Ethnic minorities across the U.S. frequently experience disparities in their health outcomes, face worse access to healthcare resources, and receive health services of lower quality (Dickman, Himmelstein, & Woolhandler, 2017; Holm, Vogeltanz-Holm, Poltavski, & McDonald, 2010). Even though formally the reduction and elimination of health disparities is one of the priority governmental goals, in real life, considerable health disparities persist. Health inequalities have been consistently linked with a widening economic inequality in the U.S., with “every chronic condition, from stroke to heart disease and arthritis, follow[ing] a predictable pattern of rising prevalence with declining income” (Dickman, Himmelstein, & Woolhandler, 2017, p.1431). They have also been linked to complex interacting factors of social, biological, cultural, and psychological nature, which are unique for ethnic populations and often poorly researched (Holm, Vogeltanz-Holm, Poltavski, & McDonald, 2010).
American Indians’ current health status is lower than national average in the United States. According to Thomas Sequist from the Department of Healthcare Policy Harvard Medical School, “The population of American Indians and Alaska Natives (AIAN) in the USA, which comprise about 5 million individuals, have worse health outcomes than other Americans” (Sequist, 2017, p.1379). For instance, based on the data provided by Sequist, life expectancy among this subpopulation is 4+ years lower than the one that characterizes the overall U.S. population. Further, American Indians death rates are nearly 50% higher than death rates found in the white population. What is more, research has established that American Indians die at much higher rates than the majority of other ethnic subpopulations in the country from CVD (cardiovascular disease), alcoholism-related disorders, tuberculosis, motor vehicles crashes, unintentional injuries, diabetes, suicide, and homicide (Holm et al., 2017). In addition, there have been reports of greater rates of multiple disease such as asthma, some cancers, diabetes, and rheumatic diseases in particular populations of American Indians across the United States. Sequist (2017) also notes than in comparison with white people, American Indians have a greater prevalence of tobacco use, obesity, physical inactivity, as well as lower rates of consuming fruit and vegetables. He further provides the following finding: American Indians “report a “fair or poor” health status more frequently than white people (20% vs 9%), as well as an increased burden of diabetes, hypertension, asthma, substance use disorder, and mental illness” (Sequist, 2017, p. 1379). In addition, Sequist (2017) observes that American Indians are more likely to report that they do not have a personal doctor in comparison with whites (28.3% vs 18.7%). Additionally, those American Indians who live in remote or isolated communities have difficulty in accessing healthcare for such conditions as renal transplantation and acute myocardial infarction (Sequist, 2017).
Health promotion in the conventional medicine has been associated with disease prevention. Lundy & Janes (2009) explain that since health has been traditionally understood as the absence of disease, “the definition of health promotion would necessarily include the idea of disease prevention” (p.304). In this regard, conventional health promotion practices take place at three basic levels: primary, secondary, and tertiary. At the same time, given that how people define health promotion depends on how they define health, it turns out that American Indians’ understanding of health promotion would be different. Specifically, for this American subpopulation, health is associated with the state of “harmonious balance,” so Native American medicine aims at returning the person to the state of this balance in every sphere of his or her life and links any imbalances to the spirit first (Healthandhealingny.org, 2017). In this way, health promotion strategies take into account the foundations of health as perceived by this population. For instance, a five-year intervention by CDC introduced back in 2008 was called “Using Traditional Foods and Sustainable Ecological Approaches to Promote Health and Help Prevent Diabetes in American Indian and Alaska Native Communities.” The health promotion initiative was informed by the leaders of tribes and earlier identified needs of increasing traditional foods access (CDC.gov, 2016).
Also known as Traditional Foods Project, 2008-2014, the intervention described above aimed at preventing the occurrence of heart disease, stroke, diabetes, and associated with these conditions risk factors among Native Americans at the primary level. Some examples include increasing the availability of traditional foods, reviving healthy traditional ways through stories, and increasing the access to physical activity. At the secondary level, the program aimed at reducing chronic disease impacts on the population of American Indians by providing activities that prevent complications in people with diabetes and physical activity programs aimed at reducing the effects of chronic diseases. At the tertiary level, the program provided for engaging people with diabetes in diabetes management programs.
Even though the program described above was primarily focused on primary and secondary prevention of chronic diseases among Native Americans, it catered to the needs of the population and was a good choice for government funding. In particular, the program used the American Indian approach to health as balance and this culture’s focus on natural medicine and spirituality as the cornerstone of prevention (through promoting traditional healthy food practices). To a lesser extent, it used the conventional approach to prevention and management of chronic diseases. It corresponded to the need of the population by addressing one of the gravest health issues in the group: obesity and related problems.
Overall, the health status of American Indians in the United States is lower than in white or most other ethnic minority populations nationally. Health promotion in this group, however, should consider the understanding of health by American Indians and their commitment to holistic medical practices. At the level of prevention, health promotion initiatives should incorporate traditional American Indian values and practices and use them along conventional practices in order to cater to the needs of this ethnic minority group.
- Dickman, S., Himmelstein, D., & Woolhandler, S. (2017). Inequality and the healthcare system in the USA. Lancet, 389, 1431-1441.
- Healthandhealingny.org (2017). Traditional and indigenous healing systems. Retrieved from http://www.healthandhealingny.org/tradition_healing/native.html.
- Holm, J., Vogeltanz-Holm, N., Poltavski, D., & McDonald, L. (2010). Assessing health status, behavioral risks, and health disparities in American Indians living on the Northern Plains of the U.S. Public Health Reports, 125, 68-78.
- Lundy, K. & Janes, S. (2009). Community health nursing. Jones & Bartlett Learning.
- Sequist, T. (2017). Urgent action needed on health inequities among American Indians and Alaska Natives. Lancet, 389, 1378-1379.
- Traditional Foods Project, 2008-2014 (2016). CDC.gov. Retrieved from https://www.cdc.gov/diabetes/ndwp/traditional-foods/index.html.
