“Moving the Needle” for Native American Health

Western science alone will not “move the needle” in empowering Indian Country to achieve health equity. Recognition of Indigenous thought as an equivalent epistemology and acknowledgment of health belief systems embedded in cultural core values must be part of a standard methodology of scientific inquiry. Health equity will require consultation and support of tribal leadership to create informed health policy and decision making in the 565+ federally recognized tribes and the equitable provision of health resources to off-reservation Natives. Education and training of tribal leaders and communities about social- and self-determinants of health are needed. Self-determination is increasingly complex as the historical format of health care by the Indian Health Service gives way to the provision of responsive health care by tribal communities (PL 93-638, 1975). Creation of a tribal public health workforce will require developing human resources where they live through local resources, e.g., tribal colleges. Substandard housing, economics and education must be confronted as health equity prerequisites. Local decision making facilitated by systematic approaches such as Health Impact Assessments will advance the development of culturally supported interventions through inter-professional collaborations. Exercising their unique political status of sovereignty, tribal leaders set their own parameters for health disparities investigation by implementing tribally driven research, historical trauma investigation, tribal IRB's, and local or regionally based epidemiology centers. Significant progress toward health equity in Indian Country by 2020 will require substantial and sustained public investment, distinction in national health studies, and the inclusion of multiple belief systems as legitimate sources of knowledge.