Indigenous Futurism is a movement consisting of art,
literature, comics, games, and other forms of media which express
Indigenous perspectives of the future, past, and present in the context
of science fiction
and related sub-genres. Such perspectives may reflect Indigenous ways
of knowing, traditional stories, historical or contemporary politics,
and cultural realities.
Background
In
the late 20th century, Indigenous artists and writers experimented with
science fiction and images of Indigenous lifeways through different
spaces and times. In her anthology, Walking the Clouds: An Anthology of Indigenous Science-Fiction (2012), Grace Dillon outlines how science fiction can aid processes of decolonization. Using tools like slipstream, worldbuilding, science fiction and anthropological
First Contact scenarios, Indigenous communities construct
self-determined representations and alternative narratives about their
identities and futures. Indigenous Futurists critique the exclusion of Indigenous people from the contemporary world and challenge notions of what constitutes advanced technology. In so doing, the movement questions the digital divide,
noting that Indigenous peoples have at once been purposefully excluded
from accessing media technologies and constructed as existing outside of
modernity. The widespread use of personal computers and the Internet following the Digital Revolution
created conditions in which, to some extent, Indigenous peoples may
participate in the creation of a network of self-representations.
Grace Dillon, editor of Walking the Clouds: An Anthology of Indigenous Science Fiction,
encouraged stories through IIF, the Imagining Indigenous Futurisms
Science Fiction Contest. Lou Catherine Cornum is a writer, scholar, and
Indigenous Futurist known for their work Space NDNs. Chickasaw scholar Jenny L. Davis
emphasizes the importance of 'Indigenous language futurisms,' where she
shows that Indigenous languages are important to articulating and
understanding Indigenous temporalities.
Concept of time
The
concept of time in Indigenous Futurism moves away from Western
traditional interpretations, both culturally and within the genre of speculative fiction. Time, according to Indigenous Futurists, encompasses and connects the past, present, and future all at once. Artists may explore alternate histories, distant and near futures, separate timelines, time travel, the multiverse, and other topics in which time is not limited to a linear conceptualization. Historical themes of colonialism, imperialism, genocide,
conflict, the environment, trade and treaties, which have impacted
Indigenous cultures, are recurring and reexamined, creating new
narratives in the process.
Artists play with questions of race, privilege and "Whiteness", both in
history and within the speculative genre; they are expanded upon,
subverted, erased, reversed, etc., thereby linking culture to time,
space, and what lies in-between. The term biskaabiiyang (Anishinaabe), used by Dillon, exemplifies how Indigenous creators reflect on the impact of colonization
by returning to their ancestral roots, conflating past with present and
future, as well as reframing what the world would or could be like.
In other words, Indigenous Futurisms do not solely address the
future, but create a range of scenarios and phenomena in which
reimaginations of space, time, and Indigeneity are celebrated.
Literature
Literature
lends itself to many aspects of Indigenous Futurism. Many of the
stories revolving around Indigenous Futurisms contain an Indigenous main
character, however, this does not define the genre, when referring to
literature in Indigenous Futurisms we are referring to the Author, or
the conceptualized stories, as defined in Dillon's anthology.
Literature is currently the most diverse subject in Indigenous Futurism, works including: Love After the End, compiled by Joshua Whitehead, a collection of stories and perspectives from queer Indigenous peoples tackling colonialism and the ideas of hope.
Scholarly works including; Knotting Ontologies, Beading Aesthetics, and Braiding Temporalities, by Darren Lone Fight,
an examination of Native American literary epistemology and futurisms
including an analysis of the Indigenous Star Wars phenomena.
Visual art
An early source of collective Indigenous Futurisms is on the CyberPowWow website, a site launched by Skawennati (Mohawk) for Indigenous artworks starting in 1997 to 2004. It was a precursor to her TimeTraveller™Machinima series began with a 22nd-century Mohawk man.
Many pieces of Indigenous Futurist artwork contain iconography or symbolism that reference Indigenous oral history. Another major facet of Indigenous Futurist artwork is the adaptation of existing culture and nomenclature. For instance, artist Bunky Echo-Hawk's “If Yoda was Indian” displays show a new perspective on Yoda from the franchise Star Wars.
Kristina Baudemann focuses on storytelling and art and the integration of science fiction into Indigenous art in Indigenous Futurisms in North American Indigenous Art. She says that Indigenous people are resilient and sustainable and their art incorporates those characteristics. One specific Indigenous artist, Ryan Singer (Navajo Nation), paints in acrylic and silk-screens prints. He has two pieces of Princess Leia, from the Star Wars series that portrays the princess as Hopi, acknowledging George Lucas' cultural appropriation of the Hopi butterfly whorl hairstyle. In his first painting, Hopi Princess Leia (2009),
he shows the Hopi Princess Leia holding a gun pointing straight at the
audience while also staring directly at the audience as well. In his
second Hopi Princess Leia, named Hopi Princess Leia II (2010),
Leia is seen holding a bigger gun and still looking directly at the
audience. Baudemann analyses this depiction and says it creates
awareness of the colonial gaze, which is harmful to indigeneity. In these paintings Princess Leia is seen clad in a Hopi blanket, wearing the hairstyle typical to unmarried Hopi girls.
She is in front of her pueblo homes protecting them with her gun.
Baudemann emphasizes the idea that Hopi homes should be seen as homes
and not monuments that can be looked at by outsiders and they should not
be appropriated. Princess Leia, in the Star Wars
movies, loves her home and tries her hardest to protect it which is why
Singer chose Princess Leia to be depicted in these paintings.
Film
Indigenous Futurisms in film reflect non-colonial encounters such as utopian sovereignty and dystopian assimilation.
The continued development of Indigenous Futurist frameworks account for
the diversity of creative efforts and histories between the First
Nations, Inuit, and Native American filmmakers and communities to influence the outside world.
