Presenters Christina Oré MPH and Nicolette Teufel Shone PhD 2014 International Indigenous Development Research Conference Auckland Aotearoa New Zealand Exploring Resilience Welcome and Introduction ID: 358097
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Resilience and Indigeneity: A life course approach for American Indian, Alaska Native and Native Hawaiian health
Presenters: Christina Oré, MPH and Nicolette Teufel - Shone, PhD
2014 International Indigenous Development Research Conference, Auckland, Aotearoa/New ZealandSlide2
Exploring Resilience Welcome and Introduction
Purpose: to explore resilience along the life courseObjective: to present a series of literature reviews and original research Rationale: persistent health inequality and inequities require a shift in mind set and practice Audience: tribal community members, leaders, health practitioners, health researchers and policy makersSlide3
American Indian (AI), Alaska Native (AN), Native Hawaiian (NH)Slide4
Origins*
IntroductionCenter for American Indian Resilience (CAIR)Special Topics courseGraduate StudentsMPH and DrPH programs at the University of ArizonaShared interest and lived experience with resilience, impact of life course on health and wellbeing, and desire to improve public health practiceApproach and MethodsMet weekly, January – May 2014
Shared decision making processSeries of life stage literature reviewsSlide5
Series of literature reviews
Life course framework Christina Oré and Nicolette Teufel-ShoneEldersAgnes AttakaiCarmella Kahn-ThornbrughAdultsAdeline June-Tsosie
Michele HensonAthena Crozier and Tara ChicoAdolescentsAurora TrujilloSheena Brown
Self determination and Sovereignty
Priscillla
Sanderson and
Octavianna
Trujillo
Stephanie RainieSlide6
Historic Framework
Shelton, 2004 Tribes Full Sovereignty (pre 1778)
Assimilation and Reorganizing us (1779 – 1934)
Trying to eliminate us (1935 – 1975)
Federal Self determination Self Governance
(1975 - 2010)
Indigeneity
(Re )claiming (Re)generation (Re) naissance
(2010 -
Policy of Conquest Slide7
State of the Practice American Indian and Alaska Native Public Health
Deficit approach modelAssumptions of adaptability evidence based researchPrograms and services oriented towards individual behavioral changeNon indigenous concepts of health and wellbeingCurrent practice is limiting and potentially harmful
Overshadows and start to stifle growth, innovation, creativity being done within tribal communities to achieve health equityPerpetuates stigmatization and traumaSlide8
Literature Review: Life course framework
Purpose statement of literature reviewTo define life course theoretical approach, its current application, and implications for AIANNH public health research, specifically for resilience researchMethods Standard systematic review guidelines and 3 databases ( Pubmed, JSTOR, and ERIC)Inclusion Criteria1
) peer- reviewed, available, English language articles; 2) published between January 1, 1970 – September 30, 2014; 3) identify life course/ life span/ life stage; 4) Identify American Indian
(AI), Alaskan Native (AN
), and Native Hawaiian
(NH);
5
) identify socio-economic, socio-cultural,
political determinants
;
6
) recognize historical or temporal
determinants
Analysis
Descriptive and content analysis reference life course core conceptsSlide9
Life Course: theory and methodological toolLife course approach
is a way of considering health development over a lifetime and across generationsTimeline, Timing, Environment, and EquityConnection Timing: Individual and collective historical eventsEnvironment: Physical, economic, social factors across the life courseEquity: Understanding how disparities created, exacerbated or mitigated, and potentially transmitted
Conditions shape vulnerability or resilience to health effects of adverse exposureDirects our gaze upstream to fundamental causes now and earlier in lifeInteractive process and lifelong development so life long moments to support health wellbeingSlide10
Results: substantive and relates to the thesisPublic health (incl
