Being sorry is not enough: the sorry state of the evidence base for improving the health of indigenous populations

Indigenous people worldwide experience worse health outcomes than other population groups on measures such as life expectancy, death rates, and years of life lost (i.e., premature deaths). The historical underpinnings of this trend can be seen in the devastating effects of colonization on health outcomes for indigenous people, highlighting the urgency needed in providing effective health interventions. Differences in health policy and in social, economic, cultural, geographic, and institutional factors also contribute to disparities in health outcomes. To improve the health of indigenous populations, multiple strategies are needed to deal with the complexities of health inequity, taking into account all of these determinants. Awareness is increasing of the need for an evidence-based rather than an opinion-based approach to improving the health of indigenous populations. As the Cochrane Collaboration states: “Evidence-based health care is the conscientious use of current best evidence …” involving “information from relevant, valid research …”. Unless an evidence-based approach is taken, there is justifiable concern that ineffective strategies will be implemented, resulting in little improvement in health outcomes