I'll be looking more at social and historical determinants of health disparities, but I am even more specifically interested in looking at "upstream" issues (to coin John Snow!) that are perhaps more rooted in history and culture, resulting in what is today an abysmal situation for Native Americans.
I haven't work with Native American populations with regard to CBPR, but I have worked with another marginalized population that also has poor health outcomes--Haitian agricultural workers in the Dominican Republic. During grad school, I'd been looking for more inclusive ways of conducting fieldwork that helped break down some of the power imbalances between researchers and communities where they study (particularly in low-income countries). I started reading a lot of work by Meredith Winkler and Nina Wallerstein as well as the development literature surrounding issues of action research and participatory action research.
While I wasn't fully able to do CBPR for my dissertation research, I was able to do it for my postdoc and in the long run, it worked out quite well.
I'd like to read what you've written about it -- can you give me a title? Thanks so much for your reply. I'm just going into my first CBPR course and, while I think it is what most of us have always wanted to do (but not called CBPR), I'm looking forward to the study!
Many thanks and yes, I totally agree. I've worked with the tribes of Maine since 1985, first as an FNP on a couple of the res and more recently as the Tribal Epidemiologist for the state. I'm particularly interested in methods of CBPR that have worked for aboriginal/native folk in the past (if any) and am currently taking a CBPR course in my doctoral program. Was hoping to connect with other researchers who work with NA pops in the US/Canada and aboriginal folk in Australia as well.
Yes, actually (and I looked at your work, very impressive and so necessary!). I'm looking at Health Disparities across the tribes and comparing them with the general Maine population (which is quite poor and have considerable health disparities to start with), particularly in regard to upstream causes. I've become particularly concerned about the life expectancy of tribal members compared to non-members. I've worked for years on multiple grants with the tribes, yet I've seen nothing yet make a difference -- lots of $$ thrown at funding new programs, etc., yet none have made a lasting impact. I'm thinking that has something to do with historical issues not addressed, etc., so the band-aids don't stick and we actually leave folks worse at times than when we "tried to help". I'm sure you understand what I'm trying to say with some awkward verbiage! The tribes recently had a very comprehensive statewide health needs assessment done by Patrik Johannsen (University of Nebraska), but are still considering what to do with the raw data. I'm hoping to be able to look at some of that data in regard to doing CBPR. So... the short answer is "health disparities" while the real question is, why does my native neighbor have a shorter life expectancy than I do? emjay
I am a First Nations RN and work with the BC Centre for Disease Control. I work specifically in TB control, where the root causes are due to social determinants of health. I also teach a class at the University of BC in this very area. My underlying belief for upstream solutions lay within policy across many levels of government, including the current European system of governance on-reservations. Although the USA and Canada are quite different in many aspects, when it came to colonizing Indigenous Peoples, the tactics were very much the same. As the above lady Irene has mentioned, history is very relevant to why and where we are today in health disparities. For example, with TB, housing, poverty and access to health care services are a few of the SDH's that keep TB thriving in communities. Social exclusion and the history and policies that keep Indigenous Peoples from fully participating in society, both culturally and economically. It is a very complex issue, as you mentioned, throwing money at the problem is not the solution...Life expectancy for American Indians is very similar to Canada's First Nations. Putting more money into health care programs does not constitute increasing life expectancy, this is seen more as a bandaide solution. The term "wellness" for Indigenous Peoples has different meaning, it consists of more than "programs or health care", it includes community, culture, '"belonging and connection", good mental and spiritual health, good relationships, healthy family, healthy ways of being, inclusive of good physical health. Would love to send you some powerpoints I used for teaching if this would help...:)
That is so kind of you and I would love that. My work email is [email protected] . One of the things that I'm interested in examining is what happened historically that set up the situation we find ourselves in today; I recently read Jared Diamond's "Guns, Germs and Steel" on the fates of human societies and it makes me wonder why the "exploration and settlement" of Turtle Island led to such a different result than similar behaviors in other cultures... I so look forward to speaking with all of you scholars about such important issues! em
I have a little background paper for you, vague but I think you will get most points. I am not certain how much you may already know about this history, so you may know some.
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