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Michael E. Bird, MSW, MPH

Michael E. Bird is the Immediate Past President of the American Public Health Association.

Correspondence: Requests for reprints should be sent to Michael E. Bird, MSW, MPH, National Native American AIDS Prevention Center, 436 14th St, Suite 1020, Oakland CA 94612 (e-mail: mlittlebird{at}nnaacp.org).

	INTRODUCTION

TOP INTRODUCTION DISPARITY, DISPOSSESSION, AND... UNITED WE STAND IMPROVING THE HEALTH OF... References

 
We are the first people of this land. . . . We are Indigenous peoples throughout this land and all over the planet we call Mother Earth.

For American Indians, the reality is that the founding fathers of the United States (none of them Indians), in order to establish a more perfect union that provided them with life, liberty, and the pursuit of happiness, displaced a people who had occupied this continent for thousands of years and denied those people their lives, liberty, and happiness. It is a fact.

	DISPARITY, DISPOSSESSION, AND HEALTH INEQUALITIES

TOP INTRODUCTION DISPARITY, DISPOSSESSION, AND... UNITED WE STAND IMPROVING THE HEALTH OF... References

 
In 1970, President Richard Nixon delivered the following statement in a message to Congress:

The first Americans—the Indians—are the most deprived and most isolated minority group in our nation. On virtually every scale of measurement—employment, income, education, health—the condition of the Indian people ranks at the bottom. This condition is the heritage of centuries of injustice. From the time of their first contact with European settlers, the American Indians have been oppressed and brutalized, deprived of their ancestral lands, and denied the opportunity to control their own destiny.¹

Last year at the 129th annual meeting of the American Public Health Association, we created a plenary session on indigenous health. This session provided an opportunity for indigenous people to speak to the issues that affect the health of the native peoples of Hawaii, Central America, Canada, Alaska, and the continental United States. We shared our experiences as individuals and as indigenous people from a variety of settings. We learned more about our similarities and differences. And what we gained was a sense of network, of a community brought closer by the threat of the power of ignorance and hate, and by the unacceptability of despair and disparity.

In my mind, disparity and dispossession go hand in hand. The massive dispossession that removed native people from their ancestral lands—not to mention the genocide and cultural eradication that followed—can hardly be imagined by most people. This story is not unique to American Indians. It is all too familiar for Native Hawaiians, Australian Aborigines, the Maori of New Zealand, and tribes throughout Central and South America. It may even apply to the Irish of Northern Ireland.

Wherever there has been dispossession, we see in the dispossessed populations significant damage in health, in educational levels, and in social well-being. And dispossession of one’s land is not the only form of dispossession. Native peoples have been dispossessed of their labor, language, culture, and religious beliefs as well. We are only beginning to comprehend the consequences of what occurred long ago and still continues throughout the world. What is most important, though, is that we raise the collective awareness in this country to the level of undeniable truth: dispossession is at the root of health disparities.

Indian Health Services data show that American Indians and Alaska Natives have the worst health status of any group in this country. In 1993, their infant mortality rates were higher and life expectancy lower than those of the general population. American Indian and Alaska Native people are dying at younger ages than the rest of the nation. The leading causes of death among American Indians and Alaska Natives are heart disease and cancer, but in the area of behavioral health, these peoples’ death rates are significantly higher as well: death from alcoholism, 579% higher; unintentional injury, 21% higher; suicide, 70% higher; and homicide, 41% higher. The diabetes mortality rate is 231% higher among American Indians and Alaska Natives than in the US population as a whole. Unfortunately, some of the highest rates of diabetes in the world are found in American Indian communities.

	UNITED WE STAND

TOP INTRODUCTION DISPARITY, DISPOSSESSION, AND... UNITED WE STAND IMPROVING THE HEALTH OF... References

 
The most interesting result of the 2001 plenary session on indigenous health was how remarkably similar the historical experience has been for all indigenous populations. Another similarity was the description across the board of the relatively healthy nature of indigenous populations prior to contact, and the healthy living conditions that are universally described by historians and the first explorers. Clearly, the stories and the statistics bear witness to a certain pathology.

Indigenous peoples have given so much of themselves. And they offer the world even more at a time when the United States is struggling: The importance of the spiritual essence of all people, and our relationships to each other and the environment. Respect for all living things, and for human beings’ place in the web of life. The importance and recognition of the role of spirituality in health. The concept of the well-being of all vs the benefit of few. The value of family and family wellness. The importance of balance in one’s life and life choices. The village concept. The concept of mind, body, and spirit, and the importance of this concept to the health of individuals and communities. Generosity and reciprocity. An indigenous world view that predates the "alternative" Western view that has yet to prove its long-term sustainability and viability.

Indigenous people know the meaning of personal responsibility—but in a different, nonWestern context. The concept is much broader, more humane and functional. If I am responsible only to myself, that kind of personal responsibility can be selfish and self-serving. It does not recognize the symbiotic nature of relationships that are important on this shrinking planet. Personal responsibility for indigenous people recognizes relationships and connections to others (family, tribe, community, world community). If I am to do well, then others must also do well. I am not isolated in thought, deed, or action. All are related and interconnected. I am personally responsible; I am my brother’s keeper!

	IMPROVING THE HEALTH OF INDIGENOUS PEOPLES

TOP INTRODUCTION DISPARITY, DISPOSSESSION, AND... UNITED WE STAND IMPROVING THE HEALTH OF... References

 
Improving the health of indigenous peoples will require an effort beyond the indigenous community, from all individuals and institutions in public health. Our task is to reach and educate those people and organizations, and all branches of the federal, state, and local governments. We must help them understand who we are and how we have been affected. We must assume that this is a doable task, to bring together the data and the political process with wisdom and heart.

As a means to that end, we can put our energy into supporting and encouraging students from indigenous communities to enter the field of public health. Scholarship programs do exist, but many, many more could be established. Mentoring programs that create helpful relationships between students and those of us already in the field will ensure that the next generation continues to explore developments in health care while at the same time honoring traditional values and beliefs.

And we must maintain our commitments within our indigenous communities to be supportive of each other. Together, we are strong and capable. We are not the sum of our disparities. We will enter the broad arena as brothers and sisters on our way to building positive health and greater visibility for all of us.

But if justice on this earth can be imagined, so can a practical way to achieve it. Provided, that is, we are willing to reconcile ourselves to achieve it. Provided, that is, we are willing to reconcile ourselves to each other, and to historical truth.²

Accepted for publication June 3, 2002.

	References

TOP INTRODUCTION DISPARITY, DISPOSSESSION, AND... UNITED WE STAND IMPROVING THE HEALTH OF... References

 
1. Message from the President of the United States transmitting recommendations for Indian policy, 91st Cong, 2nd sess (July 8, 1970; H Doc 91-363).

2. Bothwell APX. We live on their land: implications of long-ago takings of Native American Indian property. Annual Survey of International and Comparative Law (Golden Gate University School of Law). 2000;6:175.

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