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3 Case Study – The Ongoing Impact of Discrimination in the United States

3 Case Study – The Ongoing Impact of Discrimination in the United States

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Case Study – The Ongoing Impact of Discrimination in the United States


neurological effects of syphilis. They were also offered free hot lunches at the

hospital, and free medicine for any other diseases they might have, and free burial

after autopsies were performed. This discriminatory research has had an ongoing

impact on medical science in that the results are used as the gold standard in our

clinical understanding of syphilis, and the findings are often cited by other


This was the longest running non-therapeutic experiment on human beings in

medical history. Between 1936 and 1973 Public Health Service scientists, physicians and nurses associated with the study published a total of 13 articles in peerreviewed journals, including such prestigious journals as the Public Health Reports,

Milbank Fund Memorial Quarterly, Journal of Chronic Diseases, and Archives of

Internal Medicine. Reviewers did not query the unethical nature of the experiment.

Medical textbooks were able to report the findings without any reference to the

extreme violation of the subjects of the experiment. The following is illustrative:

A prospective study involving 431 black men with seropositive latent syphilis of 3 or more

years’ duration was undertaken in 1932 (the Tuskegee study, 1932–1962). This study

showed that hypertension in syphilitic black men 25–50 years of age was 17 percent more

common than neurologic complications were, and both were increased over control populations. Anatomic evidence of aortitis was found to be 25–35 percent more common in autopsied syphilitics, while evidence of central nervous system syphilis was found in 4 percent

of the patients. (from G. L. Mandell et al. (1990) cited in Caplan 1992, 31).

The dry presentation of facts hides the discriminatory reality of the experiment.

Furthermore, modern day references argue that whilst the study’s comparison was

between a control (treated) group and an experimental (or untreated) group, the

original experimental group was not untreated, but was being treated with the

accepted treatment of 1932, which consisted of the ingestion of toxic heavy metals

such as mercury and arsenic. Penicillin, regarded as an effective treatment for syphilis, became available in the 1940s but the men were not given it. The original toxic

treatment meant that the untreated group was in fact contaminated by introducing a

toxic variable (Edgar 1992). The long-term study explained itself as a study of

untreated syphilis – but this was not the case. So in addition to being unethical science it was also poor science.

Some authors have suggested that this history of enforced experimentation and

unethical medical practices in relation to black people has consequences today,

with, for example, blacks being less likely than whites to receive Medicare, even in

the case of free services (Breslaw 2012). There has been a tendency for black people

to distrust health officials and the legacy of cases like the Tuskegee Syphilis

experiment has discouraged blacks from participating in experimental research

(Jones 1992).




Gender and Ethnicity in Health


Gender disparities in health further complicate our understanding of health inequalities. Epidemiologists have demonstrated that women get sicker, but men die quicker

(Lorber 1997). As a world average women have around 4 years longer life expectancy than men (Therborn 2006a). Part of the explanation for this state of affairs is

the different roles that men and women are socialised into. Data from the United

States shows that of the 4383 fatal work injuries that occurred in 2012, 93 % were

suffered by men. This is primarily because of the different work roles taken, with

agriculture, forestry, fishing and hunting sectors having the highest fatal work injury

rate, and the construction industry having the highest total number of fatal injuries

(Bureau of Labor Statistics 2014). However, the relationship between gender, work,

and health is a changing one, and over recent decades more women have entered the

workforce and in a diverse range of occupations. This may mean the gap in workplace mortality and morbidity between genders starts to close. However, work is

also regarded as having an overall beneficial effect on health, with paid employment

providing more opportunities for women, which further complicates this picture

(Bartley and Head 2007).

It has been argued that men are also more likely to adopt health-damaging behaviors such as excessive drinking of alcohol and violent acts (Farrimond 2012) and are

more likely to die from suicide, homicide, and unintentional injury, including traffic

accidents (Feyer and Langley 2000). There are also differences in the way in which

men and women attempt suicide. Men are more likely to kill themselves using firearms and are therefore more successful than women who are more likely to use

poison. Men and women also deal with illness in different ways. Men tend to use

primary health services less than women and are more likely to delay seeking help

when they are ill. However, women are more likely than men to have a disability

and suffer from disease. This is not simply because women live longer as women

have lower health ratings than men even when they are at the same age (Davis

et al. 1999).

