More than 2 million Americans below age 24 self-identify as being of American Indian or Alaska Native descent (Center for Native American Youth, n.d.). Many of the serious behavioral, emotional, and physical health concerns facing young people today are especially prevalent with Native youth (e.g., depression, violence, and substance abuse). Adolescent Native Americans have death rates two to five times the rate of whites in the same age group because of higher levels of suicide and a variety of risky behaviors (e.g., drug and alcohol use, inconsistent school attendance). Violence, including intentional injuries, homicide, and suicide, accounts for three-quarters of deaths for Native American youth ages 12 to 20. Suicide is the second leading cause of death—and 2.5 times the national rate—for Native youth ages 15 to 24.
Arrayed against these health problems are vital cultural strengths on which Native Americans can draw. At a workshop held in 2012 by the Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities of the National Academies of Sciences, Engineering, and Medicine, presenters described many of these strengths, including community traditions and beliefs, social support networks, close-knit families, and individual resilience (IOM, 2013). As roundtable member Jack Lewin of
1 The planning committee’s role was limited to planning the workshop, and the workshop summary has been prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.
Lewin and Associates said at that workshop, Native Americans have much to offer in the refashioning of health care because Native cultural traditions could guide health care reforms.
On May 6, 2014, the roundtable held a follow-up workshop titled Advancing Health Equity for Native American Youth. The overall goal of the roundtable is to convene leaders from academia, health care, government, industry, professional organizations, communities, and other sectors to discuss issues related to (1) the visibility of racial and ethnic disparities in health and health care as a national problem, (2) the development of programs and strategies by and for Native and Indigenous communities to reduce disparities and build resilience, and (3) the emergence of supporting Native expertise and leadership. The workshop on health equity for Native American youth, which was held in Albuquerque, New Mexico (see Box 1-1), addressed issues central to the roundtable’s charge.
“We know there are problems” among Native American youth, said Antonia Villarruel, co-chair of the roundtable and associate dean for research and global affairs at the University of Michigan School of Nursing,2 in her opening remarks at the workshop. “We also know that there are exciting initiatives and solutions that are being done in communities. We want to hear about those. We want to identify promising approaches that support the health and development of Native American youth.”
“We know there are problems. We also know that there are exciting initiatives and solutions that are being done in communities. We want to hear about those.” —Antonia Villarruel, University of Michigan3
Although her remarks occurred at the end of the day, Mildred Thompson, co-chair of the roundtable and senior director at PolicyLink, identified several major concepts that arose consistently across the day.4 First, she pointed to the importance of factors that contribute to resilience, including family, support networks, feeling valued, and having mentors. Recognition and promotion of these factors can help advance health equity for Native American youth, she said.
Thompson also emphasized the difference between healing and treat-
2 Now at the University of Pennsylvania.
3 Now at the University of Pennsylvania.
4 These concepts should not be seen as conclusions, although they provide an overview of the major issues that were discussed.
ment. Western culture typically emphasizes treatment, but healing is a very different approach.
She acknowledged the need for rigor and accountability in interventions. “We want our students to do well,” she said. “We don’t want to have them skip through things. We want them to be strong in their capacities.” Finally, she cited the importance of the land to Native peoples. Traditional interventions often neglect this complex influence on Native American culture and health, she said, yet it cannot be forgotten.
Bearing these themes in mind, Thompson asked, what will make a difference? “What is going to be different about how we approach our work?
What is going to be different about how we view people? What kind of strategies will be a part of our thinking that we hadn’t thought of before? How can we keep this work going in ways that make a difference?”
“We want our students to do well. We don’t want to have them skip through things. We want them to be strong in their capacities.” —Mildred Thompson, PolicyLink
A highlight of the workshop was a series of presentations by Native American high school and college students in the Albuquerque area. These presentations, which centered on the perspectives and experiences of young Native Americans, and how individual youth faced and overcame challenges within their lives and communities, are shared in Chapter 2 of this workshop summary. Of particular interest is the fact that nearly all students mentioned their grandparent(s) in their comments. Chapter 3 summarizes the workshop’s keynote address by Teresa LaFromboise, professor in the Graduate School of Education at Stanford University, who provided an overview of the protective factors and environments that contribute to resilience among Native American youth.
Chapter 4 looks specifically at health issues prevalent in Native American youth, including substance abuse and mental health problems. Chapter 5 addresses the intersection between educational disparities and health disparities and features the role of targeted educational interventions in Native American youth to reduce health disparities and educational disparities in Native Americans in particular. Finally, Chapter 6 summarizes the remarks of two presenters who were asked to reflect on the main messages they heard during the workshop.
“I would be remiss if I didn’t say my late grandmother didn’t have a profound impact on me. I have to give her a lot of credit for raising me and bringing me up, teaching me my language, and really establishing a foundation.” —Lia Abeita-Sanchez, University of New Mexico