Historical and spatial relations as fundamental determinants of American Indian infant mortality in Michigan

In 2009, the rate of infant mortality among American Indians in Michigan was more than 50% higher than the White infant mortality rate. While we often try to explain these disparities by focusing on individual risk factors and behaviors, this presentation illustrates how political, historical and social factors affect American Indian infant mortality and racial disparities in infant mortality. We created a conceptual framework and a Google Earth map to illustrate how historical and cultural factors influence the health of American Indians in the state. The policies, practices, and ideological foundation accompanying the colonization of North America affected the physical, social, and cultural environments of American Indians. By mapping the layers that show traditional tribal territories, current locations of tribal nations, and healthcare resources we were able to illustrate the cumulative effect of historical and sociopolitical factors on modern American Indian infant mortality. Environmental factors – such as tribal removal from traditional land base, loss or restructuring of traditional social environment and norms, experience of intergenerational grief, and community infrastructure – interact with the passage of time and influence health behaviors that affect maternal and infant health. This presentation highlights that colonization is a fundamental cause of American Indian infant mortality and that it is critical to consider how historical and spatial factors interact with other determinants of health. We will conclude this presentation with a discussion of how we are utilizing these tools to revise the state health department's strategy to reduce American Indian infant mortality.