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Suggested Citation:"2 Voices of Native Youth." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
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2

Voices of Native Youth

During the first session of the workshop, a panel of six high school and college Native American students took time away from studying for spring final exams to share their critical expertise and wisdom on the issues facing Native American youth and their ideas about positive change. As did many of the other presenters, they spoke not only about the challenges facing Native youth, but about the strengths on which they draw to overcome those challenges. As the moderator of the panel, roundtable member Melissa Simon, said, “There is no better way to elevate and champion the voices of Native youth than to hear their perspectives directly from them.”

Students speaking at the workshop are listed below. Their perceptions are discussed in Box 2-1:

  • Micah Clark, a graduate student at the University of New Mexico (UNM) Health Sciences Center and a project coordinator at the center’s Institute for Indigenous Knowledge and Development
  • Mary Lou Gutierrez, a student at Newcomb High School in Newcomb, New Mexico
  • Lia Abeita-Sanchez, a UNM student and research assistant at the Robert Wood Johnson Foundation Center for Native American Health Policy at UNM
  • Daniel Albert, a student at the Native American Community Academy in Albuquerque
  • Kyle Smith, a UNM student and project coordinator at the Institute for Indigenous Knowledge and Development
  • Elgin Watchman, a student at Newcomb High School
Suggested Citation:"2 Voices of Native Youth." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
×

“There is no better way to elevate and champion the voices of Native youth than to hear their perspectives directly from them.” —Melissa Simon, Northwestern University Feinberg School of Medicine

Suggested Citation:"2 Voices of Native Youth." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
×

EDUCATION AND HEALTH

Micah Clark pointed to the influence of education. It provides students with a wider range of career choices, whereas people who drop out face challenges that can affect their health and access to resources. Better paying jobs can provide insurance, information, and benefits such as access to wellness and workout centers. “You have a lot more options available to you,” she said.

In addition, being a student at UNM has taught her that “health isn’t something physical. It is everywhere around us. It is our physical, our spiritual, our mental, and our emotional” well-being, she noted. Her education has taught her to make better decisions and healthier choices, she said. It also has functioned as a protective factor by helping her balance work and school so that she is not so stressed.

Finally, Clark said that being healthy has given her a longer term perspective. “I want to do those things that are going to help generations to come,” she said. “I have a responsibility to help my people and go back and return to my community this sense of reciprocity of what they have given me. Because of my community, I am here and able to go to school. They have supported and encouraged me. That is my motivation to stay in school and to become as equipped as I can, so that I can return home and return what they have given to me.”

“I want to do those things that are going to help generations to come.” —Micah Clark

REACHING OUT TO OTHERS

Mary Lou Gutierrez said that health means being “happy with yourself and confident that you can help other people feel confident about themselves.” Students can help others who have a drug problem, are overweight, or are having problems in school, she said. Being healthy means being able to offer such help to others in a community.

Because of the problems Gutierrez herself overcame earlier in life, she reaches out to other students who are having problems. “I am like a counselor to them. I help them with their problems. I tell them that it is not fun to be in that position. It isn’t a nice feeling,” she said. She tries to help them appreciate what they have. Contributing to such an outlook “affects the whole social community and their families,” she concluded.

“I am like a counselor to them. I help them with their problems.” —Mary Lou Gutierrez

Suggested Citation:"2 Voices of Native Youth." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
×

HEALTH AND THE COMMUNITY

Lia Abeita-Sanchez built on the theme of the relationship between the community and health. Health is a product of place and environment, she said, which come together in community. “Community has been the greatest teacher in my entire life. It has made me who I am and transformed me and set me on a path that I want to maintain, not only for myself but for those who have yet to come,” she explained.

The best way to determine the health of a community is to look at its children, Abeita-Sanchez said. “If I am the reflection of health,” she said, “is my reflection your reflection?” Today, Native American communities have high rates of childhood obesity and diabetes. “If our children aren’t healthy, how can we expect our culture and language and our traditions to be healthy?” she asked.

