Racialization as a Barrier to Achieving Health Equity for Native Americans

Abstract

Racial identity is a complex idea, particularly for American Indian and Alaska Native (AI/AN) populations. The idea of a single AI/AN race developed from a European-American view of phenotypic and cultural differences. It continues to have significant consequences for AI/AN populations within the clinical-medical context. For clinicians, using this flawed category in medical decision making poses ethical challenges and has implications for patient autonomy and justice. This article briefly traces the development of the idea of an AI/AN race, the concerns raised in using this identity marker, and the ethical implications of employing the categorization. I really feel that identity is a very complicated mixture, of what you grow up with, what you find out about yourself. I didn't want to add any confusion to it. It wouldn't do me any harm, but when I asked my extended family about this-and I did go to everyone-I was told, "It's not yours to give, Louise." 1 Racial Categorization in Medicine Racial categories are ubiquitous in modern medicine, particularly in research, health professions education, public health efforts, and clinical practice. Although race as a biological category has been disavowed by professional societies, including the American Public Health Association, 2 the American Sociological Association, 3 the American Anthropological Association, 4 and the American Association of Physical Anthropologists, 5 clinicians often invoke biological differences based on racial or ethnic identity-and often a conflation of the 2 categories-to structure diagnostic and treatment approaches to a wide range of conditions, from sickle cell anemia to mental health illnesses. 6,7,8,9 In this article, we explore racialization of American Indian and Alaska Native (AI/AN) identity within clinical contexts, tracing the history and development of Native identity as a sociocultural-political identity that continues to affect clinicians' presumptions about

Social Determinants of Cancer Risk Among American Indian and Alaska Native Populations: An Evidence Review and Map

“…Use of the term “race“to describe AI/AN persons and diverse tribal citizenry as a single whole has been characterized as historically problematic. 8 , 26 Race is widely recognized as a socially constructed categorization based largely on markers of difference such as phenotype or behavior; race differs from ethnicity, genetic ancestry, or biology. 8 , 26 For members of federally recognized tribes, AI/AN race is determined based on eligibility for federal benefits.…”

“… 8 , 26 Race is widely recognized as a socially constructed categorization based largely on markers of difference such as phenotype or behavior; race differs from ethnicity, genetic ancestry, or biology. 8 , 26 For members of federally recognized tribes, AI/AN race is determined based on eligibility for federal benefits. 26 Efforts are underway to replace the use of race with other terms, including ethnicity, tribal affiliation, political entity, and ancestral identity.…”

“… 8 , 26 For members of federally recognized tribes, AI/AN race is determined based on eligibility for federal benefits. 26 Efforts are underway to replace the use of race with other terms, including ethnicity, tribal affiliation, political entity, and ancestral identity. 27 The term “race” is used in this article to maintain fidelity to the PROGRESS-Plus framework.…”

A Review of Racial Disparities in Infant Mortality in the US

“…Along with other factors, racism is likely to account for the fact that American Indian mothers who received late or no prenatal care was 2.9 times higher than Whites mothers in 2016 [ 32 ]. Current knowledge on Native American health outcomes suggests parallels to Black patient health outcomes with racism as a common denominator [ 33 , 34 , 35 ].…”

Declaring Racism a Public Health Crisis in the United States: Cure, Poison, or Both?

“…Within the United States, the historical legacies of land theft, genocide, ongoing violation of the over 500 treaty rights that were signed between 1778 and 1781 ( 16 ), and continued erasure of Native American, Alaska Native, Hawaiian, and other Indigenous communities contribute to the lack of sovereignty and disparate health outcomes seen today ( 17 ), particularly during the COVID-19 pandemic ( 18 ). An example of non-performativity within public health is continued genocide through data erasure and misclassification ( 19 ). Lack of data directly impacts the ability of local, state, federal and tribal public health authorities to address the COVID-19 virus and limits policy makers' ability to make data-driven decisions for equitable policy and resource allocation ( 20 ).…”