Discuss the background of the American Indian and Alaska Native population.
American Indian and Alaska Native Population
To “make medicine” is to engage upon a special period of fasting, thanksgiving, prayer, and self denial, even self-torture.
—Wooden Leg (late 19th century) Cheyenne
■ Objectives
1. Discuss the background of the American Indian and Alaska Native population.
2. Discuss the demographic profile of the American Indian and Alaska Native population.
3. Describe the traditional definitions of HEALTH and ILLNESS of the American Indian and Alaska Native population.
4. Describe the traditional methods of HEALING of the American Indian and Alaska Native population.
5. Describe the practice of a traditional healer. 6. Describe current health care problems of the American Indian and Alaska
Native population. 7. Describe the services rendered by the Indian Health Service.
Figure 9–1 Figure 9–2 Figure 9–3 Figure 9–4
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8. Describe demographic disparity as it is seen in health manpower distribu- tion of the American Indian and Alaska Native population as represented in the health care delivery system.
The opening images for this chapter depict objects related to traditional Ameri- can Indian HEALTH beliefs and practices. Figure 9–1 is Cherokee pottery, a wedding vase that symbolizes the union of 2 lives to become one—a HEALTHY beginning for a family. The couple drinks from each side of the vessel. Figure 9–2 is a woman holding children symbolizing the grandmother relating stories to her children or grandchildren. This is a way to pass on the cultural heritage of the family. It is an example of Acoma Pueblo pottery from Sky City, New Mexico. Figure 9–3 is a woven beaded thunderbird tie. The thunderbird has many mean- ings for American Indian people, such as their ability to control rainfall. Some people believe they are protective of HEALTH because of their strength. Beadwork is a traditional art for many people and is a spiritual undertaking. This tie was a gift from a traditional Micmac man in Boston, Massachusetts. Figure 9–4 is a sand painting. The Navajo medicine man creates the sand paintings during the diagnostic phase of a healing ceremony.
■ Background The descendants of the original inhabitants of the North American continent and Alaska numbered 2.9 million people, or 0.9% of the total population of the United States in Census 2010. This number reported American Indian and Alaska Native alone and represented a growth from 2.5 million people in 2000 (Humes, Nicholas, & Jones, 2011, p. 4). When compared to “U.S. all races,” the American Indian/Alaska Native (AI/AN) population lags behind in several areas, including lower educational levels and higher unemployment rates. The AI/AN population is a young population. The median age of the population is 28.0 years, compared with 35.3 years for all races in the United States. The population has larger families, less health insurance (the number of AI/ANs without health insurance is over double that for U.S. all races), and a pov- erty level nearly twice that of the rest of the population. The American Indian population served by the Indian Health Service is living longer than it did 30 or even 20 years ago. In fact, statistics on age at death show that during 1972– 1974, life expectancy at birth for the American Indian population was about 63.6 years and has now increased to 72.6 years, but it is still 5.2 years less than the U.S. all races life expectancy of 77.8 years (2003–2005 rates) (U.S. Depart- ment of Health and Human Services, 2012). Diseases of the heart, malignant neoplasm, unintentional injuries, diabetes mellitus, and chronic liver diseases and cirrhosis are the 5 leading causes of Indian deaths in 2007 (U.S. Depart- ment of Health and Human Services, 2011).
The first time that American Indians were counted as a separate group was in the 1860 census, and the 1890 census was the first to count Ameri- can Indians throughout the country. The counting of American Indians be- fore 1890 was limited to those living in the general population of the various
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states; the American Indians residing in American Indian territory and on American Indian reservations were not included. Alaska Natives, in Alaska, have been counted since 1880, but until 1940 they were generally reported in the “American Indian” racial category. The people were enumerated separately (as Eskimo and Aleut) in 1940 in Alaska. It was not until the 1970 census that separate response categories were used to collect data on the Eskimo and Aleut population, and then only in Alaska.
The American Indian nations that were the largest populations include the Cherokee, Navajo, Latin American Indian, Choctaw, Sioux, and Chippewa. The largest Alaska Native group was Eskimo.
To realize the plight of today’s American Indians, it is necessary to jour- ney back in time to the years when Whites settled in this land. Before the arrival of Europeans, this country had no name but was inhabited by groups of people who called themselves nations. The people were strong both in their knowl- edge of the land and in their might as warriors. The Vikings reached the shores of this country about A.D. 1010. They were unable to settle on the land and left after a decade of frustration. Much later, another group of settlers, since termed the “Lost Colonies,” were repulsed. More people came to these shores, how- ever, and the land was taken over by Europeans.
