Ethnic minorities and indigenous peoples

This chapter considers the health of ethnic minorities and indigenous peoples. The term ethnicity is currently employed to refer to groupings of people defined according to shared characteristics including ancestral and geographical origins, cultural tradition, language, and religion. Ethnicity is a fluid, multifaceted construct whose characteristics are not fixed or easily measurable, with classification dependent on context. The concept of ethnicity has superseded the largely discredited biological notion of racial differences that emerged in the first half of the nineteenth century as the basis for differentiating groups in a population. The term indigenous peoples refers to groups who are descendants of populations that inhabited a country or geographical region at the time of conquest or colonization and who retain some or all of their own social, economic, cultural, and political institutions. Ethnic-minority and indigenous populations generally have younger age distributions than the majority of the population, and often show some degree of concentration into geographically distinct areas or communities. Where data are available, ethnic minorities and indigenous peoples may have increased mortality and diminished life expectancy compared with the majority, demonstrating an ethnic patterning of cause-specific mortality and morbidity. Determinants of health that are of particular relevance for explaining the ethnic patterning of health outcomes include genetics, culture and lifestyles, consequences of migration and discrimination, lack of access to services, and socioeconomic inequalities and poverty, all of which are interrelated. The significance of these determinants may vary for different health outcomes and in different contexts. More recent perspectives regard cultural beliefs and identities as flexible and shaped by the structural conditions of people’s lives and experiences. The final section of the chapter considers policies at the societal level, including the question of self-determination for indigenous peoples, the assumptions and ideology of multiculturalism, and the critiques of this approach.