By Teniola Adegbite and Kimberly Browne
November marks Native American and Alaska Native Heritage Month, a time to celebrate and recognize the cultural richness and profound contributions of Native and Indigenous people. Within the healthcare sector, Native and Indigenous people have played significant roles, yet they remain underrepresented in healthcare professions and continue to experience severe health inequities compared to other racial and ethnic groups. This article evaluates the root of health disparities among Indigenous Americans and illuminates past and present contributions of Indigenous people while highlighting the pressing need for increased representation and culturally competent care.
Understanding Health Inequities within Native American and Alaska Native Populations
Although there has been progress in improving the health of all Americans, substantial health inequities continue to persist within Native American and Alaska Native tribal communities. Native Americans and Alaska Natives differ greatly from other major racial/ethnic groups in social determinants of health and related health outcomes. They are more likely than other communities to live in less favorable socioeconomic and material living conditions that have historically placed them at a considerable disadvantage in health and socioeconomic attainment and in advancement toward health equity. Available research shows that Native Americans and Alaska Natives have the highest rates of low educational attainment and literacy, unemployment, poverty, suicide, homicide, mental distress, disability, and residence in adverse neighborhood conditions. Also, they have one of the lowest life expectancies and high rates of premature mortality, infant and maternal mortality, injuries, and mortality from major chronic conditions. Recent analyses show substantial disparities in disability, healthcare access, and socioeconomic conditions across the major tribes.
The explanations for these health disparities are complex, and are rooted in Indigenous people’s experiences of disenfranchisement, displacement, discrimination, resulting poverty, and intergenerational trauma over centuries of American colonization. Throughout the 20th century, through various policy enactments, the United States sought to disband tribes and sell their land, essentially revoking families’ access to healthcare services from their Native health clinic, and forcing them to have to rely on the Western medicine framework, which often invalidates Native Americans’ traditional views.
Native American and Alaska Native communities have described that a significant barrier for them seeking health services is the lack of trained providers with the knowledge, skills, or training to work with their community in a more traditional form. In addition, mental health has been a targeted area of concern, mainly in part due to historical trauma that has resulted in substance dependence, Post-Traumatic Stress Disorder (PTSD), youth behavioral problems, and a rise in suicide rates among the population. Native Americans are disproportionately represented in mental health statistics, experiencing higher rates of substance abuse, suicide, and psychological distress compared to the general population. Problematically, despite this overrepresentation in mental health needs, they are severely underserved and underrepresented in the availability of mental health professionals.
Recommendations for Strengthening Tribal Communities
Although Indigenous healthcare faces a variety of barriers, multiple strategies can be pursued to combat these obstacles, starting with rebuilding the views and process of the health services offered to Native Americans as well as being more mindful to the Native holistic approach to healing and optimal health as a way of life. Viable approaches and solutions to safeguard Native access to healthcare are crucial to overall Native welfare and quality of living. Multiple strategies can be pursued to combat these obstacles, starting with rebuilding the views and process of the health services offered to Native Americans.
1. AIE (American Indian Elders) Navigators are a great way to inform Native communities about health care policies and coverage plans.
2. Expanding up to date technology, such as telehealth, is another viable way to bridge the divide. Internet connectivity is essential, especially presently, when tribal communities have unequal access to healthcare, education, and economic resources, further demonstrating the need for the incorporation of technological advancements.
3. Provide more financial resources through local, state, and federal support to build and cultivate Native American heritage, health, and cultural centers to bring more attention to Native preferences towards physical activity, nutrition, and holistic spiritual, emotional, and social health.
4. Supporting schools with the policy making mission to train and support rural and urban physicians to ensure enough physicians are available to the Native American community.
5. Incorporating Native American community healthcare workers who know the history, culture, and community will build rapport among the Indigenous groups and create a sense of comfort and trust, encouraging more people to seek care. Approximately 75% of Natives live in urban areas, yet only 1% of Indian Health Service (IHS) funds is apportioned towards the Native population. And almost 33% of all Native Americans do not carry health insurance. Between lack of funding, inaccessibility to health care, and a limited focus on Native health in general, the physical, and health and well-being needs of Indigenous people in America must take precedence to eradicate unsettling health disparities.