As the settlers expanded westward, they signed “treaties of peace” or “trea- ties of land cession” with the American Indians. These treaties were similar to those struck between nations, although in this case the agreement was imposed by the “big” nation onto the “small” nation. One reason for treaties was to legitimize the takeover of the land that the Europeans had “discovered.” Once the land was “discovered,” it was divided among the Europeans, who set out to create a “legal” claim to it. The American Indians signed the resultant treaties, ceding small amounts of their land to the settlers and keeping the rest for them- selves. As time passed, the number of Whites rapidly grew, and the number of Indians diminished because of wars and disease. As these events occurred, the treaties began to lose their meaning; the Europeans disregarded them. They de- cided that these “natives” had no real claim to the land and shifted them around like cargo from one reservation to another. Although the American Indians tried to seek just settlements through the American court system, they failed to win back the land that had been taken from them through misrepresentation. For example, in 1831, the Cherokees were fighting in the courts to keep their nation in Georgia. They lost their legal battle, however, and, like other American Indian nations after the time of the early European settlers, were forced to move westward. During this forced westward movement, many died, and all suffered. Today, many nations are seeking to reclaim their land through the courts (Brown, 1970; Deloria 1969, 1974; Fortney, 1977). Several claims, such as those of the Penobscot and Passamaquoddy tribes in Maine, have been successful. The number of federally recognized tribes has increased from just over 100 as recently ago as the 1980s to the present (2012) 564 (United States Department of the Interior, Bureau of Indian Affairs, 2010).
As the American Indians migrated westward, they carried with them the fragments of their culture. Their lives were disrupted, their land was lost, and
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many of their leaders and teachers perished, yet much of their history and cul- ture somehow remained. Today, more and more American Indians are seek- ing to know their history. The story of the colonization and settlement of the United States is being retold with a different emphasis.
American Indian people have sought ways to rebuild Indian communities and to maintain an Indian future in America. The American Indian Movement (AIM) was born in Minnesota in 1968. Today, it is apparent that the move- ment has transformed policy making into programs and organizations that have served Indian people in many communities. The policies were consistently made in consultation with spiritual leaders and elders. In fact, the movement was founded to turn the attention of Indian people toward a renewal of spiritu- ality and at the heart of AIM is deep spirituality and a belief in the connected- ness of all Indian people (Waterman & Salinas, 2006).
American Indians live predominantly in 26 states (including Alaska), with most residing in the western part of the country as a result of the forced west- ward migration. Although many American Indians remain on reservations and in rural areas, just as many people live in cities, especially on the West Coast. Oklahoma, Arizona, California, New Mexico, and Alaska have the largest num- bers of American Indians (IHS, 2007). Today, more and more people are claiming to have American Indian roots.
■ Traditional Definitions of HEALTH and ILLNESS Although each American Indian Nation or tribe had its own history and belief system regarding HEALTH and ILLNESS and the traditional treatment of ILLNESS, some general beliefs and practices underlie the more specific tribal ideas. The terms HEALTH and ILLNESS are used to indicate that, among traditional people, the connotations are holistic, as defined and discussed in Chapters 5 and 6. The data—collected through an ongoing review of the literature and from in- terviews granted by members of the groups—come from the Navajo Nation, Hopis, Cherokees, Shoshones, and New England Indians with whom I have worked closely.
The traditional American Indian belief about HEALTH is that it reflects living in “total harmony with nature and having the ability to survive under exceedingly difficult circumstances” (Zuckoff, 1995). Humankind has an in- timate relationship with nature (Boyd, 1974). The Earth is considered to be a living organism—the body of a higher individual, with a will and a desire to be well. The Earth is periodically HEALTHY and less HEALTHY, just as hu- man beings are. According to the American Indian belief system, a person should treat his or her body with respect, just as the Earth should be treated with respect. When the Earth is harmed, humankind is itself harmed and, conversely, when humans harm themselves, they harm the Earth. The Earth gives food, shelter, and medicine to humankind; for this reason, all things of the Earth belong to human beings and nature. “The land belongs to life, life belongs to the land, and the land belongs to itself.” In order to maintain