Understanding barriers to health care: a review of disparities in health care services among indigenous populations

Objectives. To review the current status of health care access and utilization among Indigenous people in the North America, Australia and New Zealand. Study Design. Literature review. Methods. A systematic search and critical review of relevant studies using online searches of electronic databases (PubMed, PsychINFO, MEDLINE) that examined issues relating to health care utilization and access. Results. Most studies found that health care access and utilization rates were found to be significantly lower among Indigenous populations. Factors such as rural location, communication and socio-economic status were found to be barriers to health care services that disproportionately affected Indigenous communities compared with the general population. Conclusions. Inequalities in health care access and utilization among Indigenous populations may play an important role in understanding why disparities in the health status of Indigenous populations continue to exist despite public health interventions. Further research is needed to understand the factors that contribute to these inequalities and to develop specific interventions to increase access and utilization among Indigenous populations.

[1]  J. Hux,et al.  Markers of access to and quality of primary care for aboriginal people in Ontario, Canada. , 2003, American journal of public health.

[2]  R. Gruen,et al.  Outreach and improved access to specialist services for indigenous people in remote Australia: the requirements for sustainability , 2002, Journal of epidemiology and community health.

[3]  M. Gracey Historical, cultural, political, and social influences on dietary patterns and nutrition in Australian Aboriginal children. , 2000, The American journal of clinical nutrition.

[4]  T. K. Young,et al.  Type 2 diabetes mellitus in Canada's first nations: status of an epidemic in progress. , 2000, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[5]  C. Korenbrot,et al.  Disparities in Hospitalizations of Rural American Indians , 2003, Medical care.

[6]  Jennifer Spaeth,et al.  Task Force on Community Preventive Services , 2009 .

[7]  D. Hoyt,et al.  Discrimination, historical loss and enculturation: culturally specific risk and resiliency factors for alcohol abuse among American Indians. , 2004, Journal of studies on alcohol.

[8]  J. Phinney,et al.  When we talk about American ethnic groups, what do we mean? , 1996 .

[9]  Martin Hefford,et al.  Reducing health disparities through primary care reform: the New Zealand experiment. , 2005, Health policy.

[10]  E. van Doorslaer,et al.  Inequalities in access to medical care by income in developed countries , 2006, Canadian Medical Association Journal.

[11]  David S. Jones,et al.  The persistence of American Indian health disparities. , 2006, American journal of public health.

[12]  I. Wronski,et al.  When the tide goes out: health workforce in rural, remote and Indigenous communities , 2006, The Medical journal of Australia.

[13]  P. Hebert,et al.  Indigenous disparities in disease-specific mortality, a cross-country comparison: New Zealand, Australia, Canada, and the United States. , 2004, The New Zealand medical journal.

[14]  E. Nauman Native American Medicine and Cardiovascular Disease , 2007, Cardiology in review.

[15]  L. Chan,et al.  Geographic access to health care for rural Medicare beneficiaries. , 2006, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[16]  Tobacco use among U.S. racial/ethnic minority groups--African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, Hispanics. A Report of the Surgeon General. Executive summary. , 1998, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[17]  E. Hunter,et al.  Indigenous suicide in Australia, New Zealand, Canada, and the United States. , 2002, Emergency medicine.

[18]  I. Ring,et al.  Indigenous health: chronically inadequate responses to damning statistics , 2002, The Medical journal of Australia.

[19]  P. Spicer,et al.  Prevalence of mental disorders and utilization of mental health services in two American Indian reservation populations: mental health disparities in a national context. , 2005, The American journal of psychiatry.

[20]  M. Tonelli,et al.  Death and renal transplantation among Aboriginal people undergoing dialysis , 2004, Canadian Medical Association Journal.

[21]  K. Newbold Problems in Search of Solutions: Health and Canadian Aboriginals , 1998, Journal of Community Health.

[22]  Y. Roubideaux,et al.  Understanding and addressing the health care needs of American Indians and Alaska Natives. , 2005, American journal of public health.

[23]  R. Cassidy,et al.  Overview of Race and Hispanic Origin: Census 2000 Brief. , 2001 .

[24]  D. Sin,et al.  Can universal access to health care eliminate health inequities between children of poor and nonpoor families?: A case study of childhood asthma in Alberta. , 2003, Chest.

[25]  M. Taualii,et al.  A nationwide population-based study identifying health disparities between American Indians/Alaska Natives and the general populations living in select urban counties. , 2006, American journal of public health.

[26]  B. Howard,et al.  All-Cause Morality and Cardiovascular Disease Mortality in Three American Indian Populations, Aged 45–74 Years, 1984–1988 The Strong Heart Study , 1998 .

[27]  S. Manson,et al.  Use of Traditional Health Practices Among Native Americans in a Primary Care Setting , 2000, Medical care.

[28]  F. Gilliland,et al.  Preventive health care among rural American Indians in New Mexico. , 1999, Preventive medicine.

