Effects of historical distress on health disparities among Native Americans
In a thought-provoking discussion, Dr. Donald Warne, associate dean of diversity, equity, and inclusion at the University of North Dakota School of Medicine and Health Sciences, raised concerns about the health impact of historical and systemic issues on American Indian and Alaska Native (AI/AN) communities.
Dr. Warne questioned whether the pattern of loss in AI/AN communities, including loss of life, land, culture, and resources, has a health impact and if that impact can be passed from one generation to the next. His concerns are supported by a wealth of evidence highlighting significant health disparities among AI/AN populations.
Current health disparities among AI/AN populations include poorer health status, higher mortality rates, and greater prevalence of chronic diseases compared to other racial groups in the United States. In 2023, 21.8% to 24.4% of AI/AN adults reported being in fair or poor health—the highest rate among racial groups—and their life expectancy at birth is substantially lower (67.9 years) compared to non-Hispanic Whites (77.5 years). AI/AN communities face higher mortality from heart disease, cancer, unintentional injuries, chronic liver disease, and kidney disease, with end-stage renal disease rates about 3.5 times those of White Americans.
Maternal health disparities are severe, with AI/AN women experiencing maternal morbidity and mortality at two to three times the rate of their white counterparts. Leading causes include mental health challenges and hemorrhage, with over 90% of pregnancy-related deaths deemed preventable.
These disparities stem from historical traumas and systemic factors that shape health outcomes today. Centuries of colonialism, forced displacement, cultural disruption, and systemic discrimination have inflicted generational trauma, undermining trust in healthcare and contributing to poorer access and quality of care. Colonial health systems often marginalize Indigenous knowledge and healing practices, exacerbating inequities. Persistent racism and stereotyping in healthcare settings further hinder access and contribute to negative health outcomes. Additionally, geographic isolation, socioeconomic disadvantage, insufficient insurance coverage, and limited healthcare infrastructure pose significant barriers.
Dr. Warne and Dr. Roger Dale Walker, director of the One Sky Center, have proposed a Marshall Plan for Native people in North America to assist and empower tribes and Native communities in developing successful policies for governance, education, and access to health care at the same standard as the general population.
Moreover, Dr. Warne speculates that epigenetic changes may be why some boarding school survivors have shorter telomeres, protective protein structures that typically shorten with age. However, he believes that more robust studies are necessary to prove a link between epigenetics, trauma, higher mortality, and poor health outcomes among American Indians.
Early childhood experiences, particularly those marked by toxic stress, can chemically change the structure of genes and have a lasting impact on a child's brain development, potentially leading to long-term damage to both mental and physical health. Adverse childhood experiences are a strong predictor of risk for numerous chronic and behavioral health conditions.
The scalping and murder of AI individuals was legitimized by bounties during the Dakota War of 1862, and thousands of AI people were killed when the government delivered smallpox-containing blankets to them, in the "first documented case of bioterrorism" on American soil. These historical atrocities continue to cast a long shadow over the health and wellbeing of AI/AN communities today.
Addressing these health disparities requires holistic, culturally informed interventions acknowledging and healing from historical trauma and improving access to quality care. However, challenges remain, such as the fact that 15 states in the U.S. do not have federally recognized tribes, potentially limiting advocacy for nationwide health services that benefit AI/AN individuals.
In locations like Kyle, South Dakota, within the Pine Ridge reservation, the average age of death for men is 48 years and for women is 54. These stark statistics underscore the urgent need for action to address the health crisis in AI/AN communities.
[1] Centers for Disease Control and Prevention. (2023). American Indian and Alaska Native Health. https://www.cdc.gov/minorityhealth/aimhi/index.html [2] Warne, D. L., & Lajimodiere, D. (2021). Historical trauma and its impact on American Indian health. American Journal of Public Health, 111(S3), S384-S389. [3] Indian Health Service. (2021). Maternal and Child Health. https://www.ihs.gov/mch/ [4] Centers for Disease Control and Prevention. (2023). Chronic Kidney Disease. https://www.cdc.gov/ckd/ [5] National Institute on Minority Health and Health Disparities. (2023). American Indian and Alaska Native Health Disparities. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=5&lvlid=53
- Dr. Donald Warne's concerns about the health impact of historical and systemic issues on American Indian and Alaska Native (AI/AN) communities point towards the need for a more comprehensive approach to workplace-wellness programs, incorporating medical-conditions such as chronic diseases, cancer, respiratory conditions, digestive-health issues, eye-health, hearing, skin-conditions, and neurological disorders.
- Acknowledging the significant health disparities among AI/AN populations, it is essential to prioritize health-and-wellness initiatives that target priority areas including cardiovascular-health, mental-health, sexual-health, and aging, to ensure equitable access to therapies-and-treatments and nutrition resources.
- In the quest for health equity, learning about autoimmune-disorders, besides other health topics, in education-and-self-development programs can empower AI/AN individuals with the knowledge required to make informed decisions about their health and well-being.
- seek out resources for fitness-and-exercise and personal-growth to combat the higher rates of weight-management challenges observed among AI/AN adults, promoting overall health and wellness.
- The critical role of eye-health in maintaining physical health and quality of life for AI/AN communities emphasizes the importance of regular eye exams and early detection and treatment of eye-health issues.
- Incorporating hearing screenings into primary healthcare services can help address the poorer hearing health status of AI/AN populations and reduce the impact of hearing-related challenges on their communication, learning, and overall wellbeing.
- The association between skin-conditions and chronic diseases, particularly in the context of historical traumas and systemic factors, necessitates a careful examination of skin-care practices within AI/AN communities and the role of cultural norms in skin health.
- Maternal-health issues are a critical area for consideration in workplace-wellness programs, addressing the disproportionately high rate of maternal morbidity and mortality among AI/AN women through education, support, and access to care during pregnancy and postnatal periods.
- In addition to improving access to healthcare services, Dr. Roger Dale Walker's proposal for a Marshall Plan for Native people in North America could address underlying social determinants of health, like socioeconomic disadvantage, geographic isolation, and insufficient insurance coverage.
- Beyond the biomedical aspects of health, workers in AI/AN communities could benefit from mental-health resources and support networks to cope with the ongoing impact of historical trauma and systemic discrimination.
- Encouraging the incorporation of Indigenous knowledge and healing practices within healthcare settings can contribute to improved health outcomes by fostering a sense of cultural safety and respect.
- Advocating for men's-health awareness and resources can help address the disparities in life expectancy between AI/AN and non-Hispanic White men and lower the rate of premature death among AI/AN men on reservations.
- To address the urgent health crisis in AI/AN communities, institutions offering career-development and learning opportunities can collaborate with tribes and Native organizations to provide educational programs and professional training in areas such as public health, healthcare administration, and health education.
- Increasing awareness of the hidden history of bioterrorism and historical atrocities against AI individuals can help foster empathy, understanding, and action towards addressing the ongoing health impact on AI/AN communities today.
- By embracing a comprehensive and holistic approach to workplace-wellness programs, addressing the unique health needs and disparities of AI/AN populations, organizations can foster a healthier, more inclusive, and more productive workforce, ultimately contributing to the overall wellbeing of AI/AN communities and breaking the cycle of historical trauma and systemic disadvantage.
