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The Imperative for Research to Promote Health Equity in Indigenous Communities

Abstract

Health disparities exact a devastating toll upon Indigenous people in the USA. However, there has been scant research investment to develop strategies to address these inequities in Indigenous health. We present a case for increased health promotion, prevention, and treatment research with Indigenous populations, providing context to the recent NIH investment in the Intervention Research to Improve Native American Health (IRINAH) network. We discuss the disproportionate costs and consequences of disparities borne by Indigenous groups, the limited evidence base on effective intervention for this population, how population uniqueness often makes transfer of existing intervention models difficult, and additional challenges in creating interventions for Indigenous settings. Given the history of colonial disruption that has included genocide, forced removal from lands, damaging federal, state and local policies and practices, environmental contamination, and most recently, climate change, we conclude research that moves beyond minor transformations of existing majority population focused interventions, but instead truly respects Indigenous wisdom, knowledge, traditions, and aspirations is needed, and that investment in intervention science to address Indigenous health disparities represent a moral imperative.

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Notes

  1. 1.

    The focus of this paper is on the Indigenous populations of the United States. The National Instututes of Health (NIH) Intervention Research to Improve Native American Health (IRINAH) program funds projects with American Indian (AI), Alaska Native (AN), and Native Hawaiian (NH) groups. Much of the research on Indigenous people in the U.S. includes data for only AI and AN people, in part, due to delayed recognition of status for NH people. Because of this, where data combines all three populations, we refer to Indigenous peoples. Where data combines AI and AN peoples, we refer to AIAN, and where data is for one group, we refer to that group.

References

  1. Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D., et al. (2006). The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience, 256, 174–186. https://doi.org/10.1186/1471-2458-8-198.

  2. Beals, J., Belcourt-Dittloff, A., Garroutte, E., Croy, C., Jervis, L., Whitesell, N., et al. (2013). Trauma and conditional risk of posttraumatic stress disorder in two American Indian reservation communities. Social Psychiatry and Psychiatric Epidemiology, 48(6), 895–905. https://doi.org/10.1007/s00127-012-0615-5.

  3. Beauvais, F., & Oetting, E. (2002). Variances in the etiology of drug use among ethnic groups of adolescents. Public Health Reports, 117, S8.

  4. Bienkowski, B. (2012, October 25). Contaminated culture: Native people struggle with tainted resources. ​Scientific American. Retrieved from: https://www.scientificamerican.com/article/contaminated-culture-native-people-struggle-with-tainted-resources/.

  5. Blackwell, D., & Lucas, J. (2015). Tables of Summary Health Statistics for U.S. Adults: 2014 National Health Interview Survey. Retrieved from cdc.gov/nchs/nhis/SHS/tables.htm.

  6. Brave Heart, M. Y. H., & Chase, J. A. (2014). Historical trauma informed clinical intervention research and practice. Retrieved from http://www.aihec.org/ourstories/docs/BehavioralHealth/2014/HistoricalTraumaInformedCllinicalInterventionResearchPractice.pdf.

  7. Brockie, T. N., Heinzelmann, M., & Gill, J. (2013). A framework to examine the role of epigenetics in health disparities among Native Americans. Nursing Research and Practice, 2013, 410395. doi:https://doi.org/10.1155/2013/410395.

  8. Burger, J., & Gochfeld, M. (2011). Conceptual environmental justice model for evaluating chemical pathways of exposure in low-income, minority, Native American, and other unique exposure populations. American Journal of Public Health, 101, S64–S73. https://doi.org/10.2105/AJPH.2010.300077.

  9. Center for Behavioral Health Statistics and Quality. (2014). 2013 National survey on drug use and health: Detailed tables. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs2013/NSDUH-DetTabs2013.htm.

  10. Chin, M. H., Walters, A. E., Cook, S. C., & Huang, E. S. (2007). Interventions to reduce racial and ethnic disparities in health care. Medical Care Research and Review, 64, 7S–28S. https://doi.org/10.1177/1077558707305413.

  11. Clifford, A. C., Doran, C. M., & Tsey, K. (2013). A systematic review of suicide prevention interventions targeting indigenous peoples in Australia, United States, Canada and New Zealand. BMC Public Health, 13, 463. https://doi.org/10.1186/1471-2458-13-463.

