Andres Bonifacio College

School of Nursing
College Park, Dipolog City

NCM 413

Submitted to:

Mrs. Julyn E. Gallardo, RN, MN

Prepared by:

Michelle Dingding

Jay Marie Gonzaga

Meville Joyce Mejias

Darmi Nicole R. Tomado

 HEALTH and ILLNESS in the American Indian and Alaska Native Population

INTRO

Health-related images of items that may be used by people of North American Indian heritage to
protect, maintain, and restore their physical, mental, or spiritual Health.

 Tiny bead—crafted cradle board from the Micmac Nation

 Baby Net from the Acho Dene Nation in Canada
 Beaded Necklace from the Cherokee Nation-Real People
 Basket woven by the Micmac Women
 Sweet Grass from American Indian Sioux Nation
 Clay Medicine Bowl of the American Indians in Mexico
 Bear for American Indians
 Medicine Bag from Acama Pueblo in New Mexico

BACKGROUND

(Timeline)

A.D. 1010- Vikings reache shores of the cuntry, but was unable to settle on the land so they left
after decadeof frustration.

Much later- another group o settlers termed as “Lot colonies” were repulsed. More peope came
to these shores and Europeans took over the land. As the settlers expanded westward, they signed
treaties of peace or treaties of land cession with the Indians. These treaties were similar t those
truck between nations, although in this case the agreement was imposed by the “big” nation onto
the small nation. One reason for these treaties was to legitimize the takeover of the land the
Europeans had “discovered”.

As time passed- The Whites rapidly grew and the number of Indians diminished due to wars and
diseases. The treaties began to lose their meaning and Europeans began treating them nothing
more than as a joke. They decided that these natives had no real claim to the land and shifted
them around like cargo reservation to another. Although Indians tried to seek settlements through
the American court system, they failed to win back the land that had been taken from them
through mispresentation. Today, many nations are seeking to reclaim their land through the
courts and several claims have been successful.

1860- First time American Indians counted as a separate group

1890- First to count American Indians throughout the country, counting of indians were only
limited to those living in the general population of various states. Indians who lived in American
Indian territory and American Indian reservations were not included.
1880- Alaska Natives in Alaska counted
1940- Alaska Natives generally reported in American Indian racial category. Enumeration of
people separately as Eskimo and Aleut
2000- Largest American Indian Nations: Cherokee, Navajo, Latin American India, Choctaw,
Sioux, Chippewa
Today- American Indians live predominantly in 26 states including Alaska. Although many
Indians remain on reservation and in rural areas, just as many people live in Cities, especially on
the West Coast. More and more people are claiming to have Indian roots.

Current Health Care Problems

 American Indians are face with a number of health related problems.

 Indian people are frequently caught in limbo when it comes to obtaining adequate health
care.
 At least one third of American Indians exist in a state of abject poverty.

With this destitution come poor living condition and attendant problems, as well as disease of the
poor:

• Malnutrition
• Tuberculosis
• High maternal and infant death rates
• Poverty and Isolated living - serve as further barriers

Morbidity & Mortality

  In fiscal year 1998, the Indian Health Service (HIS) population was estimated to be
approximately 1.46 million people, nearly 500,000 fewer than the over all American
Indian estimated population.
 The Indian population residing in the HIS services area is younger than the U.S.
population, with 33% of the population younger than 15 years old and 6% of the
population older than 65.
 Median age: 28.1

The following is a synopsis of several health statistics:

 Infant Low-birth-weight = 11%

 1990 No prenatal care = 42.1%
 1998 No prenatal care = 31.2 %
 No prenatal care in the first trimester = 2.5 times the percentage of White non-
Hispanic women in 1990
 1998 = 2.6 times the rate

Between 1990 and 1998

 Infant mortality rate = declined by 29%

 Death from Lung Cancer = increased 28.1%
 Suicide = increased 28.1%

 1992-1994 IHS age-adjusted death rates for the following causes were considerably
higher than those of the entire U.S. population:
1. Alcoholism – 579% greater
2. Tuberculosis – 475% greater
3. Diabetes mellitus – 231%
4. Accidents – 212%
5. Suicide – 70% greater
6. Pneumonia and Influenza – 61% greater
7. Homicide – 41% greater
Mental Illness

• People may frequently be treated by a traditional medicine man.

• Sweat lodge and herbs used to treat mental symptoms

Diagnostic Techniques:

• Divination - telling a future or prophecy. It is a widespread cultural practice that takes

varied forms worldwide.
• Conjuring - to summon (devil or spirit) by magical or supernatural power
• Stargazing

“Ghost sickness”

• Involves preoccupation with death and the deceased and is associated with witchcraft.

