Indigenous peoples: time to act now for equity and health.

Last week was a landmark event for the health of 370 million Indigenous people spread across 70 countries. At the fi fth session of the UN Permanent Forum on Indigenous Issues (UNPFII), a programme of action for a second decade dedicated to the world’s Indigenous peoples was launched. The overarching theme of the decade is to link specifi c objectives for Indigenous peoples with a broader global commitment to the Millennium Development Goals. The target date for both initiatives is 2015. When The Lancet announced its plans to focus on indigenous health in 2005, we were warned that it would be “unwise” to devote a series of papers to the “supposedly special health problems” of groups that were impossibly hard to defi ne. By identifying a people based on culture, language, or social organisation, the “drift to racism”, Adam Kuper argued, “may be inevitable”. Although a serious charge, and certainly a possible risk, the overwhelming need for action on Indigenous peoples’ health easily outweighs any potential harm. Today, we launch this series, together with a parallel collection of six research papers drawing attention to some of the predicaments faced by Indigenous peoples. Typically, Indigenous people, who make up about 6% of the world’s population in around 5000 separate groupings, are descendents of those who lived in an area at a time when those from a diff erent culture arrived on their land. These new arrivals subsequently came to dominate Indigenous inhabitants, who have since tried to retain their distinctive social, economic, and political characteristics amid the dominant society in which they have sometimes struggled to survive. Indigenous peoples are forced to confront many diffi culties. Poor health is possibly the most intractable problem of all. Cross-country comparisons show that life expectancy is substantially lower for Indigenous peoples. For example, Australian Aboriginal women have a life expectancy of 63 years, compared with an Australian overall average of 82·1 years. Most Indigenous populations have high mortality rates for specifi c diseases and injuries—eg, Māori (heart disease), Canadian First Nation peoples (intentional selfharm), and Native Americans and Alaskan Natives See Articles page 1758; Series page 1775; and Comment page 1716