Communities also help define how people think about health, she said. Pueblo communities, for example, have two competing understandings of health. One is the Western model, which is largely focused on disease, health maintenance, and the doctor–patient relationship. As Abeita-Sanchez put it, “If you are healthy, you are not sick.” The other understanding encompasses more than just the conventional meaning of the word “health.” The Pueblo word for health does not mean just being sound physically, she said. It is about “being sound mentally and spiritually. It is about being well.” This concept includes aspects such as being grateful for one’s family and friends. It includes not just access to resources, but happiness.

Abeita-Sanchez added that the most common way to handle a health problem is programmatic, adding that “if an adolescent goes through a rough patch, what do we do? We send them to behavioral health.” In this way, the responsibility of caring for someone is shifted from the community to someone else, usually oriented to a Western model of health. Such programs can be beneficial, of course, but is that approach necessarily going to help a person in need? “Maybe not,” she said. “We are here to take care of each other.”

The challenge is striking a balance between these two understandings of health. “How do we address and reincorporate our understanding of what it means to be healthy in the face of diabetes, in the face of heart disease, and in the face of cancer?” she asked. Communities are responsible for teaching their children what it means to be a member of that community. They therefore need to teach children what it means to be healthy. “If we just think about the negative and we see it only as disease, we are never going to move past that,” she said. “Being healthy isn’t just about not feeling sick.”

Since the Snyder Act of 1921 established the legislative authority for the Indian Health Service (IHS), Native American communities have gone

Suggested Citation:"2 Voices of Native Youth." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
×

from having some of the best health outcomes of U.S. populations to some of the worst, Abeita-Sanchez observed. Better policies can help, as can more money, but the real power comes from individuals and communities. “If we have the ability to survive for this long, how can we let ourselves in just a short period of time struggle?” she asked.

People need to make a commitment to be healthy in this broader sense, she said. “If what we say is most important in our communities is the health and well-being of our language, culture, and traditions, if I am not translating my physical health into those things that we say are the most important things in our community, it doesn’t really matter,” she said. “Maybe it is just as simple as, ‘I am going to say thank you more.’ That is healthy. That is creating a positive environment.” Small things can make a big difference, she said. “It is talking to someone where you see a need. It is telling a friend, ‘Come with me.’”

A few years before the workshop, Abeita-Sanchez recounted, she was “fed up with higher education.” After 2 years as an undergraduate at Stanford University, she had come back home thinking, “I didn’t need higher education. Forget it. I didn’t care.” But people in her home town asked her why she was so upset with college. “I had to leave to realize what I was doing and to refocus and reenergize,” she said. “Community plays a huge role in that. We all hear the cliché of, ‘Go get an education, come back, and help your people.’ For those of us who really take that to heart, we know that it is not an easy journey.” Her family and people in her community helped her through this period. “Those are the people who have challenged me and have tested me and who have made [me] constantly have to justify going against the current. It is all of those people who have come before me who have affected how I have gone through this path of higher education,” she added.

“We are all children of our community, regardless of our age,” Abeita-Sanchez concluded. “It is not just an elder thing. It is not just a youth thing. It is an everybody thing. . . . Hear all sides. Ask the elders what they want to see from youth. Ask the youth what they want to see from their elders. We all have equal responsibility to take care of one another regardless of age. Don’t let the words be hollow. Give them heart and give them meaning. That in and of itself will probably be the biggest vehicle to seeing change take place.”

“Community has been the greatest teacher in my entire life. It has made me who I am.” —Lia Abeita-Sanchez

Suggested Citation:"2 Voices of Native Youth." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
×

GARDENING AS THE PATH TO WELLNESS

Daniel Albert talked about the garden planted at his high school as part of a wellness initiative. “Doing this project helped me understand a lot about health itself,” he said. It brought students together who come from many different places. It taught them how to incorporate traditional practices and healing into wellness. It brought something colorful and living into a landscape that was formerly dominated by concrete. And it not only taught them that wellness has spiritual, intellectual, and social dimensions, but that it is “a lot of fun,” he added.

