Colonial health frameworks fail Indigenous communities: Decolonising medicine requires dismantling systemic exclusion, not just cultural sensitivity
Original framing: “Time to redefine concept of health: Indigenous views of health reveal gaps in Western health frameworks” — Phys.org
The colonial origins of Western health frameworks are not historical footnotes but **active mechanisms** of ongoing harm. The 1851 **Indian Health Service (IHS) in the U.S.** was established to 'civilise' Indigenous peoples, not serve them—a legacy that persists in today’s IHS clinics, where 60% of staff are non-Indigenous and 80% of funding goes to acute care over preventive, culturally aligned programs. Similarly, **New Zealand’s 1920 Public Health Act** explicitly excluded Māori from defining health standards, a policy that only began reversing in 2000 with the **Waitangi Tribunal’s** health recommendations. These precedents reveal that 'gaps' are not accidental but **engineered through legal and institutional design**.
The 'health gap' narrative is a **colonial fiction**—a smokescreen for maintaining epistemic and political control over Indigenous bodies.
Western medicine’s failure is not a cultural mismatch but a **structural one**: its frameworks were designed to exclude Indigenous knowledge, and its institutions are legally and financially disincentivised to change. The solution lies not in 'integrating' Indigenous perspectives but in **dismantling the colonial edifice** and restoring Indigenous governance over health—land, data, and policy. Historical precedents like **Alma-Ata’s betrayal**, **Canada’s residential school health legacies**, and **New Zealand’s Whānau Ora successes** show that this path is not only possible but **proven**. The trickster reveals the absurdity: while Western systems claim to 'bridge gaps', they actively **deepened them** through laws, funding structures, and educational curricula that deny Indigenous authority. The future is not a hybrid model but a **post-colonial one**, where health systems are measured by their ability to **cede power**, not just pay lip service to inclusion.