Nearly 12 years ago the United Nations Declaration on the Rights of Indigenous Peoples, itself a product of some 25 years of effort, was adopted by the General Assembly by a majority of 144 states in favour, 4 votes against,and 11 abstentions. Both Australia and New Zealand, along with Canada and the United States, voted against the Declaration. During the intervening 12 years, Australia (2009), New Zealand (2010), the United States (2010), and finally Canada (2016) have endorsed the Declaration. Article 24, Section 2 states:

“Indigenous individuals have an equal right to the enjoyment of the highest attainable standard of physical and mental health. States shall take the necessary steps with a view to achieving progressively the full realization of this right.”1

Given Australia and New Zealand have now adopted the Declaration (New Zealand also has obligations under the Treaty of Waitangi), how are the indigenous peoples of these countries faring with regard to health outcomes?

Differences in life expectancy are considered a ‘high level’ measure of health inequalities. The gap in life expectancy between Indigenous and non-Indigenous Australians in 2010–2012 was10.6 years for males and 9.5 years for females2. In New Zealand the gap in life expectancy between Māori and non-Māoriin 2013 was 7.3 years for males and 6.8 years for females3. Unsurprisingly then, when outcomes from specific diseases are considered, these are also indicative of inequalities. For example, Australia’s Health 2018 reports that coronary heart disease mortality is 2.1 times higher in Indigenous Australians, stroke 1.5 times, diabetes 4.0 times, and kidney disease 3.7 times2. The most recent statistics for Māori report coronary heart disease mortality is over 2.1 times higher, stroke over 1.5 times, cancer 1.8 times, and COPD 2.9 times3. Again unsurprisingly when it comes to risk factors for poor health there are also inequalities: Indigenous Australians are 1.2 times as likely to be overweight or obese, and 1.6 times as likely to be obese2, Māori are almost 1.3 times as likely to be overweight or obese, and 1.8 times as likely to be obese3.

These statistics are a reminder that although there have been improvements in the health of the indigenous peoples of Australia and New Zealand over time, significant inequity still exists.

Lifestyle Medicine approach provides the best opportunity to understand and address the causes of these inequities. While there is certainly merit in identifying and removing barriers to access to our contemporary medical system for indigenous people, and in creating services specifically focussed on indigenous health, unfortunately this system does not perform particularly effectively to improve the overall health of our population, regardless of ethnic origins. While the tools of our current health system are effective at preventing and treating infectious disease, the five leading causes of death for Aboriginal and Torres Strait Islander people from 2008-2017 were all chronic diseases, with the exception of suicide4(and a strong argument could be made that suicide most often results from yet another chronic disease – depression). In New Zealand, apart from suicide and motor vehicle accidents for males, the five leading causes of death for Māori and non-Māori arealso all chronic diseases3.

Our contemporary medical system is ill-equipped to address the epidemic of chronic disease. Unlike infectious disease, which almost without exception is due to the acute actions of a single infectious agent, chronic disease is due to cumulative damage from a combination of agents or risk factors. This means a system in which the standard model of care focusses on a singular agent solution is unlikely to be effective. While this model can work very well for most infectious disease, where the temporary infectious agent is removed by treatment, it does not work well at all for the chronic disease scenario where exposures can be near constant and cumulative. The current system generally offers the option of taking a medication, with various short and long-term side effects, every day, for the rest of the patient’s life. This model certainly has its advantages if your priority is to providea perpetual source of income for doctors and drug companies, and undoubtably there are benefits from a public health perspective in the small numbers of events prevented. However, from a more practical perspective, this model does not work particularly well. Even highly motivated patients will often forget to take medications – those of us who work in clinical practice will recognise it is hard enough for patients to take antibiotics as directed, even for a period of a week or less. Indeed, research suggests that approximately half of patients do not take their medications as prescribed5. Relatively recently, both aspirin and statins, two ‘blockbuster’ and comparatively highly effective agents, have moved from being recommended by guidelines for primary prevention to secondary prevention only. Intriguingly too, recent research has found that demographic factors may also be associated with increased risk of harm from medications – the risk of haemorrhagic events for patients taking the blood thinner dabigatran etexilate is significantly increased for Māori and Pacific Peoples6.