While
not as prominent as other mediums, video games provide a more hands-on
approach to the teaching and display of Indigenous Futurism. Representation of indigenous cultures has been part of video games for years, with iconic games such as The Oregon Trail
depicting Indigenous peoples. However, the specific genre of Indigenous
Futurism in video games is a relatively new concept and few prominent
games fall into this category.
Indigenous Futurist games range from games such as Thunderbird Strike, an action game where you take on the form of the legendary Thunderbird, gathering lightning to destroy mining equipment and factories on a terrorized and barren earth, to games such as Never Alone, which tells the story of a Iñupiaq and an Arctic fox as they explore a dire atmosphere and experience the mythology of the Alaska Natives for themselves. Thunderbird Strike features significant artistic components and lots of indigenous imagery. The indigenous creator of the game, Elizabeth LaPensée, calls the art style "woodland" or "x-ray," and it is greatly inspired by Anishinaabe culture. The game offers a form of protest specifically against the oil industry. Additionally, the popular game Fallout: New Vegas features a DLC titled Honest Hearts
that showcases Indigenous culture in a dystopian future. Various tribes
exist in the new region of Zion Canyon and the connection to nature is
showcased with rain and friendly dogs being introduced to Fallout: New
Vegas for the first time.
There has been controversy surrounding representation of Native people in video games, and iconic games such as The Oregon Trail have depicted Indigenous cultures to be dangerous and violent.
Many new video games have begun hiring consultants from the Native
community to ensure accurate representation, with the popular video game
Assassins Creed III collaborating on the game with the Mohawk Nation.
A recent Indigenous Futurist game, Terra Nova, was produced by Maize
Longboat, a member of the Mohawk tribe, and many other indigenous people
have been engaging in the production of video games centered around
indigenous themes.
Virtual reality
Virtual
reality (VR) is a medium in which the concept of screen sovereignty can
be used to combat misrepresentation of Indigenous people in media.
Indigenous VR makers are shaping the culture of technology through VR in
order to properly represent Indigenous people and their culture.
Currently, white media creators dominate the digital media field and
digital technology industries. Indigenous Matriarch 4
is a virtual reality company that provides Indigenous people with the
tools they need to participate in and remake the virtual world. Because
Indigenous people are often misrepresented in media, VR has become a
place to creatively express Native American culture and ideas.
Indigenous VR has also provided Indigenous people with the opportunity
to be leaders in a new technology field, and to be involved in
technology fields that previously excluded them and that had very little
representation of Native American and Indigenous communities.
Virtual reality is being used to create space and capacity for Indigenous creatives to tell their stories.
VR is used by many Indigenous practitioners to reimagine traditional
storytelling and express themselves and their culture, promote health
and wellbeing, and foster self-esteem and pride. New virtual platforms
have also been created that retell significant moments in Indigenous
history as well as connect to the present, like the platform AbTeC
Island (Aboriginal Territories in Cyberspace).
The 2167VR Project (2017), in partnership with the Initiative for Indigenous Futures (TIIF), commissioned the works of many Indigenous artists such as Danis Goulet (Métis), Kent Monkman (Cree), Postcommodity and Scott Benesiinaabandan (Lac Seul First Nation), notable for his work Blueberry Pie Under a Martian Sky. This immersive project exhibits virtual reality works set 150 years forward in time, paralleling Canada's 150th anniversary, each offering a different perspective on the role Indigenous peoples and identities will have in building the future.
Exhibitions
To increase this movement's visibility and bring attention to Indigenous voices, the Institute of American Indian Arts (IAIA) has established a branch, the Museum of Contemporary Native Arts (MoCNA), located in Santa Fe, New Mexico, which collects and exhibits over 10,000 Indigenous works. The MoCNA has an exhibition entitled Indigenous Futurisms, featuring the works of 27 contemporary Indigenous artists. Following the pandemic, the MoCNA has transferred the collection to an online gallery and made available a VR experience which the public can access through their devices.
Related movements
The term Indigenous Futurism, more commonly written as Indigenous Futurisms, was coined by Grace Dillon, professor in the Indigenous Nations Studies Program at Portland State University. The term was inspired by Afrofuturism and Africanfuturism, all of which encapsulate multiple modes of art-making from literature to visual arts, fashion, and music.
Indigenous Futurisms are also connected to Chicanafuturism,
"a spectrum of speculative aesthetics produced by U.S. Latin@s,
including Chican@s, Puerto Ricans, Dominican Americans, Cuban Americans,
and other Latin American immigrant populations. It also includes
innovative cultural productions stemming from the hybrid and fluid
borderlands spaces, including the U.S.-Mexico border."
Criticism
Indigenous
Futurisms as a term has received mixed feedback among Indigenous
Brazilian musicians. Many Indigenous artists do not embrace this concept
because they view preserving culture to be much more important than
thinking about the future. For example, Indigenous rapper Kunumi MC,
disagrees with the term, arguing that it is a white man's term
unreflective of Indigenous people, saying: “We, native Indigenous people
living in tribes, don't think about the future,” he says. “The white
man has a vision of progress, not us. Our progress is to preserve our
culture ... to live in the present, I have to remember my past.”
List of Indigenous Futurists
Artists working within the field of Indigenous Futurisms include:Darren Lone Fight
(Mvskoke, Mandan, Hidatsa, Arikara), a literary critic and professor
who runs Center for the Futures of Native Peoples at Dickinson College; Loretta Todd (Cree/Métis), a filmmaker who runs IM4, the Indigenous Matriarchs 4 XR Media Lab; Skawennati (Mohawk), a multimedia artist best known for her project TimeTraveller, a nine-episode machinima series that uses science fiction to examine First Nations histories;
The Anglosphere, according to James Bennett (The Anglosphere Challenge)
Core Anglosphere
Middle
Anglosphere (states where English is one of several official languages,
but not necessarily widely spoken by the native population)
Outer sphere (English-using states of other civilisations)
Periphery (states where English is widely used but is not an official governmental language)
The Anglosphere is the Anglo-American sphere of influence,
with a core group of nations that today maintain close political,
diplomatic and military co-operation. While the nations included in
different sources vary, the Anglosphere is usually not considered to
include all countries where English is an official language, so it is not synonymous with the sphere of anglophones,
though commonly included nations are those that were formerly part of
the British Empire and retained the English language and English Common Law.
