Lack Of Evidence Fails Indigenous People Worldwide

Globally, there are an estimated 370 million Indigenous people, living in 90 countries. Marginalisation, displacement and institutional racism has left Indigenous people across the world with poorer health and social outcomes compared with non-Indigenous people, including dying younger, having higher rates of infant mortality and poverty, and lower educational attainment.[1] For example, in 2012 the median life expectancy for Indigenous Australians was 10 years lower than for non-Indigenous Australians.[2]

Inequity in eye health is also evident with high income countries failing to ensure Indigenous populations have equitable access to eye care service. A recent scoping review from a team at the University of Auckland and the International Centre for Eye Health at the London School of Hygiene & Tropical Medicine also shows limited evidence that high-income countries are actively tackling this lack of access.[3]

The review, published in BMJ Global Health and carried out as part of the recent Lancet Global Health Commission on Global Eye Health, looked at existing research for eye care service delivery aimed at reaching Indigenous populations. The authors found that the majority of studies were focused on only a few countries (67% were conducted in Australia) and concerned only specific diseases (with 45% focused on diabetic retinopathy). Few Indigenous communities were involved in designing the studies, and no authors undertook rigorous evaluation of the services they had created.

“This scoping review highlights the real lack of evidence in many high-income countries on the needs and barriers facing Indigenous Peoples in accessing eye health care,” said Jaki Adams, Director of Social Justice and Regional Engagement at The Fred Hollows Foundation. “This is despite documented differences in eye health outcomes for Indigenous peoples in those countries.”

Fewer than one third of studies reported involving Indigenous communities when planning the service. Moreover, only two-fifths of the studies explicitly reported that services had been designed to be socially and/or culturally appropriate.

“With less than half of all studies describing culturally appropriate service delivery models, or engagement with Indigenous communities, this is a clear area that needs to be improved,” continued Ms. Adams. “There are good examples of Indigenous-led health services that are of great benefit to local communities and these need to be replicated elsewhere. The lack of these services in most high-income countries is worrying.”

The review also highlighted the importance of a diverse, culturally responsive health workforce—studies that employed Indigenous health workers to deliver community-based eye care were shown to improve access.

“In New Zealand, 1 out of 6 people is Māori, yet only around 1 in 85 eye care practitioners is Māori,” explains Renata Watene (Ngā Puhi, Tainui), a Māori optometrist and kaiāwhina (health advisor) at the School of Optometry and Vision Science, University of Auckland. “Ensuring better representation within training and capacity building is essential for culturally safe and inclusive services. Hopefully future research will reflect this expansion of a well-supported Indigenous eye health workforce.”

The authors note that to achieve the aim of the United Nations’ Sustainable Development Goals to ‘leave no one behind’ more and better evidence on ways to improve Indigenous eye health is needed. Furthermore, participation and leadership by Indigenous communities is paramount.

Access the Lancet Global Health Commission on Global Eye Health here: https://globaleyehealthcommission.org/

[1] Anderson I, Robson B, Connolly M, et al. Indigenous and tribal peoples’ health (the Lancet-Lowitja Institute global collaboration): a population study. Lancet 2016;388:131–57.

[2] Australian Institute of Health and Welfare 2018. Australia’s health 2018. Cat. No. AUS 221. Canberra: AIHW, 2018. doi:10.25816/5ec1e56f25480

[3] Burn H, Hamm L, Black J, Burnett A, Harwood M, Burton MJ, Evans JR, & Ramke J. Eye care delivery models to improve access to eye care for Indigenous peoples in high-income countries: A scoping review. BMJ Global Health. 2021 http://dx.doi.org/10.1136/bmjgh-2020-004484

Image on top: Explaining Vision Testing to an old woman during a Village Screening. FHFNZ, Papua New Guinea/ Theresa Gende