Health disparities ch 8 Flashcards
introduction to American indian & Alaska Native (AIAN)
legal right to healthcare - based on treaties and historical injustices like forced relocation the AIAN population has the right to healthcare through the indian health service (IHS)
IHS
- responsible for AIAN healthcare but is underfunded
- historical failures and mistrust in IHS contribute to ongoing health disparities
AIAN demographics
population - 4 million people identify as AIAN, making them fourth largest minority group in the us
diversity - 574 federally recognized tribes across 35 states
types AIAN population
- reservation residing, rural non reservation and urban residents
geographic distribution
- AIAN populations are the only racial ethic group with larger representation in rural areas, though nearly half live in urban settings
socioeconomic status - lower rates of college attainment and higher unemployment, increasing the risk of poverty, morbidity and early mortality
key factors influencing AIAN health equity
diversity - AIAN populations are not monolithic, and research from one tribe may not apply to others
rural vs urban - differences in healthcare access and needs
IHS mistrust - histroy of betrayals has led to widespread mistrust
historical trauma - long standing trauma from violence, discrimination and forced assimilation
cultural resilience - despite hardships, AIAN communities maintain strong culural identities and resilience
historical trauma
cumulative psychological wounds passed cross generations from group trauma
ex - massacres, land theft, forced treaties, sterilization, child abuse by IHS and forced boarding school attendance to assimilate AIAN children
impact of trauma - linked to depression, self injury, suicide, anxiety and substance abuse
AIAN Health disparities - alcohol and substance abuse
- highest rates among all racial ethic groups, alcohol accounts for 10% of AIAN deaths
firewater myth - a racist belief that AIAN individuals are genetically predisposed to alcohol problems, leading to a self fulfilling prophecy
elevated rates of methamphetamine use, especially in rural areas
culture as treatment approach - emphasizes health though cultural immersion and reclaiming cultural identity
AIAN Health disparities - diabetes
AIAN populations face diabetes rate 4-8 times higher than the general US population
begins in youth and contributes to conditions like hypertension, stroke and kidney failure
barriers - medical discrimination, food deserts, and lack of nutrition knowledge
interventions - programs like the special diabetes program for indians (SDPI) and culturally tailored education
AIAN Health disparities - violence
AIAN adolescents and women and more likely to experience violence
risk factors - substance use, lack of screening, economic challenges, and colonial history
protective factors - cultural involvement, family connectedness, and community support
recommendation include community programs, tribal shelters, and culturally sensitive support
Barriers to AIAN health equity
mistrust - long standing distrust of the medical and research communities
linguistic and cultural disconnects. - lack of culturally grounded approaches and language barriers
limited data - lack of population level health data
discrimination - both overt and within healthcare settings
educational challenges - legacy of boarding schools and disparities in education quality
role burdens - economic hardships and marginalization of research relevant to AIAN health
Method to achieve AIAN health equity
- community based participatory research (CBPR) - focuses on culturally relevant and community driven solutions, such as educational opportunities and mentoring for AIAN learners
- education on culture and traditions - involves researchers and community members to strengthen partnerships
- community level intervention - use peer led and bicultural competence programs, include AIAN lay health educators
- focus on culturally tailored interventions specific to each tribe - encouraging AIAN participation in health professions - develop and mentor AIAN researchers and practitioners to address health inequities from within the community
Programs and intervention for AIAN populations
- special diabetes program for indians (SDPI) : implements community driven diabetes prevention programs
- traditional foods project : combines cultural education with traditional diets
- medicine wheel model : nutrition based intervention grounded in cultural context
- youth programs : K12 diabetes prevention curriculum integrating cultural context
Recommendations for Addressing AIAN Health Disparities
Create opportunities for AIAN people to receive care in both Western and traditional contexts.
Develop culturally sensitive community programs outside traditional office settings.
Prioritize tribal involvement in support structures like shelters and mental health services.
