Tribal Leadership and Care Services: “Overcoming These Divisions That Keep Us Apart”

Abstract American Indian and Alaska Native (AI/AN) Peoples are among groups continuing to experience health disparities. Eliminating health disparities, a national priority in the United States, requires addressing structural forces, also known as structural determinants of health. This case study examines linkages between health disparities, structural forces, and colonial trauma relevant to care services and AN Peoples in Alaska. It centers on an Inupiaq Elder with leadership experience in AN tribal care services. Guided by a conceptual lens based on division–unification processes, this study yields the following findings as represented by five in vivo themes: severing of relationship, aftereffects of colonization, striking alliances, overcoming these divisions that keep people apart, and growing together in relationship. Colonial legacies continue to linger and have a multidimensional impact on AI/AN communities, including tribal care services. Healing from colonial trauma requires collective effort among AI/AN Peoples and people from the wider community. Practice implications emphasize trauma-informed approaches to promote reconciliation and a larger collective commitment to reconciliation in a global reality of increasing interdependence.

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

Innovation in Aging ◽

10.1093/geroni/igaa057.120 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 37-37

Author(s):

Sadie Giles

Keyword(s):

United States ◽

Health Disparities ◽

Life Course ◽

American Indian ◽

Old Age ◽

Alaska Native ◽

Political History ◽

The United States ◽

The Political ◽

The Life Course

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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Ethnic Disparities in AL Amyloidosis Outcomes Among Hospitalized Patients in the United States

Blood ◽

10.1182/blood-2021-147060 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 4110-4110

Author(s):

Samer Al Hadidi ◽

Deepa Dongarwar ◽

Hamisu Salihu ◽

Carolina Schinke ◽

Sharmilan Thanendrarajan ◽

...

Keyword(s):

Palliative Care ◽

Health Disparities ◽

Hospital Mortality ◽

Conflicts Of Interest ◽

The United States ◽

Hospital Death ◽

Al Amyloidosis ◽

Type I ◽

Care Services ◽

Palliative Care Services

Abstract INTRODUCTION Health disparities in immunoglobulin light chain (AL) amyloidosis have not been well described. We aimed to assess if health disparities between non-Hispanic (NH)-Whites, NH-Blacks and Hispanics exist and to describe differences between different ethnic/racial groups. METHODS We conducted a retrospective cross-sectional analysis of in-patient AL amyloidosis hospitalizations from 2016 to 2018 using the Nationwide Inpatient Sample (NIS), a database which provides nationally representative information on hospitalizations in the U.S. The studied period was chosen to capture data from the ICD-10-CM codes to avoid misclassification of AL amyloidosis which was grouped with other cases of ATTR amyloidosis in the ICD-9-CM coding system. All hospitalizations in adults (age ≥18 years) were included. The exposure for the study was the occurrence of AL amyloidosis in the discharge records. Outcomes were [1] in-hospital death [2] chemotherapy use; [3] intensive care unit (ICU) utilization; [4] palliative care consultation. The analysis for this study was performed using R program version 3.5.1; a 5% type I error rate for all hypothesis tests (two-sided) was assumed. RESULTS Admissions related to AL amyloidosis constituted 0.03% of all hospitalizations in the study period (25,470 of 90,869,381). The prevalence of AL amyloidosis related hospitalizations was higher in NH-Blacks when compared with NH-Whites (42.8 vs.28.1 per 100,000 hospitalizations). AL amyloidosis related in-hospital mortality rate was higher in NH-Whites and Hispanics when compared to NH-Blacks (6.6%% and 6.2% vs. 4.9%). In-hospital mortality with AL amyloidosis was higher in older patients, males and those who self-paid for their treatment. Utilization of ICU care was more common in NH-Blacks when compared to NH-Whites (6% vs. 4.8%). Hispanics had the lowest inpatient chemotherapy use (1.7% vs. 2.9%). Multivariable adjusted association between race/ethnicity and various outcomes showed a trend towards lower in-hospital mortality in NH-Blacks when compared to NH-Whites (OR: 0.76, 95% CI: 0.55-1.05, p=0.09) and lower utilization of palliative care services in NH-Blacks when compared with NH-Whites (OR: 0.61, 95% CI: 0.42-0.88, p=0.01). Despite very low numbers of transplant related admissions, such admissions occurred only in NH-Whites. CONCLUSIONS Our findings highlight disparities in AL amyloidosis care for NH-Blacks and Hispanics. NH-Blacks tend to have lower in-hospital mortality with higher utilization of ICU care, nevertheless, they receive the lowest palliative care services. Despite the higher utilization of ICU care, data suggest possible superior outcomes of AL amyloidosis in NH-Blacks when compared to NH-Whites. Disclosures No relevant conflicts of interest to declare.