epidemiological and medical) literature is limited to descriptions of AIANNH resilience and inequalities as individual processesSocial science (sociology, anthropology, social work) literature strong cultural components suggest these concepts are linked to Indigeneity and collectives processes of navigating and negotiating uncertain resourcesLife course is being used as a framework to explore historical trauma and decolonization in AIANNH health and wellbeingSlide11
Showcase: 5 articles
Walls & Whitbeck (2012) Intergenerational Effects of Relocation Policies on Indigenous FamiliesIntergenerational, original research, American IndianMcCloskey (1998) Three generations of Navajo women: negotiating life course strategies in the eastern Navajo agency Intergenerational, original research, American IndianBrowne, Mokuau and Braun (2009) Adversity and resiliency in the lives of Native Hawaiian elders
Elders (implications for intergenerational), theoretical, and Native HawaiianJackson and Chapleski (2000) Not traditional, not assimilated: elderly American Indians and the notion of ‘cohort’Elders (role), original research, American Indian
Walls and Whitbeck (2011) Distress among indigenous North Americans: Generalized and Culturally Relevant Stressors
Adults (caregivers), original research, American IndianSlide12
DiscussionWhat can be drawn from reviewing the literature so far? Where might the discussion proceed? Underutilized framework for understanding both pathways and contributors ( i.e. historical trauma, early childbearing, resilience) of health disparities and
For burgeoning study of resilience, social determinants, embodiment in health equity research ( paradigm shift)Slide13
Implications for Resilience* Reframing discourse on American Indian health and health inequities - Teufel-Shone et al. (2014) (under review)
Resilience – a dynamic interaction between between risk and protective factorsLink between American Indian health and resilience is poorly understood. AI communal and intergenerational resilience has not been researchedResilience in Elders ( Attakai and Kahn-Thornbrugh)Adolescents ( Trujillo and Brown)Adults (
Hensen and June-Tsosie)Life stories ( Crozier and Chico)Slide14
New Directions - IndigeneityIndigeneity – knowledge creation and sharing
“An enduring relationship between populations, their territories and the natural environment” ( Durie, 2005, p. 302)Working in the Interface distinctiveness of knowledge systemsWorking from within Indigenous peoples culture and worldviewsElders interaction with Youth ( Attakai and Kahn-Thornbrugh)Tribal governmentTribal
control on health services and public health systems (i.e. 638, Affordable Care Act) Community participatory research (Sanderson and Trujillo)Data as sovereignty ( Rainie)Slide15
ReferencesBraveman, P. (2006). Health disparities and health equity: concepts and measurement.
Annu. Rev. Public Health, 27, 167-194. Braveman, P. (2013). What is Health Equity: And How Does a Life-Course Approach Take Us Further Toward It? Maternal and child health journal, 1-7. Durie, M. (2005). Indigenous Knowledge Within a Global Knowledge System. Higher Education Policy, 18, 301 – 312. Krieger, N. (2001). Theories for social epidemiology in the 21
st century: an ecosocial perspective. International Journal of Epidemiology, 30, 668 - 677Slide16
ReferencesShelton, B.L. (2004). Legal and Historical Roots of Health Care For American Indians and Alaska Natives In the United States. Issue Brief. Henry J. Kaiser Family Foundation
Teufel- Shone, N., Sanderson, P., Ehiri, J., Reese H., & Tippens, J. (under review). Resilience and American Indian Health: A Systematic Review of a Promising Framework. American Journal of Public Health. Ungar, M. (2011). The Social Ecology of Resilience: Addressing Contextual and Cultural Ambiguity of a Nascent Construct. American Journal of Orthopsychiatry, 81, (1), 1 – 17.Walters, K., Mohammed, S.A., Evans-Campbell, T., Beltran, R.E.,
Chae, D.H., & Duran, B. (2011). Bodies Don’t Just Tell Stories, They Tell Histories: Embodiment of Historical Trauma among American Indians and Alaska Natives. Du Bois Review, 8 (1), 179-189. Slide17
Thank You
This work was supported by the Center for American Indian Resilience (CAIR), a NIH-NIMHD P20 Exploratory Center for Excellence(1p20MD006872) awarded to Northern Arizona University with subcontracts to University of Arizona and Dine College.