Barriers to Optimal Kidney Health Among Indigenous Peoples

Indigenous communities, peoples, and nations are groups of people in a particular country or region who maintain a historical continuity with their culture, and traditional ways of life that predated precolonial invasions on their territories, with a determination to preserve and transmit such cultural norms for future generations. The United Nations estimated that over 476 million people identify as Indigenous, spread across 90 countries from the Arctic to the South Pacific accounting for nearly 6.2% of the total global population.1 Indigenous peoples are heterogenous in sociocultural distributions constituting over 5000 distinct sociocultural groups across the world.

Despite the sociocultural heterogeneity, they face similar health challenges regarding burden of disease, access to and quality of healthcare, and often suffer worst outcomes compared to their non-Indigenous counterparts. For example, Indigenous peoples have higher burden of chronic diseases, including type 2 diabetes mellitus, cancer, chronic lung disease, and chronic kidney disease (CKD) resulting in increased morbidity and shorter life span.1 The risk, burden, and outcomes of kidney disease are suffered disproportionately by Indigenous peoples who are subjected to many adverse social determinants of health besides suffering from the ongoing destructive impact of colonialism in some settings. A call to action to reduce kidney disease risk and improve outcomes among Indigenous peoples around the world is imperative. Kidney care services targeted to disease risk reduction and enhanced access to optimal care need to be culturally appropriate and acceptable to Indigenous peoples whose world view of health and wellbeing tends to be more holistic and culturally intertwined than the typical western concepts of illness. Several initiatives have been launched around the world to meet this goal. We present perspectives from 3 national territories as examples of these efforts to further draw global attention on the emergent need for high quality kidney care delivery models in Indigenous communities across the globe.