The five core countries of the Anglosphere are usually taken to be Australia, Canada, New Zealand, the United Kingdom, and the United States.
These countries enjoy close cultural and diplomatic links with one
another and are aligned under military and security programmes (Five Eyes).
Definitions and variable geometry
The Anglosphere is the Anglo-American sphere of influence. The term was first coined by the science fiction writer Neal Stephenson in his book The Diamond Age, published in 1995. John Lloyd
adopted the term in 2000 and defined it as including English-speaking
countries like the United Kingdom, the United States, Canada, Australia,
New Zealand, Ireland, South Africa, and the British West Indies. James C. Bennett defines anglosphere as "the English-speaking Common Law-based nations of the world",
arguing that former British colonies that retained English common law
and the English language have done significantly better than
counterparts colonised by other European powers. The Merriam-Webster
dictionary defines the Anglosphere as "the countries of the world in
which the English language and cultural values predominate".
However the Anglosphere is usually not considered to include all
countries where English is an official language, so it is not synonymous
with anglophone.
Core Anglosphere
The definition is usually taken to include Australia, Canada, New Zealand, the United Kingdom, and the United States in a grouping of developed countries called the core Anglosphere. This term can also less frequently encompass Ireland, Malta and the Commonwealth Caribbean countries.
The five core countries in the Anglosphere are developed countries
that maintain close cultural and diplomatic links with one another.
They are aligned under such military and security programmes as:
Due
to their historic links, the Anglosphere countries share many cultural
traits that still persist today. Most countries in the Anglosphere
follow the rule of law through common law rather than civil law, and favour democracy with legislative chambers above other political systems. Private property is protected by law or constitution.
The American businessman James C. Bennett, a proponent of the idea that there is something special about the cultural and legal traditions of English-speaking nations, writes in his 2004 book The Anglosphere Challenge:
The Anglosphere, as a network
civilization without a corresponding political form, has necessarily
imprecise boundaries. Geographically, the densest nodes of the
Anglosphere are found in the United States and the United Kingdom.
English-speaking Canada, Australia, New Zealand, Ireland and
English-speaking South Africa (who constitute a very small minority in
that country) are also significant populations. The English-speaking
Caribbean, English-speaking Oceania and the English-speaking educated populations in Africa and India constitute other important nodes.
Bennett argues that there are two challenges confronting his concept
of the Anglosphere. The first is finding ways to cope with rapid
technological advancement and the second is the geopolitical challenges
created by what he assumes will be an increasing gap between anglophone
prosperity and economic struggles elsewhere.
Favourability ratings tend to be overwhelmingly positive between countries within a subset of the core Anglosphere known as CANZUK (consisting of Canada, Australia, New Zealand and the United Kingdom), whose members form part of the Commonwealth of Nations and retain Charles III as head of state. In the wake of the United Kingdom's decision to leave the European Union (Brexit) as a result of a referendum held in 2016,
there has been mounting political and popular support for a loose free
travel and common market area to be formed among the CANZUK countries.
Criticisms
In 2000, Michael Ignatieff wrote in an exchange with Robert Conquest, published by the New York Review of Books,
that the term neglects the evolution of fundamental legal and cultural
differences between the US and the UK, and the ways in which UK and
European norms drew closer together during Britain's membership in the
EU through regulatory harmonisation. Of Conquest's view of the Anglosphere, Ignatieff writes: "He seems to believe that Britain should either withdraw from Europe
or refuse all further measures of cooperation, which would jeopardize
Europe's real achievements. He wants Britain to throw in its lot with a
union of English-speaking peoples, and I believe this to be a romantic
illusion".
In 2016, Nick Cohen wrote in an article titled "It's a Eurosceptic fantasy that the 'Anglosphere' wants Brexit" for The Spectator's Coffee House blog: "'Anglosphere' is just the right's PC replacement for what we used to call in blunter times 'the white Commonwealth'." He repeated this criticism in another article for The Guardian in 2018. Similar criticism was presented by other critics such as Canadian academic Srđan Vučetić.
In 2018, amidst the aftermath of the Brexit referendum, two British professors of public policy Michael Kenny and Nick Pearce published a critical scholarly monograph titled Shadows of Empire: The Anglosphere in British Politics (ISBN978-1509516612). In one of a series of accompanying opinion pieces, they questioned:
The tragedy of the different
national orientations that have emerged in British politics after
empire—whether pro-European, Anglo-American, Anglospheric or some
combination of these—is that none of them has yet been the compelling,
coherent and popular answer to the country's most important question:
How should Britain find its way in the wider, modern world?
They stated in another article:
Meanwhile, the other core
English-speaking countries to which the Anglosphere refers, show no
serious inclination to join the UK in forging new political and economic
alliances. They will, most likely, continue to work within existing
regional and international institutions and remain indifferent to – or
simply perplexed by – calls for some kind of formalised Anglosphere
alliance.
Opinion polls
A 2020 poll by YouGov
revealed that Australia was the most positively viewed country by
Americans outside of the United States, followed by Canada, Ireland, the
United Kingdom, Italy and New Zealand.
Another 2020 poll by YouGov showed that New Zealand, Canada and
Australia were the most positively viewed countries by British people,
and more favourably viewed by British people than the United Kingdom
itself, with the United States ranking 34th.