  12. Cochran, P. A. L., Marshall, C. A., Garcia-Downing, C., Kendall, E., Cook, D., McCubbin, L., & Gover, R. M. S. (2008). Indigenous ways of knowing: Implications for participatory research and community. American Journal of Public Health, 98, 22–27. https://doi.org/10.2105/AJPH.2006.093641.

  13. Cook, A., Spinazzola, P., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., et al. (2005). Complex trauma in children and adolescents. Psychiatric Annals, 35, 390–398.

  14. Delafield, R., Hermosura, A., Townsend, C. K. M., Hughes, C. K., Palakiko, D. M., Dillard, A., … Kaholokula, J. K. (2016). A community-based participatory research guided model for dissemination of evidence-based interventions. Progress in Community Health Partnerships: Research, Education, and Action, 10(4), 585–595. https://doi.org/10.1353/cpr.2016.0067.

  15. Dube, S. R., Anda, R. F., Felitti, V. J., Edwards, V. J., & Croft, J. B. (2002). Adverse childhood experiences and personal alcohol abuse as an adult. Addictive Behaviors, 27, 713–725.

  16. Ehlert, U. (2013). Enduring psychobiological effects of childhood adversity. Psychoneuroendocrinology, 38, 1850–1857. https://doi.org/10.1016/j.psyneuen.2013.06.007.

  17. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) study. American Journal of Preventive Medicine, 14, 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8.

  18. Fuentes, D., & Aranda, M. P. (2012). Depression interventions among racial and ethnic minority older adults: A systematic review across 20 years. The American Journal of Geriatric Psychiatry, 20, 915–931. https://doi.org/10.1097/JGP.0b013e31825d091a.

  19. Gittelsohn, J., Anderson Steeves, E., Mui, Y., Kharmats, A. Y., Hopkins, L. C., & Dennis, D. (2014). B'More healthy communities for kids: Design of a multi-level intervention for obesity prevention for low-income African American children. BMC Public Health, 14, 942. https://doi.org/10.1186/1471-2458-14-942.

  20. Gone, J. P., & Alcantara, C. (2007). Identifying effective mental health interventions for American Indians and Alaska Natives: A review of the literature. Cultural Diversity and Ethnic Minority Psychology, 13, 356–363. https://doi.org/10.1037/1099-9809.13.4.356.

  21. Gone, J. P., & Trimble, J. E. (2012). American Indian and Alaska Native mental health: Diverse perspectives on enduring disparities. Annual Review of Clinical Psychology, 8, 131–160. https://doi.org/10.1146/annurev-clinpsy-032511-143127.

  22. Gonzales, K. L., Lambert, W. E., Rongwei, F., Jacob, M., & Harding, A. K. (2014). Perceived racial discrimination in health care, completion of standard diabetes services, and diabetes control among a sample of American Indian women. The Diabetes Educator, 40, 747–755. https://doi.org/10.1177/0145721714551422.

  23. Goodluck, C., & Willeto, A. A. A. (2009). Seeing the protective Rainbow: How families survive and thrive in the American Indian and Alaska Native community. Retrieved from aecf.org/m/resourcedoc/aecf-howfamiliessurviveindianandalaskan-2009.pdf#page=1.

  24. Gorin, S. S., Badr, H., Krebs, P., & Prabhu Das, I. (2012). Multilevel interventions and racial/ethnic health disparities. JNCI Monographs, 2012, 100–111. https://doi.org/10.1093/jncimonographs/lgs015.

  25. Guadagnolo, B. A., Cina, K., Helbig, P., Molloy, K., Reiner, M., Cook, E. F., & Petereit, D. G. (2009). Medical mistrust and less satisfaction with health care among Native Americans presenting for cancer treatment. Journal of Health Care for the Poor and Underserved, 20, 210–226. https://doi.org/10.1353/hpu.0.0108.

  26. Hall, G. C. N., Yip, T., & Zárate, M. A. (2016). On becoming multicultural in a monocultural research world: A conceptual approach to studying ethnocultural diversity. American Psychologist, 71, 40–51. https://doi.org/10.1037/a0039734c.

