Why Do We Have Poor Health? How Colonialism Continues to Marginalise Indigenous Peoples

Written by Wasiq Silan.

Image Credit: 泰安鄉 by Chia Ying Yang/ Flickr, license: CC BY 2.0.

Despite the varying colonial histories with Indigenous peoples in other parts of the world, Indigenous people in Taiwan have one disturbing issue in common: poor health. Among other indicators (such as maternal mortality, birthweight, malnutrition, obesity and so on), Indigenous peoples in Taiwan die almost a decade sooner than the general population. 

Why this disparity? We are taught to believe the argument that blames Indigenous peoples for their own high-risk behavioural choice, lack of awareness, low educational attainment, and dysfunctional families; closer examination shows that we need to look beyond the individual level. Indeed, Māori health researchers Papaarangi Reid and Bridget Robson have noted that the weight of colonisation and ongoing colonial impacts have led directly to Indigenous health inequalities. In other words, colonialism should be included as a social determinant of Indigenous health. Taking elderly care as an example, my article delves into policies and practices of elderly care for the Indigenous peoples to explore the broader picture behind the stigmatised image and how colonialism plays a role in determining Indigenous health. 

Reclaiming Name Transforms: My Methodological and Theoretical Positioning 

This article is linked with breathing life into my Indigenous identity and name as a Tayal. In practice, I journey from the westernised name Grace to re-centring I-An, the name in Mandarin Chinese given by my parents, and reclaiming Wasiq, the Tayal name given by my grandmother. The article is not merely an intellectual expedition about Indigenous resurgence and elderly care for Indigenous peoples, but also it is an awakening transformation that changes me as a Tayal researcher.

By re-locating my standpoint at the level of the Tayal community, my article utilises the Tayal hermeneutics–a holistic way of being based in the Tayal law called Gaga–as a critical lens informed by the Indigenous research paradigm to examine the discrepancy between the policy and practices in elderly care cases. Therefore, by incorporating Bacchi’s method of “problematisation,” I discuss how these policies create problems when they define and propose “better solutions.” For example, I have analysed elsewhere that Taiwan’s policies frame disadvantaged indigenous health as a structural problem of insufficiencies in medical and health resources. In addition, the media representation emphasises Indigenous peoples’ behaviour as a risk to their own worse health status. By focusing on how problems are constituted and brought into existence, the issue of power, ideology, and language could be better reflected. Indigenous peoples have been treated as mere research objects and the embodiment of “the problem” itself. That explains why the word research triggers pain and anxieties linked to colonialism.

Instead of studying elderly care as an indifferent outsider, my research design aims to develop an alternative discourse responsive to the lives and everyday experiences of the Bnkis, Tayal Elders. To do that, I followed in my grandmother’s footsteps by going to a “Day Club” to promote the health and well-being of her community. The Day Clubs are a government-funded project launched by the Council of Indigenous Peoples (CIP) as a response to providing culturally sensitive care for the Indigenous elders. In the Tayal territory, local churches often run the Day Clubs with extended assistance from volunteers. Growing from 40 Day Clubs in 2006 to 430 Day Clubs in 2020, the Day Clubs have been touted by Taiwan to be a panacea to solve long-term care problems for the disabled Indigenous elderly. The process of (re)negotiating my way back to my community marked an initiation of reclaiming my name through rebuilding relationships. Why is it needed? Doing research in Indigenous communities is based on an intricate web of relationships. It is not simply “enter the field,” “recruit participants,” and “collect data.” 

By taking part in the day club activities, I learned the importance of being patient, diligent, and humble, and I gradually became more acquainted with the Tayal culture and language, being and knowing. It could be added that during the period of participant observation, I was inspired by an indigenous method called “Dadirri” used by the Ngangikurungkurr people of Daly River in Northern Territory, Australia. In practical terms, she adapted and embraced the lifestyle and rhythm of life of the Bnkis and tried to understand as much as possible about their perceptions and relations with humans, mountains, rivers, and landscapes by listening and observing in a non-intrusive way.

Ongoing Colonialism Versus Living Tayal Culture.