Albert’s school also tries to take an active role in the community. This role may take the form of simply collecting food and distributing it to parents in need. Nevertheless, said Albert, helping each other helps everyone.

“Helping each other helps everyone.” —Daniel Albert

EXERCISE, HEALTH, AND COMMITMENT

Kyle Smith emphasized the importance of being organized and disciplined in staying healthy. Students can have erratic schedules given their classes, work, travel, and group projects, he said, adding that “maintaining my sanity, keeping calm, keeping organized, and also keeping motivated, those are very difficult.”

A particular challenge for Smith has been establishing a routine for physical activity and healthy eating. He has worked hard to develop a regular exercise schedule. “When you establish that schedule, you feel like you have got to do it. Right now, I am on a fixed schedule. I have learned the ins and outs of organization,” he said. With the support of his family “always pushing me and telling me to do my best and always being there as my foundation,” he has been biking, running, swimming, and hiking. The result, he says, has been “a clear mind, a clear conscience, and also the ability to work in a lot of different projects around the community.”

Smith said that he exercises not only for himself, but for the people around him. He recalled interviewing a community leader who said how important it is to demonstrate the behavior that you desire of others. “That is something I take very deeply,” he said. “When I am running, I am running for my family, I am running for my elders, I am running for community, I am running for those who are not capable and who cannot run.” Running for others brings a different dimension to physical activity, he said. “It is not about looking great or who can get the fastest time. It is about being an influence on your community.”

Suggested Citation:"2 Voices of Native Youth." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
×

“When I am running, I am running for my family, I am running for my elders, I am running for community, I am running for those who are not capable and who cannot run.” —Kyle Smith

INFORMATION AND SUPPORT

For Elgin Watchman, health means simply “being happy with yourself and people around you.” Students who have problems, such as alcohol or drug problems, need health-based information on what those substances are doing to them and support from others. Watchman himself was headed down the wrong path until his uncle returned from Afghanistan. “He inspired me to eat healthier and to exercise more,” he said.

Watchman also pointed to the amount of bullying that goes on in his school, adding that “whenever I see a kid walking around that looks like an outsider to other groups of kids, I try to ask that kid to go do something with me.” In physical education, he might ask a student who looks intimidated to go for a short run. “If you want to have a healthy life, you have to start now. Maybe 20 years down the road, you will remember what I told you,” he explained.

“If you want to have a healthy life, you have to start now.” —Elgin Watchman

THE INFLUENCE OF SOCIAL MEDIA

During the discussion period, several students mentioned the potential of social media to both improve and detract from health. Abeita-Sanchez described a campaign in which Native Americans representing every language family in New Mexico were videotaped saying the same slogan, explaining that “it was great. We were all standing out there in the wind with our sign and yelling into the microphone and laughing. . . . Can we do more of those?” Such activities require coordination and can be hit or miss, she acknowledged. But such campaigns, if well thought out and well designed, can engage young people and motivate change.

The use of social media can depend on access, she reminded the group. When she has just one bar of reception, getting on Facebook can kill the battery of her phone. Clark agreed with the observation about access. Her community just had its first cell tower erected. “I used to have to commute just to do homework if I went home and needed to do homework. I would call up my cousin and ask to use a computer or wi-fi,” she explained. Internet access is a good thing, but is not always guaranteed, said Clark.

Suggested Citation:"2 Voices of Native Youth." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
×

Several students also called attention to the potential of social media to waste time. Being on social media can sometimes “defeat the purpose because I am supposed to be doing something rather than be on Facebook or Instagram,” said Smith. But social media also can be motivating by seeing how other people overcame their problems. Such stories “are inspiring to me and make me want to become a better person and keep my health on track,” Smith said.

