Search results

Indigenous populations and communities around the world confront historical, cultural, socioeconomic and forced geographic limitations that have profound impacts on mental wellness. The impacts of colonialism and, for some indigenous populations, forced residential schooling and the resulting loss of culture and family ties, have contributed to higher risks of mental illness in these groups. In addition, there are barriers to healing and mental wellness, including inconsistent cultural competence of mainstream mental health professionals, coupled with the limited numbers of indigenous mental health professionals. The Wharerata Declaration is a proposed framework to improve indigenous mental health through state‐supported development of indigenous mental health leaders, based on a new indigenous leadership framework. Developed by the Wharerata Group (original membership noted in the acknowledgements section at the end of this article), the framework will be presented for support to the member countries of the International Initiative for Mental Health Leadership (IIMHL) in 2010.

The demand for evidence‐based health practices has created a cultural challenge for Indigenous people around the world. This paper reports on the history and evolution of evidence‐based care into its mainstream status within the behavioural health field. Through the leadership of an Alaska Native tribal organisation, an international forum was convened to address the challenges of evidence‐based practice for Indigenous people. Forum participants developed a model for gathering evidence that integrates rigorous research with Indigenous knowledge and values. The model facilitates development of practices and programmes that are culturally congruent for Indigenous people, accepted and validated by the research community, and deemed supportable by private and governmental sponsors.

Purpose – To examine potential sex differences among American Indian and Alaska Native peoples (AIANs) in diabetes prevalence, comorbidities, healthcare utilization, and treatment costs within the Indian Health Services (IHS).

Methodology/Approach – Data were drawn from the IHS Improving Healthcare Delivery Data Project with 437,608 persons in our analytical sample. We described sex and age differences in diabetes, comorbidities, healthcare utilization, and treatment costs among the adults with diabetes. We evaluated the statistical differences between men and women using confidence intervals calculated at the 95% level, with nonoverlapping confidence intervals indicating statistical significance.

Findings – The prevalence of diabetes among females was somewhat higher than that of males (10.82 vs 9.16%, respectively, p < 0.05). Among adults with diabetes, males had statistically higher prevalence of hypertension, cardiovascular disease, and substance use disorders and fewer mental health disorders compared to females. Although males had overall lower average cost of services than females, males had higher utilization for hospital inpatient services than females, and females used more outpatient services.

Research limitations/implications – We are limited to one fiscal year of data and thus cannot predict the influence of healthcare utilization patterns on the overall health of this population. Although a large sample, the findings are only generalizable to the active users of the participating IHS Service Units.

Originality/Value of Paper – This study fills a major gap in our knowledge of sex differences in diabetes prevalence, comorbidities, healthcare utilization, and treatment costs among AIANs. Differences in the comorbidities that characterized the AIAN adult males and females with diabetes in this sample have important implications for mortality and cost of care. Diabetes management that addresses such gender-specific comorbidities, particularly substance use disorders among men and mental health disorders among women, promises to reduce these comorbidities and related complications.

Current research about American Indians of all ages is in short supply, yet design and allocation of public services and resources are increasingly guided by ‘evidence’ provided by research. The health and wellness of this population is persistently poorer than that of other marginalized populations. American Indian tribes have been beset progressively since the earliest arrival of European settlers by both malevolent and well-intentioned assaults on their cultures and peoples. This long history of cultural and physical genocide continues into the present and undermines the effectiveness of Eurocentric processes for research that have been shaped by values and beliefs antithetical to those of most tribes (e.g. individualism, proprietary ownership, science as the way of knowing). Individual and collective historical trauma is present in all of the more than 500 federally recognized tribes in the United States of America, and a lack of trust further compromises the validity and positive impact of most research. This chapter describes the roots and foundations of flawed and successful research and identifies practical resources and approaches that are valid and beneficial for conducting research with indigenous people. The processes described in this chapter are grounded in the experiences of tribes in the United States of America; however, parallel experiences of indigenous populations that have a continuing legacy of trauma are found in many other countries (such as in Brazil and New Zealand) and the insights and approaches found in this chapter may be applicable to some degree.