Indigenous Health Equity and Wellness

Catherine E. Mckinley, Michael S. Spencer, Karina Walters, Charles R. Figley, Catherine E. Mckinley, Michael S. Spencer, Karina Walters, Charles R. Figley

• Publisher: Routledge
• Year: 2022
• Print ISBN:
  9780367714840
• eBook ISBN:
  9781000545388
• Topic: Social Sciences
• Subtopic: Health Care Delivery
• Index: Social Sciences

This book focuses on promoting health equity and addressing health disparities among Indigenous peoples of the United States (U.S.) and associated Territories in the Pacific Islands and Caribbean.

It provides an overview of the current state of health equity across social, physical, and mental health domains to provide a preliminary understanding of the state of Indigenous health equity. Part 1 of the book traces the promotive, protective, and risk factors related to Indigenous health equity. Part 2 reports promising pathways to achieving and transcending health equity through the description of interventions that address and promote wellness related to key outcomes.

The chapters in this book were originally published as a special issue of the Journal of Ethnic & Cultural Diversity in Social Work.

Introduction:
Mental, physical and social dimensions of health equity and wellness among U.S. Indigenous peoples: What is known and next steps

Catherine E. McKinley

, Michael S. Spencer, Karina L. Walters, and Charles R. Figley

ABSTRACT

This special issue and introduction focuses on promoting health equity and addressing health disparities among Indigenous peoples of the United States (U.S.) and associated Territories in the Pacific Islands and Caribbean. We provide an overview of the current state of health equity across social, physical, and mental health domains. In Part 1 of the special issue, we trace promotive, protective, and risk factors related to Indigenous health equity. Part 2 of the special issue describes interventions that address and promote wellness, providing promising pathways to achieving and transcending health equity.

Health equity is a salient focus within social work research, as evidenced by the American Academy of Social Work & Social Welfare’s grand challenge to “Close the Health Gap” (Grand Challenges for Social Work, 2020). In support of this grand challenge and with the collaboration of its co-chairs, Michael Spencer and Karina Walters (Grand Challenges for Social Work, 2020), this special issue focuses on promoting health equity and addressing health disparities among Indigenous peoples of the United States (U.S.) and associated Territories in the Pacific Islands and Caribbean. Specifically, Indigenous peoples of the contiguous U.S. and Alaska (American Indians and Alaska Natives) belong to 574 federally recognized tribes (Bureau of Indian Affairs, 2020), more than 60 state recognized tribes (National Conference on State Legislatures, 2016), and Indigenous groups situated outside either jurisdiction. Moreover, the Indigenous people of Hawai’i (Kānaka Maoli) as well as the following Indigenous populations of U.S. associated Pacific Island flagship territories: American Samoa (e.g., Samoans) Guam (e.g., Chamorros), and the Commonwealth of North Mariana Islands (e.g., Carolinian-Refaluwasch, Remathau), as well as three freely associated states with the U.S.: The Federated States of Micronesia (e.g, Chuukese, Phnpeian, Kosraean, Yapese), the Republic of Marshall Islands (e.g., Marshallese- Aolepān Aorōkin M̧ajeļ), and the Republic of Palau (e.g., Palauans) constitute at least another 1.4 million Indigenous Peoples. Finally, Indigenous Peoples include the 12, 272 self-identified Taíno or “Spanish/Puerto Rican American Indians” of the U.S. Territory of Puerto Rico (U.S. Census, 2010).

American Indian and Alaska Native (AI/AN), Native Hawaiians, and other Indigenous Pacific Island (NHPI) populations are rapidly growing, constituting nearly 2.5% of the total U.S. population (2% AI/AN;.04% NHPI). They are disproportionately young, with about one-third being under the age of 18 in comparison with the one-fourth of the U.S. population overall (US Census, 2012a, 2012b). Although great heterogeneity and resilience exist among AI/AN and NHPI people (hereafter referred to as “Indigenous” when combined), epidemiological data demonstrate these groups suffer devastatingly high rates of health disparities in comparison with other populations. Disparities are linked to land loss, cultural devastations, a lack of access to health environments, insufficient nutrition, and exposure to high levels of environmental contaminants (Walters et al., 2011). AI/ANs are more likely than any other group to die from obesity-related conditions, diabetes, CVD, chronic liver disease, or suicide (Holm et al., 2010). Obesity-related inequity has been linked to alarming disparities in Type 2 Diabetes/T2D and cardiovascular disease among AI/ANs, particularly youth overall (Centers for Disease Control and Prevention, 2014). Moreover, Indigenous populations have the highest rates of smoking and drinking behaviors which are related to a multitude of serious chronic long term health problems. AI/AN youth are particularly vulnerable. They are 1.3 times higher than non-AI/AN peer populations to be obese (Roberts et al., 2009); are much more likely to suffer from serious, lifelong obesity- related illnesses compared to their non-AI/AN peers; and have more than a 70% chance of being obese in adulthood.