A 2023 poll by the Lowy Institute
similarly indicated that New Zealand was the country most positively
viewed by Australians, with Canada ranking second, the UK third and the
United States twelfth. A 2020 poll by the Macdonald–Laurier Institute suggested that Australia was the most positively viewed country by Canadians. In a 2019 Pew Research Center poll, a plurality of Canadians and Australians named the United States as their country's closest ally.
Native American reservation inequality underlies a range of societal issues that affect the lives of Native American
populations residing on reservations in the United States. About one
third of the Native American population, about 700,000 people, lives on
an Indian Reservation in the United States. Reservation poverty
and other discriminatory factors have led to persisting social
inequality on Native American reservations. Disparities between many
aspects of life at the national level and at the reservation level, such
as quality of education, quality of healthcare, substance use disorders,
teenage pregnancy, violence, and suicide rates are significant in
demonstrating the inequality of opportunities and situations between
reservations and the rest of the country.
Many
contemporary disparities are rooted in the violence of colonialism. The
reservation system was created following the expansion of the United
States into tribal lands throughout the 19th and 20th centuries, during United States territorial acquisitions. This effort started with the Indian Appropriations Act of 1887,[2] which created the first reservations.
Education
The Indian Self-Determination and Education Assistance Act
(ISDEAA) resulted from culminating civil rights movements and calls for
increased attention on Native American Affairs. According to the Bureau of Indian Affairs
(BIA), the act "gave authority to federally recognized tribes to
contract with the BIA for the operation of Bureau-funded schools and to
determine education programs suitable for their children."[3]
Later federal educational amendments furthered the capabilities of
reservation schools and "provided funds directly to tribally operated
schools, empowered Indian school boards, permitted local hiring of
teachers and staff," and more.
Contemporary reservation school situations
Schools
on Native American reservations are disproportionately underachieving
compared to other schools. According to a report made to the U.S.
Department of Education "only 17% of tribally controlled schools made
Annual Yearly Progress under No Child Left Behind during the 2007-2008
school year."[4] Much of the reasoning for this discrepancy is because of the widespread and disproportionate amount of reservation poverty.
Consequently, "students from low socioeconomic families face unique
academic challenges, as their families may lack access to the resources
and socialization experiences necessary to adequately prepare and
support student achievement in school"
Furthermore, "the lack of academically successful role models and the
need to provide additional financial support to the family contributed
to the high number of dropouts among Native American students who live
in poverty."
Both student and teacher attrition are major issues in
reservation schools as well. Censuses have demonstrated the trend in
reservation schools that, "despite a growth in population... enrollment
in grades 1 through 12 has steadily declined..."[4]
The High School dropout rate for Native Americans is high, much higher
than the national average, and as quoted in a UCLA Civil Rights project
report, "Native students "...have a dropout rate twice the national
average; the highest dropout rate of any United States ethnic or racial
group. About three out of every ten Native students drop out of school
before graduating from high school both on reservations and in cities
(p. 1).""
Teachers are also remarkably and especially difficult to retain
at reservation schools, which creates problems with regularity in the
classroom and many administrative difficulties as well.
There are many reasons for poor teacher retention, mainly problems in
"poverty, hunger, ignorance, and disease", as Reyhner's Teaching
American Indian Students book argues, that discourage teachers when
students are unable or unwilling to perform or even come to school.
One of the implications of high teacher turnover is the lack of
administrative stability it causes. Administrative stability is very
important to long-range planning and crucial to the success of the
school and its students.
Healthcare
Healthcare on Native American reservations faces many barriers to success. Genetic predisposition
to many diseases as well as significant lack of government funding,
lack of medical resources, and isolation from more populated areas with
more medical resources, contribute to healthcare difficulties on
reservations.
Genetic predisposition
Native Americans have a biological genetic predisposition
to be especially susceptible to several diseases and ailments.
According to a 1997 study, "with the exception of cardiovascular
diseases and cancer, the risk of death from most causes are higher among
Native Americans than the total US population."
Diabetes mellitus
is an especially large factor in Native American healthcare. Studies
show that "rates of diabetes and its complications…are substantially
higher among Native Americans than among the US general population, and
the frequency of diabetes among Native Americans is increasing."
This increase is proposed to be based upon, as the same study states,
"several potentially modifiable factors, including obesity, dietary
composition, and physical inactivity." It is estimated that diabetes afflicts 40%-50% of adults in Native American communities, compared with the national average of around 8%. Multiple studies, including one presented in the American Journal of Epidemiology, describe the incidence of diabetes in the Pima Indians to be 19 times greater than a comparable white majority population.
However, more than genetic predisposition plays a significant
role the afflictions of Native American populations. According to the
1997 study, "genetic susceptibility plays a significant role in some
diseases, such as diabetes, while for others, the generally lower
socioeconomic status, higher prevalence of certain health risk behaviors
and lower utilization of preventative services in the Native American
population are important determinants." Also, before WWII, diabetes in Native American Communities was essentially non-existent.
Because the traditional way of life had been taken away from the
Native Americans, a domino effect of problems began to arise. During a
normal day of hunting, gathering, and normal activities, the
pre-reservation Indians expended approximately 4,000 calories a day,
while eating a high fiber, low fat diet.
After the reservation system went into effect, Indians were no longer
able to hunt or gather food, but expected to farm in a community that at
certain places had no water source, or there was no money to buy
supplies for a farm in the first place, which led to more poverty. Poverty led to poor eating habits, which led to diseases such as diabetes mellitis.
After the Indian Removal Act of 1830, subsequent treaties arose, such as the Dawes Act of 1887,
which broke up reservations into smaller pieces. In 1868, the Federal
Government established the Indian Peace Commission which took thousands
of acres of land promised to Indians in previous treaties. With the diminishing of their land, Indians had to deal with diminishing health as well.
Indian Health Service
The Indian Health Service
is a federal program whose purpose is to provide medical service and
support to Native Americans. The service covers all members of federally
recognized tribes, over 4 million people. While it receives significant
federal funds in the billions of dollars, this is still several times
less than what it should be, as estimated by tribal leaders.
