• Claire Aseremo

Equal Health: A Pursuit of the Native American Dream

Updated: Jun 6, 2020


August 11, 2019 ⋅ 6:30 P.M ⋅ Claire Aseremo⋅ Editor: Guadalupe Sandoval


In the third grade, I dressed up as Pocahontas for a class presentation.


The project seemed simple enough: choose a famous Native American in history, dress up as them, and present a biography detailing their life. I wore my long hair in two braids and knotted a strip of cloth—complete with two feathers—around my head in a mock, Indian headband. My mom had sown me a dress from brown cloth, and I wore a string of stone beads as a necklace.

It was a costume no different from the ones that arise out of a google search for “Indian costume.”


Without delving into the fact that this project was an act of cultural appropriation, this experience, in retrospect, set a dangerous precedent for my naïve, third-grade self and my equally naïve peers: it painted an image in our young minds of Native Americans as being no more than relics of the past and promoted ignorance towards the existence of whole populations of people whose presence is still very much alive.


Most Americans are largely unaware of how Native Americans live today. They remain a socially underrepresented community, present only in the smallest percentages in higher education and professional fields. Dispersed throughout the United States, many are geographically isolated, unequally accessing resources that many of us, in our everyday lives, find abundant.


In high school, I traveled to the Nez Perce reservation in Lapwai, Idaho with a group of volunteers and met Native American people within their own community for the first time. My third-grade self would have been surprised; standing amongst them, wearing the common, casual attire of t-shirts and jeans, there was no difference between us. With worn, but otherwise ordinary, houses and buildings raised around us (in place of textbook tipis and wigwams), there was no physical way of telling that the community was any different from the rest of the United States.


And yet, health statistics reveal that these communities could not be more different from ours. Compared to the rest of the population, Native American communities are disproportionately affected by health issues and inequities. According to the National Congress of American Indians, these communities are found to have 600% higher tuberculosis rates and 189% higher diabetes rates compared to the rest of the United States. [1] Even more shocking, the American Indian/Alaska Native Profile from the U.S. Department of Health and Human Services (HHS) reveals that Native Americans have an infant death rate that is “60 percent higher than the rate for Caucasians.” [2]


In order to grasp why these communities are disproportionately affected by diseases and poor health, it is necessary to first understand the difference between health disparity and health inequity. While the term “disparity” refers to the differences in health among populations, “inequity” goes further by addressing the systemic differences and acknowledging these differences as a product of social injustice. The World Health Organization (WHO) defines health inequities as:

[The] differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work, and age. Health inequities are unfair and could be reduced by the right mix of governmental policies. [7]


It is important that we recognize the statistics presented as being a product of health inequity rather than only noting the disparity between populations. The differences in health quality between Native American communities and the rest of the United States has everything to do with unfairness and injustice that dates all the way back to the history that I had been taught in the third grade. 


Our understanding of the health inequity experienced by Native populations must thus be situated within the historical and systemic context of US colonization, genocide, and racism. Our knowledge of current Native populations is so far removed from our knowledge of their ancestors; American school systems fail modern Native populations by perpetuating the perception of Native Americans as primarily a historical civilization, abandoning an education on the long-term and still-present aftermath of historical trauma in favor of one detailing American “progress.” We jump from learning of how American colonialism brought diseases, slavery, and warfare to the native populations to learning of the patriotic and highly revered freedom and independence that Americans achieved from British rule, with no more than perhaps a line of text that mentions that most modern day Native Americans live on reservations. 


Most people currently recognize reservations in a positive light as areas of refuge for Native populations to retain their culture and sovereignty, without being subject to federal laws. Historically, however, reservations were a way of keeping these populations under control and taking their land. The Indian Appropriations Act of 1851 created the Indian reservation system, and Native Americans were forced to live on the reservations without freedom to leave. [8] Moreover, forced assimilation through the 1887 Dawes Act (which divided reservations into individual plots of land) redefined gender roles within Native American populations, forcing them into lifestyles that they were unprepared for (such as farming rather than hunting for males and domestic roles for women) without the quality land and resources necessary to execute them successfully. Essentially, the reservation system isolated native populations to areas with conditions that left them unjustly susceptible to falling into a cycle of poverty.




