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Schools of Public Health and American Indian/Alaska Native Communities

Mah Sere Keita Son, MPH

American Indian/Alaska Native (AI/AN) populations in the U.S. experience poorer health outcomes than most of the nation’s other racial and ethnic groups. AI/AN are 2.6 times more likely to have diabetes as non-Hispanic whites of similar age and have a greater mortality risk for tuberculosis, suicide, pneumonia, alcoholism and influenza than the average population1. The five leading causes of death in the U.S. in 2002 for AI/AN were heart disease, cancer, unintentional injuries, diabetes and stroke2.

A number of reasons have been given to explain the poorer health outcomes experienced by AI/AN. Among these are geographic isolation, cultural barriers, access to health care, inadequate sewage disposal, and economic factors3. Another potentially significant contributor to poorer health outcomes is the shortage of AI/AN in the health workforce. Although health professionals are increasingly trained in cultural competency, the health needs of most ethnic/racial groups would best be met by health professionals with similar ethnic/racial origins whose training inherently includes culturally appropriate approaches to solving the health problems of special populations.

In the 2004 academic year, the nation’s 36 accredited schools of public health educated 19,434 graduate students. Among these, 16,293 were U.S. citizens or permanent residents, and 0.8% (129) were of AI/AN origin4. According to the 2000 U.S. Census, those who identified themselves as only AI/AN constituted 0.9% of the U.S. population5. Based on population parity standards, schools of public health fare rather well, as the percentage of public health students of AI/AN origin nearly matched the percentage of AI/AN found in the U.S. population. Nonetheless, the need to train more AI/AN public health professionals still exists as it is difficult to determine the percentage of these AI/AN public health students who will actually enter the public health workforce; furthermore, each AI/AN Tribe is unique, and the numbers of trained public health AI/AN professionals may represent only certain Tribes, leaving out others. As a result, schools of public health, although faring well in the numbers of underrepresented minorities educated each year (5,468 or 33.6% in 2004) as compared with many other health professions schools, are continually exploring ways to recruit and retain under-represented minority students who will eventually enter the health workforce and affect the current state of racial/ethnic health disparities.

One such effort is a recent collaboration fostered between the Association of Schools of Public Health (ASPH) and the Indian Health Service (IHS). In this initial partnership, ASPH developed a task force comprised of school of public health deans and Tribal leaders. The task force advised ASPH staff in assessing the types of relationships existing between schools of public health and AI/AN communities. Two sets of surveys were issued: one set of surveys was sent to schools of public health to obtain information about their collaborations with AI/AN communities, and the second set was administered to Tribal health organizations in order to gather a Tribal perspective of AI/AN public health needs and their working relationships with schools of public health. Preliminary survey results indicate that a number of schools of public health currently partner with AI/AN communities and that many Tribal communities are willing to collaborate with schools of public health in order to address their public health needs.

 

The task force is using the preliminary findings of the surveys to determine which priorities should be established to ameliorate current relationships and create new ones. They addressed a number of broad areas to pursue including community-based participatory research activities, workforce development and capacity-building, prevention research, and the translation of research into practice. The overall goal would be to develop collaborations between schools of public health and AI/AN communities with a long term framework, thus enabling schools of public health to help AI/AN communities achieve their goals gradually and over time.

Task force Tribal leaders agreed that the need to recruit more AI/AN and train them in the field of public health was necessary in order to address the public health concerns of AI/AN communities. As a result, a primary discussion item for the task force is exploring effective ways to recruit and retain AI/AN students into public health. The school of public health task force members each communicated which activities were successful means of increasing the numbers of AI/AN students in their schools. Recruitment venues such as the information booth at the American Public Health Association’s annual conference, the Society for the Advancement of Chicanos and Native Americans in Science annual conference, and the American Indian Science and Engineering Society’s conference were mentioned as having yielded a number of students. Other successful activities include:

  • Offering full scholarships and fellowships to AI/AN students
  • Collaborating with Tribal high schools and colleges
  • Sending AI/AN public health alumni and coordinators to conferences and AI/AN social events
  • Utilizing Project 1000 — a service offering free graduate school applications to underrepresented minorities
  • Advertising in Winds of Change magazine

Many of the accredited schools of public health offer programs that help recruit AI/AN students and are involved in activities to promote relationships between schools of public health and Tribal communities. More, however, needs to be done as ethnic and racial health disparities continue to hinder the overall health of the U.S. population. Studies have shown that in order to address these ethnic and racial health disparities, there needs to be equal representation among health professionals according to the race and ethnicity of the population to be served6. As a result, health professions schools and advisors to the health professions should continue to work together towards initiating and enhancing programs that attract under-represented minorities into the health professions, subsequently training a competent workforce comprised of healthcare professionals as diverse as the populations they serve.


References

  1. www.nlm.nih.gov/news/press_releases/americanindianhealth04.html.
  2. Health, U.S., 2004, Table 31.
  3. The Health Care Challenge: Acknowledging Disparity, Confronting Discrimination, and Ensuring Equality. United States Commission on Civil Rights, Sept. 1999.
  4. 2004 Annual Data Report, Association of Schools of Public Health.
  5. Census Bureau, Census 2000.
  6. NC Med J November/December 2004, Volume 65, Number 6.
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