Back to our roots

Generally speaking, it is an exciting time to work in the field of public health. Aside from the fact that public health is an interesting, trans-disciplinary profession, we are living in a time of health care reform, which is providing health care workers with novel opportunities to address public health issues. Among many of the topics that are so often studied and talked about by health care professionals, obesity [and overweight] is an undeniably important one. It is apparent that particular communities/populations are disproportionately affected by the problem of obesity. For the American Indian (AI) population, obesity has become increasingly prevalent and is therefore a major contributor to morbidity and mortality, and has become a major public health problem. Though this was something I was generally aware of, I was surprised to learn that mortality rates for AIs are among the highest in the nation. According to available data, the prevalence of overweight and obesity for AI/Alaska Native populations, at all age groups, exceeds those of all other races in the United States combined (Denny, Holtzman, & Cobb, 2003; Ogden, Carroll, Kit, & Flegal, 2014; U.S. Department of Health and Human Services, 2007; Zephier, Himes, Story, & Zhou, 2006).

In a course I am taking for my MPH degree, we were asked to address this public health issue and design an intervention to address it within a target population. I immediately knew I wanted to spend the semester focusing on AI adolescents. Among several other reasons, I was drawn to this population as my father is half AI and it is part of who I am. When planning an intervention for obesity prevention, it is absolutely important to address a wide array of things, including: the identification of health outcomes, the health behavior of interest, and the target population. This can be done with several tools, including a logic model (which helps organize ideas into very clear, succinct points), or through the lens of the Social Ecological Model. These tools were primary in my ability to develop an intervention; one so focused on empowering youth the become involved in their health.

As I researched the topic, I found myself repeatedly getting off track (or so I thought). Most notably, I stumbled upon a few articles on historical trauma. I could not help but wonder: in our attempt to address issues in such populations as AIs, are we failing to appropriately address historical trauma? Particularly, AIs faced some 400+ years of colonialism and genocide. Isn’t there still a great deal of mistrust? Aren’t we (as health care officials) still coming into their land and telling them, according to what we know, they are doing x, y, or z wrong? I wish we had better ways of empowering populations through culturally sensitive and respectful interventions, rather than focusing so much on what individuals do wrong. I realize the importance of changing behaviors, but I have becoming increasingly interested in whether the cycle of colonialism lives on. I do not mean to come across as negative, however I do feel like there has to be something that can be done differently.

This thought is was brought me to the idea of developing interventions based around what IS important, and what DOES work for the AI population. Obviously, interventions would need to be developed according to each tribe (and perhaps even more specific to particular communities within each tribe/reservation). I was able to spend the fourth of July on Madeline Island this summer and one of the major events (as Madeline was discovered by AIs) was a hoop dance exhibition. A female member of the Red Cliff tribe ran the events and, having recovered from alcoholism herself, was extremely committed to raising today’s AI youth in a way that is focused on health through such activities as hoop dancing. There were 20 or so girls ages 6–16, who were dressed in traditional garb and joyously and meticulously hoop dancing. The performance brought tears to my eyes. Why can’t this sort of beautiful thing be included better in health programs? I think these kinds of moments provide impetus for change. We all may live in he same country, but I think there is the opportunity within intervention development to get back to people’s roots.

References:

Denny, C.H., Holtzman, D., & Cobb, N. (2003). Surveillance for health behaviors of American Indians and Alaska Natives. Findings from the Behavioral Risk Factor Surveillance System, 1997–2000. Europe PubMed Central, 52(7): 1–13. Retrieved from http://europepmc.org/abstract/med/14532869

Ogden, C.L., Carroll, M.D., Kit, B.K., & Flegal, K.M. (2014). Prevelance of childhood and adult obesity in the United States, 2011–2012. JAMA, 311(8): 806–814. doi:10.1001/jama.2014.732.

U.S. Department of Health and Human Services. (2007). Obesity and American Indians/Alaska Natives. Retrieved from http://aspe.hhs.gov/hsp/07/AI%2DAN%2Dobesity/report.pdf

Zephier, E., Himes, J.H., Story, M., & Zhou, X. (2006) Increasing prevalences of overweight and obesity in Northern Plains American Indian children. Arch Pediatr Adolesc Med, 160(1): 34–39. doi:10.1001/archpedi.160.1.34.