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American Indians and Alaska Natives form a heterogeneous population with diverse cultures, languages, history, art forms, religious and spiritual beliefs, and traditional practices. Although remarkable resilience exists among this population, the legacy of colonialism, a history of genocidal practices, and intergenerational trauma have led to extreme health disparities. This program highlights structural competence in evaluating and treating AIAN patients, shedding light on systemic barriers contributing to profound health disparities. From colonial legacies to intergenerational trauma, grasp the complexities shaping health outcomes and explore interventions promoting equity in healthcare delivery. Uncover the legacy of treaties and historical agreements impacting AIAN healthcare, education, and housing access. Despite legal assurances, insufficient resources and systemic gaps have led to alarming health disparities, underscoring the urgency to bridge these divides. Through a structural competency lens, this activity offers insights into untangling barriers, fostering culturally sensitive approaches, and advocating for tailored interventions to address the healthcare inequities faced by AIAN communities. Objectives: Identify the etiology of chronic disease among the American Indian and Alaska Native populations. Determine the influence of upstream structures on American Indian and Alaska Native population health. Implement contextually tailored, culturally sensitive, strength-based care to American Indian and Alaska Native patients. Collaborate with the interprofessional team to provide culturally sensitive and appropriate care for patients with a history of intergenerational trauma to improve patient outcomes. Access free multiple choice questions on this topic.

American Indians and Alaska Natives, also known as Native Americans and Indigenous Americans, represent 574 federally recognized Indian Nations, also called First Nations and sometimes referred to as tribes. Each Nation is unique with its own history, culture, and spiritual and traditional practices. Through treaties and executive orders, American Indian and Alaska Native (AIAN) Nations have been guaranteed various services by the United States, including health care, education, and housing in exchange for tribal land and natural resources.[1] Despite the legal obligation, inequitable social policies and practices, inadequate funding, and provider shortages have forced AIAN communities to face massive disparities in health.[2] As a result, AIANs are disproportionately affected by chronic mental and physical health conditions compared to the general United States population, and they have the lowest life expectancy of any racial/ethnic group in the United States.[3][4][5] Addressing the barriers to adequate health and social care that have led to lower life expectancy rates and devastating disparities in health and healthcare delivery is essential. This article will use a structural competency framework to identify the root causes of health disparities and discuss potential opportunities for targeted interventions to effectively and appropriately evaluate and treat AIAN patients.

Dismantling health disparities faced by many AIANs and enhancing healthcare team outcomes requires a multifaceted approach. Strategies that can work to accomplish this include: Approach the care of AIAN patients through a structurally competent lens. Consider the historical and sociopolitical context that drives health disparities among AIAN populations. Recognize AIAN community-specific social determinants of health. Improve health professionals' understanding of historical, cultural, and spiritual factors that influence AIAN health. Appreciate the vast diversity that exists among AIAN people and nations. Address the distrust of Western Medicine in AIAN communities caused by a centuries-old legacy of discrimination. Address provider bias, microaggressions, and individual and institutional racism experienced by AIANs today. Incorporate issues related to AIAN health care within the medical school curriculum. Ensure adequate representation of AIANs in health care by increasing the number of AIAN students in health professional schools. Strive for maximum tribal involvement in meeting the health needs of local AIAN populations. Increase care coordination between traditional Native healers and health professionals practicing Western Medicine. Partner with AIAN community members to develop sustainable community-based interventions that integrate their culture, history, and inherent strengths into local health-based programs. Partner with AIAN communities to better understand the health impacts caused by toxin exposure and find appropriate solutions to address the adverse effects. Inquire about environmental risk factors and exposure to pollutants and metals such as uranium, arsenic, lead, copper, vanadium, and manganese. Identify individuals at high risk of developing a health condition based on exposure. Practice cultural humility and compassion in the clinical setting. Avoid stereotyping and encourage patients to share a cultural identity that is personal and unique to them. Explore each patient’s health beliefs and factors influencing their decision-making to provide contextually tailored care. Use a strength-based instead of a deficit-based approach to patient care. Appreciate tribal, cultural, and regional differences that impact each patient's illness experience.

Avoid stereotyping and encourage patients to share a cultural identity that is personal and unique to them. Explore each patient’s health beliefs and factors influencing their decision-making to provide contextually tailored care. Use a strength-based instead of a deficit-based approach to patient care. Appreciate tribal, cultural, and regional differences that impact each patient's illness experience. Achieving these goals will allow healthcare professionals to properly address health disparities, effectively evaluate and treat AIAN patients in clinical settings, and promote health equity.