[Difficulties and Policy Recommendations Related to the Deployment of Long-Term Care Resources in Taiwan`s Indigenous Areas].

Changes in the demographic structure in Taiwan have increased the need for long-term care (LTC). Person-centered and community-based care is being advocated. The need to address the specific LTC needs of Taiwan`s indigenous peoples has been a part of national LTC policy since National Long-term Care Plan 2.0 was adopted in 2015. The provision of LTC services and the deployment of related resources in indigenous areas generally lag behind Taiwan`s other areas. Potential reasons for this disparity include lack of in-charge, dedicated units; exclusive use of normative service models in indigenous areas; and conflict between talent cultivation and rooted development. Future policy should focus more on providing cultural care in indigenous areas and on offering more flexible and diversified development possibilities. The implementation of these policies may promote the development of LTC and the successful deployment of LTC resources in Taiwan`s indigenous regions.

Use of traditional and alternative healers by psychiatric patients: A descriptive study in urban South Africa.

This study investigates the pattern of use of traditional and alternative healers among psychiatric patients in Nelson Mandela Metropole. An interview schedule was applied to 254 subjects at six sites, enquiring about consultations with traditional and alternative healers in the past year. Multivariate analysis was performed to determine predictors of consultation. Overall, 78 (31%) of respondents had consulted a healer in the past year. The ethnic distribution was: 156 (61%) Black, 53 (21%) Coloured (Mixed Race), 42 (17%) White and three (1%) Indian. The male to female ratio was 119 (46.85%):135 (53.14%). The healers gave no advice about psychiatric medication to 48 (61.5%) of consulters, 23 (29.5%) were told to continue their medication, four (5.1%) told to stop, and one (1.3%) told to stop and restart later. In multivariate models, predictors of consultation were being Black and of lower education. Although 45 (58%) of the consulters indicated that medical treatment was more helpful than the healer's, 45 (58%) intended to consult again. Overall, 22% of consulters reported abuse by the healer.

Interview with the Hon. Ken Wyatt: improving Indigenous health outcomes from a political viewpoint.

In 2017, Australia celebrates 50 years since the 1967 referendum, when more than 90% of Australians voted to amend the constitution to allow the national government to create laws for Indigenous people and include them in the census. We spoke with the Honourable Ken Wyatt, the Minister for Indigenous Health and the Minister for Aged Care, about what has occurred over the past 50 years in Indigenous health from a political perspective, and what we have learnt to improve health outcomes in the future.

Improving maternity services for Indigenous women in Australia: moving from policy to practice.

The well established disparities in health outcomes between Indigenous and non-Indigenous Australians include a significant and concerning higher incidence of preterm birth, low birth weight and newborn mortality. Chronic diseases (eg, diabetes, hypertension, cardiovascular and renal disease) that are prevalent in Indigenous Australian adults have their genesis in utero and in early life. Applying interventions during pregnancy and early life that aim to improve maternal and infant health is likely to have long lasting consequences, as recognised by Australia's National Maternity Services Plan (NMSP), which set out a 5-year vision for 2010-2015 that was endorsed by all governments (federal and state and territory). We report on the actions targeting Indigenous women, and the progress that has been achieved in three priority areas: The Indigenous maternity workforce; Culturally competent maternity care; and; Developing dedicated programs for "Birthing on Country". The timeframe for the NMSP has expired without notable results in these priority areas. More urgent leadership is required from the Australian government. Funding needs to be allocated to the priority areas, including for scholarships and support to train and retain Indigenous midwives, greater commitment to culturally competent maternity care and the development and evaluation of Birthing on Country sites in urban, rural and particularly in remote and very remote communities. Tools such as the Australian Rural Birth Index and the National Maternity Services Capability Framework can help guide this work.

[A Reflection on the Policy of Transcultural Long-Term Care for the Indigenous Peoples in Taiwan].

Giving high-profile attention to socio-cultural and traditional beliefs in the promotion of long-term care policies enjoys strong, consensus support in the field of transcultural nursing. To protect the rights of indigenous people in Taiwan, the Ministry of Health and Welfare incorporated the concept of cultural care into the Long-term Care Services Act, which was approved by the Legislature in May 2014. However, the policies, resource strategies, manpower allocations, and staff educations and trainings related to this act are still await implementation in indigenous areas. Beyond the concept of professional healthcare, which considers cultural sensitivity, suitability, and ability, cultural care gives greater priority to crossing cultural barriers, integrating with the lifestyle of clients, and addressing their concerns in order to improve the well-being of target populations. The present article reviews current long-term care policy to highlight the importance of considering the cultural needs of the indigenous peoples of Taiwan in order to enhance the efficiency and impact of long-term care programs. Furthermore, the findings strongly recommend that additional resources be provided in order to meet the long-term care needs of indigenous communities. Finally, cultural-specific, long-term care service strategies should be promulgated in order to upgrade well-being in order to ease and comfort the feelings of indigenous people.

The role of law in ameliorating global inequalities in indigenous peoples' health.

This article explores aspects of law's potential for ameliorating the health deficit which Indigenous peoples experience around the globe, with a focus on international law and international legal forums. It considers the challenges and benefits of using these tools and forums to affect changes within domestic systems.

Traditional healers formalised?