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Cultural Determinants of Help Seeking: A Model for Research and Practice

Research and Theory for Nursing Practice ◽

10.1891/1541-6577.23.4.259 ◽

2009 ◽

Vol 23 (4) ◽

pp. 259-278 ◽

Cited By ~ 47

Author(s):

Denise Saint Arnault

Keyword(s):

Help Seeking ◽

Health Care Services ◽

Cultural Models ◽

The Body ◽

Structural Determinants ◽

Research And Practice ◽

Care Services ◽

National Priority ◽

Cultural Determinants ◽

Distribution Of Resources

Increasing access to and use of health promotion strategies and health care services for diverse cultural groups is a national priority. While theories about the structural determinants of help seeking have received empirical testing, studies about cultural determinants have been primarily descriptive, making theoretical and empirical analysis difficult. This article synthesizes concepts and research by the author and others from diverse disciplines to develop the midrange theoretical model called the Cultural Determinants of Help Seeking (CDHS). The multidimensional construct of culture, which defines the iterative dimensions of ideology, political economy, practice, and the body, is outlined. The notion of cultural models of wellness and illness as cognitive guides for perception, emotion and behavior as well as the synthesized concept of idioms of wellness and distress are introduced. Next, the CDHS theory proposes that sign and symptom perception, the interpretation of their meaning, and the dynamics of the social distribution of resources are all shaped by cultural models. Then the CDHS model is applied to practice using research with Asians. Finally, implications for research and practice are discussed.

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The Changing Landscape of Health Care Provision to American Indian Nations

American Indian Culture and Research Journal ◽

10.17953/aicr.39.1.j1u030g668113403 ◽

2015 ◽

Vol 39 (1) ◽

pp. 1-24 ◽

Cited By ~ 3

Author(s):

Stephanie Rainie ◽

Miriam Jorgensen ◽

Stephen Cornell ◽

Jaime Arsenault

Keyword(s):

United States ◽

Health Care ◽

American Indian ◽

Alaska Native ◽

Health Care Services ◽

The United States ◽

Health Care Provision ◽

Care Provision ◽

Health Service Provision ◽

Care Services

Health service provision has been an aspect of indigenous-United States relationships for over two hundred years, yet America's First Peoples continue to suffer from poor health outcomes when compared with other racial or ethnic groups in the United States. An important change over recent decades is that more and more tribes are managing their own health care services—a realignment of administration and authority that has the potential to substantially improve American Indian and Alaska Native health in years to come. This paper describes the history of health care provision to federally recognized American Indian tribes. It continues by documenting the sparse research literature on tribal management of health care services and identifying information still needed to bring knowledge of this topic up-to-date. Five challenges for tribal management of health-care services that should be considered by tribes and policymakers in their health-care efforts and brought to bear on future research are discussed. By addressing both tribal control of health-care services and the role of tribes in changes to federally provided health care, this paper adds the lens of tribal sovereignty to current discussions of the history and policy context for American Indian and Alaska Native health.

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Federal Indian Law as a Structural Determinant of Health

The Journal of Law Medicine & Ethics ◽

10.1177/1073110519898041 ◽

2019 ◽

Vol 47 (S4) ◽

pp. 34-42

Author(s):

Aila Hoss

Keyword(s):

Health Disparities ◽

Alaska Native ◽

The Body ◽

Structural Determinants ◽

Adverse Health Outcomes ◽

Federal Indian Law ◽

Indian Law ◽

Health Laws ◽

Structural Determinant

Federal Indian law is the body of law that defines the rights, responsibilities, and relationships between three sovereigns, Tribes, states, and the federal government. This area of law has defined, oftentimes poorly, the contours of treaty rights, criminal and civil jurisdiction, economic development, among other issues. Much has been documented in terms of the implications of social, legal, political, and economic systems that perpetuate inequities amongst American Indian and Alaska Native populations. There has also been substantial research on health inequalities. Yet, there has been less discussion on the role of law in perpetuating these adverse health outcomes in these populations. The social and structural determinants of health are the factors and conditions, such as housing, education, and politics, that create health disparities. For years, law has been described as a tool to promote health and even a determinant of health. And while research has explored Tribal health laws and federal Indian health policies, more needs to be analyzed in terms of the role of foundational principles of federal Indian law in perpetuating health disparities. This article argues that federal Indian law is a structural determinant of health by linking health disparities to the constructs of this body of law.

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The Complexity of Health Disparities: More Than Just Black–White Differences

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2020_persp-20-00199 ◽

2021 ◽

pp. 1-10

Author(s):

Charles Ellis ◽

Molly Jacobs

Keyword(s):

Health Disparities ◽

Clinical Outcomes ◽

The United States ◽

Careful Examination ◽

White Americans ◽

Speech Language Pathology ◽

Death Rates ◽

The Social ◽

Health Related ◽

Language Pathology

Health disparities have once again moved to the forefront of America's consciousness with the recent significant observation of dramatically higher death rates among African Americans with COVID-19 when compared to White Americans. Health disparities have a long history in the United States, yet little consideration has been given to their impact on the clinical outcomes in the rehabilitative health professions such as speech-language pathology/audiology (SLP/A). Consequently, it is unclear how the absence of a careful examination of health disparities in fields like SLP/A impacts the clinical outcomes desired or achieved. The purpose of this tutorial is to examine the issue of health disparities in relationship to SLP/A. This tutorial includes operational definitions related to health disparities and a review of the social determinants of health that are the underlying cause of such disparities. The tutorial concludes with a discussion of potential directions for the study of health disparities in SLP/A to identify strategies to close the disparity gap in health-related outcomes that currently exists.

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