Symptoms:

• Bad dreams
• Weakness
• Feelings of danger
• Loss of appetite
• Confusion

“Pibloktoq”

• Is a malady that afflicts some members of artic and subarctic Eskimo communities.
• It is characterized by abrupt dissociative episodes accompanied by extreme
excitement followed by convulsive seizures and coma.

“Alcoholism”

• Is a major health problems among American Indians

 • A comparison of the 10 leading causes of death among American Indian/Alaska
Native and general population reveals unintentional injuries (3), chronic liver disease
and cirrhosis (6), suicide (9), and homicide and legal intervention (10)) rank higher as
cause of death than for the population at large.
• Each of these causes of death is related both to mental health problems and to
alcoholism.

Relative Risk of Health Problems for Person 51-61 years old: Odd Ratio for Minority Groups
Compared to Whites

American Indian Black Hispanic Asian/Indian

Diabetes 2.52 2.46 2.00 1.01

Cancer 2.42 0.77 0.66 0.23

Congestive Heart 2.24 1.43 0.82 0.37

Failure

Angina 2.17 2.05 1.14 0.63

Heart Problems 2.00 1.07 0.71 0.51

Head Injury 1.95 0.60 0.89 0.04

Psychological 1.76 0.98 1.38 0.26

problems

Lung disease 1.74 0.74 0.75 0.44

Comparison Selected Health Status Indicators: 1999-All Races and American Indian and Alaska
Natives

Health Indicator All Races American Indian and Alaska

 Natives

Crude birth rate per 1,000 14.5 16.8

population by race of mother

Percentage of live births of 83.2 69.5

women receiving prenatal care
first trimester

Percentage of live births to 7.57 7.15

teenage childbearing women-
under 18

Percentage of low-birth 7.57 7.15

weight per live births >2500
grams, 1997-1999

Infant mortality per 1000 live 7.2 9.3

births 1996-1998

Cigarette smoking by adults- Men: 26.1 Men: 38.8

percentage of persons, 1997-
Women: 21.9 Women: 31.7
1999

Cancer- all sites per 100,000 384.5 148.6

population, 1997
Lung cancer incidence per Men: 65.4 Men
100,000 population, 1997
Women: 40.7 Women

Breast cancer incidence per 113.1 28.7

100,000, 1997

Prostate cancer incidence per 136.0 41.2

1000,000, 1997

Male death rates from suicide, 18.1 19.1

all ages, age adjusted per
100,000 resident population,
1999

Male death rates from 9.3 15.4

homicide, all ages, age
adjusted per 100,000 resident
population, 1999
 15 Leading Causes of Death for American Indian or Alaska Native (2019)

Fetal alcohol syndrome

“My son will forever travel through a moonless night with only the roar of the wind for
company” (Doris, 1989). This quote reflects on the tragedy of FES, an affliction that affects
countless American Indian Children. The symptoms include:

 abnormal growth height, weight and/or head circumference

 CNS in behavioural and/or mental health problems
 Appearance with a specific pattern of recognizable deformities

An estimated of 70,000 fetal alcohol children are born each year in the US many of
whom are American Indians. Dorris (1989) further points out that the son of an alcoholic
biological father is three times more likely to himself become an abusive drinker.

This problem has grown over time and the impact increases with each generation.
Mortality and morbidity rates for American Indians were directly affected by alcohol abuse.

Hawk Littlejohn, the medicine man of the Cherokee Nation, EAstern Band, attribute sthis
problem from a traditional point of view to the fact that American Indians have lost the
opportunity to make choices. They can no longer choose how they live or how they practice their
medicine and religion.

He believes that once people returns to a sense of identification within themselves, they
begin to rid themselves of this problem of alcoholism.

Domestic Violence

This is another problem related to alcohol abuse in the American Indian people. Domestic
violence and battering of women.

Battered woman- is a woman who is physically assaulted by her husband, boyfriend, or

s some significant other.

The assault may range from a push to severe, even permanent injury, to sexual abues,
child abuse and neglect. Once the pattern of abuse is esablished, subsequent episodes of abuse
tend to get worse. This abuse is not traditional in american indian life but has evolved.

True Indian love is based on a tradition of mutual respect and the belief the men and
women are part of ordered universe that should live in peace. In a traditional indian home
children were raised to respect their parents, and they were not corporally punished. Violence
toward women wa snot practed. In the modern times, however, the sanctions and prrotections
against domestic violence have decreased and the women are far more vulnerable.