  27. Hoover, E., Cook, K., Plain, R., Sanchez, K., Waghiyi, V., Miller, P., et al. (2012). Indigenous peoples of North America: Environmental exposures and reproductive justice. Environmental Health Perspectives, 120, 1645–1649.

  28. Indian Health Services. (2015). Trends in Indian health 2014 edition: General mortality statistics. Retrieved from https://www.ihs.gov/dps/includes/themes/newihstheme/display_objects/documents/Trends2014Book508.pdf.

  29. Indian Health Services. (2016). Indian health disparities. Retrieved from https://www.ihs.gov/newsroom/includes/themes/newihstheme/display_objects/documents/factsheets/Disparities.pdf.

  30. Jernigan, V. B. B., D’Amico, E. J., Hearod, J., Buchwald, D. & Duran, B. (2017). Multilevel interventions in tribal communities: Challenges and opportunities. Prevention Science.

  31. Kaholokula, J. K. (2007). Colonialism, acculturation, and depression among Kānaka Maoli of Hawai’i. In P. Culbertson & M. N. Agee (Eds.), Penina Uliuli: Contemporary challenges in mental health for Pacific peoples (pp. 180–195). Honolulu: University of Hawai'i Press.

  32. Kaholokula, J. K. (2016). Racism and physical health disparities. In A. N. Alvarez, C. T. H. Liang, & H. A. Neville (Eds.), The cost of racism for people of color: Contextualizing experiences of discrimination. Washington: American Psychological Association Press.

  33. Kaholokula, J. K., Grandinetti, A., Keller, S., Nacapoy, A. H., Kingi, T. K., & Mau, M. K. (2012). Association between perceived racism and physiological stress indices in Native Hawaiians. Journal of Behavioral Medicine, 35, 27–37. https://doi.org/10.1007/s10865-011-9330-z.

  34. Kaholokula, J. K., Nacapoy, A. H., Grandinetti, A., & Chang, H. K. (2008a). Association between acculturation modes and type 2 diabetes among Native Hawaiians. Diabetes Care, 31, 698–700. https://doi.org/10.2337/dc07-1560.

  35. Kaholokula, J. K., Saito, E., Mau, M. K., Latimer, R., & Seto, T. B. (2008b). Pacific Islanders’ perspectives on heart failure management. Patient Education and Counseling, 70, 281–291. https://doi.org/10.1016/j.pec.2007.10.015.

  36. Koepke, K. (2012). Traditional Healing Meets Western Medicine. Indian Country Today. Retrieved from: https://indiancountrymedianetwork.com/news/traditional-healing-meets-western-medicine/.

  37. Koithan, M., & Farrell, C. (2010). Indigenous native American healing traditions. The Journal for Nurse Practitioners : JNP, 6, 477–478. https://doi.org/10.1016/j.nurpra.2010.03.016.

  38. Konkel, L. (2015). Racial and ethnic disparities in research studies: The challenge of creating more diverse cohorts. Environmental Health Perspectives, 123, A298–A302. https://doi.org/10.1289/ehp.123-A297.

  39. Koss, M. P., Yuan, N. P., Dightman, D., Prince, R. J., Polacca, M., Sanderson, B., & Goldman, D. (2003). Adverse childhood exposures and alcohol dependence among seven Native American tribes. American Journal of Preventive Medicine, 25, 238–244. https://doi.org/10.1016/S0749-3797(03)00195-8.

  40. Kropp, F., Lilleskov, M., Richards, J., & Somoza, E. (2014). Client and provider views on access to care for substance-using American Indians: Perspectives from a Northern Plains urban clinic. American Indian and Alaska Native Mental Health Research, 21, 43–65.

  41. Langdon, E. J., & Wiik, F. B. (2010). Anthropology, health and illness: An introduction to the concept of culture applied to the health sciences. Revista Latino-Americana Enfermagem, 18, 459–466. https://doi.org/10.1590/S0104-11692010000300023.

  42. LaVeist, T. A., Gaskin, D., & Richard, P. (2011). Estimating the economic burden of racial health inequalities in the United States. International Journal of Health Services, 41, 231–238.

