Native American Barriers to Health for Occupational Therapy

Native American health outcomes are generally worse than those of the general U.S. population. Native Americans have higher rates of poverty and lower access to healthcare, which can contribute to poor health outcomes. Some specific health disparities that Native Americans face include:

-Higher rates of diabetes, heart disease, and obesity.
-Higher rates of suicide and substance abuse.
-Higher infant mortality rates and lower life expectancy.
-Higher rates of certain types of cancer such as lung and liver cancer
-Higher rates of infectious diseases such as tuberculosis.[1]https://www.ihs.gov/newsroom/factsheets/disparities/


Additionally, Native American communities have been disproportionately affected by the COVID-19 pandemic.[2]Van Dorn, A., Cooney, R. E., & Sabin, M. L. (2020). COVID-19 exacerbating inequalities in the US. The Lancet, 395(10232), 1243-1244.

These disparities are due to a complex interplay of factors such as historical trauma, lack of access to healthcare, and socioeconomic factors. However, it’s important to note that not all Native American communities experience these disparities to the same degree or severity. Therefore, being client-centered is important.

Native American communities also face unique challenges when it comes to accessing healthcare. Many Native American communities are located in remote or rural areas, which can make it difficult for people to access the healthcare services they need. Some organizations may be underfunded to provide adequate healthcare to this population. While an obvious solution such as telehealth may come to mind, even the most basic of access issues such as internet availability should be considered first.

Cultural barriers also play a role in limiting access to healthcare for Native Americans. Many Native American communities have traditional healing practices and may prefer to use these practices in conjunction with or instead of Western medicine. However, not all healthcare providers are familiar with or respectful of these traditional practices, which can make it difficult for Native Americans to access the care they need. Some beliefs and traditions for this population include:

1. There is a single higher power known as Creator, Great Creator, Great Spirit, or Great One, among other names. This being is sometimes referred to in gendered form, but does not necessarily exist as one particular gender or another. There are also lesser beings known as spirit beings or spirit helpers.

2. Plants and animals, like humans, are part of the spirit world. The spirit world exists side by side with, and intermingles with, the physical world. Moreover, the spirit existed in the spirit world before it came into a physical body and will exist after the body dies.

3. Human beings are made up of a mind, body and spirit. The mind, body, and spirit are all interconnected; therefore, illness affects the mind and spirit as well as the body.

4. Wellness is harmony in mind, body and spirit; unwellness is disharmony in mind, body, and spirit.

5. Natural unwellness is caused by the violation of a sacred social or natural law of Creation (e.g., participating in a sacred ceremony while under the influence of alcohol, drugs, or having had sex within four days of some ceremony).

6. Unnatural unwellness is caused by conjuring (witchcraft) from those with harmful or destructive intentions. This may be referred to as “bad medicine”.

7. Each of us is responsible for our own wellness by keeping ourselves attuned to self, relations, environment, and universe.[3]Portman, T. A., & Garrett, M. T. (2006). Native American healing traditions. International Journal of Disability, Development and Education, 53(4), 453-469.

Family is a major aspect of the Native American culture that should be considered when working with these clients. Specifically, the closeknit nature of Native Americans families can be a strength, but also a barrier to progress and meeting clients’ goals. This can be because families may be overly-involved in decision making when it comes to therapy interventions. A common example is the practice of food sharing and gift giving, but this may be a big no-no such as in the hospital setting where there may be diet restrictions set by the doctors. But this should not be seen as judgmental and OTs should be respectful of this dynamic and find a balance where possible.

Education is a large part of healthcare and this is especially true for occupational therapy practice. OTs often educate on things like safety, ADLs, leisure, socialization, rest and sleep, and so on. One way to promote success is the awareness of the value of storytelling for this culture and group harmony. Compared to Western culture, each occupation may be viewed and valued differently even for something like ADLs. For example, ensuring modest and respecting certain objects which may be seen as sacred like feathers or herbs. Always for permission before touching the client and their belongings. The client’s hair is such a consideration. Privacy may be required such as with toileting so this should be addressed ahead of time.[4]Palacios, J., Butterfly, R., & Strickland, C.J. (2005). American Indians/Alaska Natives. In J.G. Lipson & S.L. Dibble (Eds.), Culture & Clinical Care (27-41). San Francisco, CA: The … Reference List

With communication, there may be different cultural norms such as interrupting someone being seen as less acceptable. Long pauses may be seen as a deficit, but may in fact be cultural. The same applies to decreased eye-contact, which may be a sign of respect. Even a firm handshake may be seen as overly aggressive (use a light shake).[5]Bender, Dayton and Yoosook, Penelope, “Culturally Responsive Care for American Indians and Alaskan Natives: An Online Training Module for Occupational Therapists” (2020). Occupational … Reference List – Very opposite of American culture in some regard.

