Indigenous Health

Before you begin (for non-Indigenous researchers):

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. "Pan-Indianism" is out-of-date, reductionist, and conflates distinct cultures, perspectives, and variables.

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 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)