  43. Libby, A. M., Orton, H. D., Novins, D. K., Beals, J., Manson, S. M., & Team, A.-S. (2005). Childhood physical and sexual abuse and subsequent depressive and anxiety disorders for two American Indian tribes. Psychological Medicine, 35, 329–340. https://doi.org/10.1017/S0033291704003599.

  44. Mathews, T. J., MacDorman, M. F., & Thoma, M. E. (2015). Infant mortaility statistics from the 2013 period linked birth/infant death data set. Retrieved from cdc.gov/nchs/products/nvsr.htm.

  45. McFarland, B. H., Gabriel, R. M., Bigelow, D. A., & Walker, R. D. (2006). Organization and financing of alcohol and substance abuse programs for American Indians and Alaska Natives. American Journal of Public Health, 96, 1469–1477. https://doi.org/10.2105/AJPH.2004.050575.

  46. McOliver, C. A., Camper, A. K., Doyle, J. T., Eggers, M. J., Ford, T. E., Lila, M. A., et al. (2015). Community-based research as a mechanism to reduce environmental health disparities in American Indian and Alaska native communities. International Journal of Environmental Reseach and Public Health, 12, 4076–4100. https://doi.org/10.3390/ijerph120404076.

  47. Miranda, J., Bernal, G., Lau, A., Kohn, L., Hwang, W. C., & LaFromboise, T. (2005). State of the science on psychosocial interventions for ethnic minorities. Annual Review of Clinical Psychology, 1, 113–142.

  48. Moore-Nall, A. (2015). The legacy of uranium development on or near Indian reservations and health implications rekindling public awareness. Geosciences, 5, 15–29. https://doi.org/10.3390/geosciences5010015.

  49. Mousseau, A.C., Ivanich, J., Walls, M., Whitbeck, L., & Whitesell, N.R. (2017). Pathways of adaptation: Two case studies with one evidence-based substance use prevention program tailored for Indigenous youth. Preventions Science.

  50. Moy, E., Smith, C. R., Johansson, P., & Andrews, R. (2006). Gaps in data for American Indian and Alaska Natives in the national healthcare disparities report. American Indian and Alaska Native Mental Health Research, 13, 52–69.

  51. National Center for Health Statistics. (2016). Health, United States, 2015: With special feature on racial and ethnic health disparities. Retrieved from www.cdc.gov/nchs/data/hus/hus15.pdf.

  52. National Congress of American Indians (2017). Tribal Governance. Retrieved from http://www.ncai.org/policy-issues/tribal-governance.

  53. Novins, D. K., King, M. J., & Stone, L. S. (2004). Developing a plan for measuring outcomes in model systems of care for American Indian and Alaska Native children and youth. American Indian and Alaska Native Mental Health Research, 11, 88–98.

  54. Pacheco, C. M., Daley, S. M., Brown, T., Filippi, M., Greiner, K. A., & Daley, C. M. (2013). Moving forward: Breaking the cycle of mistrust between American Indians and researchers. American Journal of Public Health, 103, 2152–2159.

  55. Paradies, Y., Priest, N., Ben, J., Truong, M., Gupta, A., Pieterse, A., et al. (2013). Racism as a determinant of health: A protocol for conducting a systematic review and meta-analysis. Systematic Reviews, 2, 85.

  56. Rosenthal, W. A., & Khalil, D. D. (2010). Exploring the challenges of implementing participatory action research in the context of HIV and poverty. Curationis, 33, 69–78.

  57. Sarche, M., & Spicer, P. (2008). Poverty and health disparities for American Indian and Alaska Native children: Current knowledge and future prospects. Annals of the New York Academy of Sciences, 1136, 126–136. https://doi.org/10.1196/annals.1425.017.

  58. Sequist, T. D. (2017). Urgent action needed on health inequities among American Indians and Alaska Natives. Lancet, 389, 378–379.

  59. Shonkoff, J. P., Garner, A. S., Siegel, B. S., Dobbins, M. I., Earls, M. F., Garner, A. S., et al. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129, e232–e246. https://doi.org/10.1542/peds.2011-2663.