Men and women in the same or similar social situations may have different experiences of illness. Ivory and colleagues (2011) drew on Durkheim’s concepts of

integration and regulation to explore the impact of social fragmentation on mental

health at a neighbourhood level. They found that both social deprivation (material

resources) and social fragmentation (the level of integration and regulation) were

associated with mental health outcomes for men and women, but neighbourhood

fragmentation had a greater negative impact on women, particularly unemployed


An issue that has come under sustained scrutiny has been the relationship

between medical practitioners and women. It has been suggested that the medical

encounter reinforces patriarchal domination and is frequently based on assumptions

of stereotypical male and female roles. The idea of patriarchal domination suggests

that the way society is structured or organized means that women are oppressed and

dominated by men as a whole. Women health professionals may then reinforce this

4.4 Gender


patriarchal domination in the same ways as their male counterparts as they are part

of, or entangled in, this structural form of oppression.

An example to illustrate how the medical encounter may reinforce patriarchal

domination is that women have higher rates of diagnoses of depression than men

(Van de Velde et al. 2013). We can consider two broad explanation for this. One is

that women actually do have higher rates of depression as an outcome of their life

experiences and the social roles they perform. So women face greater risk of depression following events involving children, housing, and reproduction (Nazroo et al.

1998). Such events include miscarriage and medically complicated pregnancies

through to children facing criminal charges or being involved in drug consumption.

Depression has been linked to powerlessness, a lack of choice and role overload,

where gender-specific demands can mean that women take on paid work as well as

household caring duties (Van de Velde et al. 2013).

A second broad explanation for the differences in diagnoses of depression by

gender is sexism in medicine. Sexism in medicine is evident in the way in which

women’s accounts of their own symptoms are at times ignored by doctors (Broom

2009). In a study of people who had been diagnosed with chronic fatigue syndrome,

a contested condition in medicine, 85 % of women so-diagnosed were, at some

stage in their illness, given a psychiatric diagnosis, but only 30 % of men (Broom

and Woodward 1996). Men’s accounts of their physical symptoms were more likely

to be given credence by health professionals than women’s accounts (Broom and

Woodward 1996).

As women are diagnosed with depression more frequently than men they also

consume larger quantities of psychotropic drugs. In cases where men and women

both have mental distress symptoms women consume more antidepressants and

hypnotics/anxiolytics (Hausken et al. 2007). Critics see this as a medicalized

response to personal troubles and potentially as a form of social control of women

where social problems are reconceptualized as individual problems and psychotropics are used as a medical means to constrain women (Norris et al. 2011).

In contrast to depression, women are under-diagnosed for coronary artery disease (Weisz et al. 2004). Men are more likely to be diagnosed correctly as having

heart disease than women (Curry and O’Brien 2006). It has been found that in the

case of ischaemic heart disease, women are less likely to receive medically proven

secondary prevention therapies such as beta blockers, aspirin and ACE inhibitors

than men, but more likely to be prescribed anxiolytic benzodiazepines (Williams

et al. 2003). This suggests that when physicians are confronted with a patient who

has symptoms of angina, which can include chest pain, nausea and fatigue, they are

more likely to attribute those symptoms to anxiety if the patient is a woman, and

more likely to attribute those symptoms to ischaemic heart disease if the patient is a

man. Women who are hospitalized for strokes are also less likely to receive interventions, like carotid endarterectomies, than men (Ramani et al. 2000). So what

applies to heart disease applies to cerebrovascular disease. This also applies to some

acute conditions, for instance, women are more likely to die from hospital-acquired

pneumonia than men (Crabtree et al. 1999).



