National Native Children's Trauma Center

Neal Halfon and Miles Hochstein, “Life Course Health Development: An Integrated Framework for Developing Health, Policy, and Research,” Millbank Quarterly 80(3)(September 2002): 433-479. DOI: 10.1111/1468-0009.00019

An individual’s health is a consequence of multiple factors, which themselves are influenced by the biological, behavioral, social, and economic contexts of that individual’s life. As a person ages, and health determinants and contexts change, cumulative risk and protective factors prompt programmed responses from our bodies’ regulatory systems, especially during early childhood, adolescence, and other critical and sensitive periods of human development. In sum, many “health trajectories” can develop from initial starting conditions. The Life Course Health Development (LCHD) framework presented in this article explains how health trajectories develop over an individual's lifetime. Based on the relationship between experience and the biology and psychology of development, the LCHD framework offers a conceptual model for health development and a more powerful approach to understanding diseases than a strictly medical view. Ultimately, this broader understanding of health development helps not only individuals and providers but also public health entities, community developers, and governments shift emphasis away from disease treatment toward more effective preventive strategies.

Danielle Hiraldo, Kyra James, Stephanie Russo Carroll, “Case Report: Indigenous Sovereignty in a Pandemic: Tribal Codes in the United States as Preparedness,” Frontiers in Sociology 6(15 March 2021): article 617995. DOI: 10.3389/fsoc.2021.617995

Indigenous Peoples globally and in the United States have combatted and continue to face disease, genocide, and erasure, often the result of settler colonial policies and the complex array of traumas and resource constraints that followed. 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. This brief research report examines 41 publicly available tribal public health and emergency preparedness codes to gain a better understanding of tribes’ institutional public health capacity. 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, and advance desired public health outcomes in Native communities.

Mary F. Cwik, Allison Barlow, Novalene Goklish, Francene Larzelere-Hinton, Lauren Tingey, Mariddie Craig, Ronnie Lupe, & John Walkup. 2014. “Community-Based Surveillance and Case Management for Suicide Prevention: An American Indian Tribally Initiated System.” American Journal of Public Health 104(Supp3)(June): e18-e23.

Suicide and self-injurous behaviors are signficant concerns for many American Indian and Alaska Native nations. In responding to these concerns within its own community, the White Mountain Apache Tribe exercised its sovereignty in the creation of an innovative, mandated community-based surveillance system. With assistance from Johns Hopkins University, the tribe created a system that enables local, detailed, and real-time data collection beyond clinical settings, with in-person follow-up to facilitate connections to care. Total reporting and the proportion of individuals seeking treatment have increased over time, suggesting that this innovative surveillance system is feasible, useful, and serves as a model for other communities and the field of suicide prevention. One of the system’s central features is the requirement, created under tribal law, that self-injurious behavior be reported. From an Apache tribal perspective, the tribal reporting mandate reflects the tribe’s collective will to address suicide and self-injurious behaviors as a serious and life-threatening public health problem that demands immediate, caring, and culturally appropriate follow-up and referral.

Victoria M. O’Keefe, Mary F. Cwik, Emily E. Haroz, and Allison Barlow. 2021. “Increasing Culturally Responsive Care and Mental Health Equity With Indigenous Community Mental Health Workers.” Psychological Services 18(1)(February): 84-92.

A history of genocidal practices, cultural assaults, and continuing oppression contribute to high rates of mental health and substance use disorders in American Indian and Alaska Native communities. Under-resourced mental health care and numerous barriers to services maintain these disparities. Indigenous community mental health workers hold local understandings of history, culture, and traditional views of health and wellness and may reduce barriers to care while promoting tribal health and economic self-determination and sovereignty. The combination of Native community mental health workers alongside a growing workforce of Indigenous mental health professionals may create an ideal system in which tribal communities are empowered to restore balance and overall wellness, aligning with Native worldviews and healing traditions.

Harvard Project on American Indian Economic Development. 2008. “Health Aide Training Programs: Alaska Native Tribal Health Consortium.” Honoring Nations (Honoring Contributions in the Governance of American Indian Nations Program), Harvard University, Cambridge, MA.

The opportunity to see a medical professional when needed is something that many people living in the United States take for granted. For those living in rural Alaska however, visiting a medical professional is rarely easy. Communities are isolated, medical needs are significant, and patients’ cultural and linguistic backgrounds can affect diagnoses and treatments. The Alaska Native Tribal Health Consortium has taken on these challenges by educating village residents to serve as the primary medical providers within the state’s tribal health care system.

Kay Miller Temple. 2022. “From Idea to Reality: Federal Funding Supports Quapaw Nation’s Community Paramedicine Program.”

Initiated during the COVID-19 pandemic, the Quapaw Nation Community Paramedicine Program fills a critical gap in health care provision by delivering basic services to community members in their homes and by helping create a continuum of care that aids in the prevention of more serious health emergencies. Paraprofessional providers offer medical support such as blood pressure and blood sugar checks; assess clients’ broader physical needs, such as the need for supportive equipment like ramps; and promote positive mental health through non-medical home visits and a focus on traditional wellness practices. At the time of writing, the program was still in its early stages–yet it already was generating results. Non-emergency 911 calls had decreased, and where paramedicine visits had led to improvements in community members’ physical and mental wellbeing, even community paramedicine services were required less often.

Kelley Fong. 2019. “Concealment and Constraint: Child Protective Services Fears and Poor Mothers’ Institutional Engagement.” Social Forces 97(4)(June): 1785–1810. DOI: 10.1093/sf/soy093

Drawing on in-depth interviews with 83 low-income mothers, this research considers whether and how concerns about Child Protective Services (CPS) affect poor mothers’ engagement with healthcare, educational, and social service systems, which are legally mandated to report suspected child abuse or neglect. The findings show that CPS concerns rarely prompted mothers to avoid systems wholesale. Even so, mothers tended to conceal their hardships, home life, and parenting behavior from potential reporters. As reporting systems serve as vital sources of support for disadvantaged families, mothers’ practices of information management, while perhaps protecting them from CPS reports, may preclude opportunities for assistance and reinforce a sense of constraint in families’ institutional interactions. This finding points to a key question for policymakers and administrators–what can family-supportive services do to be perceived by families as partners rather than as surveilling authorities? More succinctly, how can services offered in tribal communities and to tribal citizens shift engagement from “mandatory reporting” to “mandatory supporting”?

Guixiang Zhao, Jason Hsia, Alexander Vio-Valentin, William S Garvin & Machell Town. 2022. “Health-Related Behavior Risk Factors and Obesity among American Indians and Alaska Natives of the United States: Assessing Variation by Indian Health Service Region.” Preventing Chronic Disease 19(January). DOI: http://dx.doi.org/10.5888/pcd19.210298

2017 data from the Behavioral Risk Factor Surveillance System, which includes participants from all 50 U.S. states and the District of Columbia, show that after adjustment for sociodemographic characteristics, American Indians and Alaska Natives were 11% more likely to report current smoking (P < .05) and 23% more likely to report obesity (P < .001) than non-Hispanic Whites. While these patterns persisted in most Indian Health Service (IHS) regions, there were notable exceptions. For example, in the Southwest region, American Indians and Alaska Natives were 39% less likely to report current smoking than non-Hispanic Whites (P < .001), and in the Pacific Coast region, Native participants were 54% less likely to report heavy drinking (P < .01) but 34% more likely to report physical inactivity (P < .05). These differences point to the importance of place- and population-specific public health measures to address the risk factors of chronic disease and thus underscore the importance of tribal public health policymaking.