In addition, AI/AN youth are much more likely than non-AI/AN youth to initiate alcohol, tobacco, and other drug use (ATOD) at much younger ages and also have higher rates of tobacco use (45% vs 29%) and illicit drug use compared to their non-native peers (Stanley et al., 2014). Additionally, AI/AN youth have the highest suicide rate among all ethnic groups (3x higher) in the U.S., and suicide is the second leading cause of death for AI/AN youth 15–24 years old (Zamora-Kapoor et al., 2016). Overlapping suicide and HIV risk factors, particularly among sexual and gender minority youth, place AI/AN youth at increased risk for suicide and HIV. In fact, HIV diagnosis among gay Indigenous males increased from by 63% from 2005 to 2014 (CDC, 2018). AI/ANs have the shortest time to AIDS diagnosis than any other racial or ethnic group and have the poorest HIV survival rates-reflecting disparities in education, prevention efforts and systems of care. Despite the glaring health disparities, there is a paucity of culturally-grounded research addressing and preventing the health disparities of Indigenous populations. Indigenous populations are dramatically underrepresented in research, particularly in the behavioral science literature, leaving the field with little data on important risk factors, coping behaviors, and health outcomes. Without a larger body of evidence, it will be difficult to identify the strategies and develop the programs necessary to reduce Indigenous health disparities.

Moreover, despite Treaty agreements to provide for the wellness and health of many Indigenous peoples, an absence of clear understanding of the current state of health equity poses a barrier to ameliorating and addressing health disparities. A lack of culturally relevant and evidence-informed solutions to promote wellness and address these health gaps serves to further exacerbate these inequities. In this introduction to the special issue, we first provide a brief overview of some of the key physical and social/behavioral outcomes relevant for adult Indigenous peoples of the U.S. using a culturally relevant framework. In the articles for Part 1 of this special issue, we track culturally relevant promotive, protective, and risk factors relating to health equity as they relate to the focal outcomes of these articles. In Part 2 of the special issue, we provide articles focused on promising intervention strategies to promote wellness among diverse Indigenous peoples. The focus now turns to a culturally relevant framework for wellness.

The framework of historical oppression, resilience, and transcendence (FHORT)

Health equity among Indigenous populations is inseparable from experiences of historical oppression and cultural disruption imposed by colonization, yet also from the concomitant resilience, transcendence, and strengths of Indigenous Peoples. Thus, the culturally-grounded Framework of Historical Oppression, Resilience and Transcendence (FHORT) developed through over a decade of ethnographic work with Indigenous communities informs the approach to this special issue (Burnette & Figley, 2017). Historical oppression expands upon the prominent concept of historical trauma, which focuses on the massive trauma imposed upon Indigenous peoples historically (Brave Heart et al., 2011; Walters et al., 2011). This expansion delineates forms of oppression, recognizing that historical oppression (a) is localized to the distinct contexts and histories of Indigenous peoples colonized throughout history; and (b) explicitly focused on the forms of oppression that are both historical and contemporary in nature (Burnette & Figley, 2017). These contemporary forms of oppression have not subsided or ended; they continue, are perpetuated, and exacerbated by the harm imposed by colonization through the chronic and cumulative risk factors of economic and environmental marginalization, discrimination and racism, health inequities, chronic stress and trauma, and additional factors (Burnette & Figley, 2017). Health inequities and historical oppression, are thus, highly related and inseparable. Notwithstanding experiences of structural and historical oppression, Indigenous peoples strive for resilience, transcendence, and wellness across mental, emotional, physical, social, and spiritual dimensions.

According to the FHORT, the interconnections and balance across eco-systemic risk, promotive and protective factors (i.e. societal, community, cultural, environmental, familial, relational, and individual) interact and contribute to greater or impaired wellness across physical, spiritual, social, and mental dimensions. Some even experience transcendence despite being chronically exposed to historical oppression (See Figure 1). These interrelated risk (i.e., those that worsen or contribute to problems), protective (i.e., those that protect against deleterious or enhance wellness), and promotive factors (i.e., strengths and resources, regardless of whether adversity is present) (Masten, 2018) interact across ecological levels to predict key outcomes related to wellness and health (Burnette & Figley, 2017). Transcendence expands upon the experience of recovering or adapting well, to describe people attaining deeper levels of meaning, life satisfaction, posttraumatic growth, and wholeness, than if they had never experienced adversity (Burnette & Figley, 2017). The FHORT is one culturally congruent framework to address health equity among Indigenous people; other promising frameworks, such as the Indigenist Stress-coping model (Walters et al., 2009) and the Native-Reliance theoretical framework (Lowe, 2002; Lowe et al., 2019) are covered in the issues’ articles.

Figure 1. Framework of historical oppression, resilience, and transcendence (FHORT). Promotive, protective, and risk factors interact and occur across ecological (macro [societal, community], meso [familial, agencies], and micro levels [individual]).

The focus now turns to a brief overview of the current state of health equity across social, physical, and mental health domains. Because Indigenous youth outcomes have been introduced and are systematically covered elsewhere (Burnette & Figley, 2016), these sections focus on adults. This overview is by no means exhaustive, but provides a preliminary understanding of the state of Indigenous health equity with which to situate the remainder of the articles. We then summarize the articles contained in Part 1 of the special issue, tracing the promotive, protective, and risk factors related to Indigenous health equity. Finally, we provide an overview of the articles contained in Part 2 of this special issue, reporting promising pathways to achieving and transcending health equity through interventions to address disparities and promote wellnes...

Table of contents

• Cover
• Half-Title Page
• Title Page
• Copyright Page
• Contents
• Citation Information
• Notes on Contributors
• 1 Introduction: Mental, physical and social dimensions of health equity and wellness among U.S. Indigenous peoples: What is known and next steps
• Part 1: Promotive, Protective, and Risk Factors for Indigenous Health Equity
• Part 2: Promising Interventions for Indigenous Health Equity
• Index