After six years of doctoral research, I have three main conclusions presented as three framing strategies evident in the elderly care policies: the frame of secludedness, the frame of inadequacy, and the frame of culture. Generally, elderly care policies in Taiwan continue to avoid its colonial past (and present); in doing so, it makes the relationship between the state and the Indigenous peoples unequal. 

In the frame of secludedness, the problem of elderly care for Indigenous peoples is represented as a logistical challenge of sending care resources to remote and isolated areas where Indigenous peoples live. Consequently, the kind of care the elderly need is compartmentalised by the location where care is given, e.g., home, community, or institution. What this frame creates is a depoliticised task of resource distribution in which Indigenous peoples are victims. The frame of inadequacy sees the problem of elderly care for Indigenous peoples as a matter of their unqualified skillset for providing professional care for the elderly and incompetence in purchasing care services in the Indigenous areas. Indigeneity is represented as an undesirable quality, as Indigenous peoples are suggested to be deficient in the appropriate kind of knowledge and skills to care. In this frame, care comes from outside the Indigenous community from places with “adequate care skills.”

Last but not least, the frame of culture tackles the problem of the absence of culturally sensitive care. The issue of culture is addressed as a critical component of delivering care for the tribal elders. The Indigenous elderly are represented through a lens of a racialised minority-ness. They are frozen into authentic and culturally rich elders. Cultural competence and cultural sensitivity, in the same vein, are being fixed to the core of best practice. Interestingly, at the same time, the meaning of culture in this frame has been stretched to include a resurgence of tribal subjectivity (buluo-ism). Contrary to the depoliticised and victimising stance of the previous two frames, the frame of culture creates space where Indigenous peoples can act and find solutions on their own. But the question raised is that indigeneity is represented as a homogenised category. Hence, it foreshadows how the state will set terms for its relationship with Indigenous peoples in the future.

These are the state’s lenses to create and produce the “Indigenous problem.” However, the analysis of the “Indigenous problem” in the policy documents has demonstrated that the problem of elderly care has become a matter of Indigenous peoples’ secludedness, incompetence and their authentic culture. 

Second, my research with the Bnkis in the Day Club has shown that the state’s ideal way of care generates an uneasy tension among the intermediaries (care workers) and the Bnkis in the Day Club. The tension arises because the idealised “tribal care” promoted in the Day Club turns a blind eye to fluid, contextual and living Tayal culture that gives form to the kind of care that the Bnkis prefer.

Third, I underline that today’s Taiwanese society seeks to deal with questions arising from “multiculturalism” that has always been there. But, no matter how multicultural Taiwan has claimed to be, the approach to accommodating Indigenous elders still derives from a middle class, urban, Han-Chinese norm. It individualises, generalises, and medicalises what care ought to be, and marginalises Indigenous elders’ view of good care.

Towards a Shared Tomorrow

My article utilises elderly care as an example to demonstrate that these imbalanced state-Indigenous power relations have relevance to the implementation of social policy. These state-Indigenous relationships reflect the histories of marginalisation, nullification, and negligence by the state. Moreover, care policy for the Indigenous elderly manifests an ongoing colonial legacy. Therefore, we need more Indigenous-led projects to shed light on how Indigenous knowledges and onto-epistemologies may play a role in policies. Ultimately, it is relevant to heal the trauma caused by colonialism in contemporary Taiwan. This has global relevance to the Indigenous rights worldwide: conceptualising and elevating the Indigenous ways of knowing is a prerequisite for a meaningful future partnership between Indigenous peoples and the state.

Wasiq Silan (I-An Gao) is a descendent of the Tayal People from the northern region of Taiwan and she completed her PhD in 2021 at the University of Helsinki. She is working as a postdoctoral researcher in a research project Coming of age in Indigenous communities: Ageing, quality of life and home-based elderly care in Sápmi and Atayal region (2019-2022), funded by the Norwegian Research Centre. She is currently affiliated to the Centre for Research on Ethnic Relations and Nationalism (CEREN).

This article is published as part of a special issue on Health Justice in Diversity.

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