Many women are reluctant to admit that ty are victims of abuse because they believe that
they will be blamed for the assault. Hence, the beatings continue.
 Long-range solutions: teaching children to love - to nurture children and give them self-
esteem, teaching boys to love and respect women, to give girls sense of worth.

Domestic violence has an effect on the community and on the family. a pattern of abuse
is easily established. It begins with tension: the female attempts to keep peace, but the male
cannot contain himself, a fight erupts and then the crisis arrives. The couple may make up, only
to fight again. Attempt to help must be initiated or the cycle escalates

Some of the services available to household experiencing domestic violence include:

Tribal health: Direct services for physical and mental health

Law enforcement: Police protection may be necessary

Legal assistance: Assistance for immediate shelter and emergency food and
transportation

Urban Problems:

More then 50% of American Indians live in urban areas. An example would be in Seattle
where there are over 15,000 Indians, Although the population is not particularly dense, its rates
of Diphteria, TB otitis mediawith subsequent hearing defects, alcohol abuse, inadequate
immunization, iron-deficiency anemia, childhood developmental lags, mental health problems,
and carries and toher dental problems are high.

In dysfuncitonal families, problems arise that are related to marital differences and
financial strain, which usually are brought about by unemployment and the lack of education or
knowledge of special skills.

Between 5000-6000 Indians live in Boston. They experience the same problem as
American Indians in other cities yet there is an additional problem. Few non-Indian residents are
even aware that there is an adequate Indian community in that city or that is in desparate need of
adequate health and social services

NURSING CARE OF CHILDREN, ADULTS AND OLDER ADULTS: American Indian

Challenges in American Indian Children’s Development

Demographic Challenges: Poverty, Education, and Employment

American Indian and Alaska Native people today represent roughly 1.5% of the
total U.S. population. Relative to the general U.S. population, it is a young and growing
population, with one-third of people younger than 18 years, and fertility rates that exceed
those of other groups. More than one-quarter of the American Indian population is living
in poverty. American Indian children and families are even more likely to live in poverty.
U.S. Census Bureau statistics reveal that 27% of American Indian families with children
live in poverty, whereas 32% of those with children younger than 5 years do—rates that
are again more than double those of the general population and again are even higher in
certain tribal communities.

Discrepancies in education and employment are also found. Overall, there are fewer
individuals within the American Indian population who possess a high school diploma or
GED (71% versus 80%) or a bachelor’s degree (11.5% versus 24.4%). Such educational
discrepancies appear early, with American Indian children’s math and reading skills
falling progressively behind those of their white peers as early as kindergarten to fourth
grade, as well as other challenges persisting throughout the school years, including higher
dropout rates and grade retention.
American Indian people have lower labor force participation rates than those of the
general population, whereas family unemployment rates range from 14.4% overall to as
high as 35% in some reservation communities. The poverty and unemployment observed
in American Indian communities is related to broader economic development challenges
in American Indian communities, including geographic isolation and the availability of
largely low-wage jobs.
Physical Health Disparities in the American Indian and Alaska Native Population

Based on existing data, there can be little doubt that the American Indian and Alaska
Native population as a whole is confronted with ongoing disparities in health. According
to the Indian Health Service (IHS), the federal agency that provides medical care to
roughly 1.6 million American Indian and Alaska Native people, the age-adjusted death
rate for adults exceeds that of the general population by almost 40%, with deaths due to
diabetes, chronic liver disease and cirrhosis, and accidents occurring at least three times
the national rate, and deaths due to tuberculosis, pneumonia and influenza, suicide,
homicide, and heart disease also exceeding those of the general population. Although
studies of urban American Indian and Alaska Native health are limited, those that do
exist suggest similar health-related disparities, including higher rates of and deaths due to
accidents, liver disease and cirrhosis, diabetes, alcohol problems, and tuberculosis
compared to the general population from the same area.
Across the developmental spectrum American Indian and Alaska Native children also
experience physical health–related disparities relative to their non-Native peers. National
Center for Health Statistics data document rates of inadequate prenatal care and post-
neonatal death among American Indian and Alaska Native infants that were two to three
times those of white infants and even higher, among rural American Indian and Alaska
Native infants. IHS data showed a similar pattern, with an American Indian and Alaska
Native postneonatal death rate roughly twice that of both the U.S. all-races and white
rates (4.8 deaths per 1000 live births versus 2.7 and 2.2, respectively), and accounted for
by the increased number of American Indian and Alaska Native deaths due to sudden
infant death syndrome (1.8 versus 0.8 deaths/1000 live births), pneumonia and influenza
(0.4 versus 0.1), accidents (0.4 versus 0.1), and homicide (0.2 versus 0.1). Fetal alcohol
spectrum disorders are also greater among American Indian and Alaska Native children
occurring in 1.7–10.6 per 1000 births, indicating as much as a fivefold difference
compared with national rates.
 Additional physical health disparities emerge for American Indian and Alaska Native
children beginning in early childhood and continuing throughout development. Of
particular note are childhood obesity and overweight and childhood dental caries. In one
of the largest studies to assess childhood obesity among American Indian and Alaska
Native children, 39% were defined as overweight or obese—defined as a body mass
index (measured in kilograms per square meter of body surface area) above the 85th
percentile. In national studies, American Indian and Alaska Native children are twice as
likely to be overweight and three times as likely to be obese, with rates of both growing
by 4% since the mid-1990s. The disparities for childhood dental caries are equally
striking. According to recent IHS data, 79% of American Indian and Alaska Native
preschool children had caries experience, whereas 68% had untreated dental decay—a
prevalence of more than three times that of their non-Native peers.

