Fighting from the Grassroots: Indigenous Health Justice is All About Life

Written by Yunaw Sili and Besu Piyas.

Image credit: SAM_5874 by coolloud/ Flickr, license: CC BY-NC-ND 2.0.

The story began in 2006. That year, the Council of Indigenous Peoples in Taiwan issued a guideline stating that if Indigenous students need preferential treatment for college admission, they must pass the national Indigenous language certification test. As a result, many parents were worried that their children’s access to higher education would become more difficult. Because of this issue, we started our grassroots organising work in Hanxi Village, Datong Township of Yilan County. That was the first time we engaged and coordinated with the community people on local concerns. On April 19th, 2006, we demonstrated in front of the Council of Indigenous Peoples, fighting for our youth’s college rights. 

Immediately following this – in 2007 – the community became concerned about the government’s takeover of water supplies in our ancestral domain without any consent. This was because the government broke the pipes that our elders had built-in traditional head-water sites and installed large culverts to divert water to urban areas. As a response, on June 8th, 2007, the community once again recruited locals, including the elderly, to protest against the Water Resource Agency, Ministry of Economic Affairs and Council of Indigenous Peoples. Because of these two campaigns, we could reach an agreement in the community. Therefore, we founded the Yilan County Kanke Indigenous Sustainable Development Association (YCKISDA) to deal with community issues soon. 

After YCKISDA was founded, the women among our members noticed a need for senior care in the local community. Unfortunately, most people left the community for the city due to a lack of career opportunities. Even though the Long-term Care Service Act was enacted in 2015, we noted that the Act and the related regulations still limited senior care service. The existing regulations imposed several restrictions, requiring home-care services to be provided solely to elders in their own houses. However, since most of our elders are accustomed to staying in the traditional gathering houses or farms, the regulations appear incompatible with Indigenous customs. In addition, for a long time, public long-term care services have been difficult to acquire in the most remote Indigenous community, which is why we want to create a home-care service institution run on our own. 

Furthermore, we began to organise an alliance for Indigenous long-term care services, which was officially established as the Taiwan Indigenous Long-term Care Service Rights Promotion Association in 2018, in collaboration with outside professionals, scholars, and other interest groups. Simply put, the association works on the advancement of long-term care legislation and Indigenous care issues. It comprises local organisations and Indigenous frontline practitioners from several counties and cities, including Hualien, Taitung, Yilan, Hsinchu, Taichung, Nantou, Chayi, Pingtung, and others. 

Long-term Care is an Urgent Health Issue for Indigenous Peoples

Long-term care is one of the urgent health issues confronting Indigenous peoples. Most service recipients are Indigenous elders who have inherited the most valuable wisdom from ancestors. Nonetheless, Indigenous peoples’ right to health is regularly subjected to and excluded by discriminatory policies. 

It is important to note that the Indigenous health justice issues stem from peoples’ colonial trauma. Indigenous peoples used to experience colonisers’ land looting, and it caused the Indigenous community to suffer from oppression. It even led to a loss of self-determination over our own fate and has resulted in significant internal historical trauma. Moreover, the state has long absorbed colonial ruling ideologies, resulting in the current situation in which Indigenous peoples’ autonomy over their own lives and health has not been recognised and valued. 

Unlike the narrow definitions that people have used in the past to understand what Indigenous peoples’ health is, indigenous health relates to climatic, social, environmental, geological, genetic, and cultural aspects, as well as the body, mind, and spiritual itself. When indigenous health is all about life, we should start from this idea to better understand how traumas affect indigenous health, not just mentally but physically. 

For example, while most Indigenous elders have planted millet in their inherited land since they were youngsters, climate change has recently altered their millet plantation traditions learned from their parents. As a result, many of them feel frustrated in such a circumstance, and such a mental issue is what we cannot easily ignore when we talk about indigenous health. This is one of the evident reasons we must provide Indigenous peoples with the care that is adapted to their specific concerns and procedures that allow Indigenous peoples to participate and make their own decisions. 

Fighting from the Ground Up

As members of the association that originated from the grassroots, we insist on conducting a yearly survey on local problems. Therefore, the representatives of each county and city help organise local forums and invite frontline practitioners to participate and speak out about the difficulties and hurdles they encounter with the long-term care services. After collecting all issues raised by the local practitioners, we undertake a comprehensive analysis based on this data, and use it to formulate policy demands for the year. It is also worth noting that we host several forums, symposiums, news conferences, and even petitions to the government and the general public to overcome structural difficulties with service delivery and resource deployment. 

Just as indigenous health is grounded in the land, we expect our concerns to always emerge from the grassroots. Local practitioners should lead the actions as these are the key persons to mobilise the masses to understand local needs better. To give a specific example, when people apply for long-term care services, the number of subsidies they may receive depends on whether they are low-income or low-and-middle-income. The current rule is unjust to Indigenous peoples because it ignores that land is not available for valuation when Indigenous people may inherit many lands from their ancestors. While the government includes how much land the person owns in the evaluation, the genuine poverty condition of Indigenous people cannot be revealed in this respect. As a result, some individuals cannot obtain reasonable subsidy status. 

We gathered instances with local practitioners and pushed the government in the hopes that they would amend the policy to protect the rights of elderly Indigenous people. As in the case of the subsidy status, we may examine particular concerns in regulations and policies and then file complaints and launch campaigns in various methods. This could be a means to address the structural issues while also recognising the rights of Indigenous peoples through actions. 

Aside from advocating for the indigenous long-term care campaign, we are also actively participating in a group founded this year by seven Indigenous medical, health, and social welfare-related organisations. With such a horizontal ally, we are proposing the enactment of the “Indigenous Health Law,” which may become a basic law for Indigenous peoples’ health. Articulating the voices from the grassroots, we believe that our campaign will be able to safeguard Indigenous peoples’ basic rights to health. Therefore, the majority will be aware of the health disparities that Indigenous peoples have endured since the colonial period. 

In addition to promoting the passage of the Indigenous Health Law, we are planning to draft a separate act to provide long-term care services for Indigenous peoples. This is because the existing Long-term Care Service Act is intended for all citizens regardless of their differences. Indigenous peoples should have the right to self-determination in all policies affecting them. We must enact legislation to guarantee our right to care and exercise actual autonomy in our care needs. This has been a long fight for Indigenous peoples’ health and care, and we are continually striving for the people. 

Yunaw Sili is a PhD. Student at the Department of Communication Studies in Shih-Hsin University, Taiwan.

Besu Piyas is the Executive Director at the Taiwan Indigenous Long-term Care Service Rights Promotion Association. 

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

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