  60. Simonds, V. W., Goins, R. T., Krantz, E. M., & Garroutte, E. M. (2014). Cultural identity and patient trust among older American Indians. Journal of General Internal Medicine, 29, 500–506. https://doi.org/10.1007/s11606-013-2578-y.

  61. Sondik, E. J., Huang, D. T., Klein, R. J., & Satcher, D. (2010). Progress toward the healthy people 2010 goals and objectives. Annual Review of Public Health, 31, 271–281. https://doi.org/10.1146/annurev.publhealth.012809.103613.

  62. Substance Abuse and Mental Health Services Administration. (2012). The NSDUH Report: Need for and Receipt of Substance Use Treatment among American Indians or Alaska Natives. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH120/NSDUH120/SR120-treatment-need-AIAN.htm

  63. Tippeconnic, I. J. W., & Fox, M. J. T. (2012). American Indian tribal values: A critical consideration in the education of American Indians/Alaska Natives today. International Journal of Qualitatitve Studies in Education, 25, 841–853. https://doi.org/10.1080/09518398.2012.720730.

  64. Trotter, R. T., Laurila, K., Alberts, D., & Huenneke, L. F. (2015). A diagnostic evaluation model for complex research partnerships with community engagement: The partnership for Native American Cancer Prevention (NACP) model. Evaluation and Program Planning, 48, 10–20. https://doi.org/10.1016/j.evalprogplan.2014.09.001.

  65. U.S. Department of Health and Human Services. The Secretary’s Advisory Committee on National Health Promotion and Disease Preventsion Objectives for 2020. (2008). Phase I report: Recommendations for the framework and format of Healthy People 2020. Retrieved from http://www.healthypeople.gov/sites/default/files/PhaseI_0.pdf.

  66. U.S. Department of Health and Human Services. (2016). HHS FY2016 budget in brief. Retrieved https://www.hhs.gov/about/budget/budget-in-brief/ihs/index.html.

  67. van der Kolk, B. A., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005). Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma. Journal of Traumatic Stress, 18, 389–399. https://doi.org/10.1002/jts.20047.

  68. Volkow, N. (2012). Advancing American Indian/Alaska native substance abuse research. American Journal of Drug & Alcohol Abuse, 38, 371. https://doi.org/10.3109/00952990.2012.712174.

  69. Wallerstein, N., & Duran, B. (2010). Community-based participatory research contributions to intervention research: The intersection of science and practice to improve health equity. American Journal of Public Health, 100, S40–S46 https://doi.org/10.2105/AJPH.2009.184036.

  70. Walters, K. L., Johnson-Jennings, M., Stroud, S. Rasmus, S., Charles, B., John, S., … Boulafentis, J. (2017). Growing from our roots: Strategies for developing culturally grounded prevention programs in American Indian, Alaska Native, and Native Hawaiian communities. Preventions Science.

  71. Whitbeck, L. B., Walls, M. L., Johnson, K. D., Morrisseau, A. D., & McDougall, C. M. (2009). Depressed affect and historical loss among North American indigenous adolescents. American Indian and Alaska Native Mental Health Research (Online), 16, 16–41.

  72. Whitbeck, L. B., Walls, M. L., & Welch, M. L. (2012). Substance abuse prevention in American Indian and Alaska Native communities. American Journal of Drug and Alcohol Abuse, 38, 428–435. https://doi.org/10.3109/00952990.2012.695416.

  73. Wildcat, D. R. (2013). Introduction: Climate change and indigenous peoples of the USA. Climatic Change, 120, 509–515. https://doi.org/10.1007/s10584-013-0849-6.

  74. Yurkovich, E. E., & Lattergrass, I. (2008). Defining health and unhealthiness: Perceptions held by Native American Indians with persistent mental illness. Mental Health, Religion & Culture, 11, 437–459.

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Correspondence to Linda R. Stanley.

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Stanley, L.R., Swaim, R.C., Kaholokula, J.K. et al. The Imperative for Research to Promote Health Equity in Indigenous Communities. Prev Sci 21, 13–21 (2020) doi:10.1007/s11121-017-0850-9

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Keywords

  • Indigenous populations
  • American Indian
  • Alaska Native
  • Native Hawaiian
  • Intervention research
  • Health disparities