Gender and Ethnicity in Health

Efforts to determine the efficacy and safety of medications have played out differently for men and women. In ascertaining therapeutic effectiveness or appropriate doses, research subjects in clinical trials are more likely to be male. The United

States Food and Drug Administration (FDA) policy from 1977 to 1993 was to

exclude women of child bearing potential from phase 1 and phase 2 trials (Pinnow

et al. 2009). Phase 1 trials are designed to screen for safety and phase 2 trials are to

demonstrate effectiveness. Even with the reversal of this policy women are still

underrepresented in phase 1 and 2 trials and some trials for drugs to treat conditions

that occur in men and women are conducted only on men (Pinnow et al. 2009). The

problem here is that for various pharmacokinetic and physiological reasons there

are differences by gender in responses to drugs, so excluding one gender from clinical trials may mean that issues of safety and effectiveness are missed.

Systemic issues related to social and political organization play an important part

in gendered differences in the experience of illness. In a study based on twenty-five

European countries Van de Velde and colleagues found that in jurisdictions with

greater levels of macro-gender equality, measured by such things as women’s economic participation, power over economic resources and political participation,

men and women equally benefitted with lower levels of depression. But there was

some complexity here in that different outcomes applied to different circumstances.

For example, in a jurisdiction where there were high levels of gender equality in

power over resources, such as equality in income, this equality benefitted women

who were not in traditional roles, such as not cohabiting and being in paid employment. The converse implication, Van de Velde and colleagues (2013) argue, is that

women who do not conform to traditional roles in societies of low equality in power

over resources will have higher levels of depression.

In understanding different health outcomes by gender structural, institutional and

interpersonal factors play a part. It is to the last of these that we now turn to inform

our understanding of health inequalities in general.


Interpersonal Impacts on Health Inequalities

It has been shown that different social groups get different outcomes and interactions with health personnel when accessing and using health services. There are

many reasons why health professionals might respond to or interact with patients


In order to deal with the massive amount and complexity of information we confront in our daily lives we all categorize and stereotype (van Ryn and Burke 2000).

We assign people to a particular group, and we associate particular groups with

certain characteristics. Categorizing people is an everyday activity – but it is also an

activity that occurs in institutional settings such as the clinical encounter. It may be

even more pressing for clinicians to categorize patients given the complexity of the

task. The short consultation times, or the emergency situations being dealt with,


Interpersonal Impacts on Health Inequalities


may require the need to make quick judgments about situations (van Ryn and Burke


A great deal of evidence suggests that clinicians categorize in ways that may at

times be inappropriate. Research undertaken at New York State hospitals revealed

that clinicians were more likely to perceive African American patients with coronary artery disease as “at risk for noncompliance with cardiac rehabilitation, substance abuse, and having inadequate social support” and clinicians reported “less

affiliative feelings toward African American patients” (van Ryn and Burke 2000,

821). African Americans were perceived as being less rational, less intelligent and

less pleasant than whites and were rated as less educated than whites even at the

same levels of educational attainment. Similarly patients with lower socio-economic

status were more likely to be seen by clinicians as having responsibility for the care

of family members than patients with higher socio-economic status. This attitude

persisted even when the researchers controlled for dependent family members (van

Ryn and Burke 2000). Clinicians had more positive perceptions of white and higher

class groups than African American and lower class groups, and associated different

activities with these groups.

Categorizing can then be influenced by the cultural representations that are available to us, which tell us something about the social norms that we are influenced by

and how those social norms are reinforced. Another illustration of this is research on

medical advertising which showed that in advertisements for cardiovascular medications in medical journals by far the majority of users of the drugs portrayed in the

advertisements were male, whereas in advertisements for antidepressants by far the

majority of users of the drugs were portrayed as female (Curry and O’Brien 2006).

The advertisements aimed at clinicians drew on stereotypes discussed above in relation to anxiety or mental health problems being associated with women and heart

problems being associated with men for the same symptoms, and by doing so the

advertisements reinforce those stereotypes.

Cultural representations and assumptions about risk intermingle. In vignette

studies of primary care doctors’ diagnosis of coronary heart disease (CHD) women

patients were asked fewer questions than men (Arber et al. 2004), were less likely

to receive components of a physical examination than men (McKinlay et al. 2007)

and physicians were more certain of a CHD diagnosis for men compared to women

(Lutfey et al. 2010). Physicians treated a demographic variable – gender – as a diagnostic feature that lowered the risk of CHD. This occurred in a situation where the

presentation of symptoms by the men and women actors in the vignettes was the

same (Lutfey et al. 2010). An explanation for this is that physicians had prior

assumptions about risk that overrode presenting symptoms in the determination of

the diagnosis.