Psychosocially, it is important to screen for and address potential historical trauma, which refers to the long-term psychological and emotional effects of the traumatic events experienced by Native American communities, such as forced removal from their ancestral lands, forced attendance at boarding schools, and other forms of mistreatment. [6]Ehlers, C., Gizer, I., Gilder, D., Ellingson, J., & Yehuda, R. (2013). Measuring historical trauma in an American Indian community sample: contributions of substance dependence, affective … Reference List There may be an overall mistrust of the US government, and subsequently the healthcare system as a whole. This historical trauma has been linked to a range of health problems, including higher rates of addiction, suicide, and certain types of cancer.

To address historical trauma, consider getting trained in cultural humility and trauma-informed care to better understand and serve the unique needs of Native American communities. Trauma-informed care for Native American populations helps in recognizing and valuing the diversity within the community. This means understanding that there are many different tribes and nations within the larger Native American population, and each has its own unique culture, history, and traditions that is very different than American culture. This requires a flexible approach to care that can be adapted to meet the specific needs of different tribes and nations.

Additionally, it is also important to recognize that trauma-informed care should be integrated into all aspects of service delivery, not just mental health services in an isolated box. This means that trauma-informed principles should be applied to services such as housing, education, and employment, as well as healthcare across all meaningful occupations.

Finally, OTs should recognize that the trauma experienced by Native American populations is not only the result of historical events, but also the result of ongoing systemic issues such as poverty, lack of access to healthcare, and discrimination. Substance abuse, suicide, mental health issues, and other healthcare disparities mentioned above can pose barriers to OT in addition to the primary diagnosis or referral reason for OT seevices. Addressing these issues is an important part of a trauma-informed approach to care for Native American populations, as it helps create the conditions necessary for healing and recovery.

In summary, occupational therapy practice for Native American populations must involve recognizing and valuing the diversity within the community, adapting the approach to meet the specific needs of different tribes and nations, integrating trauma-informed principles into all aspects of service delivery and addressing ongoing systemic issues such as poverty, lack of access to healthcare, and discrimination to create the conditions necessary for healing and recovery for the client and their families.

References

References
1 https://www.ihs.gov/newsroom/factsheets/disparities/
2 Van Dorn, A., Cooney, R. E., & Sabin, M. L. (2020). COVID-19 exacerbating inequalities in the US. The Lancet, 395(10232), 1243-1244.
3 Portman, T. A., & Garrett, M. T. (2006). Native American healing traditions. International Journal of Disability, Development and Education, 53(4), 453-469.
4 Palacios, J., Butterfly, R., & Strickland, C.J. (2005). American Indians/Alaska Natives. In J.G. Lipson & S.L. Dibble (Eds.), Culture & Clinical Care (27-41). San Francisco, CA: The Regents, The University of California.
5 Bender, Dayton and Yoosook, Penelope, “Culturally Responsive Care for American Indians and Alaskan Natives: An Online Training Module for Occupational Therapists” (2020). Occupational Therapy Capstones. 438.
https://commons.und.edu/ot-grad/438
6 Ehlers, C., Gizer, I., Gilder, D., Ellingson, J., & Yehuda, R. (2013). Measuring historical trauma in an American Indian community sample: contributions of substance dependence, affective disorder, conduct disorder and PTSD. Drug and Alcohol Dependence, 133(1), 180-187. doi: http://dx.doi.org/10.1016/j.drugalcdep.2013.05.011
Jeff is a licensed occupational therapist and lead content creator for OT Dude. He covers all things occupational therapy as well as other topics including healthcare, wellness, mental health, technology, science, sociology, and philosophy. Buy me a Coffee on Venmo.