The United States health care system is widely recognized as one of the most efficient in the world. However, the health status of most Americans ranks poorly compared with other western, industrialized nations. The minority populations are the most affected with many indicators showing that their death rates and health states are comparable to those of the Third World Nations. Similarly, compared to the white population, the minority still rank very low. The health disparity being as a result of systemic social or economic barriers to health based on their race and ethnicity. This paper, therefore, addresses some of the health disparities among the minority population, specifically American Indians while focusing on health promotion interventions that take into account values, attitudes and culture of the community.
Overview and Health Status of American Indian in the US
The American Indians trace their origins from any of the original people of North America, South America, and Central America, who have preserved their main culture or tribal affiliation. As of 2017, the United States Census Bureau estimated their population at 6.8 million, which is approximately 2.2 percent of the total U.S population. By 2030, it is projected that their population will grow at by 50% to approximately 9 million persons. When it comes to health status, American Indians are the second worst of minority groups in the United States. Regarding infant mortality rates, American Indian are nearly twice as likely to die before their first birthday as on-Hispanic white infants (CDC, 2017). The leading cause of their deaths being Sudden Infant Death Syndrome (SIDS), congenital malformations, and low birthweight. More worrying still, mothers are 4.5 times more likely to die during childbirth or during pregnancy compared to non-Hispanic mothers. In comparison with other minority groups that have continued experiencing a significant decline in infant mortality, the American Indian rate continues to remain inexorably high ( Rutman et al.,2016) .
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Among the adults, heart diseases and cancer are the leading cause of death among American Indians. According to the U.S. Centre for Disease Control and Prevention, American Indians are more likely to die prematurely from cancer and heart diseases as compared to white. Besides, they are more likely to have higher incidences of stroke-related deaths than Hispanics and white women. When it comes to diabetes type 2, American Indians have a higher prevalence than that of any other ethnic group. According to the Indian Health Service, reports indicate that the rate of diagnosed diabetes increases exponentially every year not only for older people but also among youths aged 15 to 19 years old. Regarding general mental health, American Indians experience psychological severe distress 1.5 times more than the general population (OMH, 2013). Most of them have a high prevalence of mental disorders such as depression, substance abuse disorders, and anxiety. This often results in most of them committing suicide. While the overall suicide rate among them is almost similar to those of the whites, there are significant differences when it comes to specific age groups. Most of American Indians suicide rates are among adults over 75 years.
As a result of living in poverty, most American Indians have the challenge of adopting healthy eating habits. Besides, the consequences of poverty push them into living in reservations located in rural areas. Often, the cost of food is very high, the selection and availability are minimal. These kinds of constraints present a challenge when it comes to accessing fruit and vegetable intake. This results in AI/AN communities adopting diets that are very high in fat. The implication of poor dietary habits is the development of type 2 diabetes among AI/NA communities.
Barriers to health
Strong evidence indicates socioeconomic status among American Indians contributes to lower health status among American Indians. In the United States, educational attainment, level of income and occupation are some of the indicators that are used to measure the status of health status among individuals. On all the three indices, American Indians have substantially lower incomes compared to whites. Similarly, unemployment is 2.5 times higher than the rest of the US population. The result is living in poverty leading to less or no access to health care services especially the screening of cancer and cancer prevention. According to the Indian Health Service (HIS), cancer screening of American Indians was significantly lower in the overall US population. For instance, only, 59 percent were screened for cervical cancer, 48 percent breast and, 39 percent colorectal cancer. The late diagnosis and lack of treatment at contributes to decreased chances of survival, thus high mortality rates.
Also, in general, American Indians have lower levels of educational attainment compared to whites. Approximately 20 percent of American Indians are said to not having completed high school education or higher which is very high compared the Hispanic population which stands at 8 percent. Lower levels of educational attainment have a direct implication when it comes to accessing prevention information. Besides, throughout history lower levels of education have been associated with persons engaging in unhealthy and risky behaviors. These behaviors include bad eating behaviors that are more likely to lead to obesity and the use of commercial tobacco increasing cancer risks and other chronic conditions. Still, most of them do not understand the importance of health insurance coverage. According to CDC, a quarter of American Indians lack health insurance, compared to 12 percent of whites and 18 percent of blacks. This prevents their access to health care services.
