American Indians/Alaskan Natives
The American Indian/Alaskan Native (AI/AN) population is growing rapidly, is young, and is geographically scattered. Nearly 2.5 million people of the Americas and live across the United States, Alaska, and the Aleutian Islands. The largest concentrations are found in the Pacific region of the United States and in the West, Southwest, and Midwest, especially in Alaska, Arizona, Montana, New Mexico, Oklahoma, and South Dakota (OMHD, 2007a).
American Indians may also be called Native Americans, and both terms are used in this course. This diverse group includes approximately 569 tribal groups plus an unknown number of tribes that are not federally recognized. Each has its own language, beliefs, customs, health practices, and rituals. Tribes exist as sovereign entities, but federally recognized tribes are entitled to health and educational services provided by the federal government. Indian Health Services (HIS) is responsible for serving the health needs of these populations but more than half do not permanently reside on a reservation so have limited or no access to HIS services. Geographic isolation, economic factors, and suspicion toward traditional spiritual beliefs are some of the reasons why health among these groups is poorer than other groups (OMHD, 2007a). Tribes or clans are the primary social unit and may or may not be blood relatives. They are a strong source of identity and support (Dossey et al., 2000).
Cultural Issues
Traditional AI/AN healing systems are holistic ones that focus on balancing mind, body, and spirit within the context of the community. These healing systems have been practiced for thousands of years and involve a deep sense of connection with place and land. These traditional healing practices also focus on benefits to the emotional, spiritual, psychological, and cultural aspects of the tribe. Often, large communal ceremonies serve as the method of promoting the well-being of the entire tribe as the tribal healer reaffirms the group's cultural values (Management Sciences for Health, n.d.).
AI/AN tribes have survived despite repeated governmental policies of extermination and genocide. These tribes have strong networks, with a deep sense of tribal purpose. They respect and share all ways of healing for all sorts of ills. The strengths and protective factors in Native American families and communities include the following (Dossey, 1997; Management Sciences for Health, n.d.):
- strong identification with their culture
- a central role of the family in the development of children
- a deep connection with the past through native stories, group learning, ceremonies, and traditions
- the use of traditional ceremonies (such as sweat lodge ceremonies, vision quests, talking circles, and spirit camps) that contribute to the healing of the individual, reaffirm community norms, and continue the training and practices of the ways of traditional healing
- adaptability, strength, and the wisdom to survive
- the wisdom of and respect for the elders
- core values of harmony, sharing, hospitality, and giving thanks
- belief that illness is due to a lack of harmony, evil spirits, fear and jealousy of other nations, or failure to live according to the code of life
Health Care Issues
The five leading causes of death for Alaska Natives include heart disease, cancer, unintentional injuries, diabetes, and stroke. In addition, AI/ANs have a disproportionately high prevalence of mental health issues, obesity, substance abuse, and sudden infant death syndrome (OMHD, 2007a). Additional health care issues related to this group include the following (Indian Health Service, 2006; Management Sciences for Health, n.d.):
- American Indians and Alaska Natives born today have a life expectancy that is 2.4 years less than the U.S. all race populations (74.5 years to 76.9 years, respectively).
- Safe and adequate water supply and waste disposal facilities are lacking in approximately 12% of American Indian and Alaskan Native homes, compared to 1% of the homes for the U.S. general population.
- Native Alaskan men and women suffer disproportionately higher rates of colon and rectal cancers compared to European Americans.
- Lactose intolerance is common among Native Americans.
- American Indian and Alaska Native infants die at a rate of 8.5 per every 1,000 live births compared to 6.8 per 1,000 for the U.S. all race populations.
Obtaining effective care for the AI/AN population is often difficult because of the following barriers (Leininger & McFarland, 2002):
- a paternalistic health care delivery system that fosters dependency
- forced cultural change
- interference from the wasicu or white man
- lack of economic opportunity
- failure of the community to believe that they can make a difference in their own health
- tribal leadership that may not make health a priority
- recognizing the differences between the Indian concepts of personal insight, individual awareness, and self-actualization and the traditional view of the world
- understanding the profound importance of family and community in healing and illness prevention
- understanding the communal effect of traumatic experiences (such as formal boarding schools, imposed religions, economic oppression, or other community events such as an accident, suicide, or death of an elder)
- understanding and respecting tribal practices and health belief systems
- understanding that, for some Indians, eye contact may be avoided and touch may be limited
- incorporating traditional healing practices into care
- listening to community members and adjusting your thinking and approaches based on their input
- becoming part of the circle of healing and fostering relationships with the rest of the healers in the circle
- respecting the village, since it identifies the person
- waiting and being patient, since the village and its members move at a pace that recognizes the physical and demographic realities of its members
- empowering your clients so they become self-reliant
- helping communities prepare leadership that strives to achieve and maintain health for its members
Providing culturally competent care for American Indians and Alaskan Natives involves consideration of these issues (Leininger & McFarland, 2002; Management Sciences for Health, n.d.):