The current health disparities found within these reservations are thus a direct result of the isolation, poverty, and inadequate resources/funds allocated to the Native community. The predominance of diabetes, high blood pressure, tuberculosis, and mortality can be attributed to “cultural barriers, geographic isolation […] and low income,” according to HSS. [2] Educational and resource barriers, as well as the prevalence of manufactured high-sugar beverages and food, within reservations result in poor diets and, subsequently, poor health. With reservations separate from the rest of society, medical resources such as hospitals or healthcare professionals are far and few. Meanwhile, according to the National Health Interview Survey (2017), the percentage of American Indians/Alaskan Native population under the age of 65 without health insurance is 26.9%, which is astounding compared to the national average of 8.8%. [3] This presents a significant problem within the community and contributes to the lack of medical attention being given to those who need it. It also serves as a significant indicator that change is needed.



Minnesota Department of Health 2011.


Approaches to improvements in Native American health need to be multifaceted and considerate of many interrelated factors. Currently, organizations and government facilities, such as the Indian Health Services, exist to help these communities. [4] The Affordable Care Act (ACA) reauthorized the Indian Health Care Improvement Act in order to increase government aid in addressing the unmet needs of Native American communities. [4] But to properly address the needs of the community, it is also important to be aware of the cultural differences that, while being one of the many barriers to healthcare, must be respected.

At the reservation, I experienced first-hand the richness of cultural traditions within the  community. A woman of the Nimiipuu (a name chosen by the Nez Perce, meaning “the People”), told me of how taking part in a sweat, a very sacred and ceremonial purification ceremony, cured her cancer. Health miracles like this, she explained, are not uncommon among those who take part in the ceremony. Traditional healing practices also remain prevalent among Native Americans. Some members of the community turn towards healers rather than medical professionals. In order to address the inequities within minorities and underrepresented communities such as Native Americans, it is important to not only be informed of the historical context they exist in and the health statistics that highlight problems in healthcare, but also be mindful not to impinge  on their existing identities and values. In 2016, a news article was published on the site of the Association of American Medical Colleges titled: “More Native American Doctors Needed to Reduce Health Disparities in Their Communities.” This article addresses the importance of having Native American health professionals due to their familiarity with native culture and their ability to better relate to and address the needs of their communities. [5]



To be effective in attending to the needs of others, it is necessary to bridge the gap between cultural differences and understand the social and historical factors that contribute to the prevalence of health concerns. The Centers for Disease Control and Prevention (CDC) emphasizes this, suggesting that “[d]ocumenting characteristics contributing to the health of [Native Americans] can better equip health professionals to identify priorities and culturally and linguistically appropriate interventions to improve health and decrease health disparities.” [6] Essentially, this works by attempting to do the same thing that Native American health professionals are able to do: address needs while understanding the context and respecting the experiences of a specific group of people.


As agents of change and advocates of health equity, we must keep this in mind. We are no longer naïve third-graders, unaware of the reality of the modern era. It is our responsibility to be knowledgeable of the lives of those who are underrepresented and have unequal access to healthcare. It is especially necessary to understand that many of the differences that we see in healthcare are inequities, stemming from systemic differences that are rooted in historical injustice. Equally important is being understanding and compassionate, recognizing that people of these communities have their own cultural beliefs and lifestyles, and that approaches to healthcare cannot be universally applied.


Sources:

1. http://www.ncai.org/about-tribes/demographics

2. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=62

3. https://www.census.gov/library/publications/2018/demo/p60-264.html

4. https://www.ihs.gov/aca/

5. https://news.aamc.org/diversity/article/native-american-health-disparities/

6. https://www.cdc.gov/mmwr/volumes/67/wr/mm6747a4.htm

7. https://www.who.int/features/factfiles/health_inequities/en/ 8. https://www.history.com/topics/native-american-history/indian-reservations


Recommended sources for further inquiry:

https://link.springer.com/article/10.1007/s12546-016-9159-y

https://www.asaging.org/blog/historic-and-ongoing-issue-health-disparities-among-native-elders

https://www.history.com/topics/native-american-history/native-american-timeline

About the Author

Claire Aseremo is an undergraduate student at University of California - Los Angeles.


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