Indigenous Health

Before you begin researching American Indian and Alaska Native health issues:

Recognize that there is no single, cohesive Native American culture

• The cultures of the distinct nations who originally inhabited North America as as diverse and distinct as those of any other continent, and this carries over into issues of health.

Consider who is speaking

• Did the research methods used involve the community from beginning to end? Are outsiders interpreting meaning for the community? The health outcomes a community desires may not be the same as what the medical establishment thinks are important or desirable.

Consider language

• Terms used to refer to Indigenous populations vary by country, by database, by discipline, and by whose perspective is privileged.
  • Common terms for Indigenous populations vary by country:
    • In the United states, people use "Native American", "American Indian", "Alaska Native", "Native", and very rarely, "Indigenous".
      • The US government Office of Management and Budget established "American Indian or Alaska Native" as terms to be used in official US government documents in 1977.
      • The categories used by the US Census have varied over time, and the current category used is "American Indian or Alaska Native", with other categories available for Indigenous peoples of Hawaii and the Pacific ocean.
      • These terms usually do not reflect what communities call themselves or desire to be called.
  • In databases, use the subject heading for Indigenous populations as well keywords for any preferred terms for a local or regional population (see below for more on subject headings).
    • For example, on PubMed you might search ("Indians, North American"[Mesh] OR Lakota),
    • while on CINAHL this same search would be ((MH "Native Americans") OR Lakota)
  • Terms used vary by discipline, especially for specific aspects of culture
    • for example, what your discipline calls "traditional medicine" another may call "ethnopharmacology", while a tribe may just name the specific substance, like "tobacco", which may not actually have plant material from the Nicotiana genus in it at all.
  • perspective
    • Some historically racist aspects of medicine (ie, the spirometer) remain embedded in modern practice. Be wary of "evidence" that ties health outcomes to race, rather than racism or socioeconomic inequity.

Consider historical context

• American Indians and Alaska Natives have extensive histories prior to contact with Europeans, and these may inform modern health practices and issues within these communities even as most health research studies focus on health issues arising from the violence of colonialism and resulting historical trauma.

  • In recent history (1900 to the present), the way the US interacts with Native American communities has changed enough that a refresher in Native American and US Government relations is advised. Be aware of the role of boarding schools, forced sterilizations and relocations, as well as historical availability of health care.

Consider modern context

• In the United States, only 574 tribes are federally recognized, and 76 are state-recognized.
  • tribes must petition the government for recognition, and this process is ongoing to this day, with some cases taking 30 years (NCAI).
  • federal or state recognition determines whether a tribe or tribal may access healthcare via the Indian Health Service
    • the IHS provides care to 2.2 million American Indians and Alaska Natives (IHS), which means that 3.5 million American Indians and Alaska Natives do not receive care from the IHS (HHS).
• Large research studies in the recent past have betrayed the trust of American Indian communities (WA Post)
  • The Havasupai Tribe in Arizona, "...learned that researchers at Arizona State University (ASU) had gathered blood samples from them to search for a link to diabetes but used the samples to look for other diseases and genetic markers, thereby violating the basic tenets of human subject research." (Robyn 2011 AMA Journal of Ethics)
• Lack of basic infrastructure  on reservations results in specific health challenges:
  • "Forty percent of on-reservation housing is considered substandard (compared to 6 percent outside of Indian Country) and nearly one-third of homes on reservations are overcrowded. Less than half of the homes on reservations are connected to public sewer systems, and 16 percent lack indoor plumbing. In some areas, up to 50 percent of Native homes are without phone service. Additionally, 23 percent of Native households pay 30 percent or more of household income for housing." (NCAI)

These journals are mostly not listed in traditional academic journal article databases such as PubMed or CINAHL. This means that you will need to separately search each journal website (in addition to other database searches you might carry out) in order to be sure to include that journal in your search. You can double-check whether a journal is indexed in a database either by searching for the journal in the database (most have a list of journals they index), or by going to the journal website (typically the About page), and looking to see if they state where the journal is indexed.

You can search for your topic using CINAHL Subject Headings (sometimes not preferred terminology of specific communities) or combine these terms with other keywords when searching:

You can search for your topic using Medical Subject headings (MeSH) (sometimes not preferred terminology of specific communities) or combine these terms with other keywords when searching:

These are open-access article databases that provide searchable listings of Indigenous-focused research.

*You may need to come back to our library website to search for the full-text version of the resources you find.