Resilience and health in American Indians and Alaska Natives: A scoping review of the literature

Abstract

American Indians and Alaska Natives suffer from disproportionately high rates of chronic mental and physical health conditions. These health inequities are linked to colonization and its downstream consequences. Most of the American Indian and Alaska Native health inequities research uses a deficit framework, failing to acknowledge the resilience of American Indian and Alaska Native people despite challenging historical and current contexts. This scoping review is based on a conceptual model which acknowledges the context of colonization and its consequences (psychological and health risk factors). However, rather than focusing on health risk, we focus on protective factors across three identified domains (social, psychological, and cultural/spiritual), and summarize documented relationships between these resilience factors and health outcomes. Based on the scoping review of the literature, we note gaps in extant knowledge and recommend future directions. The findings summarized here can be used to inform and shape future interventions which aim to optimize health and well-being in American Indian and Alaska Native peoples.

Sleep Problems and Health Outcomes Among Urban American Indian and Alaska Native Adolescents

“…Urban American Indian and Alaska Native adolescents are a population that is rarely included in research, despite facing a disproportionate burden of chronic health conditions. 4 , 50 It is important to understand how sleep may be associated with health disparities among American Indian and Alaska Native adolescents to help inform prevention and intervention programming to increase health equity for this population.…”

“…American Indian and Alaska Native people have significant strengths, including strong cultural identity and shared values and traditions, which serve as protective health factors . However, the legacy and enduring effects of historically based trauma, such as forced relocation from tribal homelands, have contributed to disproportionately higher chronic disease burden among this population, including increased risk for alcohol and other drug use, suicide, obesity, type 2 diabetes, and cardiovascular disease .…”

“…American Indian and Alaska Native people have significant strengths, including strong cultural identity and shared values and traditions, which serve as protective health factors. 1 , 2 , 3 , 4 However, the legacy and enduring effects of historically based trauma, such as forced relocation from tribal homelands, have contributed to disproportionately higher chronic disease burden among this population, including increased risk for alcohol and other drug use, 5 , 6 suicide, 7 , 8 obesity, 9 type 2 diabetes, 10 and cardiovascular disease. 11 , 12 , 13 The COVID-19 pandemic exposed important sources of resilience in American Indian and Alaska Native people, including community connection and family cohesion, 14 but also highlighted inequities, including increased exposure to poverty, crowding, food insecurity, and reduced health care access, which increase susceptibility to COVID-19 infection and mortality.…”

Medicolegal death investigations on tribal lands—underrepresented or underserved?

“…AIAN people experience health challenges (e.g., diabetes, heart disease, influenza and pneumonia, mental health and substance use disorders) at a disproportionately higher rate than the general population [ 11 ]. These higher disease burdens and mortality rates have been attributed to adverse social determinants of health, including structural racism, education, disproportionate poverty, access to healthcare and health insurance, discrimination in the delivery of health services, exposure to environmental toxins, broad quality-of-life adversities linked to socioeconomic characteristics, among other causal mortality and morbidity relationships [ [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] ]. Moreover, the COVID-19 pandemic had a sharp impact on the non-Hispanic AIAN population, which experienced the greatest decline in life expectancy (1.9 years) relative to other racial/ethnic groups between 2020 and 2021 [ 30 ].…”