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Implementation Considerations for Advancing Health Equity among Tribal Populations

There are 574 federally recognized American Indian/Alaska Native (AI/AN) tribes in the United States, more than 100 state recognized tribes, and additional tribes that are neither state nor federally recognized. The American Indian Cancer Foundation outlines major factors related to health inequities that tribal communities experience, including:

  • Trauma related to historical genocide, ethnic cleansing, residential/boarding schools, and loss
  • Stressors related to racism, poverty, and systemic inequities
  • AI/AN populations living on tribal lands remain regulated and influenced in many ways by the federal government, unlike other communities that have been marginalized

The National Tribal Behavioral Health Agenda outlines multiple strategies to incorporate when working with tribal populations on health equity programs:

  • Integration of traditional and Western practices – Some programs advancing health equity will integrate traditional healing ceremonies and practices with Western practices. Integrated services often focus not just on individuals but on families and communities and are often intergenerational.
  • Acknowledgement of historical and intergenerational trauma – Programs should ensure that families impacted by trauma receive appropriate support. Programs should also allow tribes flexibility to tailor and implement practices that best support their local needs.
  • Honor the connection to nature and the environment – Respect for nature is a commonality that many tribes share. When appropriate, rural health equity programs should proactively collaborate with other programs to protect and incorporate environmental resources as part of honoring nature. This includes working with water and waste infrastructure, improving access to traditional foods, and supporting and protecting elders.
  • Improve awareness and visibility of AI/AN communities – Health equity programs should support capacity-building efforts for tribes to incorporate their own best practices. Tribal populations should have opportunities to work with media outlets and collaborators in a way that works best for their own purposes.

AI/AN populations across the U.S. may share some commonalities with regard to health and economic disparities, a historically complex relationship with the U.S. government, valuing traditional practices honoring elders, and respecting nature. However, AI/AN tribes are distinct from one another. They represent a diverse range of customs, languages, cultures, and geographic territories. There is no one-size-fits-all approach for health equity programming in AI/AN communities.

Resources to Learn More

American Indian Health Equity/Disparities
Discusses health equity and the causes of health disparities and health inequality within AI/AN populations. Compares AI/AN mortality data with all races of the U.S.
Organization(s): Northern Arizona University Center for American Indian Resilience

Beyond Health Equity: Achieving Wellness Within American Indian and Alaska Native Communities
Describes the partnership of tribal communities and research scientists working with the National Institutes of Health (NIH) to implement a community-based participatory research (CBPR) initiative integrating education, research, and advocacy to improve health and reduce health disparities.
Author(s): Blue Bird Jernigan, V., Peercy, M., Branam, D., et al.
Citation: American Journal of Public Health, 105, Suppl 3, S376-S379
Date: 7/2015

Indian Health 101: Fulfilling a Promise
Overview of the Indian health system and the legislative history and regulatory structure supporting the system. Discusses health disparities and the disproportionate impact of COVID-19 among AI/AN populations.
Author(s): Chavis, C. D.
Organization(s): National Indian Health Board (NIHB)
Date: 11/2020

Indigenous Health Equity
Discusses the use of inappropriate interventions based on Western cultural norms to address the rise in AI/AN health disparities. Emphasizes the importance of self-determination in breaking the barriers to improved health outcomes by restoring their culture and traditional knowledge systems.
Author(s): Echo-Hawk, A.
Organization(s): Urban Indian Health Institute (UIHI)
Date: 8/2019

Tribal Equity Toolkit 2.0: Tribal Resolutions and Codes to Support Two Spirit & LGBT Justice in Indian Country
Overview of existing tribal laws that may discriminate against Two Spirit/LGBT individuals by preventing them from accessing employment, housing, and other opportunities and benefits. Includes sample resolutions and code language to facilitate the development of policies and laws strengthening equality in tribal communities to ensure Two Spirit/LGBT people have equal opportunities.
Organization(s): The Native American Program of Legal Aid Services of Oregon, the Indigenous Ways of Knowing Program at Lewis & Clark Graduate School of Education and Counseling, the Western States Center, the Pride Foundation, and Basic Rights Oregon
Date: 11/2013