THE ROLE OF GRANDMOTHERS

In response to a question about the person to whom each student would give the most credit for inspiring their educational pursuits, many of the students mentioned their grandmothers. “Immediately, my grandma popped into my head,” said Clark. “She always reminded us she only made it through eighth grade. She wanted us to keep going to school and to go to school for her and make up for her not being able to attend school. She had responsibilities at home, sheep herding and taking care of her family. My grandma is my inspiration for being in school and encouraging me to keep at it,” she explained.

Smith also gave credit to his grandmother, saying that “she was the one I did everything with. My parents were always workaholics. They still are. I admire them for that because it helped me become a student and it helps me achieve education. . . . But the backbone of that was my grandmother. She taught me a lot about culture. She taught me a lot about planting. I didn’t understand the things she was saying and how it would translate to current times. She would always give indigenous knowledge. What didn’t make sense then is all coming together now. I am starting to use that in my everyday life. I am becoming more proud to speak my language. For Navajo, I have only had a vocabulary of 20 words, but 20 is turning into 40 and 40 is turning into 60. I have a lot to thank my grandmother for, for teaching me those cultural things when my parents were working to make a better life for me.”

Abeita-Sanchez said, “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 establishing a foundation. It is people like her that have really driven me down this path. Those are also the people who gave me some of my earliest memories. In fact, one of my earliest memories was at the elementary school. We had the elderly center next door. They took us over there to hang out with the elders one day. I remember this vividly. One of the elders pulled me aside. It was an older gentleman. He said, ‘We are all proud of you, each and every one of you. Always remember when you leave here and

Suggested Citation:"2 Voices of Native Youth." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
×

you step outside your door, you not only represent you and your family, but everyone else in our community and everyone else that came before you.’”

THE EFFECTS OF MONEY

When asked about the influence of money on health, Albert said that “money has impacted my life a lot. My mom is just barely paying the bills. . . . She makes those choices of what is good and what is not based on the cost, and sticks to a budget.” Money affects everyone somehow, he said. When he was named a Gates Scholar, it took a great load off his mother.

Money can improve health—for example, at a store where the potato chips are cheaper than an apple, said Abeita-Sanchez. But money is not the only determinant of health. Having a healthy attitude and learning how to maintain good health can be the most important resources. “We can all learn from each other,” she said.

Other students said that money was simply a distraction. Some live without electricity and running water, said Gutierrez, like her grandparents, sticking to traditional ways of life. Others, herself included, spend money extravagantly on clothes. Money is “just an object,” she said. It can become “an addiction to spend money on stuff that you don’t really need.” People should use money for what they need and not what they want, she said.

THE WISDOM OF YOUTH

Native youth are moved by internal and external factors toward educational and health equity. Their own strength is evident and is creating new paths each day as they affect entire communities. Many workshop participants, both in their presentations and in their conversations during breaks, expressed their gratitude and respect for the courage, integrity, and optimism demonstrated by the students who spoke at the workshop. As roundtable member Ned Calonge said, “Your sharing today has been meaningful to all of us in the room. . . . The older I get, the more often I am humbled by the wisdom of youth.”

“The older I get, the more often I am humbled by the wisdom of youth.” —Ned Calonge, The Colorado Trust

Suggested Citation:"2 Voices of Native Youth." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
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Suggested Citation:"2 Voices of Native Youth." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
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Suggested Citation:"2 Voices of Native Youth." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
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Suggested Citation:"2 Voices of Native Youth." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
×
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Suggested Citation:"2 Voices of Native Youth." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
×
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Suggested Citation:"2 Voices of Native Youth." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
×
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Suggested Citation:"2 Voices of Native Youth." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
×
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Suggested Citation:"2 Voices of Native Youth." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
×
Page 11
Suggested Citation:"2 Voices of Native Youth." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
×
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Suggested Citation:"2 Voices of Native Youth." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
×
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Suggested Citation:"2 Voices of Native Youth." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
×
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More than 2 million Americans below age 24 self-identify as being of American Indian or Alaska Native descent. 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 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. In May 2014, the Academies held a follow-up workshop titled Advancing Health Equity for Native American Youth. Participants discussed 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. This report summarizes the presentations and discussions from the workshop.

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