It should be clear that medicine as it is currently practiced does not hold the key to dealing with the epidemic of chronic disease in Australia and New Zealand, and nor will it ameliorate health inequities. Perhaps the most important reason contemporary medicine is proving to be largely impotent against the oncoming tide of chronic disease is because the ‘social determinants’ or ‘distal determinants’ of health are the true drivers of these conditions. Both Australia’s Health 2018 and the recent Waitangi Tribunal Report on Stage One of the Health Services and Outcomes Kaupapa Inquiryemphasise the importance of the contribution of these determinants to the health status of the indigenous people of Australia and New Zealand respectively. Indeed Australia’s Health 2018 estimates that socioeconomic factors account for over a third of the health gap between Indigenous and non-Indigenous Australians. This is still an underestimate considering there is an approximate 10.8% overlap between socioeconomic factors and ’health risk factors’ (tobacco smoking, alcohol consumption, diet, insufficient activity, and overweight and obesity), along with a 46.8% ‘unexplained component’ in their model. Adding this to what is known and accepted from a Lifestyle Medicine paradigm, namely that distal determinants of health – the physical, political, economic, and socio-cultural environments – are the true drivers of health outcomes of populations through their influence on medial and proximal determinants8, then it becomes very clear that emphasis on improving access and increased spending on indigenous health with a focus on more proximal determinants will be misplaced.

Indigenous Australians in 2016 had an employment rate of just 45%, 57% lived in rental accommodation, and 47% between the ages of 20-24 had completed Year 12 or its equivalent2. In 2013 Māori had an unemployment rate of 10.4%, 49.5% lived in rental accommodation, and 45.1% had attained school completion3. In the same year, nearly a quarter of Māori lived in the most deprived areas, compared with 6.8 percent of non-Māori3. Clearly what is needed first and foremost, if the gap is to be closed in health outcomes between indigenous and non-indigenous people in Australia and New Zealand, is real action on closing the socioeconomic gap. As health professionals we have an obligation to recognise this, and in so doing to recognise that our craft is not a panacea for the health inequalities experienced by indigenous people. We must advocate in the first instance not for additional resources to be allocated to medical treatment, but for these to be directed instead towards the direct alleviation of poverty and socioeconomic inequality in our society.

Nevertheless, where medicine is concerned, Lifestyle Medicine approaches have immense potential to empower indigenous peoples to improve health outcomes. Happily, Lifestyle Medicine also appears more compatible with indigenous models of health. Indeed, Aboriginal, Torres Strait Islander, and Māori peoples have recognised the importance of a holistic approach to health that we have come to categorise as ‘Lifestyle Medicine’ for generations, and have been shielded for the majority of their history from the pervasive influences of industrial-age thinking, germ theory, and the emphasis on individual endeavour and responsibility that characterise Western medicine. In Australia’s Health 2018, the following statement is made concerning the Indigenous Australian perspective on health:

“For Indigenous Australians, good health is more than the absence of disease or illness; it is a holistic concept that includes physical, social, emotional, cultural, spiritual and ecological wellbeing, for both the individual and the community. This concept of good health emphasises the connectedness of these factors and recognises how social and cultural determinants can affect health.”2

Any practitioner of Lifestyle Medicine will see immediate parallels between this definition and the focus of Lifestyle Medicine. Similarly, a popular Māori model of health is the Whare Tapa Whā model, developed duringa hui of Māori health workers in 1982 and describedby Dr. Mason Durie9. This holistic model of health is comprised of four ‘taha’ or cornerstones: taha tinana (physical), taha whānau (social), taha wairua (spiritual), and taha hinengaro (emotional). Clearly Lifestyle Medicine, with its recognition of not only the importance of the interaction of various determinants of health, but also with its attention to evidence-based therapies to improve physical, social, emotional, cultural, spiritual, and ecological wellbeing, including nutrition, physical activity, sleep and stress management, and relationships is very much more aligned with indigenous ideas of health.

Besides being a ‘better fit’ with existing indigenous models of health, lifestyle approaches offer vastly superior outcomes to those being offered by the current medical system. Provided that substantial efforts are also made to address the overarching role of more distal determinants of health in the outcomes of indigenous people (especially socioeconomic), outcomes achievable through Lifestyle Medicine approaches will enable closing of the gap. In fact, lifestyle approaches will enable Aboriginal, Torres Strait Islander, and Māori communities to rapidly attain better health outcomes than Australia and New Zealand’s non-indigenous populations. While standard medicine accepts a risk reduction approach for coronary artery disease, Lifestyle Medicine pioneers (drawing heavily on lessons learned from the diets of indigenous peoples for whom CAD is almost entirely non-existent) have demonstrated how the number one cause of mortality can be not only prevented, but reversed10,11. While standard medicine defaults to lifelong medication and monitoring for type 2 diabetes, with dialysis units and amputations awaiting an unacceptably high number of indigenous Australians and New Zealanders, Lifestyle Medicine offers reversal12. While standard medicine too often confuses controversial screening methods for breast cancer13 and prostate cancer14 with prevention, Lifestyle Medicine promises our greatest hope of real prevention, and in some cases perhaps even cure15.

