A Confluence of Policy Inequality: Health Disparities in Old Age Among American Indian and Alaska Native Populations

Abstract Racial health disparities in old age are well established, and new conceptualizations and methodologies continue to advance our understanding of health inequality across the life course. One group that is overlooked in many of these analyses, however, is the aging American Indian/Native Alaskan (AI/NA) population. While scholars have attended to the unique health inequities faced by the AI/NA population as a whole due to its discordant political history with the US government, little attention has been paid to unique patterns of disparity that might exist in old age. I propose to draw critical gerontology into the conversation in order to establish a framework through which we can uncover barriers to health, both from the political context of the AI/NA people as well as the political history of old age policy in the United States. Health disparities in old age are often described through a cumulative (dis)advantage framework that offers the benefit of appreciating that different groups enter old age with different resources and health statuses as a result of cumulative inequalities across the life course. Adding a framework of age relations, appreciating age as a system of inequality where people also gain or lose access to resources and status upon entering old age offers a path for understanding the intersection of race and old age. This paper will show how policy history for this group in particular as well as old age policy in the United States all create a unique and unequal circumstance for the aging AI/NA population.

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Envisioning health equity for American Indian/Alaska Natives: a unique HIT opportunity

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocz052 ◽

2019 ◽

Vol 26 (8-9) ◽

pp. 891-894 ◽

Cited By ~ 2

Author(s):

Theresa Cullen ◽

Jan Flowers ◽

Thomas D Sequist ◽

Howard Hays ◽

Paul Biondich ◽

...

Keyword(s):

United States ◽

American Indian ◽

Health Information ◽

Health Equity ◽

Alaska Native ◽

Management System ◽

Information Needs ◽

Patient Management ◽

The United States ◽

Core Mission

Abstract The Indian Health Service provides care to remote and under-resourced communities in the United States. American Indian/Alaska Native patients have some of the highest morbidity and mortality among any ethnic group in the United States. Starting in the 1980s, the IHS implemented the Resource and Patient Management System health information technology (HIT) platform to improve efficiency and quality to address these disparities. The IHS is currently assessing the Resource and Patient Management System to ensure that changing health information needs are met. HIT assessments have traditionally focused on cost, reimbursement opportunities, infrastructure, required or desired functionality, and the ability to meet provider needs. Little information exists on frameworks that assess HIT legacy systems to determine solutions for an integrated rural healthcare system whose end goal is health equity. This search for a next-generation HIT solution for a historically underserved population presents a unique opportunity to envision and redefine HIT that supports health equity as its core mission.

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Drawing from justice theories to support targets of online harassment

New Media & Society ◽

10.1177/1461444820913122 ◽

2020 ◽

pp. 146144482091312

Author(s):

Sarita Schoenebeck ◽

Oliver L Haimson ◽

Lisa Nakamura

Keyword(s):

United States ◽

Social Media ◽

Criminal Justice ◽

American Indian ◽

Alaska Native ◽

Online Survey ◽

The United States ◽

Online Harassment ◽

Justice Theories

Most content moderation approaches in the United States rely on criminal justice models that sanction offenders via content removal or user bans. However, these models write the online harassment targets out of the justice-seeking process. Via an online survey with US participants ( N = 573), this research draws from justice theories to investigate approaches for supporting targets of online harassment. We uncover preferences for banning offenders, removing content, and apologies, but aversion to mediation and adjusting targets’ audiences. Preferences vary by identities (e.g. transgender participants on average find more exposure to be undesirable; American Indian or Alaska Native participants on average find payment to be unfair) and by social media behaviors (e.g. Instagram users report payment as just and fair). Our results suggest that a one-size-fits-all approach will fail some users while privileging others. We propose a broader theoretical and empirical landscape for supporting online harassment targets.

