November is Native American Heritage Month, a time to honor the rich cultures, histories, and contributions of Native American communities. It is also an opportunity to reflect on the challenges these communities face, particularly in the realm of health sovereignty and equity. The health of Native American communities is deeply intertwined with their history, systemic inequities, and ongoing efforts to reclaim sovereignty and improve outcomes. Here, we explore the historical context, challenges, and strides being made toward health equity and sovereignty.
Historical Context and Systemic Inequities
The health disparities experienced by Native American communities today are rooted in a legacy of colonialism and systemic inequities. The forced displacement, broken treaties, and discriminatory policies of the past have left lasting scars, creating intergenerational trauma that continues to affect physical and mental well-being.
Legacy of Colonialism and Historical Trauma
The history of colonization disrupted traditional ways of life, severing Native peoples from their lands, resources, and cultural practices. This upheaval has contributed to persistent health disparities, including higher rates of chronic diseases, mental health challenges, and substance use disorders. The trauma of this history is not just a relic of the past—it is passed down through generations, manifesting in both physical and mental health outcomes1.
Federal Trust Responsibility
The U.S. government has a legal and moral obligation to provide healthcare to Native American communities, as established through treaties with Tribal Nations. This responsibility led to the creation of the Indian Health Service (IHS), a federal agency tasked with delivering healthcare to nearly 2.6 million Native Americans. However, the IHS has long been underfunded, resulting in resource shortages, limited access to care, and delayed treatment. In 2016, per-person funding for IHS was significantly lower than for inmates in the federal prison system, highlighting the systemic neglect of Native health needs2.
Health Sovereignty: A Path to Self-Determination
Health sovereignty is a cornerstone of tribal self-determination, empowering Native communities to govern their own healthcare systems and address their unique needs.
Inherent Right to Self-Governance
Tribal sovereignty is the inherent authority of Native Nations to govern and protect the health, safety, and welfare of their citizens. This includes the right to design and operate culturally relevant health programs that align with traditional values and practices.
Tribal-Run Healthcare
Under the Indian Self-Determination and Education Assistance Act (ISDA), many tribes have taken control of their healthcare services, moving away from federal management. This shift has allowed tribes to tailor healthcare programs to their communities’ specific needs. A 2024 Supreme Court decision further affirmed the IHS’s obligation to fully reimburse tribes for operating these programs, marking a significant victory for tribal self-determination.
Indigenous Data Sovereignty
Indigenous data sovereignty is another critical aspect of health sovereignty. It ensures that Native Nations have control over the collection, ownership, and use of their data, including public health information. By governing their data, tribes can improve health outcomes, ensure accuracy, and develop initiatives that reflect their communities’ realities1.
Health Equity Challenges
Despite progress, Native American communities continue to face significant health disparities and systemic barriers to care.
Significant Health Disparities
Native Americans experience lower life expectancy and higher rates of chronic diseases, such as diabetes, chronic liver disease, and heart disease, compared to other U.S. populations. Mental health challenges, including high rates of suicide, also disproportionately affect Native communities2.
Social Determinants of Health
Structural inequities have created poor social conditions that directly impact health. Many Native communities face food insecurity due to limited access to supermarkets, inadequate housing, and lower rates of insurance coverage. These social determinants of health exacerbate existing disparities and hinder efforts to achieve equity2.
Cultural Differences in Healthcare
Traditional Native American views of health emphasize the interconnectedness of spiritual, mental, and physical well-being, as well as the relationship between individuals, their communities, and the environment. Western healthcare models often fail to account for these holistic perspectives, creating a disconnect between providers and patients2.
Advancing Health Equity and Sovereignty
Efforts to address these challenges and advance health equity must center Native voices, invest in infrastructure, and embrace culturally informed approaches.
Centering Native Voices
Achieving health equity requires shifting the narrative from one of deficiency to one of strength and sovereignty. This means honoring Native knowledge, values, and traditions while empowering communities to lead their own health initiatives.
Improving Public Health Data
Indigenous data sovereignty practices are essential to ensuring that Native voices are accurately represented in health data. By owning and governing their data, tribes can guide culturally appropriate, tribal-led health programs that address their unique needs2.
Investing in Infrastructure
Modernizing health IT systems, expanding internet access, and increasing the healthcare workforce in tribal communities are critical steps toward improving care. These investments can help bridge gaps in access and ensure that Native communities receive the quality care they deserve2.
Culturally-Informed Approaches
Culturally relevant health initiatives are key to improving outcomes. Programs like the CDC’s “Tribal Practices for Wellness in Indian Country” fund projects that use cultural traditions to promote mental, physical, and spiritual health. Traditional models, such as the Medicine Wheel, offer a holistic framework for community well-being, emphasizing balance and interconnectedness2.
Conclusion
Native American Heritage Month is a time to celebrate the resilience and contributions of Native communities while acknowledging the systemic challenges they face. Advancing health sovereignty and equity requires honoring tribal self-determination, addressing systemic inequities, and investing in culturally informed solutions. By centering Native voices and traditions, we can work toward a future where health equity is not just an aspiration but a reality for all Native American communities.
Source: Understanding Health Disparities in Indigenous CommunitiesAug 27, 2023 — The explanations for these health disparities are complex, and are certainly rooted in Indigenous people’s experiences…California Health Care Foundation
A Call to Improve Upon the Health Disparities Affecting Native …The goal of this article is to inform and educate across several areas in which AI/AN populations experience disparate health outc…Society of Behavioral Medicine (SBM)
Native American Heritage Month 2023 – Baltimore and MarylandOct 29, 2023 — Spotlight: Understanding Health Equity. Health equity is crucial for ensuring the well-being of all members of society…Health Care for the Homeless
About
DISC Health
The Health Equity Action Lab (HEAL) is an initiative by Dynasty Interactive Screen Community aimed at addressing health disparities in the U.S. and globally. By engaging media and stakeholders, HEAL seeks to reduce health inequalities and raise awareness. Their approach includes overcoming socio historical barriers and confronting the institutional, social, and political factors that perpetuate healthcare inequality.
Howard University Hospital (HUH)
Howard University Hospital, established in 1862 as Freedmen’s Hospital, has a rich history of serving African Americans and training top medical professionals. Located in Washington, D.C., it is the only teaching hospital on the campus of a historically Black university. HUH is a Level 1 Trauma Center and a critical healthcare provider for underserved populations. It offers advanced medical services, including robotic surgery, and has received numerous accolades for excellence in specialties like heart care, stroke treatment, and radiology.
Learn more about Howard University Hospital (HUH)
Howard University Faculty Practice Plan (FPP)
The Howard University Faculty Practice Plan is a multi-specialty physician group in Washington, D.C., dedicated to advancing healthcare and eliminating health disparities. It offers comprehensive services, including primary and specialty care, mental health, imaging, and cancer care, all connected to Howard University Hospital. FPP emphasizes patient-centered, respectful care for the diverse community and provides free health screenings and events to promote wellness.
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