Although certainly the historical details leading to the currently observed health outcomes for Aboriginal, Torres Strait Islander, and Māori are different, strikingly and unacceptably these outcomes share more in common with each other than they do with the outcomes for non-indigenous people in Australia and New Zealand. This implies that inequalities stem from the impact of colonisation and the subsequent influence of this on the distal determinants of health for indigenous people. In order for Australia and New Zealand to take the ‘necessary steps’ towards enabling the ‘full realisation’ of indigenous peoples’ right to the highest attainable standard of physical and mental health, nothing less than wide-ranging and radical policy that rapidly addresses socioeconomic inequalities will be effective. In addition, a Lifestyle Medicine approach moves the focus of health back towards the holistic view Aboriginal, Torres Strait Islander, and Māori people have traditionally valued. Lifestyle Medicine provides the best opportunity within medicine for rapidly closing the gap between health outcomes, and Lifestyle Medicine approaches will empower indigenous communities to lead the way to achieving substantially better health outcomes than those possible through the standard medical paradigm.

  1. Coronavirus Mortality Rate (COVID-19) – Worldometer. (2020). Retrieved 26 March 2020, from
  2. Onder, G., Rezza, G., & Brusaferro, S. (2020). Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy. JAMA. doi: 10.1001/jama.2020.4683
  3. Liu, W., Tao, Z., Lei, W., Ming-Li, Y., Kui, L., & Ling, Z. et al. (2020). Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease. Chinese Medical Journal, 1. doi: 10.1097/cm9.0000000000000775
  4. Romeo, J., Wärnberg, J., Nova, E., Díaz, L., Gómez-Martinez, S., & Marcos, A. (2007). Moderate alcohol consumption and the immune system: A review. British Journal Of Nutrition, 98(S1), S111-S115. doi: 10.1017/s0007114507838049
  5. Mozaffarian, D. (2016). Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity. Circulation, 133(2), 187-225. doi: 10.1161/circulationaha.115.018585
  6. Calder, P., & Kew, S. (2002). The immune system: a target for functional foods?. British Journal Of Nutrition, 88(S2), S165-S176. doi: 10.1079/bjn2002682
  7. Milner, J., & Beck, M. (2012). The impact of obesity on the immune response to infection. Proceedings Of The Nutrition Society, 71(2), 298-306. doi: 10.1017/s0029665112000158
  8. Nieman, D., Henson, D., Nehlsen-Cannarella, S., Ekkens, M., Utter, A., Butterworth, D., & Fagoaga, O. (1999). Influence of Obesity on Immune Function. Journal of the American Dietetic Association, 99(3), 294-299. Doi: 10.1016/S0002-8223(99)00077-2
  9. Sanchez, A., Reeser, J., Lau, H., Yahiku, P., Willard, R., & McMillan, P. et al. (1973). Role of sugars in human neutrophilic phagocytosis. The American Journal Of Clinical Nutrition, 26(11), 1180-1184. doi: 10.1093/ajcn/26.11.1180
  10. Calder, P., & Kew, S. (2002). The immune system: a target for functional foods?. British Journal Of Nutrition, 88(S2), S165-S176. doi: 10.1079/bjn2002682
  11. Wu, D., Lewis, E., Pae, M., & Meydani, S. (2019). Nutritional Modulation of Immune Function: Analysis of Evidence, Mechanisms, and Clinical Relevance. Frontiers In Immunology, 9. doi: 10.3389/fimmu.2018.03160
  12. Singh, R. K., Chang, H. W., Yan, D., Lee, K. M., Ucmak, D., Wong, K., Abrouk, M., Farahnik, B., Nakamura, M., Zhu, T. H., Bhutani, T., & Liao, W. (2017). Influence of diet on the gut microbiome and implications for human health. Journal of translational medicine, 15(1), 73.
  13. Kamada, N., Seo, S., Chen, G., & Núñez, G. (2013). Role of the gut microbiota in immunity and inflammatory disease. Nature Reviews Immunology, 13(5), 321-335. doi: 10.1038/nri3430
  14. Skinner, M., Bentley-Hewitt, K., Rosendale, D., Naoko, S., & Pernthaner, A. (2013). Effects of Kiwifruit on Innate and Adaptive Immunity and Symptoms of Upper Respiratory Tract Infections. Nutritional Benefits Of Kiwifruit, 301-320. doi: 10.1016/b978-0-12-394294-4.00017-1
