Health and Health Policy

NNIs health policy research effort analyzes how tribes can create positive health and wellness outcomes for their citizens. NNI’s work, focused in recent years on the social determinants of health and tribal control of health care services, argues for a reclaiming of what strengthens Indigenous health and well-being in Native communities.

In recent years, some American Indian and Alaska Native nations have begun to reassert control over the design, maintenance, and delivery of their own health-care systems, and subsequently in defining and affecting factors beyond the health care system that result in healthy communities. While the challenges inherent in securing funding, retaining qualified personnel, and building effective governmental and administrative institutions are significant, evidence shows that increased Native control over the design, delivery, and governance of Native health and health care can reduce health inequities for Indigenous peoples and protect, promote, and sustain healthy Indigenous nations.

NNI researchers share this work through policy briefs, editorials, commentaries, presentations, and scholarly publications aimed at sharing research, stories of what has been tried in other Indigenous nations, and connecting those who think about healthy Indigenous nations.


Research Poster: Reimagining Indigenous Health: Moving Beyond the Social Determinants of Health

While the social determinants of health framework introduces important consideration of proximal and distal factors that affect individual health, the model needs to be reimagined to fit Indigenous context. From many Indigenous epistemologies, health springs from different factors, for example, traditional practices and cultural continuity. Health is a property of a community, and less a property of individuals. Health is about relationships with ancestors, future generations, and is specific to time and place. Reimagining, rather that incremental adaptation, will be necessary to extend the WHO social determinants framework to the Indigenous context. This poster examines several assumptions within the World Health Organization social determinants of health framework that might not fit the Indigenous community epistemologies and argues for a re-imagining of what strengthens Indigenous health and well-being in Indigenous communities.

Report: Beyond Health Care: Community, Governance, and Culture in the Health and Wellness of Native Nations

This project asked, “What actions can Native nations and organizations take—outside the conventional health care system—to improve the health and wellness of Native communities?” Our original plan was to analyze primary and secondary health and other community data from six participating tribes. When it became clear that comparable information across the six tribes was unavailable, the project changed. Three new lines of inquiry emerged after visiting the six Native nations, convening tribal leaders and program staff, and meeting with Indigenous and ally scholars whose work addresses Indigenous community health and wellness

Paper: The Changing Landscape of Health Care Provision to American Indian Nations

Health service provision has been an aspect of indigenous-United States relationships for over two hundred years, yet America's First Peoples continue to suffer from poor health outcomes when compared with other racial or ethnic groups in the United States. An important change over recent decades is that more and more tribes are managing their own health care services—a realignment of administration and authority that has the potential to substantially improve American Indian and Alaska Native health in years to come. This paper describes the history of health care provision to federally recognized American Indian tribes. It continues by documenting the sparse research literature on tribal management of health care services and identifying information still needed to bring knowledge of this topic up-to-date. Five challenges for tribal management of health-care services that should be considered by tribes and policymakers in their health-care efforts and brought to bear on future research are discussed. By addressing both tribal control of health-care services and the role of tribes in changes to federally provided health care, this paper adds the lens of tribal sovereignty to current discussions of the history and policy context for American Indian and Alaska Native health.

Case Report: Indigenous Sovereignty in a Pandemic: Tribal Codes in the United States as Preparedness

Indigenous Peoples globally and in the United States have combatted and continue to face disease, genocide, and erasure, often the systemic result of settler colonial policies that seek to eradicate Indigenous communities. Many Native nations in the United States have asserted their inherent sovereign authority to protect their citizens by passing tribal public health and emergency codes to support their public health infrastructures. While the current COVID-19 pandemic affects everyone, marginalized and Indigenous communities in the United States experience disproportionate burdens of COVID-19 morbidity and mortality as well as socioeconomic and environmental impacts. In this brief research report, we examine 41 publicly available tribal public health and emergency preparedness codes to gain a better understanding of the institutional public health capacity that exists during this time. Of the codes collected, only nine mention any data sharing provisions with local, state, and federal officials while 21 reference communicable diseases. The existence of these public health institutions is not directly tied to the outcomes in the current pandemic; however, it is plausible that having such codes in place makes responding to public health crises now and in the future less reactionary and more proactive in meeting community needs. These tribal institutions advance the public health outcomes that we all want to see in our communities.

Presentations and Podcasts

Interview with Dr. Stephanie Carroll about New Research on COVID-19 Spread in Indian Country

Listen to public health researcher Stephanie Carroll, co-author of “American Indian Reservations and COVID-19: Correlates of Early Infection Rates in the Pandemic.” Hear about this new research showing which factors, like household plumbing and language barriers, correlate with a higher spread of the virus, and policy recommendations to address these factors.

Lead Contact:

Stephanie Russo Carroll
Associate Director and Senior Researcher

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