Additionally, federal spending cuts have slashed the program down
another $800,000 this year with sequestration cuts, further reducing
the already under-funded program and further exacerbating the issues of
healthcare for Native Americans.
Lack of support
The lack of preventative medicine
knowledge and resources, specifically, contributes to and exacerbates
the medical predispositions of many Native Americans. The lack of
research done on, and the lack of attention paid to Native Americans and
reservation healthcare is part of the problem. A study done by the
Agency for Healthcare Research and Quality found that "only 42% of
measures of health care quality and access tracked in the National
Healthcare Disparities Report could be used to assess disparities among
American Indians and Alaska Natives." The same source also argued that
"data from American Indians and Alaska Natives need to be improved to
allow better targeting of interventions to reduce health care
disparities and monitoring the success of these activities." A lack of healthcare providers in reservations also detrimentally effects quality and continuity of care.
Lack of healthcare providers
A lack of healthcare providers in reservations also detrimentally effects quality and continuity of care.
Tribal communities are often sequestered in unfavorable and isolated
locations. According to a study of provider vacancies in the Indian Health Service (IHS), conducted by the Department of Health and Human Services (2016), about half of the clinics studied identified their remote location as a large obstacle for hiring and retaining staff.
Issues surrounding isolation, lack of shopping centers, schools, and
entertainment also dissuades providers from moving to these areas. Such
vacancies lead to cutting of patient services, delays in treatment, and
negative effects on employee morale. Studies show that these problems may be addressed by growing a Native American healthcare workforce.
Native American healthcare workforce
A
2009 study finds that there is a strong prevalence of cross-cultural
miscommunication, mistrust, and lack of satisfaction among Native
American patients when it comes to healthcare.
A connection between mistrust from a community and health disparities
is established in a 2014 study on "Cultural Identity and Patient Trust
Among Older American Indians". Native Americans have reported facing discrimination which has affected the quality of care they received. The Association of American Medical Colleges
(AAMC) supports that doctor-patient relationships and communication can
be improved if members of their tribal communities themselves become
healthcare providers.
Native American doctors Siobhan Wescott and Beth Mittelstet argue
that greater funding should be directed towards educating and
encouraging indigenous people to become physicians in order to help
remedy issues with staffing, reduce discrimination in care, lower Native
American poverty rates, and increase patient advocacy among physicians. In 2018, the AAMC reported that there American Indian and Alaskan natives constitute only 0.3% of the physician workforce. In 2018, they made up about 2% of the total US population. Assistant professors at the University of Minnesota School of Medicine have proposed creating new formal graduate medical education programs based in tribal communities which focus on delivery systems, social determinants of health, and community influenced solutions. The Indian Health Service offers loan repayment programs to encourage post-graduate doctors to take fellowships on reservations.
Several institutions such as UCSF, The University of Washington, and
Massachusetts General Hospital have fellowships dedicated to filling
full-time coverage positions.
Scholarships are also available to indigenous students pursuing
medicine as well as those non-indigenous students who seek to work in
tribal communities.
A summit in 2018 called "Populating the Native Health Care
Workforce with American Indian and Alaska Native Physicians: Moving the
Needle on Quality of Health Care in Indian Country" gathered tribal
leaders, IHS administrators, and medical school leaders to find barriers
and come up with solutions to low Native American provider rates.
The solutions include garnering interest in medicine with students
before college, creating a single online resource platform for AI/NA
students, expanding financial aid opportunities, and enhance programs
that aid students in academics.
Tribal sovereignty and healthcare
The
Indian Self-Determination and Education Assistance Act of 1975 allows
tribes to enter into a contract with the government to assume control
over healthcare facilities, thus side-stepping the Indian Health Service and allowing tribes more autonomy over how they approach and deliver health care. It also gives tribes direct access to federal grants not available to the IHS. The Cherokee Indian Hospital in North Carolina is self-governed, with 50% of funds coming from the IHS. Other funds come from sources like Medicaid and casino revenue, which would not be available under IHS control. Construction of the hospital was deliberate in incorporating cultural history and creating a reduced stress environment. Not all communities, however, have other significant sources of revenue such as the casino.
One drawback to Tribal leadership in the context of provider
retention is presented from a research survey of Navajo Area IHS
physicians. A major reason cited for a provider leaving was due to the transfer of IHS control to the Navajo Nation. The uncertainty in benefits and pay from this transition contributed to their decision to leave.
Several policy options have been proposed to help expand funding
for Native American health initiatives that revolve around recognizing
tribal sovereignty. One includes having the Navajo Nation create its own
Medicaid agency, effectively designating it as a state.
This would come with its own logistical issues of transferring those in
the Navajo nation already under Medicaid through the state.
However, without having to navigate the varying laws of the multiple
states the Navajo Nation exists in, tribal sovereignty could be upheld
and administration would be smoother. Another policy opportunity would be to prevent cuts to Medicaid programs under the IHS. This would allow for better continuity of care in addressing the many health disparities they face.
Another proposition is to utilize section 1115 of the Social Security
Act which allows states to waive Medicaid requirements in favor of their
own programs.
Arizona already implemented this in 2012 by directing funds to the IHS
and tribal facilities to cover care health costs for Native Americans.
Obesity
American
Indians of all ages and sexes have a generally high prevalence of
obesity. Researchers have identified that issue has only come to light
in the past few generations and much of it is linked to many individuals
having a lack of healthy food options and an increased amount of time
spent being sedentary. The overall health of Native Americans is
considerably worse than the general population.
Since the early 1950s, the rate of mortality from infectious disease
has decreased substantially. But mortality related to behavioral or
lifestyle factors has increased, and chronic diseases such as diabetes
mellitus, heart disease, and cancer are among the leading causes of
death in adults.
Chronic diseases such as diabetes mellitus in particular, are strong
indicators of an increasing prevalence of obesity in American Indians.
