Chronic respiratory disease in Indigenous peoples: a framework to address inequity and strengthen respiratory health and health care globally.

Indigenous peoples around the world bear a disproportionate burden of chronic respiratory diseases, which are associated with increased risks of morbidity and mortality. Despite the imperative to address global inequity, research focused on strengthening respiratory health in Indigenous peoples is lacking, particularly in low-income and middle-income countries. Drivers of the increased rates and severity of chronic respiratory diseases in Indigenous peoples include a high prevalence of risk factors (eg, prematurity, low birthweight, poor nutrition, air pollution, high burden of infections, and poverty) and poor access to appropriate diagnosis and care, which might be linked to colonisation and historical and current systemic racism. Efforts to tackle this disproportionate burden of chronic respiratory diseases must include both global approaches to address contributing factors, including decolonisation of health care and research, and local approaches, co-designed with Indigenous people, to ensure the provision of culturally strengthened care with more equitable prioritisation of resources. Here, we review evidence on the burden of chronic respiratory diseases in Indigenous peoples globally, summarise factors that underlie health disparities between Indigenous and non-Indigenous people, propose a framework of approaches to improve the respiratory health of Indigenous peoples, and outline future directions for clinical care and research.

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Déclaration de conflit d'intérêts

Declaration of interests ABC reports multiple grants related to studies on Indigenous children's lung health to her institution from the Australian National Health and Medical Research Council (NHMRC); she is also the lead author of several point-of-care manuals and educational resources related to Indigenous children's lung health, for which no payments have been received. TK reports personal fees for advisory board membership from Covis Pharma Canada. GJR reports payment of a training grant to his institution from the US Maternal and Child Health Bureau of the Health Resources & Services Administration; he is also an editor of the paediatric pulmonology section of UpToDate. GGA reports a grant for a study on Indigenous lung health to his institution from the Canadian Institute of Health Research. MT reports multiple grants related to studies on Indigenous health to her institution from the NHMRC; she also established two Aboriginal-controlled primary health-care services. PJT reports multiple grants related to studies on Indigenous lung health to his institution from the NHMRC; he is also the medical director of an Aboriginal-controlled primary health-care service and has co-authored point-of-care manuals and educational resources related to Indigenous lung health, for which no payments have been received. DMG reports grant funding and consulting fees from the Wellcome Trust, unrelated to this manuscript, and support for attending conferences from the Pan African Thoracic Society; she is also Treasurer of the Pan African Thoracic Society Executive Committee. All other authors declare no competing interests.