Health Equity: A Native American Perspective

Topics:
Health Equity

Including Native American perspectives in discussions of health equity is essential to gaining a comprehensive understanding of health. As the cornerstone and fundamental concept in the healing sciences, health has been revered by cultures throughout human history as a precious asset, possessing intrinsic value for individuals and the communities to which they belong. Moreover, it serves as an instrumental resource for sustaining life.1 Health equity encompasses an evaluation of the fair or unfair health statuses among individuals, families, communities, or entire populations, including Native Americans. The overarching objective remains the promotion of optimal health for all, acknowledging their unique health potential within the context of their cultural and historical backgrounds.

In a state of good health, individuals experience a sense of physical, emotional, social, and spiritual well-being, enabling them to engage in valued activities. In an ideal world, every person should have an equitable opportunity to attain good health. However, health providers, health scientists, and their collaborators are well aware that achieving health equity remains a distant aspiration. Native Americans encompass a rich tapestry of cultures, languages, and traditions, with each tribe and nation having unique health care needs and challenges. Recognizing and respecting this diversity is vital in addressing health equity.

Health inequity often revolves around inequalities among social groups with varying levels of social advantage or disadvantage, often termed “position within social hierarchies.”2 Social position encompasses factors such as economic resources, power, prestige, education, occupation, rural or urban residence, and racial, ethnic, tribal, religious, or national identity. Historical injustices, such as forced relocation, loss of ancestral lands, and the impact of colonization, have had enduring effects on Native American health. These experiences contribute to contemporary health inequities within these communities. Moreover, the preservation of cultural practices and traditional healing methods plays a vital role in Native American health and well-being.

Native American communities often face challenges related to access to quality health care, economic resources, education, and employment opportunities. Native American health is deeply intertwined with cultural and historical factors. Traditional practices, beliefs, and ceremonies impact the mental and spiritual well-being of individuals and communities.3 Understanding and addressing social determinants of health from a Native American perspective is key to advancing health equity.4 Collaborative efforts with Native American communities should involve their active participation in decision-making processes, ensuring that interventions are culturally appropriate and respectful of their values and traditions.

When conducting research on health equity, it is crucial to consider how health equity is defined, as it can profoundly influence research approaches for investigating and measuring activities and outcomes related to this concept. A fundamental perspective on health equity has been biological: when variations in health status lack reasonable biological explanations, questions of equity arise. The definition of health equity holds significant implications for shaping research methodologies aimed at exploring and quantifying activities and outcomes related to health equity, especially concerning Native American communities. A foundational perspective on health equity can be considered from a biological lens while focusing on variations in health status that lack reasonable biological explanations, prompting questions about the presence of equity.

Evidence-based research can help uncover the social, cultural, racial, ethnic, and environmental factors affecting health inequities and identify effective and cost-efficient interventions to mitigate these inequities.5 Addressing health inequities within Native American communities requires a comprehensive understanding that goes beyond biological considerations to encompass the broader context of their unique circumstances. This inclusive approach ensures that assessments of health equity are culturally relevant and respectful of the distinct health potential within Native American populations.

Research on health equity among Native Americans should be guided by an exploration of the specific factors influencing Native American health, acknowledging the diversity among tribes, and recognizing the importance of tribal sovereignty. Community context, including access to traditional lands and natural resources, affects the cultural and economic determinants of health among Native Americans. It is essential to employ community-based participatory research approaches, fostering partnerships between researchers and Native American communities to co-create solutions that address their unique needs and aspirations.

Furthermore, incorporating Native American knowledge systems into health equity research enhances the understanding of holistic well-being.6 Native American concepts of health often encompass spiritual, mental, and physical dimensions, emphasizing the interconnectedness of individuals with their communities and the environment. Research within Native American communities should prioritize culturally tailored approaches, involving community members in study design and implementation.7 This fosters trust and ensures research relevance. Ongoing surveillance efforts should not only focus on health inequities but also explore the resilience, strengths, and cultural assets within Native American communities.

