Native American Wellness: A State of Affairs
Denise Alvarado
You have noticed that everything an Indian does is in a circle, and that is because the Power of the World always works in circles, and everything tries to be round…The sky is round, and I have heard that earth is round like a ball, and so are all the stars. The wind, in its greatest power, whirls. Birds make their nest in circles, for theirs is the same religion as ours…Even the seasons form a great circle in the or changing, and always come back again to where they were. The life of a person is a circle from childhood to childhood, and so it is in everything where power moves. (Black Elk, as cited in Neihardt, 1959).
Native Americans represent a population in dire need of wellness attention (Herring, 1997; LaFramboise, 1988; Terrell, 1994) particularly in the areas of mental health and substance abuse (Portman, 2001). In general, Native Americans tend to be at a higher risk for mental health problems than other ethnic groups, with an estimated 80% frequency of co-occurring mental health and substance use disorders (Provan & Carson, 2000). Additionally, Native Americans face some of the highest rates of obesity in the world (Wharton & Hampl, 2004). According to the 2001 report of the Surgeon General, widespread racial and ethnic disparities exist in the mental health and health diagnosis and treatment of minorities, with Native Americans unlikely to receive the treatment they need, improperly treated when they do receive it, and more likely than Caucasians to leave treatment prematurely (Sue& Zane, 1994). Even when efforts are made to control sociodemographic factors, such as geographical location and socioeconomic status, disparities across race and ethnicity persist (U.S. Department of Health and Human Services, 2001).
Inequalities in income and education have been found to be associated with populations with the worst health status (USDHHS, 2000). Higher incomes allow for increased access to health services, better housing, and greater participation in health-promoting behaviors (2000), whereas lower incomes and poverty decrease or inhibit access to healthcare, decent housing, and health-promoting behaviors (SH, 2004). Indeed, Native Americans have an unemployment rate that is 2.5 times higher than the rest of the U.S. population (Indian health Service, 2001), and the poverty rate as of 1999was 25.7%, compared with 24% for African Americans,22.6% for Hispanics, and 8.1% for non-Hispanic Whites (U.S. Bureau of the Census, 2003). Disease patterns among Native Americans, however, are also associated with cultural dislocation and discrimination, and the management Sciences for Health division of the Office of Minority Health and Bureau of Primary Healthcare, currently recommends providers examine the historical experiences of Native Americans in order to more fully comprehend the impact historical trauma has on health and well-being.
The following startling facts illustrate not only the persistence of health care disparities for Native American populations, but also suggest that targeted attempts at wellness interventions have been either nonexistent or dismally ineffective:
1. Native Americans have an average life expectancy that is almost 6 years less than that of the rest of the U.S. populations. (Indian Health Service [IHS], 2002).
2. Age-adjusted death rates are greater for Native Americans than the rest of the U.S. population for alcoholism (740% higher), suicide (190% higher), homicide (180% higher), diabetes (390% higher), injuries (340 % higher), and tuberculosis (500% higher). (IHS, 2001).
3. The five leading causes of death in 1999 were coronary heart disease, cancer, accidents and unintentional injuries, diabetes mellitus, and cerebrovascular disease. (Center for Disease Control [CDC], 2001).
4. Mortality rates due to alcoholism are seven times higher than the general population. Methamphetamine abuse is increasing in many Native American communities and is associated with dangerous behavior and violent events, primarily in Native American youth. (IHS, 2001a).
5. The prevalence of adult smoking among 5 ethnic groups is highest among native Americans (34.1%), followed by African Americans (26.7%), Caucasians (25.3%), Hispanics (20.4%, and Asian Americans and Pacific Islanders (16.9%). (CDC, 2000).
6. Native American youth living in urban areas are at increased risk for serious mental illness and substance abuse problems, suicide, gang activity, teen pregnancy, abuse, and neglect. (IHS, 2001b).
Compounding the persistent social and health conditions of Native Americans is the lack of service providers who are of Native American descent or who have experience working with Native American populations, as well as the lack of culturally appropriate assessment methods and treatment interventions. For example, there are 229 doctors per 100,000 individuals in the general population, as opposed to fewer than 90 doctors for every 100,000 Native Americans (Intercultural Cancer Council [ICC], 2001). Additionally, current methods of psychological and educational assessment and interpretation have bee suggested to be based on measuring the individual’s cultural capitol rather than their natural intelligence or aptitude (Kendall, 2001). Problems can lay in the interpretation of test results, in test content (Fox, 2000; Nitko, 1983; Zurcher, 1998), in inappropriate standardization samples (Overton, 1996), in slope and intercept bias (Anastasi, 1988; Zurcher, 1998), in language bias, as well as, in the labeling process. Further, many Native Americans lack a basic familiarity with Western medical and psychological concepts, and demonstrate a tendency to interpret mental health or health problems in spiritual terms or some other culture-specific context (Snowden, 2003).
A great deal of literature reveals the many benefits of wellness (Witmer & Sweeney, 1992), cultural identity (Krieger, 1999), and spirituality (see Hettler, 1980, 1986; Opatz, 1986; Sweeney & Witmer, 1991; Zimpfer, 1992) on quality of life and health. In general, identification with a cultural group has been found to have a positive impact on well-being (Weaver, 1998), and Savolaine and Granello (2002) have suggested that dimensions of spirituality, such as meaning and purpose, play a crucial role in individual wellness. In addition, countless studies have demonstrated the importance of spirituality and culture in the lives of Native American people. Yet, few studies have focused on the interplay between the three variables in Native American populations.
Despite the fact that a great deal of research has revealed the many benefits of wellness (Witmer & Sweeney, 1992), Western mainstream society does not have a standard definition of what constitutes wellness or well-being. For obvious reasons, this could create problems when measuring the construct across cultures. To illustrate this point, the Western medical profession has broadly defined wellness as the absence of pathology or disease (Sarafino, 1994). On the other hand, the field of health psychology has defined wellness as a state on a continuum of illness/wellness, with premature death at one end of the spectrum and a high level of health at the other (1994). From this perspective, health indicates a positive state of physical, mental, and social well-being, rather than merely the absence of disease, with wellness dependent upon the various states of well-being (1994). Alternately, traditional Native American perspectives of wellness tend to encompass two worlds; the physical world, as well as, the world of the spirit (see Cohen, 1998; Lowery, 1998; Voss, Little Soldier, & Twiss, 1999). Indeed, spirituality is an integral component of Native American wellness, and health reflects a person’s relationship to self, family, community, the environment, and all living things (Cohen, 1998; MSH, 2004). Thus, it is apparent that disparities exist not only in Native American health status and access to services, but also in the basic definitions of wellness between cultures.
Excerpt from :
Alvarado, D. M. (2005). The relationships among cultural identity, spirituality, and wellness in a Native American population sample. Unpublished thesis. Walden University.
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