Challenges in Intervention and Services

The physical and mental health disparities faced by American Indian and Alaska Native
populations can in part be accounted for by the serious lack of funding for health care
within the IHS system and by the numbers of American Indian and Alaska Native people
not served by IHS who are without any other form of health insurance or benefit.

A U.S. Commission on Civil Rights report documented that the IHS is so severely
underfunded that it spends just $1914 per patient per year compared with twice that
amount ($3803) that is spent on a federal prisoner in a year.

Amazingly, this finding is little departure from the state of health care more than a
century ago. As Jones accounts, in 1890 the Commissioner of Indian Affairs calculated
that based on government salaries paid to physicians in the Army, Navy, and Indian
health, “the government valued people [at] $21.91 per soldier, $48.10 per sailor, and
$1.25 per Indian” (p. 2128). The lack of funding is especially dire for mental health
services. According to providers in 10 of the 12 IHS service areas, mental health was
 identified as the number-one health problem confronting American Indian and Alaska
Native communities today; along with social problems, it was estimated to contribute to
more than one-third of the demands for services. Despite such a demand, only 7% of an
already limited IHS budget is allocated for mental health and substance abuse
services. The effect of this underfunding on the availability of mental health services is
dramatic; by one estimate there were only two psychiatrists and four psychologists per
100,000 people served by the IHS—one-seventh the number of psychiatrists and one-
sixth the number of psychologists available to the general population

NURSING CARE OF CHILDREN, ADULTS AND OLDER ADULTS: Alaska Native

 ALASKA NATIVE is an Indigenous people in Alaska.

 There are five distinct groups: Tlingit and Haida, Inupiaq, Yupiks, Aleuts, and
Athabascans.
 Ancestors of Alaska Natives migrated into the area 2,000 years ago.
 Some are descendants of the third wave of migration, in which people settled across the
northern part of North America.
 Alaska was occupied by approximately 80,000 indigenous people.
 The phrase "time of contact" means the earliest time when a Native group had significant
direct interaction with Europeans.
 
HEALTH AND ILLNESS
 Alaska Native people's belief about HEALTH is that it reflects living in total harmony
with nature.

CAUSES OF ILLNESS.
 They believe that ILLNESS stems from an individual’s disharmony with the
environment and healing must therefore begin in the person’s spirit.
 Alaska Native healers may include: Herbalists, Spiritual healers, Medicine men, or
Medicine women
  They know the interrelationships of human beings, the earth, and the universe. They
know the ways of plants & animals, sun, moon and the stars. 
 
TRADITIONAL METHODS OF HEALING
 Alaska Natives see their healers for spiritual reasons such as: To seek
guidance, Truth, Balance, Reassurance, and Spiritual well‐being. 
 To determine the cause and treatment of an illness they perform special ceremonies.
 Some traditional ways of defining health are known as Kusiut “a learned one" who are
medicine men.

METHODS IN PREVENTING ILLNESS

 Teach traditional plant knowledge.
 Ethical plant harvesting.
 Hands-on activities to encourage a holistic approach to wellness.
 