Because the prevalence rates of obesity are higher in American Indians,
studies have shown that the population will suffer from greater health
complications later on in life as well.
History
Native Americans hunting bison, a staple of the diet
The problem of poor nutrition in Native American communities has a
historical narrative. The traditional Native American diet consisted
wholly of lean meats, protein, fruits and vegetables and low in fat,
non-processed sugars and sodium.
Native people also hunted and fished quite extensively. This lifestyle
persevered until the 1830s through the 1840s, when under the Indian Removal Act,
Native American tribes signed treaties with the U.S. government that
relocated the entire population to live on secluded land which became
known as a reservation.
This relocation also removed the Native people from their usual sources
of food and the active lifestyle that hunting and gathering required.
The removal created a significant dissonance in the ability to nourish
properly. In addition, in 1890, the government placed a ban on Native
Americans which prevented them from leaving their lands to fish, hunt or
gather in their usual territories. In exchange, they were given
government rations of flour, lard and sugar.
These options were much cheaper but contained proportionally lower
nutritional value. These foods became the new staple for American
Indians as they developed a taste for the only foods available to them
by law. Overtime, these foods were introduced to subsequent generations
and the food became socialized into the household.
Access to food
Near
many Indian reservations, the access to healthy food can be a big
challenge. Areas surrounding many reservations are large food deserts,
which are defined as communities without ready access to healthy and
affordable food. Food deserts shift the consumer focus of eating
healthier food to just merely securing enough food to feed individuals.
The geographical isolation of many reservations create logistical and
cost challenges, limiting people's ability to access affordable
nutritious food because they live far from large grocery stores.
Many reservations also do not have adequate transportation in and out,
so that increases the difficulty of being able to go to grocery stores
in the area. In some studies, researchers have found that rural
residence was positively associated with food insecurity for American
Indian households without children. In addition, American Indians had
significantly higher levels of food insecurity than the rest of the
population, even after controlling for a wide range of demographic and
socioeconomic characteristics. In order to combat the issue of food
insecurity in Native American communities, a sub-set of the food stamp
program, known as the Food Distribution Program on Indian Reservations,
or FDPIR, was started. The program provides culturally appropriate food to Native American communities.
The logistical reality of the program is that it is a delivery system.
The USDA purchases and ships FDPIR foods to the corresponding state
agencies based on their orders from a list of available foods. These
administering agencies store and distribute the food, determine
applicant eligibility, and provide nutrition education to recipients.
USDA provides the administering agencies with funds for program
administrative costs. Individuals are eligible for the program if they
'qualify as American Indian or non-Indian households that reside on a
reservation.
You could also qualify if you belong to a household in approved areas
near a reservation or in Oklahoma that contain at least one person who
is a member of a federally-recognized tribe.
Diabetes
Diabetes
is a prevalent issue in the American Indian and Native American
communities. Some of the issues that arise from diabetes are accelerated
development of cardiovascular diseases, renal disease, and loss of
visual acuity, all of which contribute to excess morbidity and mortality
rates.
Akin to obesity, the increasing prevalence has been attributed to
lifestyle changes in diet and physical activity. Among youth with Type
II diabetes, an estimated 50 to 90 percent have a BMI ≥ 85th percentile
for age. The prevalence of obesity among AI youth with Type II diabetes
was 79.4 percent. Obesity prevalence was only 12.5 percent among youth
with Type I diabetes.
Other risk factors for Type II diabetes include family history and
hypertension. The serious complications of diabetes are increasing in
frequency among Native Americans. Of major concern are increasing rates
of kidney failure, amputations, and blindness.
Among people with diabetes, the rate of diabetic end-stage renal
disease is six times higher among Native Americans. Diabetes is the most
frequent cause of non-traumatic lower limb amputations.
Amputation rates among Native Americans are 3-4 times higher than the
general population. Diabetic retinopathy is a term used for all
abnormalities of the small blood vessels of the retina caused by
diabetes, such as weakening of blood vessel walls or leakage from blood
vessels. Diabetic retinopathy occurs in 18 percent of Pima Indians and
24.4 percent of Oklahoma Indians.
Obesity is a particularly important challenge to the health status of
Native Americans because of a lack of resources and health
interventions.
Most studies of Native American infants, preschool children,
schoolchildren, and adults have confirmed a high prevalence of being
overweight. Researchers have hypothesized that there is a genetic
component to being overweight as well as a large amount of environmental
factors that contribute.
Intervention programs
Community-based
interventions to modify diet and activity levels to prevent obesity in
Native American communities are important steps in addressing obesity in
Native American communities at an early age, but many of these programs
are either grossly underfunded or do not exist in a capacity in which
they are needed. Pilot school-based programs in the Southwestern United
States suggest that Native American communities are actively receptive
towards interventions within a school setting and that over time there
is the potential of having a lower number of children meeting the BMI
threshold of being obese.
The cultural diversity of the Native American community along with the
geographic diversity of many reservations, makes one specific kind of
policy difficult. In ideal circumstances, Native Americans with diabetes
will have their disease under good control and be monitored frequently
by a healthcare team knowledgeable in the care of diabetes.
Because people with diabetes have a multi-system, chronic disease, they
are best monitored and managed by highly skilled healthcare
professionals trained with the latest information on diabetes to help
ensure early detection and appropriate treatment of the serious
complications of the disease. A team approach to treating and monitoring
this disease serves the best interests of the patient. Patient
education is critical. People with diabetes can reduce their risk for
complications if they are educated about their disease, learn, and
practice the skills necessary to better control their blood glucose
levels, and receive regular checkups from their healthcare team. People
with diabetes, with the help of their healthcare providers, should set
goals for better control of blood glucose levels, as close to the normal
range as possible for them.
Junk-food tax
The largest Indian reservation in the United States, the Navajo nation,
approved a sales tax on junk-food sold within the reservation. The
piece of legislation approved increased by 2% the sales tax on food with
little to no nutritional value.
