Disrupting the cycle of Native health disparities
Taking an Indigenous approach to address health disparities can begin changing the current perception that Native identity is a risk factor for poor health.
Heather Peters will never forget the day she was talking with Teresa Peterson, a colleague with whom she has since come to have a more than 14-year research partnership. Peters, a professor of psychology at the University of Minnesota Morris, had just finished telling Peterson that many health professionals consider Native identity as a risk factor for poor health. Peterson, a member of the Upper Sioux Community and independent consultant and researcher, was taken aback.
“It blew my mind,” says Peterson.
“I couldn't understand it. We view being Native as a strength and asset in our community. So part of [Heather and my] work has been to help inform the field—all the different fields that view us that way.”
Teresa Peterson
Their subsequent conversation and research collaboration illustrates the tension between Western medicine and Indigenous culture, one with lasting consequences for Native health.
Changing the narrative
It’s true that many Native communities do have higher rates of some health afflictions: obesity and diabetes, coronary heart disease, and substance abuse. But the way in which Western medicine often frames these issues of health, coupled with one-size-fits-all research and medical approaches that disregard Native culture, has ingrained such a negativity around Native health that Western-based measurement tools and interventions may very well be part of the problem, says Peters.
“So you get this stereotype that if you're Native you're going to be overweight, you're going to have diabetes,” says Peters. “That leads to learned helplessness. The idea that, well, if this is predestined, if this is just ‘I'm Native so therefore I'm going to have diabetes,’ then why do anything if there's nothing I can do that's going to make a difference?”
These stereotypes around Native health, in turn, can be internalized. “What we were hearing from community members is that, ‘Well, I'm Native. Every family member has had diabetes. Therefore I'm going to have diabetes,’” says Peters.
It’s what is called an external locus of control, the idea that your destiny—whether it’s health, in this case, or something else—is predetermined by outside forces you have no control over, which then exacerbates unhealthy behaviors. And there is plenty of research that clearly links an external locus of control to poor health outcomes. For example, higher levels of external locus of control predict higher levels of stress, depression, intake of junk food, substance abuse, and physical illness.
Ultimately, says Peters, it leads to what she and Peterson call the “cycle of Native health disparities.” And so they decided to do something about it.
In the Cycle of Native Health Disparities model, colonization led to historical trauma and subsequent health disparities between Native communities and the broader U.S. population that persist to this day. Western-based measurement tools and interventions may contribute to these disparities.
Disrupting the cycle
In about 2010, the Native nonprofit Dakota Wicohan (DW) began partnering with Peters on work that would lead to disrupting the cycle of health disparities through an approach that viewed Native culture as an asset. Dakota Wicohan, located in Morton, MN, near the Upper and Lower Sioux Communities, is an organization dedicated to preserving the Dakota language and Dakota ways of life.
Members from the DW community expressed being tired of health practitioners defining, measuring, and viewing their health solely through a deficit-based lens (“here’s what’s wrong with you”) and wanted the opportunity to define and assess their health for themselves.
Peterson, who was at that time director of DW, along with other DW staff, wanted instead to take a strengths-based approach to evaluate the impact of DW’s cultural programming on Dakota community members. They hoped to measure whether their programming was improving wicozani, a Dakota term for the “overall health and well-being” of community members.
The result was the creation of the Wicozani Instrument, a nine-item self-report tool that measures mental, physical, and spiritual health from an Indigenous worldview, as well as the perceived importance of those measures to an individual's quality of life.
What DW, Peters, and Peterson found after thorough study was that the Wicozani Instrument worked. By focusing on overall health and well-being, rather than on ailments and sickness, individuals had the space to consider what health looks and feels like and to take control of their own health.
“As wicozani went up, suicide ideation went down. So it affirmed that we could use this scale, our strength-based perspective, to really gauge our work,”
Teresa Peterson
Another finding, says Peterson, is that DW’s programming was very helpful for women and girls, but it was not as beneficial for men and boys.
That led to a shift in DW’s cultural programming.
“It dawned on us that all of our programming was led by the matriarchs of our community. So that finding caused us to really seek out male staff and focus on what our young men and boys need to support their overall well-being and sense of belonging and identity,” says Peterson.
Different cultures, different interventions
There are fundamental differences between Indigenous and Western culture, says Peters. One key difference is that Native cultures are often community focused, while Western culture focuses on the individual. Peterson agrees, and offers an illustrative example through the Dakota language.
“Our whole culture is really based on relationship and relationality. It's embedded in our language,” she says. “When I introduce myself in the (Dakota) language, it isn't saying ‘I am this person.’ It's saying, ‘I belong to a group of people … My people call me this.’”
Take suicidality among Native teens as an example.
Community-based anti-suicide programs for youth have much more success in Native communities than individually based anti-suicide programs. “So we have to frame the intervention to meet the needs of the community,” says Peters. “Just because something works for white people because they're coming from an individualistic background, it's not going to necessarily apply to people from community-based cultures.”
Rather than, say, placing an individual in one-on-one therapy to help them change their negative thought patterns, a community-based intervention would go beyond working with the individual.
“You are really thinking of wraparound services,” says Peters. “You are not just working with the student who has suicidal ideation, but you are educating all community members about the signs and symptoms of suicidal ideation, and about how to intervene. It’s about how do we, as a community, let everyone know that they belong, and that they matter.”
An ongoing collaboration
Today, the U of M Morris collaboration with DW has resulted in the development of five additional Indigenous measures which have been used by Native and non-Native entities, says Peters, including doctors, school counselors, psychologists, and other health professionals. The value of what DW, Peterson, and Peters created really hit home when Washington, D.C.’s Child and Family Services Agency invited them to share how they developed and validated the Wicozani Instrument so that they could develop measures to assess the effectiveness of community centers designed to address high rates of child abuse in eight Washington boroughs.
“They were interested in replicating our process because the Wicozani Instrument was the only validated community-defined measure of health they identified.”
Heather Peters
In some sense it is a reflection that “Western science is finally catching up to Indigenous perspective and thought and knowledge,” says Peterson.
Peterson is also grateful the University of Minnesota Morris has recognized its role in the community. “It isn't just to be this isolated institution,” says Peterson. “They're there to be in service to the community and to the people, and especially with its history as a former boarding school. And so having that commitment to serving Indigenous and Native populations and communities, I think, is a good model for other universities to look at.”
U of M Morris chancellor Janet Schrunk Ericksen agrees.
“Professor Peters sees a need and figures out what she could do—and what we could do as a campus—to address it. Her deft blending of cultural humility and academic expertise provides an extraordinary model for responsible and effective research and teaching.”
Janet Schrunk Ericksen
Chancellor, University of Minnesota Morris
Giving links:
- Consider making a donation to support Dakota Wicohan, which restores Dakota and Indigenous peoples’ culture, health, and well-being.
- Consider making a donation to support educational opportunities for U of M Morris students who wish to enhance their academic experiences.