COMMON ILLNESS AND HERBAL TREATMENTS USED BY ALASKA NATIVE
 JUICE FROM MILKWEED- Warts
 SPRUCE BARK AND WATER- Obesity
 COMBINATION OF BLUEBERRIES & HUCKLEBERRIES- Diabetes
 EAT A HEAD OF LETTUCE A DAY- Insomnia
 
NURSING CARE OF CHILDREN, ADULTS, & OLDER ADULTS
 
 Alaska Native children and teens face considerable hurdles from birth that stem
from historical trauma, health inequities, socioeconomic barriers, and racism yet endure
with proper support. 
 The needs of Alaska Native children are extraordinary, as they are disproportionately
affected by violence, substance use, obesity-related diseases, and toxic stress related to
adverse childhood experiences.
  During their pregnancies, women restricted their activities and took special care with
their diet and behavior to protect the baby.
 They believe that eating raccoon or pheasant would make the baby sickly
 Consuming speckled trout could cause birthmarks.
 Eating black walnuts could give the baby a big nose.

 They thought that wearing neckerchiefs while pregnant caused umbilical strangulation

 Lingering in doorways slowed delivery. 

 Expectant mothers and fathers participated in rituals to guarantee safe delivery, such as
daily washing hand, feet and employing medicine men to perform rites that would make
deliveries easier.
 A home visiting nurse in a Midwestern City provides families with in-home support
throughout pregnancy and a child's early years.
 An elder who does not feel respected will give superficial information or not respond at
all.  
 If the elder is not comfortable explaining the protocols, he or she might refer you to
someone who can teach the protocols.
 When working with Alaska Native older adults it is important to slow down your pace of
speech to match the pace of the patient. 

 It is necessary to listen more than talk and speak in soft tones unless the Alaska Native
older adults have hearing loss. Speaking loudly indicates rudeness or anger.

TRANSCULTURAL PERSPECTIVE OF AMERICAN INDIAN AND ALASKA NATIVE

IN CHILD BEARING

1. A pregnant woman should not look at a deformed, injured, or blind person or the baby
will have the same defect.

2. Being around dying people or animals is unhealthy for the mother and baby.

3. If a pregnant woman eats animals’ feet, her baby will be born feet first.
4. If the pregnant woman eats the tail of an animal, her baby will get stuck during delivery.

5. If berries are eaten during pregnancy, the baby will have a birthmark.

6. If liver is eaten during pregnancy, it will make the infant’s skin darker.

7. To tie knots or weave during pregnancy will cause complications of the umbilical cord at
birth.

8. Preparation such as choosing a name or making the cradleboard prior to the birth of the
infant may jeopardize the infant’s survival or well-being.

9. Albinism is believed to be caused by the father eating the white leaf inside the corn husk
before conception.

10. If the father shoots a rabbit or other small animal, the child will have a mark or deformity
in the same area the animal is shot.

11. If a snake is killed, the infant will be born spotted like the snake and die.

12. Different tribes clearly specify the appropriate dress, position, and who is in attendance
for birth, as well as dietary and bathing specifications during the postpartum period.

13. During labor, a badger’s claw may be put in the woman’s belt because the badger is good
at digging his way out.

14. A nap during labor may result in a change in the desired sex of the infant.

15. Exposure to cold during pregnancy may result in a lengthy labor as the cold may freeze
the woman’s bag of waters and hold the baby back.

16. If a raw bean is swallowed during labor and it slipped down with ease, the delivery will
be easy.

17. While the infant’s cord is being cut following birth, the mother bites on a white pebble to
ensure the child’s teeth will be strong and white.
18. The placenta and umbilical cord (including the cord stump), as any body tissue, is sacred
to the Native American people and should not be discarded indiscriminately.

19. Most newborns are swaddled, breastfed, and greeted with a special ceremony depending
on the tribe and the sex of the infant.

20. After the cord stump falls off, the navel may be treated by rubbing it with dirt from the
doorstep. This trodden dirt is used because it is believed to keep the navel down and in
place.
 REFERENCES

BOOKS

 Neihardt, N. (1993). The sacred hoop. Tekamah, NE: Neihardt.

 Senier, S. (2001). Voices of American Indian assimilation and resistance. Norman:
University of Oklahoma Press.

LINKS

 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2567901/?
fbclid=IwAR3o3v0E7MQZCz1ePQbA4gJ7hVSOLnW3K8WxT67CeNI9T8KpNKIdRLi
TTeY
 jognn.org/article/S0884-2175(15)33875-2/pdf
 https://healthychildren.org/English/news/Pages/Caring-for-the-Health-of-American-
Indian-and-Alaska-Native-Children-and-Adolescents.aspx
 https://nursing.jnj.com/nursing-news-events/providing-culturally-competent-nursing-
care-in-alaska
 https://pubmed.ncbi.nlm.nih.gov/14509499/