In medicine, statistical discrimination is where a health professional applies a

“reasonable decision making rule” that leads to unequal treatments of different

groups (Balsa and McGuire 2001, 881). Physicians draw on statistical averages or

their previous experience of a set of symptoms with people from a particular group

(gender, ethnicity, social class and age being obvious groupings) (Lutfey et al.

2010). If research indicates that people with a particular characteristic are less likely



Gender and Ethnicity in Health

to comply with a particular drug regime then the physician is less likely to prescribe

that drug regime to a patient who has that particular characteristic (Balsa and

McGuire 2001). The characteristic may be related to age, gender, ethnicity or some

other variable. Where there is uncertainty about a diagnosis and the prevalence of

illness is higher or lower in a particular group, that prevalence rate might have an

important influence on health care decision making (Balsa et al. 2005). The reliance

on disease statistics in diagnosis may become more prominent if the physician finds

the patient difficult to understand. In this instance the noise of the miscommunication may sharpen the focus on the signal provided by prior research on probabilities

and risk profiles (Balsa et al. 2005). That is, in situations of diagnostic uncertainty

in relation to the individual patient the health professional is more likely to make a

diagnosis on the basis of statistics about the particular group that the patient can be

categorized as belonging to. The health professional is using a reasonable decision

making rule.

The social distance between the physician and the patient can have a bearing on

the interaction between them. For example, physicians tend to perceive working

class patients as not seeking a role in decision-making and having a limited capacity

to understand health information (Davies and Elwyn 2008). Middle class patients

with higher levels of education may deal better with bureaucratic organizations and

be more assertive in consultations (Arber et al. 2006). The capacity of middle class

people to better negotiate the healthcare system relates to their level of cultural capital. Cultural capital is a kind of resource that accrues to people in the early stages of

socialization. It provides them with the skills and knowledge that they draw on, but

do not have to be conscious of (Bourdieu 1986). Patients with more privileged backgrounds accrue more cultural capital and so are more likely to get their views across

in the consultation.

The concept of aversive racism has been used to explain why clinicians treat

patients from other ethnic groups differently. Aversive racism occurs when dominant groups avoid interactions with subordinate groups (Smedley et al. 2003).

Aversive racism may occur amongst individuals who hold on to liberal values,

including wanting to overcome and combat racism, but at the same time are uncomfortable or uneasy around members of a different ethnic group. If we translate this

to the health setting, this may mean being ill at ease with the social chit-chat that

provides important opportunities for the clinician to establish trust and communication lines, and to informally assess a patient’s condition.



Social inequality is not simply about assets and wealth. Histories of slavery, migration and colonization have on-going effects, as do histories of gender discrimination

and patriarchy. Men and women do not have the same experience of health or interaction with the health system. To understand this we need to consider processes of

socialisation and explore the impact of patriarchy. Being alert to the complex



interactions between ethnicity, gender and other forms of social stratification and

health outcomes makes it clear that we must go beyond blaming individuals for their

poor health and instead apprehend what aspects of social organization are having

unwanted and unjust health effects. When considering aspects of social organization

our brief is wide-ranging, involving reflection on the impacts of everyday interactions in health encounters through to understanding the systemic features of social

organization that foster forms of discrimination and oppression.


Arber, S., McKinlay, J., Adams, A., Marceau, L., Link, C., & O’Donnell, A. (2004). Influence of

patient characteristics on doctors’ questioning and lifestyle advice for coronary heart disease:

A UK/US video experiment. British Journal of General Practice, 54(506), 673–678.

Arber, S., McKinlay, J., Adams, A., Marceau, L., Link, C., & O’Donnell, A. (2006). Patient characteristics and inequalities in doctors’ diagnostic and management strategies relating to CHD:

A video-simulation experiment. Social Science & Medicine, 62(1), 103–115.

Australian Institute of Health and Welfare. (2011). Life expectancy and mortality of Aboriginal and

Torres Strait Islander people. Canberra: Australian Institute of Health and Welfare.