Historical Foundations: Susan La Flesche Picotte
A pioneering figure in the history of Native Americans in healthcare is Dr. Susan La Flesche Picotte, the first Native American woman to earn a medical degree in the United States. Born in 1865 on the Omaha Reservation in Nebraska, Picotte graduated from the Women’s Medical College of Pennsylvania in 1889. Picotte’s journey was not merely about breaking barriers; she dedicated her career to improving health care for her people. She tirelessly worked on the Omaha Reservation, often traveling miles on horseback to treat patients. Additionally, Picotte went on to found the first private hospital on a Native American reservation, the Susan La Flesche Picotte Memorial Hospital in Walthill, NE. Her career efforts extended beyond delivery of healthcare as she advocated for public health, hygiene education, and the reservation’s socioeconomic improvements, emphasizing how cultural understanding enhances care quality.
Modern Contributions: Maricela Zurita Cruz
In recent years, Maricela Zurita Cruz, a present-day activist for Indigenous women’s health, has exemplified the active role Indigenous people continue to play in healthcare. A member of the Zapotec community from Oaxaca, Mexico, Cruz has worked diligently to provide culturally sensitive health services to those individuals who are most likely to face disparities. Over the course of her education, she overcame significant language and cultural barriers, which inspires her advocacy for language-concordant care – a critical aspect of ensuring quality health outcomes. Cruz’s work emphasizes community health equity, focusing on improving access to healthcare for marginalized Spanish and indigenous language speakers. Her initiatives stress culturally relevant care that respects and integrates patients’ linguistic and cultural contexts into the healthcare system. Importantly, she has contributed by translating reproductive health, safe sex, and maternal mortality presentations from Spanish into her local community’s language of Chicano. She had the honor of meeting with First Lady Michelle Obama in 2010 during a tour of Mexico, in which she had the opportunity to share her personal journey and highlight the contributions she’d already made to the field.
Underrepresentation in Healthcare Professions
Despite profound contributions, Native and Indigenous individuals are significantly underrepresented in the healthcare workforce. According to statistics from the Association of American Medical Colleges (AAMC), Native Americans comprise a meager fraction of practicing physicians, making up about 0.56% of the medical community, starkly contrasted with their 2.9% share of the total U.S. population. This underrepresentation perpetuates healthcare disparities and emphasizes the need to recruit and support Indigenous students in medical education.
One barrier to entry is educational access and financial support – many Native and Indigenous communities face systemic hurdles, including lack of resources and mentorship in pursuing higher education. Moreover, retention in medical training programs is often hindered by a lack of culturally affirming support and recognition, mirroring broader societal inequities. To mitigate this, in 2022, the Ohiyesa Premedical Program was founded to support more Native Americans and Alaskan Natives to pursue medical training.
Meeting the Needs of Native and Indigenous Language Speakers
As evidenced by Cruz’s work, language concordant care is vital in healthcare, ensuring patients and providers speak the same language. This reduces misunderstandings, increases patient satisfaction, and improves health outcomes. For patients who might speak languages other than English at home, language accessibility can be the difference between receiving effective care or suffering from misdiagnoses and poor health management. In the San Francisco Bay Area, where a diverse spectrum of people reside, including speakers of Indigenous languages from regions including Central and South America, ensuring language accessibility is critical. Institutions are increasingly adopting strategies like hiring bilingual staff, implementing employed interpreter services, and investing in technology to overcome language barriers. This helps facilitate high-quality care delivery to the over 220,000 people in California who report speaking a language from the “other Native North American languages” category in home per US Census Bureau data.
Meeting the needs of Indigenous language speakers involves not only increasing interpreter services but also advocating for systemic changes that incorporate cultural literacy in healthcare training. This means developing curricula designed to train students in culturally sensitive practices and equipping healthcare professionals with resources to engage effectively with Indigenous patients. Collaborative efforts with community organizations can further play a pivotal role in bridging care gaps. By actively engaging with Indigenous communities, healthcare providers can build trust and reliability, tailoring health services to meet specific cultural and linguistic needs.
Concluding Reflections
Native American and Alaska Native Heritage Month not only serves as a reminder of the resilience and unyielding spirit of Native and Indigenous people in healthcare — it is also a call to action. The ongoing inequities faced by Native and Indigenous peoples in healthcare reflect generations of historical injustice and system neglect. And while underrepresentation poses significant challenges, the contributions of individuals like Susan La Flesche Picotte, Maricela Zurita Cruz, and countless others highlight a legacy of commitment to community well-being. Creating an equitable healthcare system demands cultural understanding, representation, and investment in linguistically concordant care. By devoting efforts into recruiting, retaining, and supporting more Native and Indigenous professionals within healthcare, we honor the past and pave the way for an inclusive and equitable healthcare system where all are empowered to achieve their full potential.
