by Fred Fisher, MPA
In a recent essay we published on the NNCTC blog, Patrice Kunesh writes about “the sticky residue of settler colonialism,” which she defines as “hostile policies aimed at disempowering tribal government and crushing Native culture.” Among the ongoing effects of this colonial residue, as Patrice writes, have been “generations of economic inequities and precarious housing conditions, as well as egregious health disparities, particularly for Native youth.”
I was reminded of Patrice’s comment when I saw this HRSA funding announcement for a Community Health Worker Training Program, because I firmly believe that one of the keys to eliminating colonialism’s hold on the present and future is tribal health sovereignty. For better or worse, the road to tribal health sovereignty still runs through the federal government in many instances. That is the case with this worthy grant program, which I encourage tribal stakeholders to review.
Health care for American Indian and Alaska Native people has always been a core component of the federal trust responsibility to tribal nations. However, since the passage in 1978 of the Indian Education and Self-Determination Act, the federal government has increasingly exercised this trust obligation through a transfer of its authority and control from federal agencies to the tribes themselves. In response to this crucial policy shift, tribes immediately began to lean into the opportunity to recreate health care systems and delivery that are culturally responsive and tailored to community needs.
In the decades since 1978, many tribal nations have enhanced the design and delivery of health care through efforts to make services culturally responsive and tailored to tribal population and community needs. The results have been impressive both in improved health outcomes and consumer satisfaction.[i] Randall Akee, in a 2018 blog post on the new challenges to the Indian Child Welfare Act, states that his research has “failed to uncover a single example of how removing control, jurisdiction, or authority from tribal governments improves outcomes for American Indian and Alaska Natives.” This aligns with the findings of a Harvard Project on American Indian Economic Development report, “The Context and Meaning of Family Strengthening in Indian America,” which characterizes effective services to tribal children and families as those that meet the following conditions:
· Effective programs and policies are self-determined;
· Leadership can emerge from many levels of tribal society;
· “Buy-in” on the part of tribal communities and formal leadership is essential;
· Effective initiatives are institutionalized;
· Effective initiatives are spiritual at their core.[ii]
Tribal nations are redefining the nature of health itself to include personal and community well-being and are increasingly designing and delivering programs and services at all levels of Tribal administration and governance that tap into local community assets and resources to promote health and well-being. In most tribal communities, the people who live there—elders, parents, relatives, youth, and others (in development terms, the tribal community’s social capital)—are increasingly being engaged as resources in health promotion as opposed to recipients of health services. This is an important shift in vision that tribal leaders and others with deep cultural understanding are tapping into to realize a more sustainable and positive health future for their children and families.
Despite the progress that has been made in the exercise of tribal health sovereignty since 1978, the disproportionate impact of the COVID-19 pandemic on American Indian and Alaska Natives exposed many of the remaining gaps in health equity for Native children and families. The Community Health Worker Training Program[ii] may offer an important resource to re-building Native Nations in the aftermath of this public health crisis. The purpose of the programs is:
· to enhance the skill and knowledge of current community health worker and increasing the number of local health care workforce to respond to public health needs in underserved communities.
The objectives are:
· Expanding local capacity to recruit, train, and support new community health workers by reducing barriers to enrollment in the program (e.g.; support for tuition, health insurance, child care for trainees);
· Reinforcing and updating current knowledge and expanding the skill sets of health workers;
· Workforce development and employment; and, perhaps most importantly,
· Health Equity.
These goals and objectives appear to offer a good cultural match for many tribal nations. Tribal colleges and universities may be the perfect home for a program like this. I encourage readers to explore entire program announcement and consider applying.
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For more information on Tribal Health Sovereignty and Self-Determination in action, see the following profiles:
Quapaw Community Health Program
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[i] For a thorough analysis of this transfer of power and authority using the implementation of a dental aide program by the Swinomish Tribe in Washington State as a case study, see: Geoffrey D. Strommer, S.K. Roels, C. P. Mayhew. Tribal Sovereign Authority and Self-Regulation of Health Care Services: The Legal Framework and the Swinomish Tribe’s Dental Health Program.
[ii] For an excellent essay on incorporating traditional healing and spiritual practices into public health, see: Healing Historical Trauma: How Native American researchers are turning long-held traditions into novel public health solutions by Jackie Powder in the latest edition of Hopkins Bloomberg Public Health.
[iii] For on-going updates on grants, loans, research, and other health resources that improve health in rural America and in Indian Country, consider becoming an on-line subscriber to the Rural Health Information Hub.
Fred Fisher, MPA, is the NNCTC’s Community Development Advisor.