Balsa, A., & McGuire, T. (2001). Statistical discrimination in health care. Journal of Health

Economics, 20(6), 881–907.

Balsa, A., McGuire, T., & Meredith, L. (2005). Testing for statistical discrimination in health care.

Health Services Research, 40(1), 227–252.

Bartley, M., & Head, J. (2007). Resilience and change: The relationship of work to health. In

A. Scriven & S. Garman (Eds.), Public health: Social context and action (pp. 48–59).

Maidenhead: Open University Press.

Blakely, T., Tobias, M., Atkinson, J., Yeh, L. C., & Huang, K. (2007). Tracking disparity: Trends in

ethnic and socioeconomic inequalities in mortality, 1981–2004. Wellington: Ministry of


Bourdieu, P. (1986). The forms of capital. In J. Richardson (Ed.), Handbook of theory of research

for the sociology of education (pp. 241–258). New York: Greenwood Press.

Breslaw, E. (2012). Lotions, potions, pills, and magic: Health care in early America. New York:

New York University Press.

Broom, D. (2009). Gender and health. In J. Germov (Ed.), Second opinion: An introduction to

health sociology (pp. 130–155). Melbourne: Oxford University Press.

Broom, D., & Woodward, R. (1996). Medicalisation revisited: Toward a collaborative approach to

care. Sociology of Health & Illness, 18(3), 357–378.

Bureau of Labor Statistics. (2014). Census of fatal occupational injury charts, 1992–1012 (preliminary data): United States Department of Labor.

Bynum, B. (2000). Discarded diagnoses. Lancet, 356(9241), 1615.

Caplan, A. (1992). When evil intrudes. Hastings Center Report, 22(6), 29–32.

Chen, D., & Yang, T. (2014). The pathways from perceived discrimination to self-rated health: An

investigation of the roles of distrust, social capital, and health behaviors. Social Science &

Medicine, 104, 64–73.

Crabtree, T., Pelletier, S., Gleason, T., Pruett, T., & Sawyer, R. (1999). Gender-dependent differences in outcome after the treatment of infection in hospitalised patients. JAMA, 282(22),


Curry, P., & O’Brien, M. (2006). The male heart and the female mind: A study of the gendering of

antidepressants and cardiovascular drugs in advertisements in Irish medical publication. Social

Science & Medicine, 62(8), 1970–1977.



Gender and Ethnicity in Health

Davies, M., & Elwyn, G. (2008). Advocating mandatory patient ‘autonomy’ in healthcare: Adverse

reactions and side effects. Health Care Analysis, 16(4), 315–328.

Davis, P., Graham, P., & Pearce, N. (1999). Health expectancy in New Zealand, 1981–1991: Social

variations and trends in a period of rapid social and economic change. Journal of Epidemiology

and Community Health, 53(9), 519–527.

Edgar, H. (1992). Outside the community. Hastings Center Report, 22(6), 32–35.

Farrimond, H. (2012). Beyond the caveman: Rethinking masculinity in relation to men’s healthseeking. Health, 16(2), 208–225.

Feagin, J., & Bennefield, Z. (2014). Systemic racism and U.S. Health care. Social Science &

Medicine, 103, 7–14.

Feyer, A., & Langley, J. (2000). Unintentional injury in New Zealand: Priorities and future directions. Journal of Safety Research, 31(3), 109–134.

Hausken, A. M., Skurtveit, S., Rosvold, E. O., Bramness, J. G., & Furu, K. (2007). Psychotropic

drug use among persons with mental distress symptoms: A population-based study in Norway.

Scandinavian Journal of Public Health, 35(4), 356–364.

Ivory, V., Collings, S., Blakely, T., & Dew, K. (2011). When does neighbourhood matter? Multilevel

relationships between neighbourhood social fragmentation and mental health. Social Science

& Medicine, 72(12), 1993–2002.

Jones, J. (1981). Bad blood: The Tuskegee syphilis experiment. New York: Free Press.

Jones, J. (1992). The Tuskegee legacy: AIDS and the black community. Hastings Center Report,

22(6), 38–40.

