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| Native American Child HealthHome | Awards | Locum Tenens | Activities | Resources | Reach Out & Read
American Indian/Alaska Native Health Disparities Dates: March – April 2007 On March 19, 2007 a Listserv® discussion of AI/AN health disparities was launched and generated a modest amount of discussion. At its conclusion on April 16, 2007, ten responses were logged from six different participants. I would like to thank the following respondents for their thoughtful perspectives and their gracious participation: John Ratmeyer, MD, Gallup Indian Medical Center; Carlos Lerner, MD, MPhil, Kayenta Service Unit; Stephen Rinsler, MD, Ashville, NC; Jim Jarvis, MD, University of Oklahoma College of Medicine; and Bron Anders, MD, University of California San Diego. Thanks also to Sunnah Kim, MS, CPNP – AAP CONACH Coordinator; Steve Holve, MD, Indian Health Service Chief Clinical Consultant in Pediatrics; Ruth Etzel, MD, PhD, Research Director, Southcentral Foundation; and George Brenneman, MD, AAP Committee on Native American Child Health for their expert edits of the Listserve® introduction and their generous guidance throughout the discussion. Introduction: Native Americans, in particular, continue to endure some of the worst health in the nation.3 When compared to the general population, Native Americans fare significantly worse on infant mortality, invasive infectious diseases, RSV hospitalizations, intentional and unintentional injuries, cancer survival, lower respiratory tract illnesses, obesity and diabetes-related morbidity and mortality, and many other measures. While much has been accomplished in reducing these disparities over the past century, there remains a great deal left to be done. There exists much controversy surrounding the cause of health disparities in minority populations. A recent article published in the December 2006 issue of the American Journal of Public Health chronicles 500 years of health disparities for American Indians and explores the myriad of theories proposed over the centuries to explain their existence and persistence.4 The author makes the following observation and poses the following two questions: “Health disparities have persisted, even as the underlying disease environment has changed. Do American Indians have intrinsic susceptibilities to every disease for which disparities have existed? Or does the history of disparity suggest that social and economic conditions have played a more powerful role in generating Indian vulnerability to disease?” The author strongly argues that access to wealth and power can be linked to health status and that poverty and all of its associations are at the root of the health disparities problem. I am confident that few if any of you would question the existence or argue the depth of the health disparities endured by our Native American patients and communities. However, I would wager that there is not consensus regarding their underlying causes or how best to address them. Much money and interest is being paid in contemporary America to uncover the genetic foundations of health and disease. But is this the proper way to proceed? It is widely accepted that genetic mapping and interpretation holds promise for the health of individuals and that knowledge of one’s own genetic makeup might lead to individualized “designer” preventions or cures. However, will similar technological advances prove beneficial to the health of populations, especially those that are economically and socially disadvantaged? Is there even a genetic basis for “race?” Or, is “race” a purely human creation; a social construct? Is it prudent to focus already scarce health care resources on the discovery of genetic differences that define groups, populations, and “races” rather than focus on applying already available and proven technologies in combating health disparities?5,6,7 Finally, is this fervent focus on the genetic differences between groups, populations, and “races” dangerous and likely only to derail any progress toward achieving health equity by further reinforcing and institutionalizing the concept of “inferiority;” i.e. the science of racism? Through this Listserv® discussion, I would like to explore your views regarding the above points, in addition to several other questions:
Please jot down your thoughts and pass them along. I am hopeful that this discussion will be both lively and productive. Perhaps together we will even be able to generate some tangible ideas or actions that, if applied, will positively contribute to the elimination of Native American child health disparities by the year 2010.
Conclusion: Since the Listserv® discussion concluded, the American Academy of Pediatrics has released its Health Disparities/Health Equity Action Plan. You can find view the document and additional information by logging in here: http://www.aap.org/moc/strategicplan/healthequity.cfm This Action Plan actually addresses three of the four questions posed in the Listserv® discussion introduction (specifically # 2, 3, &4). I am amazed at the parallels! For an in depth discussion of the issue of health equity and a proposed operational definition (a little different than that cited by the AP) and a critique of this definition, the interested person can go here: Braveman P. Health disparities and health equity: concepts and measurement. Annu Rev Public Health. 2006;27:167-94. http://www.ncbi.nlm.nih.gov/pubmed/16533114?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum Finally, additional references related to systematic governmental underfunding of AI/AN programs (all programs, not just health) and the impact of this neglect on health and wellness and its relationship to concepts of treaty rights and justice may be accessed here:
Health disparities continue to be present among AI/AN populations in the US and reflect poorly on the resolve of our society to care for its original citizens. If we are in fact a just society, then what is our true commitment to our treaty obligations and the disadvantaged segments of our population? Health disparities and health equity are certainly complex issues, but ones that serve as a window into the very soul of our being. Let us hope that we can soon adopt the policies that will allow for significant and measurable progress toward the elimination of health disparities and achievement of health equity for all AI/AN communities.
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