The tax was placed until the year 2020, by the-Navajo nation council.
Navajos in favor wanted to pass a bill that could serve as a model for Indian country to improve the rates of diabetes and obesity among tribal members.
Proposals targeting sugary drinks with proposed bans, size limits, tax
hikes and warning labels have not gained widespread traction across the
country. The effort is really much more in the message of Navajo people
making better choices for quality foods.e obesity rate for some age groups is as high as 60%.
Diabetes was the fourth-leading cause of death in the Navajo area from
2003 to 2005, the health service said. With a junk-food tax, lawmakers
looked to increase support among other neighboring reservations. The
pilot project will last until 2020, after which the analysis of obesity
and the health of Native Americans living on the Navajo Nation will be
assessed.
The use of drugs, alcohol, and cigarettes on reservations is higher on Native American reservations than the national averages.
According to research on alcoholism in Native American populations,
"the problem of alcohol abuse is now defined as one that is both foreign
to and destructive of the traditional culture"
Native American youth show higher rates of drinking and drug use than
most other racial or ethnic groups and those that live on reservations
are at the highest risk of developing alcohol related problems.
According to Kunitz study on alcoholism in Native American populations,
reasons for the prevalence of alcoholism and alcohol consumption on
reservations is attributable to "access to alcohol became much easier,
and patterns of drinking that had not been particularly problematic in
the past began to have measurable consequences in respect of morbidity
and mortality." Such consumption and addiction is especially prevalent on reservations.
Another explanation for the prevalence of alcoholism on reservations is
advertising and the responsibility of beer and alcohol manufacturers
and distributors.
Marijuana and prescription drug
use for Native American teens are twice the national average and young
people have been shown to start experimenting with alcohol at the age of
14.
The onset of alcohol usage before the age of 15 has been found to be
associated with lower achievement, academic problems, drug use and alcoholism later in life.
Alcoholism in Native American populations has been shown to be associated with development of disease, including sprains and muscle strains, hearing and vision problems, kidney and bladder problems, head injuries, pneumonia, tuberculosis, dental problems, liver problems, and pancreatitis.
Alcoholism death rates among young Native Americans is 3.4 deaths per
100,000, over ten times the national average of 0.3 deaths per 100,000
of the general population.
Though alcohol usage varies by region and tribal affiliation, there
remains a high risk factor for all Native American populations and
particularly those on Native American reservations.
Teenage pregnancy
Teenage pregnancy
among the Native American population represents the third highest birth
rate in the United States with 59 per 1,000 births in 2007.
Between 2005 and 2007 the birth rate among Native Indian teen girls
increased 12%, more than twice the national increase in teenage
pregnancy.
Rates of teenage pregnancy however differ by geographic region and
tribal affiliation. Teen pregnancy of 15- to 19-year-old women in the Navajo Tribe have among the highest rates of teenage pregnancy, 15.8% higher than the national average.
Contraceptive use among Native American teenagers
Native American populations show some of the lowest documented rates of contraceptive use in the United States.
A recent health study shows that 65% of males and 57% of females report
having sexual intercourse by the 12th grade. Only 40% and 50%
respectively report always using contraceptives and more than one third
of males and one half of females had sex without contraceptives between
the 7th and 9th grade. 7% of females in a study of Native American
schools report incidences of pregnancy but rates are skewed due to
school drop out rates. Data from the ADD Health Survey conducted on students of Bureau of Indian Affairs
schools show that high school students from schools on Native American
land are more likely to have had sexual intercourse when compared to the
national rates of high school students. In general Native youth are
more likely to have sexual intercourse at a younger age compared to
their peers and are less likely to have used contraception the last time
they had sex compared to their peers.
The low rates of contraceptive use are sometimes attributed to a
historical disinclination of public discussions of sexuality and
perceptions of shame associated with sexual behavior. Additionally access to sexual health organizations and family planning centers on Native American reservations remains limited.
Consequences of teenage pregnancy in Native youth
The high concentration of poverty and extreme poverty on Native American reservations has potentially severe consequences for pregnant teenagers.
These negative consequences include educational deficits, economic
strain, poor marital outcomes, as well as slowed cognitive, social, and
physical development in children of adolescent parents. In 2006, 90% of teenage pregnancies among Native teenagers aged 15 to 19 were to unmarried mothers.
Single parent, female headed households are at higher risk of
impoverishment with almost 41% of all single parent female headed
households in the United States residing below the national poverty
line.
The recent rise in teenage pregnancy in Native Teen populations
coupled with the already high rates of poverty on Native American
Reservations has potentially detrimental consequences for Native
families. A Study completed by the United States Department of Agriculture
found Native American young mothers on reservations show a tendency to
begin prenatal care later than their peers. They were also found to have
higher rates of substance use disorder during pregnancy and are more likely to have diabetes during pregnancy.
Native Americans on reservations in particular showed greater rates of
participation in public assistance services and their children suffered
higher rates of nutritional, dietary, and clinical risks than children
not born on the reservation.
Advocates suggest the implementation of policies and programs that will
delay sexual initiation and improve contraceptive use among Native
teenagers as a possible solution to the rising rates of teen pregnancy.
Native American women have the highest rates of violent crime victimization, more than double that of other racial groups.
In the violent acts committed against Native women, Native American
women are more likely to have injuries that require medical attention
than crimes committed against other races. They are also more likely to
face an armed assailant than female victims of violent acts of other
races.
On a number of Native American reservations Native Women are murdered
at a rate representing ten times the national average. Violent crime
rates over all on Native American reservations are 2.5 times the
national average while some individual reservations reach 20 times the
national average of violent crime.
Historical factors
Some
scholars suggest that historically, physical and sexual violence in
Native American communities was rare in Pre-Colonial society. Traditional gender roles
advocated co-dependence, where women's contributions were honored and
respected and where violence against Native women was heavily punished
by Native justice systems.
