Distrust - A Barrier to Health Care for Native American Patients

Transcription

1 Distrust - A Barrier to Health Care for Native American Patients Mary J. Owen, MD Center of American Indian and Minority Health University of Minnesota Medical School, Duluth Campus Minnesota Medical Association 2019 Annual Conference

2 Objectives: Explain distrust as a barrier to health care for Native American patients (5 minutes) Examine key factors in Native identity (10 minutes) Examine Native American health disparities (5 minutes) Discuss causes of distrust in reviewing articles (10 minutes) Recognize Native American resiliency and cite current examples (5 minutes) Discuss potential clinical approaches to distrust (15 minutes) Questions and/or further discussion of articles (10 minutes)

3 Distrust As A Barrier to Health Care A primary barrier Guadagnolo BA, Cina K, Helbig P, et al. Medical mistrust and less satisfaction with health care among Native Americans presenting for cancer treatment. J Health Care Poor Underserved. 2009;20(1): doi: /hpu Connell, Wang, Crook, and Yadrick, Barriers to Healthcare Seeking and Provision Among African American Adults in the Rural Mississippi Delta Region: Community and Provider Perspectives, Medical distrust has been reported as a structural barrier to preventive health screenings as well as to health care seeking and access among minority groups [10, 11, 13, 16, 17, 28, 31]. Impacts acute, chronic and preventative care Actionable

4 Terminology American Indian/Alaska Native Indigenous Native American Native Tribal Nation name Indian

5 What does it mean to be Native American? Identity: tribally enrolled (blood quantum), community belonging, traditional knowledge 573 Federally recognized tribes It s a commonality of historical experience: of genocide, of devastation, the destruction of civilizations, and a memory of who the people are before imperialism, before Columbus, before European overseas colonization. Roxanne Dunbar-Ortiz

6 Sovereignty Government to government Political vs. Racial Identity

7 Am J Public Health Jun;104 Suppl 3:S doi: /AJPH Epub 2014 Apr 22.

8 Am J Public Health Jun;104 Suppl 3:S doi: /AJPH Epub 2014 Apr 22.

9 Am J Public Health Jun;104 Suppl 3:S doi: /AJPH Epub 2014 Apr 22.

10 American Indian Health Policy: Historical Trends and Contemporary issues Donald Warne and Linda Bane Frizzell

11 Themes Complexity Chronic underfunding Importance of self governance

12 Community as a source of health in three racial/ethnic communities in Oregon: a qualitative study Carolyn A Mendez-Luck, Jeffrey W Bethel, R Turner Goins, Marc B Schure and Elizabeth McDermot

13 Three themes Social Connectedness Trauma Invisibility

14 Causes of Distrust

15 Resiliency NAGPRA Growing Native pride movement Language Revitalization Food Sovereignty Public Health programming: SMDPI/Chronic Kidney Disease

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17 Clinical Approaches to Distrust

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20 Take Aways Distrust is a primary barrier to health care for Native American peoples that health care providers can positively impact Common community strengths and/or experiences of Native American peoples: Social Connectedness---relationships are key Shared history and a memory of who we once were Sovereignty gives Native people the right to self governance Identity is defined by tribal governments, communities and individuals themselves Experience a personal and collective sense of invisibility and high levels of trauma Have withstood 500 years of assault on their culture and yet, persist and grow stronger

21 References 1. Am J Public Health Jun;104 Suppl 3:S doi: /AJPH Epub 2014 Apr Connell, C.L., Wang, S.C., Crook, L. et al. J Community Health (2019) 44: