American Indian Health Disparities, Where’s The Moral Outrage?

One view of health is that a relatively small portion of one’s health status is the result of healthcare utilization. A large component of one’s health is manifested from social determinants of health, genetics, and any resulting behaviors. If solid education, poverty eradication, job building, optimum nutrition, clean water, safety, housing, drug and alcohol programs, and language and culture revitalization contribute a larger percentage to one’s health than the healthcare system does, then maybe we shouldn’t be cutting these programs to bolster healthcare. Instead, we need complete, sustained attention and conviction in Indian country around these “causes of the causes”.

Historical trauma has undoubtedly fed into the health and well being of America’s indigenous people. This is trauma suffered by one’s ancestors and is manifested in the present day individual. Historical trauma can result in depression, anxiety, loss of role, identity, shame and all the behaviors that may be sought to alleviate the these conditions. A further complication is that there may be contemporaneous individual trauma occurring. Homicide, suicide and violence numbers are all elevated for American Indians by comparison to U.S. all races numbers. Historical trauma in part is a result of the federal policy periods beginning in the 1800s, such as removal, reservation, termination, and allotment and assimilation. American Indians were not granted citizenship widely until the Snyder Act in 1924. These policies and the histories they generated are undoubtedly feeding into the health of American Indians today.

With earlier onset of disease, shorter life spans, higher levels of poverty, lower levels of education and the lack of truly comprehensive care, Indian Country needs focused attention, assistance, and an influx of real dollars for health and infrastructure. Health care for American Indians was to have been an unquestioned provision, as a result of lands already ceded, treaties signed and law. Unfortunately, I have been a nurse for over 20 years and the things I saw then I am still writing about today. The status quo is deafening. Again I ask, where is the moral outrage and where is the call to action?