In conclusion, recognizing and including Native American perspectives in health equity discussions broadens our understanding of the complex factors influencing health outcomes. Collaborative, culturally focused research and interventions are vital to promoting equity and improving the health and well-being of Native American communities. This inclusive approach aligns with the principles of distributive justice and human rights, ensuring that no community is left behind in the pursuit of optimal health for all.

References

  1. Anand S. ( 2002). The concern for equity in health. Journal of Epidemiology and Community Health, 56, 485–487. https://doi:10.1136/jech.56.7.485
  2. Yamin, A. E. (2009). Shades of dignity: exploring the demands of equality in applying human rights frameworks to health. Health and Human Rights, 11(2), 1-18. PMID: 20845838.
  3. Gone, J. P. (2013). Redressing First Nations historical trauma: theorizing mechanisms for indigenous culture as mental health treatment. Transcultural Psychiatry, 50(5), 683-706. https://doi.org/10.1177/1363461513487669
  4. Ruger, J. P. (2004). Ethics of the social determinants of health. The Lancet, 364(9439), 1092-1097. https://doi.org/10.1016/S0140-6736(04)17067-0
  5. Bullard, R. D. (2015). Phylon: Vol. 49, No. 3, 4, 2001 Environmental Justice in the 21st Century: Race Still Matters. Phylon52(1), 72–94
  6. Stanley, L. R., Swaim, R. C., Kaholokula, J. K., Kelly, K. J., Belcourt, A., & Allen, J. (2020). The imperative for research to promote health equity in indigenous communities. Prevention Science, 21(Suppl 1), 13-21. https://doi.org/10.1007/s11121-017-0850-9
  7. Christopher, S., Watts, V., McCormick, A. K., & Young, S. (2008). Building and maintaining trust in a community-based participatory research partnership. American Journal of Public Health, 98(8), 1398-1406. https://doi.org/10.2105/AJPH.2007.125757

Citation:
Lowe, J. Health Equity: A Native American Perspective. Milbank Quarterly Opinion. December 11, 2023.


About the Author

John Lowe, RN, PhD, FAAN, is the Joseph Blades Centennial Memorial Professor at the University of Texas at Austin School of Nursing. He is a Cherokee Native American tribal member and also has Creek and Lenape Native American tribal heritage. Dr. Lowe currently serves as a member of the Advisory Council to the National Institutes of Nursing Research. Dr. Lowe co-authored with Dr. Roxanne Struthers (Ojibwe) the Conceptual Framework for Nursing in Native American Culture.

Dr. Lowe was the first Native American man to be inducted as a fellow in the American Academy of Nursing and currently serves as a member of the selection committee. He is an alumnus of the Minority Fellowship Program (MFP) at the American Nurses Association and has served as the chair of the National Advisory Council to the MFP. He developed and studies interventions for the prevention and reduction of substance use and other risk behaviors among Native American and Indigenous youth and young adults globally. These studies and other health programs are guided by models that Dr. Lowe developed which include the Cherokee Self-Reliance, Native Self-Reliance, and Native-Reliance theoretical framework and models. Dr. Lowe also developed the first manualized Talking Circle intervention to reduce substance use and other risk behaviors among Native American youth and young adults and Indigenous youth globally in countries such as Canada and Australia. He is currently the Principal Investigator of several National Institutes of Health funded research projects that study the effectiveness of these interventions. The Talking Circle intervention has been recognized by the U.S. Department of Justice’s Office of Justice Programs as a “Promising Evidence-Based Program” for the well-being of youth, recognized as the first manualized Talking Circle intervention, featured as one of the American Academy of Nursing’s “Edge Runners,” and most recently featured in the National Academy of Medicine report of The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity.

Dr. Lowe’s work also has been acknowledged through numerous awards such as the American Nurses Association Luther Christman Award, Florida Nurses Association Cultural Diversity Award, Great 100 Centennial Research Award, Nursing Educator of the Year Award, Nurse of the Year Award, Lifetime Achievement In Education & Research Award, and the Researcher of the Year at the Professor Rank Award. Dr. Lowe has presented nationally and internationally and has published several articles and books.

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