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Endogenous Selection Bias and Cumulative Inequality over the Life Course: Evidence from Educational Inequality in Subjective Well-Being

European Sociological Review ◽

10.1093/esr/jcaa003 ◽

2020 ◽

Vol 36 (3) ◽

pp. 333-350

Author(s):

Fabian Kratz ◽

Alexander Patzina

Keyword(s):

United States ◽

Panel Data ◽

Life Course ◽

Panel Study ◽

Well Being ◽

The United States ◽

Subjective Well Being ◽

Interviewer Effects ◽

Endogenous Selection ◽

The Life Course

Abstract According to theories of cumulative (dis-)advantage, inequality increases over the life course. Labour market research has seized this argument to explain the increasing economic inequality as people age. However, evidence for cumulative (dis-)advantage in subjective well-being remains ambiguous, and a prominent study from the United States has reported contradictory results. Here, we reconcile research on inequality in subjective well-being with theories of cumulative (dis-)advantage. We argue that the age-specific endogenous selection of the (survey) population results in decreasing inequalities in subjective well-being means whereas individual-level changes show a pattern of cumulative (dis-)advantage. Using repeated cross-sectional data from the European Social Survey (N = 15,252) and employing hierarchical age-period-cohort models, we replicate the finding of decreasing inequality from the United States with the same research design for Germany. Using panel data from the German Socio-Economic Panel Study (persons = 47,683, person-years = 360,306) and employing growth curve models, we show that this pattern of decreasing inequality in subjective well-being means is accompanied by increasing inequality in intra-individual subjective well-being changes. This pattern arises because disadvantaged groups, such as the low educated and individuals with low subjective well-being show lower probabilities of continuing to participate in a survey and because both determinants reinforce each other. In addition to allowing individual changes and attrition processes to be examined, the employed multi-cohort panel data have further key advantages for examining inequality in subjective well-being over the life course: They require weaker assumptions to control for period and cohort effects and make it possible to control for interviewer effects that may influence the results.

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THE LIFE COURSE OF CRIMINOLOGY IN THE UNITED STATES: THE AMERICAN SOCIETY OF CRIMINOLOGY 2003 PRESIDENTIAL ADDRESS*

Criminology ◽

10.1111/j.1745-9125.2004.tb00511.x ◽

2004 ◽

Vol 42 (1) ◽

pp. 1-26 ◽

Cited By ~ 82

Author(s):

JOHN H. LAUB

Keyword(s):

United States ◽

Life Course ◽

Presidential Address ◽

The United States ◽

American Society ◽

The Life Course

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Resilience in American Indian and Alaska Native Public Health: An Underexplored Framework

American Journal of Health Promotion ◽

10.1177/0890117116664708 ◽

2016 ◽

Vol 32 (2) ◽

pp. 274-281 ◽

Cited By ~ 8

Author(s):

Nicolette I. Teufel-Shone ◽

Julie A. Tippens ◽

Hilary C. McCrary ◽

John E. Ehiri ◽

Priscilla R. Sanderson

Keyword(s):

United States ◽

Health Promotion ◽

American Indian ◽

Alaska Native ◽

Data Extraction ◽

Target Population ◽

The United States ◽

Original Research ◽

Data Synthesis ◽

Collective Resilience

Objective: To conduct a systematic literature review to assess the conceptualization, application, and measurement of resilience in American Indian and Alaska Native (AIAN) health promotion. Data Sources: We searched 9 literature databases to document how resilience is discussed, fostered, and evaluated in studies of AIAN health promotion in the United States. Study Inclusion and Exclusion Criteria: The article had to (1) be in English; (2) peer reviewed, published from January 1, 1980, to July 31, 2015; (3) identify the target population as predominantly AIANs in the United States; (4) describe a nonclinical intervention or original research that identified resilience as an outcome or resource; and (5) discuss resilience as related to cultural, social, and/or collective strengths. Data Extraction: Sixty full texts were retrieved and assessed for inclusion by 3 reviewers. Data were extracted by 2 reviewers and verified for relevance to inclusion criteria by the third reviewer. Data Synthesis: Attributes of resilience that appeared repeatedly in the literature were identified. Findings were categorized across the lifespan (age group of participants), divided by attributes, and further defined by specific domains within each attribute. Results: Nine articles (8 studies) met the criteria. Currently, resilience research in AIAN populations is limited to the identification of attributes and pilot interventions focused on individual resilience. Resilience models are not used to guide health promotion programming; collective resilience is not explored. Conclusion: Attributes of AIAN resilience should be considered in the development of health interventions. Attention to collective resilience is recommended to leverage existing assets in AIAN communities.

