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

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“…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.…”