Otago-led review finds Indigenous peoples define health through five themes

The design matters for what these findings can carry. The paper is titled as a systematic review of definitions ^[4], so its unit of evidence is a statement of what health means, and its output is a set of five recurring themes ^[3] drawn from Aotearoa, Australia, Canada, the mainland US and Hawai'i ^[2]. That design fits the question of what Indigenous definitions contain. It fits less well the claim phys.org leads with, that the mismatch is "leading health systems to fall short in caring for vulnerable communities" ^[1]. A review of definitions cannot measure the size of that shortfall or say which systems show it.

Set the five themes beside the WHO wording and the overlap is partial. The definition, as Gemmell-Sinnott quotes it, is "a state of complete physical, mental and social well-being, not just the absence of illness" ^[5]. Holistic well-being and relationships sit nearest to that. Cultural knowledge, connection to land and self-determination fall outside its wording. That comparison is ours, drawn from the WHO wording and the five themes as reported.

Gemmell-Sinnott said the definition "doesn't reflect how Indigenous people define and view health" ^[7]. Her argument for why the wording has aged is about what changed around it. She said: "The definition hasn't changed in 80 years, but the global understanding of the burden of disease has transformed, the evidence base for structural determinants of health has grown substantially, and international human rights frameworks have been reoriented toward self-determination." ^[6] Self-determination is also one of the five themes ^[3], so one of her three developments and one of the review's findings point the same way.

"This is not about whose knowledge is more valid, but a recognition that not all people understand or experience health and well-being through the same lens," she said. ^[8]

The release did not disclose how many studies the review included, how the themes were derived, or any indicator set or health system that has tried what she proposes.

In our view, the themes as reported support the case that Indigenous definitions and the WHO's differ in emphasis. The case that systems built on the WHO wording underserve these communities as a result needs outcome comparisons, a different kind of evidence from a review of definitions.