  21. Wu, D., Lewis, E., Pae, M., & Meydani, S. (2019). Nutritional Modulation of Immune Function: Analysis of Evidence, Mechanisms, and Clinical Relevance. Frontiers In Immunology, 9. doi: 10.3389/fimmu.2018.03160
  22. Devereux, G., Macdonald, H., & Hawrylowicz, C. (2009). Vitamin D and Asthma: Time for Intervention?. American Journal Of Respiratory And Critical Care Medicine, 179(9), 739-740. doi: 10.1164/rccm.200901-0145ed
  23. Devereux, G., Wilson, A., Avenell, A., McNeill, G., & Fraser, W. (2010). A case-control study of vitamin D status and asthma in adults. Allergy, 65(5), 666-667. doi: 10.1111/j.1398-9995.2009.02220.x
  24. Li, Q. (2009). Effect of forest bathing trips on human immune function. Environmental Health And Preventive Medicine, 15(1), 9-17. doi: 10.1007/s12199-008-0068-3
  25. Bratman, G., Hamilton, J., & Daily, G. (2012). The impacts of nature experience on human cognitive function and mental health. Annals Of The New York Academy Of Sciences, 1249(1), 118-136. doi: 10.1111/j.1749-6632.2011.06400.x
  26. Barton, J., & Pretty, J. (2010). What is the Best Dose of Nature and Green Exercise for Improving Mental Health? A Multi-Study Analysis. Environmental Science & Technology, 44(10), 3947-3955. doi: 10.1021/es903183r
  27. The University of Adelaide. (2016). Report to the Sleep Health Foundation 2016 Sleep Health Survey of Australian Adults. Adelaide. Retrieved from
  28. Shearer W.T., Reuben J.M., Mullington J.M., et al: Soluble TNF-alpha receptor 1 and IL-6 plasma levels in humans subjected to the sleep deprivation model of spaceflight. J Allergy Clin Immunol 2001; 107: pp. 165-170
  29. Benca, R., & Quintans, J. (1997). Sleep and Host Defenses: A Review. Sleep, 20(11), 1027-1037. doi: 10.1093/sleep/20.11.1027
  30. Webster Marketon, J., & Glaser, R. (2008). Stress hormones and immune function. Cellular Immunology, 252(1-2), 16-26. doi: 10.1016/j.cellimm.2007.09.006
  31. Glaser, R., & Kiecolt-Glaser, J. (2005). Stress-induced immune dysfunction: implications for health. Nature Reviews Immunology, 5(3), 243-251. doi: 10.1038/nri1571
  32. Janicki-Deverts, D., Cohen, S., Turner, R. B., & Doyle, W. J. (2016). Basal salivary cortisol secretion and susceptibility to upper respiratory infection. Brain, behavior, and immunity, 53, 255–261.
  33. McAteer, O. (2020). Coronavirus sparks huge jump in social media use, study finds. Retrieved 23 March 2020, from
  34. Vannucci, A., Flannery, K., & Ohannessian, C. (2017). Social media use and anxiety in emerging adults. Journal Of Affective Disorders, 207, 163-166. doi: 10.1016/j.jad.2016.08.040
  35. Woods, H., & Scott, H. (2016). #Sleepyteens: Social media use in adolescence is associated with poor sleep quality, anxiety, depression and low self-esteem. Journal Of Adolescence, 51, 41-49. doi: 10.1016/j.adolescence.2016.05.008
  36. Douglas L. Noordsy, M.D. (2019). Lifestyle Psychiatry.
  37. Black, D., & Slavich, G. (2016). Mindfulness meditation and the immune system: a systematic review of randomized controlled trials. Annals Of The New York Academy Of Sciences, 1373(1), 13-24. doi: 10.1111/nyas.12998
  38. Uchino, B., Cacioppo, J., & Kiecolt-Glaser, J. (1996). The relationship between social support and physiological processes: A review with emphasis on underlying mechanisms and implications for health. Psychological Bulletin, 119(3), 488-531. doi: 10.1037/0033-2909.119.3.488
  39. Moynihan, J. A., Larson, M. R., Treanor, J., Duberstein, P. R., Power, A., Shore, B., & Ader, R. (2004). Psychosocial factors and the response to influenza vaccination in older adults. Psychosomatic Medicine, 66(6), 950-3.
  40. Pressman, S., Cohen, S., Miller, G., Barkin, A., Rabin, B., & Treanor, J. (2005). Loneliness, Social Network Size, and Immune Response to Influenza Vaccination in College Freshmen. Health Psychology, 24(3), 297-306. doi: 10.1037/0278-6133.24.3.297
  41. Cohen, S. (1997). Social ties and susceptibility to the common cold. JAMA: The Journal Of The American Medical Association, 277(24), 1940-1944. doi: 10.1001/jama.277.24.1940

This article has been re-published with permission from its original authors, Mark Blencowe and ASLM President, Dr Sam Manger. It was originally published on The GP Show