[29]  S. Manson,et al.  Characteristics Associated with Reservation Travel Among Urban Native American Outpatients , 2005, Journal of health care for the poor and underserved.

[30]  P. Martens,et al.  Mortality Comparisons of First Nations to All Other Manitobans: A Provincial Population-based Look at Health Inequalities by Region and Gender , 2005, Canadian journal of public health = Revue canadienne de sante publique.

[31]  S. J. Cook Use of traditional Mi'kmaq medicine among patients at a First Nations community health centre. , 2005, Canadian journal of rural medicine : the official journal of the Society of Rural Physicians of Canada = Journal canadien de la medecine rurale : le journal officiel de la Societe de medecine rurale du Canada.

[32]  V. Curran,et al.  The role of medical education in the recruitment and retention of rural physicians , 2004, Medical teacher.

[33]  R. Cassidy,et al.  Overview of Race and Hispanic Origin: 2000 , 2001 .

[34]  Maria Yellow Horse Brave Heart The Historical Trauma Response Among Natives and Its Relationship with Substance Abuse: A Lakota Illustration , 2003 .

[35]  Y. Paradies A systematic review of empirical research on self-reported racism and health. , 2006, International journal of epidemiology.

[36]  T. Laveist On the Study of Race, Racism, and Health: A Shift from Description to Explanation , 2000, International journal of health services : planning, administration, evaluation.

[37]  P. Spicer,et al.  Disparities in patterns of alcohol use among reservation-based and geographically dispersed American Indian populations. , 2005, Alcoholism, clinical and experimental research.

[38]  A. Bruce,et al.  Nursing Practice With Aboriginal Communities: Expanding Worldviews , 2005, Nursing science quarterly.

[39]  L. Whitbeck,et al.  Prevalence and comorbidity of mental disorders among American Indian children in the Northern Midwest. , 2006, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[40]  Corinne Squire Culture in Psychology , 2000 .

[41]  D. Holtzman,et al.  Disparities in chronic disease risk factors and health status between American Indian/Alaska Native and White elders: findings from a telephone survey, 2001 and 2002. , 2005, American journal of public health.

[42]  R. Mayberry,et al.  Racial and Ethnic Differences in Access to Medical Care , 2000, Medical care research and review : MCRR.

[43]  D. Rogers,et al.  Cancer disparities research partnership in Lakota Country: clinical trials, patient services, and community education for the Oglala, Rosebud, and Cheyenne River Sioux tribes. , 2005, American journal of public health.

[44]  Maria Yellow Horse Brave Heart,et al.  The historical trauma response among natives and its relationship with substance abuse: a Lakota illustration. , 2003, Journal of psychoactive drugs.

[45]  Sarah Muttitt,et al.  Integrating telehealth into Aboriginal healthcare: the Canadian experience , 2004, International journal of circumpolar health.

[46]  F. Tester,et al.  Isumagijaksaq: mindful of the state: social constructions of Inuit suicide. , 2004, Social science & medicine.

[47]  Jonathan E Fielding,et al.  Culturally competent healthcare systems. A systematic review. , 2003, American journal of preventive medicine.

[48]  L. Whitbeck,et al.  Perceived discrimination and early substance abuse among American Indian children. , 2001, Journal of health and social behavior.

[49]  M. Moffatt,et al.  Prevalence and predictors of inadequate prenatal care: a comparison of aboriginal and non-aboriginal women in Manitoba. , 2005, Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC.

[50]  P. Hebert,et al.  Disparities in indigenous health: a cross-country comparison between New Zealand and the United States. , 2005, American journal of public health.

[51]  C. Caldwell-Harris,et al.  When Personality and Culture Clash: The Psychological Distress of Allocentrics in an Individualist Culture and Idiocentrics in a Collectivist Culture , 2006, Transcultural psychiatry.

[52]  R. Struthers,et al.  Nursing in the Native American Culture and Historical Trauma , 2003, Issues in mental health nursing.

[53]  Sabrina T. Wong,et al.  Rural American Indian Medicaid health care services use and health care costs in California. , 2006, American journal of public health.

[54]  R. Sternberg,et al.  Intelligence, race, and genetics. , 2005, The American psychologist.

[55]  J. Penrod,et al.  Universal health insurance coverage does not eliminate inequities in access to cardiac procedures after acute myocardial infarction. , 2003, American heart journal.

[56]  A. Blum,et al.  Tobacco Use Among U.S. Racial/Ethnic Minority Groups-African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics: A Report of the Surgeon General , 1998 .

[57]  L. Whitbeck,et al.  Perceived discrimination, traditional practices, and depressive symptoms among American Indians in the upper midwest. , 2002, Journal of health and social behavior.

[58]  Héctor Betancourt,et al.  The Study of Culture, Ethnicity, and Race in American Psychology , 1993 .

[59]  Diabetes prevalence among American Indians and Alaska Natives and the overall population--United States, 1994-2002. , 2003, MMWR. Morbidity and mortality weekly report.