摘要：Inaccuracies in the identification of Indigenous status and the collection of and access to vital statistics data impede the strategic implementation of evidence-based public health initiatives to reduce avoidable deaths. The impact of colonization and subsequent government initiatives has been commonly observed among the Indigenous peoples of Australia, Canada, New Zealand, and the United States. The quality of Indigenous data that informs mortality statistics are similarly connected to these distal processes, which began with colonization. We discuss the methodological and technical challenges in measuring mortality for Indigenous populations within a historical and political context, and identify strategies for the accurate ascertainment and inclusion of Indigenous people in mortality statistics. An accurate picture of mortality informs a society as to its social progress, because mortality is a key indicator of effective public health policies and programs. Mortality data, particularly the causes of infant and childhood mortality, also reflect a broader set of social, economic, and political issues. 1 We address the key issues underpinning an accurate assessment of the excess burden of mortality carried by Indigenous populations, and cite the experiences of these populations in Australia, Canada, New Zealand, and the United States. 2–7 We provide an overview of the gaps, challenges, and strategies to improve the accuracy of Indigenous mortality assessment within a historical context and suggest how these challenges may be addressed. Complete population ascertainment is essential to accurately define Indigenous life expectancy. Partial ascertainment of population groups results in erroneous information, most often because of the misclassification of Indigenous people as non-Indigenous. These effects are predominantly to the detriment of Indigenous popuations. 2,8 Five primary or core public health data sources are available—census, vital registration, surveillance, health care administrative or utilization data, and health survey data—and are affected by underlying challenges. In general, the challenge is about the correct, inclusive, and consistent identification of Indigenous people in all 5 sets. However, the accurate ascertainment of population births and deaths (vital statistics) is fundamental to the accurate assessment of the trends in mortality, which is the main focus of our article. Although core public health data demonstrate the changing health status of the population and enable the effects of health policies, services, and interventions to be monitored and evaluated, vital statistics data provide the numerator and denominator necessary to calculate mortality rates. Deficiencies and inaccuracies in vital statistics and other data collections impede the strategic implementation of evidence-based public health interventions aimed at preventing avoidable mortality (e.g., lack of vaccination data and avoidable accident and injury). Therefore, new strategies are required to improve data ascertainment, collection, and reporting within Indigenous populations, with more consideration given to ethical policy and methodological rigor. 8–11