Sociopolitical factors also impinge American Indians from accessing health care services. Majority of American Indians have a lot of mistrust for services offered by the government agents. The United States government is in the record for mistreating American Indian community through genocide, forced migration and culture erasure. Even today, they feel that program designed by the government especially health programs are meant to eliminate them. Research also shows that social problems such as discrimination also prevents them from accessing health services leading to high mortality rates (Rutman et al., 2016).
Health Promotion Activities by AI/AN
AI/AN people use various traditional activities and rituals to promote wellness. Research suggests that most AN/IN patients seek the services of traditional healers and religious elders. Approximately 38 percent of urban AI/AN believe that “white man” medicine cannot entirely deal with their sickness. They, therefore, visit traditional healers who give them traditional medicine made from various plants. Since healing is considered as a sacred work, the religious leaders intercede on their behalf to promote not only healing but also spiritual renewal.
AI/NA also hold traditional ceremonies such ad Inuit also called Eskimo where the spiritual leader of the tribe interprets various sickness afflicting their members. The leader also determines the cause of the illness and later isolates the broken taboo to prevent it from being passed from other members of the family. Just like the Shamans from different cultures, individuals go under trance so that they can leave the body and travel far away from the community.
Health promotion Prevention
The prevalence of health disparity among AI/NA shows the need to design health promotion programs that detect assets within the community both at the primary and secondary level. Fundamental level aims at preventing diseases before they occur through altering unhealthy and unsafe behaviors. According to Suarez-Balcazar, Mirza and Garcia-Ramirez (2018) , the health community often focuses on general health messages that the rest of the population is used to such as a lot of emphasis on fitness, substance abuse related messages and the importance of taking low -fat diets. However, this kind of general information on AI/AN is likely to have minimal impact unless reinforced by specific messages that relate to their cultural beliefs. Traditionally, the AI/NA use storytelling as a method of instruction when it comes to transmission of knowledge. The stories are compelling because they are not only entertaining, but they convey the needed information. When designing programs for this minority population, the principle of including credible messengers from the community is essential. The messengers will play an important role in tailoring the messages so that they are not only culturally sensitive but are more personalized (Anderson et al., 2015). Similarly, the AI/NA believe in resiliency in the face of life negative events, stress and other forms of risks. Health care providers can use this cultural resilience in AI/NA communities to support healing through messages of hope and courage, thus improving life expectancy.
AI/ NA people seek the services of traditional healers, spiritual leaders and various rituals to promote health wellness. These rituals include dancing, prayers, naming ceremonies, vision, and dreams. Research shows that integrating these traditional methods with western medicine can significantly contribute to health promotion among AI/NA, reducing the health disparities. According to Anderson et al. (2015), 38 percent of AI/NA living in urban areas often combine traditional medicine and that of modern physicians. 61percent of those residing in semi-urban areas often rate the advice of the traditional healers higher than that of the physician. Using the holistic approach that emphasizes the importance of addressing a person as a whole and the community, this particular concept can help in the empowerment of communities in certain ways. One, often screening and preventive services are offered separately from the physician’s office. It is therefore imperative to have collaboration with their traditional healers and among different health care providers that understand the importance of cultural competency ( Anderson et al.,2015) . This fragmentation of services will help AI/NA already with the diseases navigate complicated bureaucracy associated with the healing process.
In conclusion, as the AI/NA population continues to grow in the United States, there is the likelihood of health disparity also increasing. The US government has initiated various programs and initiatives, but their focus has been on treatment and disease as opposed to health promotion well-being. This paper has, therefore, addressed health promotion that is congruent with AI/AN beliefs such as resilience, traditional experience, and community-based approaches.
References
Anderson, L. M., Adeney, K. L., Shinn, C., Safranek, S., Buckner‐Brown, J., & Krause, L. K. (2015). Community coalition‐driven interventions to reduce health disparities among racial and ethnic minority populations. Cochrane Database of Systematic Reviews , (6).
Centers for Disease Control and Prevention( CDC). (2017) The health of American Indian or Alaska Native population https://www.cdc.gov/nchs/fastats/american-indian-health.htm
Rutman, S., Loughran, J., Tanner, L., & Randall, L. L. (2016). Native generations: A campaign addressing infant mortality among American Indians and Alaska Natives in urban areas. American Indian and Alaska native mental health research (Online) , 23 (5), 59.
Suarez-Balcazar, Y., Mirza, M. P., & Garcia-Ramirez, M. (2018). Health disparities: Understanding and promoting healthy communities.
U.S. Department of Health and Human Services Office of Minority Health (OMH). (2013). Cancer and American Indians/Alaska Natives. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlID=31
