Originally published in the November 2022 issue of the Notes on Antiracism, Justice, and Equity newsletter.

From the earliest days of colonization, the diseases brought from the “Old World” proved far more lethal to American Indian people than any weapon in the European arsenal. Infectious diseases, including measles, smallpox, and the plague resulted in the annihilation of entire communities lost forever. The toll taken by these diseases — combined with war, the expulsion of American Indian people from their ancestral lands, and the destruction of traditional ways of life — effectively destroyed the historical tribal governance structures, holistic view of life, cultural traditions, and the health and wellness previously known and practiced by American Indian people for millennia.

This month, we celebrate the rich history and accomplishments of American Indians, and honor our most unlikely and remarkable accomplishment: the fact that we have survived. The strengths and resilience of our ancestors are a testimony to their conquering insurmountable odds and of overcoming oppression, despite relentless challenges to their existence.

As a consequence of federal government control under the U.S. Constitution, American Indians were forced to become dependent on the federal government for the provision of health services. Services provided to American Indian people have been guaranteed through the Constitution, treaties, executive orders, and other legal bases. However, the U.S. government did not understand the “holistic” approach to health and wellness. Rather, a medical model was used instead of a public health model, which tribal populations had used since time immemorial.  Whereas, before colonization, American Indians were able pursue a “balance of life” that was inclusive of achievements, aspirations and fulfillment of contributions to perpetuate “life” and environmental harmony for future generations.

It is critical to understand the unique governmental relationship based on how the federal government relates to tribal nations as distinct sovereign political entities, not as a racial classification. This trust responsibility is a government-to-government relationship, as established in the U.S. Constitution which promises education, welfare, and health as a “duty protection.”

Given all the “broken promises” and severe underfunding at 40 to 60% of “level of need” (U.S. Commission on Civil Rights, Office of the General Counsel, 2004, 2018), our American Indian population continues to have its health status decline. In fact, if the Indian Health Service had not used a pseudo public health model (includes sanitation, environmental, and behavioral health services) since 1955, the health status of American Indian tribes and American Indian communities would have suffered more needless loss of life related to preventable and treatable illness as a matter of social justice and civil rights.

It is also important to understand how American Indians “survived” to this day. Resilience is a major factor in understanding health and wellness equity. It is important to understand the “diversity” of each tribe’s governance, respect for elders, community reciprocity, historical trauma, kinship, food security, healing, economy, social participation, and extended family of each of the 574 federally recognized tribes and American Indian communities.

Actions you can take to help improve the health and wellness status of American Indian people:

• Learn more about the true history and approach towards health and wellness that American Indian people have practiced.
• Explore the SPH American Indian Health and Wellness Certificate (does not require student enrollment).
• Students can also consider pursuing the SPH Graduate Minor.

While these courses focus on American Indian Public Health and Wellness, there are many parallels that can be made by students related to other governance structures from around the world. There are advantages to learning accurate history, other health models, innovative humility and health in all services, and the importance of using a holistic approach of health and wellness for all populations. The classes can help fortify the knowledge of all students regardless of race, and culture, that can be utilized in individual professional endeavors.

Linda Bane Frizzell
Eastern Cherokee and Lakota
SPH Associate Professor