HDG #029: Indigenous Social Determinants of Health (ISDOH)
Read time: 10 minutes
November is National American Indian Heritage Month. I actually did not know this until after I’d already decided to focus this week’s article about Indigenous Social Determinants of Health (SDOH).
There are a lot of awareness days/months, but I’ll admit that not knowing about this one perturbed me—especially in light of Thanksgiving Day coming up, a day centered in controversy and relevant to the growing conversations on decolonization.
The latter warrants its own future article as it pertains to healthcare and public health, but this week we’re exploring one unique facet: Indigenous social determinants of health (ISDOH), which I was first turned onto by my good friend and tribal health advocate, Dave Panana.
If you’re reading this, data tells me that you’re most likely very familiar with the concept of SDOH based on my readership analytics. But if not, SDOH refers to factors like socioeconomic status, environment, education, and other “social” factors outside of what happens within the four walls of the healthcare system that influence, or determine, as much as 80% of a person's health outcomes by some estimates. I use quotations because it can be argued that these factors go well beyond just social.
I’ve written before about how the data in healthcare is inherently biased (and how we are too), and this is another perfect example that has very real implications. Our SDOH narrative, typically grounded in Census data and other data related to information about people who appear in common datasets, historical data, federal systems, and urban communities significantly shifts when talking about Indigenous populations, and standard SDOH models simply don't fully capture the unique challenges, experiences, and factors that impact these communities.
While the same could be said about other groups, segments, or subpopulations (which all sound so clinical and technical when we are talking about people—eww), I’ve often thought about this specifically because the unique challenges—from cultural nuances, relationship with governments, indigenous data sovereignty, to lack of inclusion and small number/erasure from common datasets, and siloed healthcare systems—demand a tailored approach.
So much so that global health organizations such as the World Health Organization (WHO), the United Nations (UN), the National Network of Public Health Institutes (NNPHI), and the National Indian Health Board (NIHB) are actively publishing frameworks and guidance specifically for Indigenous SDOH. The 76th World Health Assembly's resolution on Indigenous Health and the NIHB's advocacy also highlights the need for culturally competent health approaches, recognizing the unique needs of Indigenous Peoples. At the 22nd Session of the United Nations Permanent Forum on Indigenous Issues, leaders emphasized the integration of Indigenous perspectives in health policy and research.
The Indigenous Determinants of Health (IDH) report, a cornerstone in this effort, emphasizes Indigenous cultures' interconnectedness with nature and spirituality. This holistic view of health calls for a paradigm shift in understanding Indigenous health. It highlights several key SDOH factors that are particularly relevant for Indigenous populations, including:
Cultural Integrity and Practices: Recognizing and preserving Indigenous cultures, languages, and traditional practices as vital components of health and well-being. This includes respecting Indigenous knowledge systems, spiritual beliefs, and healing practices.
Impact of Colonization and Historical Trauma: Addressing the long-term effects of colonization, including historical trauma, forced assimilation, and systemic discrimination. This involves acknowledging and rectifying past injustices and their ongoing impact on Indigenous health.
Environmental Health and Connection to Land: Emphasizing the deep connection Indigenous Peoples have with their land and environment, and how this relationship is integral to their physical and mental health. This includes access to clean water, traditional food sources, and preserving sacred and culturally significant lands.
Social and Economic Inequities: Tackling the socioeconomic disparities that Indigenous communities face, such as poverty, lack of access to quality education, and employment opportunities. These factors are crucial in determining health outcomes.
Political Self-Determination and Autonomy: Supporting the political empowerment and self-determination of Indigenous Peoples. This includes involving Indigenous communities in decision-making processes that affect their lives and health.
Access to Culturally Appropriate Healthcare: Ensuring that healthcare services are culturally sensitive and accessible to Indigenous Peoples. This involves training healthcare providers in cultural competence and integrating traditional healing practices with conventional medicine.
Intergenerational Trauma and Healing: Recognizing the impact of intergenerational trauma on health and the importance of intergenerational healing. This involves approaches that consider the collective trauma experienced across generations and the need for holistic healing practices.
Racism and Discrimination: Addressing systemic racism and discrimination in healthcare and broader societal contexts, which significantly impact the health and well-being of Indigenous Peoples.
. . .
This is a growing topic that we’re seeing more and more awareness about every day. For instance, we saw this most recently addressed in the 2020 Census’ move to now collect data across 1,187 American Indian and Alaska Native (AIAN) tribes and villages. From efforts like this, we are starting to get more granular data that will allow us to better serve people across the nation, like these insights they published:
As of the 2020 Census, 1.5 million people identified as Cherokee, the largest American Indian population group in the U.S..
The Yup’ik (Yup'ik Eskimo) population was recorded at 9,026, making it the largest Alaska Native alone group.
The total American Indian and Alaska Native population, alone or in combination, reached 9.7 million in 2020.
There are 324 federally recognized American Indian reservations and 221 Alaska Native village statistical areas.
As of 2023, there are 574 federally recognized Indian tribes.
The number of single-race American Indian and Alaska Native veterans of the U.S. armed forces was 122,579 in 2022.
This is a growing topic of conversation, but we are barely starting to scratch the surface of the deep nuance within and among these communities.
. . .
Actionable Idea of the Week:
To integrate Indigenous perspectives into health data analysis, begin by reviewing the Indigenous Determinants of Health (IDH) report.
Reflect on how these unique factors differ from conventional SDOH models. Engage with Indigenous health experts and communities for deeper insights, ensuring your data analysis and policy formulations are culturally sensitive and inclusive. Consider using the recent statistics from the U.S. Census Bureau to understand the scale and diversity of Indigenous populations, aiding in more accurate and representative health data analytics.
As always, it starts with awareness. Here are some other information-rich reference sources used to compile this article:
UN’s mandated areas + emerging issues among Indigenous peoples
National Indian Health Board’s tribal and government, public health, and behavioral health resources
World Health Organization’s summary from the 21st session of the UN Permanent Forum on Indigenous Issues in May 2022
NNPHI’s partner, Seven Directions: A Center for Indigenous Public Health’s reports and toolkits, including some related to ISDOH
Reclaiming Indigenous Health in the US: Moving Beyond the Social Determinants of Health, a published article
Census 2020’s Look at the Largest American Indian and Alaska Native Tribes and Villages in the Nation, Tribal Areas and States and Heritage Month Facts
. . .
Keep an eye on this topic—as more awareness and guidance becomes available for specific populations (possibly even using this as an example), it can also get us thinking about similar subgroup or cohort-specific SDOH frameworks which could help improve equity initiative design in a very meaningful way.
See you next week!
-Stefany
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