Resilience and Indigeneity: A life course approach for American Indian, Alaska Native and Native Hawaiian health

Presenters: Christina Oré, MPH and Nicolette Teufel - Shone, PhD2014 International Indigenous Development Research Conference, Auckland, Aotearoa/New Zealand

Exploring Resilience Welcome and Introduction

Purpose: to explore resilience along the life course

Objective: to present a series of literature reviews and original research

Rationale: persistent health inequality and inequities require a shift in mind set and practice

Audience: tribal community members, leaders, health practitioners, health researchers and policy makers

American Indian (AI), Alaska Native (AN), Native Hawaiian (NH)

Origins* Introduction

Center for American Indian Resilience (CAIR) Special Topics course

Graduate Students MPH and DrPH programs at the University of Arizona

Shared interest and lived experience with resilience, impact of life course on health and wellbeing, and desire to improve public health practice

Approach and Methods Met weekly, January – May 2014 Shared decision making process Series of life stage literature reviews

Series of literature reviewsLife course framework

Christina Oré and Nicolette Teufel-Shone

EldersAgnes AttakaiCarmella Kahn-

Thornbrugh

AdultsAdeline June-TsosieMichele HensonAthena Crozier and

Tara Chico

AdolescentsAurora TrujilloSheena Brown

Self determination and SovereigntyPriscillla Sanderson

and Octavianna TrujilloStephanie Rainie

Historic

Framework

Shelton, 2004

Tribes Full Sovereignty (pre 1778)

Assimilation and Reorganizing us (1779 – 1934)

Trying to eliminate us (1935 – 1975)

Federal Self determination Self Governance (1975 - 2010)

Indigeneity(Re )claiming (Re)generation (Re) naissance (2010 -

Policy of Conquest

State of the Practice

American Indian and Alaska Native Public Health Deficit approach model Assumptions of adaptability evidence based research Programs and services oriented towards individual

behavioral change Non indigenous concepts of health and wellbeing

Current practice is limiting and potentially harmful Overshadows and start to stifle growth, innovation,

creativity being done within tribal communities to achieve health equity

Perpetuates stigmatization and trauma

Literature Review: Life course framework

Purpose statement of literature review To define life course theoretical approach, its current application, and implications

for AIANNH public health research, specifically for resilience research

Methods Standard systematic review guidelines and 3 databases ( Pubmed, JSTOR, and

ERIC)

Inclusion Criteria1) peer- reviewed, available, English language articles;

2) published between January 1, 1970 – September 30, 2014;

3) identify life course/ life span/ life stage;

4) Identify American Indian (AI), Alaskan Native (AN), and Native Hawaiian (NH);

5) identify socio-economic, socio-cultural, political determinants;

6) recognize historical or temporal determinants

Analysis Descriptive and content analysis reference life course core concepts

Life Course: theory and methodological tool

Life course approach is a way of considering health development over a lifetime and across generations Timeline, Timing, Environment, and Equity

Connection Timing: Individual and collective historical events Environment: Physical, economic, social factors across the life course Equity:

Understanding how disparities created, exacerbated or mitigated, and potentially transmitted

Conditions shape vulnerability or resilience to health effects of adverse exposure

Directs our gaze upstream to fundamental causes now and earlier in life

Interactive process and lifelong development so life long moments to support health wellbeing

Results: substantive and relates to the thesisPublic health (incl epidemiological and medical) literature is

limited to descriptions of AIANNH resilience and inequalities as individual processes

Social science (sociology, anthropology, social work) literature strong cultural components suggest these concepts are linked to Indigeneity and collectives processes of navigating and negotiating uncertain resources

Life course is being used as a framework to explore historical trauma and decolonization in AIANNH health and wellbeing

Showcase: 5 articles1. Walls & Whitbeck (2012) Intergenerational Effects of

Relocation Policies on Indigenous Families Intergenerational, original research, American Indian

2. McCloskey (1998) Three generations of Navajo women: negotiating life course strategies in the eastern Navajo agency Intergenerational, original research, American Indian

3. Browne, Mokuau and Braun (2009) Adversity and resiliency in the lives of Native Hawaiian elders Elders (implications for intergenerational), theoretical,

and Native Hawaiian

4. Jackson and Chapleski (2000) Not traditional, not assimilated: elderly American Indians and the notion of ‘cohort’ Elders (role), original research, American Indian

5. Walls and Whitbeck (2011) Distress among indigenous North Americans: Generalized and Culturally Relevant Stressors Adults (caregivers), original research, American Indian

DiscussionWhat can be drawn from reviewing the literature so far?

Where might the discussion proceed?

Underutilized framework for understanding both pathways and contributors ( i.e. historical trauma, early childbearing, resilience) of health disparities and

For burgeoning study of resilience, social determinants, embodiment in health equity research ( paradigm shift)

Implications for Resilience* Reframing discourse on American Indian health and

health inequities - Teufel-Shone et al. (2014) (under review)

Resilience – a dynamic interaction between between risk and protective factors

Link between American Indian health and resilience is poorly understood.

AI communal and intergenerational resilience has not been researched

Resilience in Elders ( Attakai and Kahn-Thornbrugh) Adolescents ( Trujillo and Brown) Adults ( Hensen and June-Tsosie) Life stories ( Crozier and Chico)

New Directions - Indigeneity

Indigeneity – knowledge creation and sharing “An enduring relationship between populations, their territories and the

natural environment” ( Durie, 2005, p. 302) Working in the Interface distinctiveness of knowledge systems Working from within Indigenous peoples culture and worldviews

Elders interaction with Youth ( Attakai and Kahn-Thornbrugh)

Tribal governmentTribal control on health services and public health systems

(i.e. 638, Affordable Care Act) Community participatory research (Sanderson and Trujillo)Data as sovereignty ( Rainie)

References

Braveman, P. (2006). Health disparities and health equity: concepts and measurement. Annu. Rev. Public Health, 27, 167-194.

Braveman, P. (2013). What is Health Equity: And How Does a Life-Course Approach Take Us Further Toward It? Maternal and child health journal, 1-7.

Durie, M. (2005). Indigenous Knowledge Within a Global Knowledge System. Higher Education Policy, 18, 301 – 312.

Krieger, N. (2001). Theories for social epidemiology in the 21st century: an ecosocial perspective. International Journal of Epidemiology, 30, 668 - 677

References Shelton, B.L. (2004). Legal and Historical Roots of Health Care For

American Indians and Alaska Natives In the United States. Issue Brief. Henry J. Kaiser Family Foundation

Teufel- Shone, N., Sanderson, P., Ehiri, J., Reese H., & Tippens, J. (under review). Resilience and American Indian Health: A Systematic Review of a Promising Framework. American Journal of Public Health.

Ungar, M. (2011). The Social Ecology of Resilience: Addressing Contextual and Cultural Ambiguity of a Nascent Construct. American Journal of Orthopsychiatry, 81, (1), 1 – 17.

Walters, K., Mohammed, S.A., Evans-Campbell, T., Beltran, R.E., Chae, D.H., & Duran, B. (2011). Bodies Don’t Just Tell Stories, They Tell Histories: Embodiment of Historical Trauma among American Indians and Alaska Natives. Du Bois Review, 8 (1), 179-189.

Thank You

This work was supported by the Center for American Indian Resilience (CAIR), a NIH-NIMHD P20 Exploratory Center for Excellence(1p20MD006872) awarded to Northern Arizona University with subcontracts to University of Arizona and Dine

College.