Ladapo, J., & Ogedegbe, G. (2014). Do black patients with chronic kidney disease benefit equally

from all blood pressure lowering agents? British Medical Journal, 348, g142.

Lorber, J. (1997). Gender and the social construction of illness. Thousand Oaks: Sage.

Lutfey, K., Eva, K., Gerstenberger, E., Link, C., & McKinlay, J. (2010). Physician cognitive processing as a source of diagnostic and treatment disparities in coronary heart disease: Results of

a factorial priming experiment. Journal of Health and Social Behavior, 51(1), 16–29.

McKinlay, J., Link, C., Freund, K., Marceau, L., O’Donnell, A., & Lutfey, K. (2007). Sources of

variation in physician adherence with clinical guidelines: Results from a factorial experiment.

Journal of General Internal Medicine, 22(3), 289–296.

Nazroo, J., Edwards, A., & Brown, G. (1998). Gender differences in the prevalence of depression:

Artefact, alternative disorders, biology or roles? Sociology of Health & Illness, 20(3),


Norris, P., Horsburgh, S., Lovelock, K., Becket, G., Keown, S., Arroll, B., Cumming, J., Herbison,

P., & Crampton, P. (2011). Medicalisation or under-treatment? Psychotropic medication use by

elderly people in New Zealand. Health Sociology Review, 20(2), 202–218.

Pearson, D. (2001). The politics of ethnicity in settler societies: States of unease. Houndmills:


Pinnow, E., Sharma, P., Parekh, A., Gevorkian, N., & Uhl, K. (2009). Increasing participation of

women in early phase clinical trials approved by the FDA. Women’s Health Issues, 19, 89–93.

Ramani, S., Byrne-Logan, S., Freund, K., Ash, A., Yu, W., & Moskowitz, M. (2000). Gender differences in the treatment of cerebrovascular disease. Journal of the American Geriatrics

Society, 48, 741–745.

Rees, P., & Wohland, P. (2008). Estimates of ethnic mortality in the UK: Working paper 08/04.

Leeds: The University of Leeds.

Salmond, C., & Crampton, P. (2000). Deprivation and health. In P. Howden-Chapman & M. Tobias

(Eds.), Social inequalities in health: New Zealand 1999 (pp. 9–63). Wellington: Ministry of


Smedley, B., Stith, A., Nelson, A., & Committee on understanding and eliminating racial and ethnic disparities in health care. (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington DC: The National Academies Press.

Therborn, G. (2006a). Meaning, mechanisms, patterns, and forces: An introduction. In G. Therborn

(Ed.), Inequalities of the world: New theoretical frameworks. multiple empirical approaches

(pp. 1–58). London: Verso.



Therborn, G. (2006b). Preface. In G. Therborn (Ed.), Inequalities of the world: New theoretical

frameworks, mulitple empirical approaches (pp. xiii–xviii). London: Verso.

Van de Velde, S., Huijts, T., Bracke, P., & Bambra, C. (2013). Macro-level gender equality and

depression in men and women in Europe. Sociology of Health & Illness, 35(5), 682–698.

van Ryn, M., & Burke, J. (2000). The effect of patient race and socio-economic status on physicians’ perceptions of patients. Social Science & Medicine, 50, 813–828.

Weisz, D., Gusmano, M., & Rodwin, V. (2004). Gender and the treatment of heart disease in older

persons in the United States, France and England: A comparative, population-based view of a

clinical phenomena. Gender and Medicine, 1(1), 29–40.

Whiteis, D. G. (2008). Poverty, policy and pathogenesis: Economic justice and public health in the

U.S.A. In J. Green & R. Labonté (Eds.), Critical perspectives in public health (pp. 66–78).

Abingdon and New York: Routledge.

Williams, D., Bennett, K., & Feely, J. (2003). Evidence for an age and gender bias in the secondary

prevention of ischaemic heart disease in primary care. British Journal of Clinical Pharmacology,

55(6), 604–608.

