some debate about the definition of Indigenous people.2 Some definitions emphasise the political subordination of Indigenous peoples by the colonising nations. Others focus on the sociocultural characteristics of Indigenous societies (being, for example, small scale and decentralised) that have made them vulnerable to political domination and exploitation. This debate notwithstanding, colonial processes have, since the 18th century, had a pervasive influence on the lives of Indigenous peoples across the Pacific region.

During the 18th and 19th centuries, in particular, the colonisation of the Pacific by European imperial powers was pivotal to this history. Here we only hint at the complexity of this process and the devastation and havoc it caused Indigenous societies. All the Indigenous peoples we discuss experienced steep declines in population during the initial phase of colonisation as a result of the combined effect of dispossession, social change, and introduced epidemic diseases.3, 4, 5, 6, 7, 8, 9, 10

For many Indigenous societies in the Pacific, colonisation has been a multilayered process, with Indigenous lives entangled in the shifting fortunes of European and, in some instances, non-European powers. US Associated Micronesia, for instance, had been under Spanish, German (1899–1914), and Japanese (1914–43) control before the USA assumed responsibility after World War II for the strategic UN-mandated trust. During the 20th century, some European powers maintained their status as external colonial powers, such as the French in French Polynesia. Others, such as Britain, withdrew to create self-governing dominions in Australia (from 1901) and New Zealand (1852). Importantly, the role of the USA as a colonial power increased over this period, as we discuss in the history of Hawai‘i and US Associated Micronesia.

Section snippets

Approach

In view of both the size and diversity of the Pacific region, a comprehensive analysis of Indigenous health is beyond the scope of this review. The health of Indigenous people in Asia and the Americas is taken up elsewhere in the series. Here we present a set of case studies focusing on Australia, New Zealand, Hawai‘i, and US Associated Micronesia. Such an approach enables us to provide some of the historical and social context for contemporary Indigenous disadvantage in health. This contextual

Population

Aboriginal peoples have occupied Australia for at least 60 000 years. Today, there are two main groups of Indigenous Australians: Aboriginal people from the Australian continent and the island state of Tasmania, and Torres Strait Islanders. In 2001, these two groups combined made up 2·4% of the total Australian population (492 700 people).15 Of this total, 90% described themselves as Aboriginal, 6% as Torres Strait Islander, and 4% as both Aboriginal and Torres Strait Islander.12 Compared with

The Māori population

Māori people came to Aotearoa (New Zealand) in a series of epic canoe voyages from eastern Polynesia between 1200 and 700 years ago.27 According to the 2001 census, there were 526 281 Māori in New Zealand, constituting 14·7% of the total population.28 At this time, the median age of Māori was 21·9 years compared with 34·8 years for the total New Zealand population.28 Children younger than 15 years make up 37·3% of the Māori population and 20% of the non-Māori population.29

Colonial history

The first recorded

The Kanaka Maoli population

Kanaka Maoli (Native Hawaiians) settled the isolated Hawaiian archipelago via voyaging canoes over 1500 years ago from what is now French Polynesia.48 Hawai‘i has a population of 1·2 million.49 In the 2000 US census, which allowed for single race and mixed race categories, Native Hawaiians (single and mixed race) constituted 19·8% of the population. Other major ethnic groups were: white (29·3%) Asian (58%, which includes Japanese [24·5%]), Chinese (14·1%), and Filipino (22·8%).49

Colonial history

In 1778,

Population

US Associated Micronesia is the name commonly used to describe the Republic of the Marshall Islands, the Federated States of Micronesia, the Republic of Palau (Belau), Guam, and the Commonwealth of the Northern Mariana Islands. Micronesians are descended from seafarers who sailed from Asia and Polynesia, arriving at the island atolls between 2000 BC and 500 BC. The Republic of the Marshall Islands has a population of 50 840 (1999 census) and the Federated States of Micronesia (which includes

Current debates about Indigenous Policy and Rights

The Indigenous social movements that emerged across the world from the late 1960s have resulted in the greater recognition of the civil rights of Indigenous people in the Pacific region, and in some cases the recognition of specific Indigenous rights. In settler states, these political debates have been between Indigenous people and settler institutions. For US Associated Micronesia, the various independence movements have realigned relations with its former colonial power. Despite this

Search strategy

The data we present here are drawn from both published (indexed) academic work and government publications. A search of PubMed was done with search terms such as “Indigenous”, “Aborigin*”, “Torres Strait Islander”, “Pacific Islander”, “Micronesia*”, “Native Hawaiian”, “Kanaka Maoli”, with “Health Outcomes” and/or “Mortality” and/or “Morbidity”. This information was supplemented by Indigenous health and social data published by governments and statistical agencies in the different

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