What barriers exist in delivering healthcare to Indigenous people living with multimorbidities in settler-colonies and how can culturally appropriate care improve outcomes: a narrative review of aetiology and management

Problem

There is a global increase in the prevalence of individuals living with chronic health conditions, particularly among the most marginalised groups such as Indigenous people in Australia, Canada, New Zealand and the United States of America. These communities have historically faced discrimination, racism and a loss of human agency. Multimorbidity is the presence of two or more health conditions occurring simultaneously and the treatment of multimorbidities requires a concerted effort to personalise primary care. Indigenous populations in the aforementioned settler- colonies face many barriers to healthcare that leads to an increase in multimorbidity and mortality. Some of these barriers include but are not limited to; a lack of comprehensive primary care, remoteness to secondary care centres, increased health discrimination and socioeconomic deprivation.

Approach

A narrative review methodology was used (Ferrari, 2015). This approach highlights the key concepts and overview of the available literature. This narrative review aims to understand what barriers exist in delivering healthcare to Indigenous people living with multimorbid conditions and what can be done to improve access to culturally appropriate care. The CINAHL Plus, Medline and Google Scholar databases were searched in the English language. The search strategy yielded 21 studies in Australia, Canada, New Zealand and the United States of America of Indigenous populations living with multimorbidity. The search strategy was limited to including at least diabetes or cardiovascular disease as one of the multi-morbid conditions and the inclusion of the perceived barriers to healthcare as evidenced by the authors.

Findings

The results of this narrative review provide evidence for deficiencies in primary care, a lack of accessibility of healthcare in remote areas, poor public health initiatives and a lack of culturally appropriate care. Multimorbidities affects a growing number of the global population. This increases in Indigenous populations in developed countries who were subject to colonisation. A focus on culturally appropriate care and strong public health initiatives can improve health outcomes in these communities.

Consequences

Poor accessibility to comprehensive and culturally appropriate primary and secondary care can lead to less than favourable health outcomes in Indigenous populations living with multimorbidities. There is a need for informed and inclusive care in communities that are often overlooked by health policy makers. Indigenous populations have higher rates of multimorbidity, poor nutrition, socioeconomic deprivation and are often lost to follow up post hospitalisation.