Chapter 5

The Health of Indigenous Communities

Abstract Indigenous peoples in all settler societies have poorer health outcomes

than settler groups. This chapter outlines the history of colonization in settler societies, the role of the state in controlling and disenfranchising indigenous peoples, and

the health disparities that are a result of this historical legacy. Various examples of

indigenous communities are used, including those in North America and New

Zealand, with a detailed case study of indigenous life in Australia. The chapter

addresses various explanations for why health disparities continue to exist between

indigenous and settler populations, as well as the evolution of a range of health

initiatives to try to mitigate these disparities.

Keywords Health of indigenous peoples • Colonization • Australia • Historical

trauma • Indigenous health practices • Traditional healing • Cultural competence



Between the fifteenth and nineteenth centuries European states embarked on an

unprecedented process of imperialist expansion. Millions of migrants moved from

Europe to the Pacific and to the continents of Asia, Africa and the Americas. This

massive settlement of non-indigenous groups, known as colonization, led to the

establishment of what have been called settler societies with political domination

over indigenous peoples (Pearson 2001). There are a number of terms in English

that are used as labels for those people who inhabited the lands that were to become

the new homes of settlers: aboriginals, natives, indigenes, first nations’ peoples and

other terms. Terms take on particular connotations in different settings and at different times. In this chapter a variety of terms will be used that are deemed most appropriate by contemporary authors in referring to these people who found themselves a

minority in their own lands.

This chapter will touch upon the experiences of a variety of indigenous communities but in order to provide some limits on the discussion there will be a focus on

those nation-states where the Anglo-Celtic diaspora played a significant role, particularly in North America, Australia and New Zealand. Indigenous communities in

all settler societies have poorer health outcomes than settler groups in those societies.

© Springer International Publishing Switzerland 2016

K. Dew et al., Social, Political and Cultural Dimensions of Health,

DOI 10.1007/978-3-319-31508-9_5




The Health of Indigenous Communities

This chapter describes the history of colonization in settler societies and its consequences for the health of indigenous populations, as well as some of the efforts

made to ameliorate the impacts of colonization.


The Colonized Experience

Although indigenous communities across geographical areas differ markedly in

their social structures, physical environments and encounters with settlers, there are

also a number of similarities in their experiences, particularly land dispossession

and population loss. The two phenomena intertwine, and cause and effect could

work in both directions. Population loss could lead to land dispossession or land

dispossession could lead to population loss. Land dispossession was also facilitated

by particular legal and political strategies. Direct military aggression in the shape of

major battles between the indigenes and the professional armies of the colonists

occurred in New Zealand and the United States as indigenes attempted to resist land

dispossession, but not in Canada where there was a long history of economic and

political alliances prior to mass settlement, or in Australia where skirmishes and

raids were smaller in scale (Pearson 2001).

Land dispossession could be facilitated by the impact of diseases and deterioration in health of indigenous populations. As Breslaw (2012) notes, in the early

1600s populous native American villages on the north eastern coast of America that

had kept potential colonizers at bay became deserted as a result of an unidentified

plague (possibly smallpox) killing 90 % of the population. These newly emptied

spaces became a first home for the Pilgrims as the colonizers gained a foothold in

North America. The Pilgrims believed that God had cleared the land of inhabitants

for them to occupy. Having no immunity to diseases like smallpox, measles, influenza, chicken pox and whooping cough meant adults and children were affected by

these diseases, leaving few in the community able to care for the sick, and this in

turn was exacerbated by a lack of knowledge about how to respond to these new

forms of disease, with no concept of contagion or quarantine being available. So the

death toll from these introduced diseases could be extremely high (Breslaw 2012).

With increasing colonization the stress of displacement and a range of ecological

changes such as alterations in land use, introduction of pests and so on exacerbated

health problems for native Americans (Breslaw 2012).

A century before this devastation to the communities on the north eastern coast

of America an epidemic devastated the Aztecs, facilitating the Spanish conquest of

Mexico (Breslaw 2012). This obliteration of thriving communities throughout

America was a common experience, with an estimate of 95 % of the American

Native population dying within the first 100 years of Spanish exploration (Breslaw

2012). For the Spanish the high death toll of American Indians meant a loss of

workers, and this led to the development of slave labour from Africa to fill the gap

(Breslaw 2012).

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