Before the 16th century and the arrival of European colonists, more than 1,000 tribes—nearly 60 million indigenous people—lived across North America. These were sophisticated societies with expertise in large-scale farming and long-distance trade, and with varying levels of technological development. While some illnesses, diseases, and parasitic infections did exist among these early communities, a traditional diet of hunted and gathered foods low in fat, sugar, and sodium—along with healthy socioeconomic conditions, natural pharmacology, and a deep well of traditional healing practices—helped keep widespread health crises in check.
Rapid Dutch, French, and English colonization between 1534 and 1620, followed by the spread of European settlers across the continent, brought new pathogens to AI/AN populations—and also set off cycles of destabilization in Native communities that would lay the groundwork for generations of mistrust toward mainstream medicine, historical trauma, and lasting health disparities.
Epidemics shaped the early post-Columbian health experience of indigenous communities. Smallpox, for instance, first swept across North America in the late 1770s. Nearly every tribe was affected, with the Pacific Northwest hit especially hard. The disease returned in 1837, devastating tribes of the northern Great Plains, and surfaced again in 1851. Other illnesses that spread quickly among AI/AN populations included measles, chickenpox, and influenza.
The eugenics era soon followed, built on the belief that limiting reproduction in certain populations would improve the population overall. Even when government programs were created to deliver services, they still ran on the widespread assumption that AI/AN people were mentally, morally, and socially defective and unable to make their own health decisions. As late as the 1960s and 1970s—years after many state laws had banned the practice—thousands of Native American women, somewhere between 25% and 50% of them, were subjected to forced sterilization by the Indian Health Service.
This turbulent history—including boarding schools and the forced removal of American Indian and Alaska Native (AI/AN) children from their families—fostered broad distrust of the government and modern medicine among indigenous populations, contributing to a range of health disparities in Native communities. Burdened by higher rates of infant and neonatal mortality, chronic disease, mental illness, substance abuse, alcoholism, and suicide, AI/AN communities have a significantly lower life expectancy than white Americans. AI/AN populations are twice as likely to develop diabetes and nearly six times as likely to contract tuberculosis as the general population, and they also face heart disease, cancer, and lung disease along with higher rates of obesity. More recently, during the first year of the COVID-19 pandemic, AI/AN populations saw the highest rates of infection, hospitalization, and death of any ethnicity or race.
Yet despite these challenges, indigenous communities have kept persevering—pursuing and demanding the full breadth and depth of health and medical services, and the quality of care, that they rightly deserve.
Individual Efforts and Legal Progress
Many individuals took it upon themselves to improve conditions in their communities and tribes, pushing past the boundaries of race, gender, and socioeconomic status.
In 1889, Susan La Flesche, a member of the Omaha tribe, became the first AI/AN woman to graduate from medical school. She went back to her home reservation as the only physician serving patients across 1,350 square miles. In 1913 she founded a hospital there and spent nearly 25 years treating patients and advocating for better health and hygiene practices.
Soon after, in 1892, Isabel Cobb, a Cherokee woman from Tennessee, earned her medical degree and became the first female physician in Indian Territory—the land set aside by the U.S. government under the policy of Indian Removal. Also holding degrees from the Cherokee Female Seminary and Glendale Female College, Isabel was better educated than most women of her era, a foundation she drew on during nearly 40 years of treating patients and practicing medicine in the Cherokee Nation.
Other notable figures include:
Susie Walking Bear Yellowtail, a member of the Crow nation, was among the first Native American nurses in the U.S. She fought against forced sterilization and helped break down the language barriers that kept Native patients from receiving quality care.
Carlos Montezuma, the first Native man to earn a medical degree, graduated from Chicago Medical College in 1889.
Dr. Patricia Nez Henderson, a member of the Navajo Nation, has conducted research on genetic nicotine use in Native Americans that has contributed to national smoking-reduction efforts. Though far from perfect, federal legislation has helped clear a path for improvements in AI/AN healthcare. That work continues to evolve in scope, offering growing protection, freedom, and provisions for Native tribes. Federal legislative milestones include the Snyder Act of 1921, Public Law 93-638 (Indian Self-Determination and Education Assistance Act of 1975), Indian Health Care Improvement Act of 1976, Indian Gaming Regulatory Act of 1988 and more.
Tribes Take the Lead
Tribally operated AI/AN healthcare systems often run more efficiently and effectively, and deliver a higher quality of care than facilities not led by tribes. By concentrating on building doctor-patient relationships and providing care tailored to the specific social and cultural issues facing AI/AN communities, tribal-led health systems demonstrate that the best healthcare for AI/AN communities comes from AI/AN healthcare professionals.
Cherokee Nation. The healthcare system run by the Eastern Band of Cherokee Indians in Asheville, North Carolina, has focused its efforts on fighting opioid addiction within its community. It now includes one of the largest integrated mental health facilities in the state—a state-of-the-art $82 million facility funded primarily by gambling revenue. During the early months of the COVID-19 pandemic, the Cherokee Nation was ahead of both the country and its state in getting its people tested and vaccinated.
Alaska Natives. Alaska Natives have developed an integrated culture-based care model called the Nuka System for Care that is tailor-made for tribal healthcare. By approaching a patient’s physical, mental, spiritual, and emotional health simultaneously, the Nuka System of Care provides a model more consistent with traditional healing, which does not separate different aspects of health. Patients are assigned a multi-disciplinary team that includes a primary care provider or nurse practitioner, a nutritionist, a pharmacist, and a behavioral health specialist for comprehensive care that treats the entire person.The Nation’s Only Tribally Affiliated Medical School. Oklahoma State University Center for Health Sciences and the Cherokee Nation have partnered together to establish the nation’s only tribally affiliated medical school. The medical school is located in the capital of the Cherokee Nation in Tahlequah, OK.
The Work That Remains
While many tribes are seeing broad new hope and opportunities for better healthcare, many others remain underserved—especially in places where higher poverty, scarce resources, and geographic isolation make investment difficult or even impossible.
For tribes located far from urban areas and lacking sufficient water, farmable land, or development opportunities, gaming can help strengthen local economies, provide services and jobs for citizens, and reshape the economic and social climate in and around the area. Where casinos or gaming are not feasible or wanted, philanthropy or partnerships with academic health systems may be needed to close financing and funding gaps.Telemedicine can bring timely care to rural and underserved communities that would otherwise go without, and so can expanding the range of providers allowed to practice in tribal areas to include physician assistants, nurse practitioners, and other non-physician professionals.
AAIP and the Future of AI/AN Health
The COVID-19 pandemic cast new light on an old reality that AI/AN populations have dealt with for generations: a lack of infrastructure to handle emerging disease outbreaks. Yet as tribal nations begin to lead the way in how their communities are served, better access to reliable healthcare and preventive medicine is essential to building trust in modern medical practices—practices that can help preserve and ensure the survival of Native culture for our children. Vaccines for influenza, COVID-19, and preventable childhood diseases are more readily adopted and accepted by communities that have had time to build trust and that feel cared for and respected by healthcare institutions invested in them and their futures.
To learn more about AAIP’s vaccine programs, visit us at wordpress-509372-3778584.cloudwaysapps.com.