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Gastric Cancer Among American Indian and Alaska Native Populations in the United States, 2005–2016

The American Journal of Gastroenterology ◽

10.14309/ajg.0000000000000748 ◽

2020 ◽

Vol 115 (12) ◽

pp. 1989-1997

Author(s):

Stephanie C. Melkonian ◽

Dornell Pete ◽

Melissa A. Jim ◽

Donald Haverkamp ◽

Charles L. Wiggins ◽

...

Keyword(s):

United States ◽

Gastric Cancer ◽

American Indian ◽

Alaska Native ◽

The United States ◽

Native Populations

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A Preliminary Estimate of the Number of People who Inject Drugs in Cherokee Nation using Capture-Recapture Methods

10.21203/rs.3.rs-144638/v1 ◽

2021 ◽

Author(s):

Molly Feder ◽

Amanda Winters ◽

Whitney Essex ◽

Jorge Mera

Keyword(s):

United States ◽

American Indian ◽

Alaska Native ◽

People Who Inject Drugs ◽

The United States ◽

Native People ◽

Cherokee Nation ◽

The Past ◽

Capture Recapture ◽

Data Source

Abstract Background: Injection drug use is an important public health issue in the United States, and estimates indicate that American Indian and Alaska Native people are disproportionately affected. Injection drug use is also the leading cause of Hepatitis C virus (HCV) infection in the United States, attributable to over half of all cases, and contributes to 44% of human immunodeficiency virus (HIV) acquisition in American Indian and Alaska Native females. Existing estimates of American Indian and Alaska Native people who inject drugs are limited. We aimed to estimate the number of people who inject drugs in Cherokee Nation.Methods: A two-sample, capture-recapture approach was used. The first data source was an abstraction of Cherokee Nation Health Services electronic medical records from February 2017 through December 2018. The second data source was an abstraction from Cherokee Nation’s HCV Elimination Program Database from August 2015 through December 2018. Individuals were included in the abstractions if they were asked if they had injected drugs in the past six months during their health visit. The indirect prevalence estimate of people who inject drugs was calculated in accordance with the UNAIDS/WHO Guidelines on Estimating the Size of Populations Most at Risk to HIV.Results: In total, 198 individuals across both data sources reported that they had injected drugs within the past six months. This included 123 unique individuals from the first source, 69 individuals from the second source, and six individuals who were included in both sources. Capture-recapture calculations indicated an estimate of 1,613 people who inject drugs (95% CI: 404, 2,821). Conclusions: This study was the first attempt at estimating the number of people who inject drugs in Cherokee Nation, and one of the few existing studies to estimate the number of American Indian/Alaska Native people who inject drugs in the United States. Gaining knowledge about the prevalence of people who inject drugs in Cherokee Nation will inform strategies to support addiction care and treatment among people who inject drugs living in Indian Country.

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Further decoding the mystery of American pain: The importance of work

PLoS ONE ◽

10.1371/journal.pone.0261891 ◽

2022 ◽

Vol 17 (1) ◽

pp. e0261891

Author(s):

David G. Blanchflower ◽

Alex Bryson

Keyword(s):

United States ◽

Life Course ◽

The Elderly ◽

The United States ◽

Cross Sectional ◽

Wear And Tear ◽

Educational Groups ◽

Employment Rates ◽

The Life Course ◽

What Matters

A recent paper showed that, whereas we expect pain to rise with age due to accumulated injury, physical wear and tear, and disease, the elderly in America report less pain than those in midlife. Further exploration revealed this pattern was confined to the less educated. The authors called this the ‘mystery of American pain’ since pain appears to rise with age in other countries irrespective of education. Revisiting this issue with the same cross-sectional data we show that what matters in explaining pain through to age 65 is whether one is working or not. The incidence of pain across the life-course is nearly identical for workers in America and elsewhere, but it is greater for non-working Americans than it is for non-workers elsewhere. As in other countries, pain is hump-shaped in age among those Americans out of work but rises a little over the life-course for those in work. Furthermore, these patterns are apparent within educational groups. We show that, if one ascribes age-specific employment rates from other OECD countries to Americans, the age profile of pain in the United States is more similar to that found elsewhere in the OECD. This is because employment rates are lower in the United States than elsewhere between ages 30 and 60: the simulation reduces the pain contribution of these non-workers to overall pain in America, so it looks somewhat similar to pain elsewhere. We conclude that what matters in explaining pain over the life-course is whether one is working or not and once that is accounted for, the patterns are consistent across the United States and the rest of the OECD.

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