Colonial and Post-colonial changes in Native American society spurred transformations in these traditional perceptions of gender norms and Native American societal structure. The General Allotment Act of 1887 allocated private lands to male heads of household that belied many traditions of maternal land inheritance.
Women also were denied access to farming responsibilities that took
away venues for accruing leadership and honor within the community.
The conversion of traditional names to Christian names in the
evangelical movement to Christianize Native populations also decreased
female gender status. The historical tracing of lineage through maternal
lines were changed to follow kinship ties through the father's last
name. These changes in gender norms are suggested to contribute to the high rates of violent crimes against Native American women.
Sexual assault and Native women
According to the National Violence Against Women Survey, 34% of American Indian and Alaskan Native women have suffered from rape or attempted rape within their lifetimes. This is greater than the 18% of white women, 19% of African American women and 7% of Asian and Pacific Islander
women that completed the survey. In South Dakota, only 10% of the
population is Native American but Native women make up 40% of all sexual
assault cases in the state. Similarly, Alaska Natives make up only 15%
of the population but represent 61% of victims of reported sexual
assault cases.
While nationwide most sexual offenses are intra-racial or between
members of the same race, the sexual offenses against Native American
women and Alaskan Native women are more often committed by white
offenders. Between 1992 and 2002, 86% of Native American victims of sexual assault described the perpetrator as non-Indian.
Obstructions to legal action
Although
violent crime and sexual assault rates are high in Native American
reservations, prosecution for these crimes is relatively low. In 2007,
on the Navajo Nation,
of the 329 rape cases reported among a population of 180,000
individuals, only 17 arrests were made in five years. In 2011, of all
rape cases reported on Native American reservations the Justice
Department only prosecuted 65%. Correspondingly, Native American reservations have a high proportion of sex offenders within the population.
The low prosecution rates and rates of arrest result from
numerous factors. Native American women have extremely low rates of
reporting sexual assault. Some women's advocacy groups in Native
American communities suggest that only 10% of all sexual offenses are
reported.
Many Native women report feelings of betraying the community by coming
forward, especially if the non-Native court systems are involved. Native
Women also report a lack of faith in the local law enforcement to make
arrests and prosecute offenders.
Even when sexual assaults are reported to the authorities, prosecution is not certain. According to a study by Amnesty International
in 2006, the local police often either do not respond to a sexual
assault case or take hours or days to respond to the victims reports. Additionally due to the overlapping jurisdiction of tribal, state, and federal authorities, enforcement of protection orders
for victims remains largely unreliable. Tension between these three
groups hinders responsiveness and efficiency in the prosecution of
sexual offenders and the protection of the victims.
Tribal authorities also have limited jurisdiction over the
prosecution of non-native offenders. 46% of the Native American
reservation population are non-natives. As of 1978, under the Supreme Court case Oliphant v. Suquamish Indian Tribe, tribal courts are denied inherent jurisdiction to criminally prosecute non-natives.
Tribal governments therefore have limited powers of legal processes
over a significant portion of the resident population. This has negative
impacts due to the high rates of intra-racial sexual assaults against
Native American women.
Re-authorization of the Violence Against Women Act
The re-authorization of the Violence Against Women Act
(VAWA) spurred controversy among the Native American community in 2012.
The act, having expired, lent itself to revisions in the United States House of Representatives and the United States Senate.
The Senate's re-authorization worked to eliminate some of the
limitations on criminal jurisdiction of the tribal courts. In the summer
of 2012, the Republican majority in the House of Representatives
proffered a separate re-authorization of VAWA. The House
re-authorization stripped tribal protections from the jurisdiction of
tribal courts.
The House's Bill would disallow Indian tribal courts from accusing
non-natives on the grounds of domestic violence within reservations.
President Obama's White House administration vowed to veto any re-authorization of VAWA that failed to include the tribal protection clause. On February 28, 2013, President Barack Obama
received the Senate's re-authorization of VAWA after a vote passing the
act in both the House of Representatives and the Senate.
In 2022 VAWA expanded its recognition of Special Tribal Criminal
Jurisdiction to cover non-Native criminals of sexual violence, abuse of
children, sex trafficking, and other assaults on Tribal law enforcement
officers and community members on Tribal lands.
Native American and Alaskan Native populations have disproportionately high rates of homicide and suicide,
particularly among younger populations. Between 1979 -1992, 2,394
individuals who lived in or near a reservation committed suicide. This
represents 1.5 times the national average during these 14 years.[75]
Since 1950 the suicide rate among 15- to 24-year-old Native American
youths has increased between 200% and 300%. This rate is higher than
other racial groups, making Indian youth suicide rates 2 to 3 times the
rates nationwide. Suicide rates are greatest especially among Native
American males following the general trends of gender and suicide.
Suicide rates vary depending on region and tribal affiliation but rates are particularly high in the Southwestern United States, the northern Rocky Mountains and Great Plains, and in Alaska. High suicide rates are often correlated with substance use disorder, alcoholism, depression, and poverty, widespread in many Native American reservations. Studies have shown that early substance use can lead to higher homicide and suicide rates among a population group.
Risk factors for suicide often include a sense of hopelessness, alcohol use disorder,
depression, poverty and a triggering conflict or event which can
include conflict or loss. Among 77% of males who died by suicide or
attempted suicide had incomes of less than 10,000 dollars and 79% were
unemployed.
Native American youth also report higher rates of exposure to violence
and sexual and physical abuse, both correlated to suicide rates. Other possible contributing factors include the mother's age at delivery, family conflict, and financial instability.
Additionally 20% of all individuals who died by suicide or attempted
suicide had a parent who had also died by suicide or attempted suicide.
Community-based programming has been shown to effectively
alleviate some of the risk factors on Native American reservations
associated with suicide. These programs have been proven to decrease
substance use and increase communal connections and support.
