Why we run when the doctor comes: Orang Asli responses to health systems in transition in Malaysia

Abstract

Globally, indigenous peoples live with stark disparities in health when compared with national populations. The disparities arise from a combination of factors that relate to the social and economic determinants of health, combined with disenfranchisement, and a rapid destruction of indigenous health systems, forests, natural resources and indigenous knowledge. In Malaysia, the indigenous peoples, known as the Orang Asli or ‘Original People’, are often viewed by authorities as ‘backward, ignorant and resistant to modern health services’, and therefore responsible for their poor state of health. This view situates the problem in the indigenous community, with the state as the benevolent provider of progress and improvement including health services. Orang Asli responses to this benevolence ranges from pragmatism to resignation to resistance. Drawing on a two-year ethnographic study, this paper explores, from the perspective of the Orang Asli, the dynamics of state and non-state societies, the structure and role of indigenous health systems and the effects of socio-economic transition in shaping Orang Asli responses to modern health services. Already burdened with poorer health compared with the national population, there is a growing problem of non-communicable diseases among the Orang Asli. Addressing this will require a shift from the benevolent dependency-creating approach commonly adopted by state public health services to one that is inclusive, responsive and participatory.