Traditional healers are the first to be called for help when illness strikes the majority of South Africans. Their communities have faith in their ability to cure or alleviate conditions managed by doctors, and much more. A visit to such practitioners' websites (they are up with the latest advertising technology!) shows that they promise help with providing more power, love, security or money, protection from evil people and spirits, enhancing one's sex life with penis enlargement and vagina tightening spells, etc. Contemplating such claims, it is easy to be dismissive of traditional healers. But in this issue of the SAMJ Nompumelelo Mbatha and colleagues1 argue that the traditional healers' regulatory council, promised by an Act of Parliament, should be established, followed by (or preferably preceded by) formal recognition by employers of sick certificates issued by traditional healers. Can matters be so simply resolved? What does this mean for doctors and other formally recognised healthcare professionals, and how to respond to such claims and social pressures?

History, law, and policy as a foundation for health care delivery for Australian indigenous children.

This article identifies significant historical and contemporary issues, programs, and progress to better understand the current policy in Australia relating to Aboriginal child health and well-being. A legislative perspective gives context to contemporary issues based on legally sanctioned historical practices specifically designed to make Aboriginal peoples disappear, particularly through the control and assimilation of Indigenous children.

Indigenous Australia and health rights.

Over the last decade, there has been a significant shift in public policy in relation to indigenous Australians. The new policy frameworks have been marked by an antipathy towards a policy discourse based on a human rights framework. This has also been associated with a shift from an approach based on "self-determination" to one founded on the idea of "mutual obligation". This article describes these developments in detail and considers the implications for human rights discourse.

Indigenous trauma: a New Zealand perspective.

The study of indigenous health is an emerging specialty and differs from other health disciplines in that the traditions and beliefs of indigenous people must be considered in developing health policy. New Zealand Maori and Australian Aboriginal and Torres Straight Islanders face similar health issues but have followed a different historical path. New Zealand was settled by the Maori from Eastern Polynesia in approximately 1300AD. A structured and settled society had developed by the time of British colonization in the 1800s. Because of Maori's obvious sovereignty over New Zealand the British negotiated a treaty in 1840 (The Treaty of Waitangi) with Maori that gave provision for their rights as British and later New Zealand citizens. Maori health indices suffered after the start of colonization but slowly rebounded in the 1900s linked to a resurgence in Maori culture, sporting and combat achievements. A sustained period of protest in the years following World War II has resulted in the inclusion of the provisions of the Treaty of Waitangi in legislation. Historical grievances of Maori relating to land confiscations and injustice are being addressed with formal apology and compensation. This process has allowed Maori to create their own infrastructure, to begin to develop their own health-care initiatives and to advise health-care authorities and governments on interventions to reduce health disparities between Maori and non-Maori New Zealanders.

Implications of land rights reform for Indigenous health.

In August 2006, the Aboriginal Land Rights (Northern Territory) Amendment Bill 2006 (Cwlth) was passed into law, introducing, among other things, a system of 99-year leases over Indigenous townships. The leasing scheme will diminish the control that traditional owners previously exercised over their lands. This is at odds with research indicating that control over land is a positive influence on Indigenous health.

Policies for traditional medicine in peripheral China.

This paper examines the management and practice of traditional medicine in three autonomous regions of the People's Republic of China: Inner Mongolia; Tibet; and Xinjiang. On this basis, the paper considers how established medical traditions might best be integrated into modern health care systems. It holds that indigenous forms of medicine that have been practiced successfully across many generations should be treated as different but equal within wider health care systems. China has made important progress toward this ideal but, at the same time, has quite a long way to go. It is highly recommended that Chinese policymakers increase their efforts to give all established traditional medicines different but equal status within regional health care systems.

Intellectual property rights and traditional medicine: policy dilemmas at the interface.

Traditional medicines play an important role in the provision of health care in many developing countries. Their use is also significant in developed countries, increasing their commercial value. Several 'high-profile' cases of patenting of traditional medicines, without consent from or compensation to their holders, have further focussed attention on their importance. Traditional medicine usually involves biological resources and the knowledge of local and indigenous peoples and/or healers regarding their medicinal use; thus, it is interlinked with biodiversity conservation and indigenous peoples' rights over their knowledge and resources. At this multi-faceted interface, complex ethical questions arise. This article provides an overview and discussion of key issues, dilemmas and challenges. It points to possible modifications and at ways to devise new forms of intellectual property ownership that may better suit the needs of those who seek to protect traditional medicine. Yet it also questions whether such protection, which may restrict access, is the preferred option. While intellectual property protection for traditional medicines has multiple and diverse objectives, the priorities are often not clear and the strategies which could be deployed may interfere with each other, as well as with the prioritization of objectives. This is further aggravated by differences in stakeholders' concepts on ownership of knowledge and by uncertain or paradoxical effects of some potentially useful strategies. Thus, policymakers should address the multiple, multi-layered issues and questions, and try to develop a range of solutions in order to address and balance the various objectives and interests.

Type 2 diabetes and children in Aboriginal communities: the array of factors that shape health and access to health care.

The human costs of unrestrained development on our traditional territory, whether in the form of massive hydroelectric development or irresponsible forestry operations, are no surprise for us. Diabetes has followed the destruction of our traditional way of life and the imposition of a welfare economy. Now we see that one in seven pregnant Cree women is sick with this disease, and our children are being born high risk or actually sick.