July 20, 2022

Communicating About Tribal Health Research

Portrait of David R. Wilson David R. Wilson, Ph.D., Director of the NIH Tribal Health Research Office

By David R. Wilson, Ph.D., Director of the NIH Tribal Health Research Office

Currently, there are 574 federally recognized American Indian and Alaska Native (AI/AN) Tribes in the U.S.  There is a special government-to-government relationship between AI/AN Tribes and the U.S. With roots in the Constitution (Article I, Section 8), this relationship has been given form and substance by numerous treaties, statutes, Supreme Court decisions, and Executive Orders. Understanding the history of the Tribes is crucial to communicating with and about AI/AN populations.

Each Tribe has its own history, governance, culture, and language. As a result, their demographic and health indicators can vary greatly. Tribal membership ranges from under 20 members to nearly 400,000 members. Reservations range from a little more than an acre to more than 27,000 square miles. 

Approximately 70% of AI/AN people now live in urban areas. U.S. government policies forced relocation to urban areas in the 1950s. Termination policies forced assimilation into non-Native culture. These have had long-term negative health effects for this population. AI/AN people in urban areas experience higher rates of poverty and inequities in employment, education, deaths due to homicide, and infant and maternal mortality compared to their non-Hispanic White counterparts. Some of these disparities may be attributed to the lack of family and cultural supports that would otherwise be available in reservation communities.

In 1975, the Indian Self-Determination and Education Assistance Act (ISDEAA) was signed into law. The ISDEAA advanced the notion that Tribes can provide better governmental services to their own members than distant federal agencies. Today, over 50% of all federal Indian programs are carried out by Tribes under ISDEAA contracts and compacts.

Many Tribal Nations now exercise full jurisdiction over diverse health, environmental, and justice programs that serve their members. For example, in response to the COVID-19 pandemic the Hopi Tribe launched a multi-level approach to pandemic mitigation that involved their own Health and Human Services Department, the Indian Health Service (IHS), and the U.S. Centers for Disease Control and Prevention (CDC). Through these partnerships, the Tribe was able to mount a comprehensive and effective response.

Tribes are increasingly determining the research that occurs within their jurisdictions. They are also playing a more central role in planning, conducting, and interpreting findings from research. The highly successful Native American Research Centers for Health program, or NARCH, supports opportunities for conducting research and career enrichment to meet Tribal health needs. 

In communicating with or about Tribal Nations, writers should be aware of the history of U.S. atrocities committed against AI/AN people and governmental policies designed to dispossess Tribes of their ancestral homelands and natural resources. AI/AN people remain diverse and resilient, with a profound understanding of the natural world and their place in it. AI/AN people view health as a holistic construct encompassing the physical, mental, emotional, social, and spiritual planes of existence.

Here are some tips for communicating more effectively with or about AI/AN people:

  • Write from a strengths-based perspective rather than deficit-based. Avoid the use of terms like “vulnerable” in describing Tribal communities.
  • When writing about or interacting with Tribal Nations, use the identifier that the Tribe prefers. If you’re not sure, ask a Tribal official or public affairs representative.
  • Emphasize solidarity in messaging (“our” not “your”).
  • Highlight protective cultural strengths (i.e., ceremonies and teachings that are meaningful to Native people and communities).
  • Be aware of past instances of research that have harmed communities and be careful not to perpetuate stereotypes.
  • Recognize Tribal diversity and refrain from generalizing findings from studies on one or several Tribes to the entire AI/AN population.
  • Keep in mind that some Native people at greatest risk for health issues live in places without paved roads, electricity, running water, or reliable broadband.

NIH is committed to increasing our communication and collaboration with Tribal Nations. With renewed partnerships and our combined strengths, Native culture and Western science can truly complement each other to save lives through respectful, inclusive, and impactful research and advancement during this critical time, and beyond.

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