Public Health in Indian Country

I found Carolyn Smith-Morris' study of the three domains of factors affecting diabetes among the Pima Indians, as well as her recommendations for how to build and implement treatment and prevention programs, to be very smart and intuitive. Separating the factors into political-economic, genetic, and cultural domains allows us to evaluate the "big-picture" problem so that a proposed recommendation can be formed with a holistic treatment in mind. Like many issues facing Indians today, diabetes can be partially attributed to the influence of white people. However, even if we bear a degree of responsibility, we must be careful not to fall into the morally flawed trap of white savior complex.

In class today, we discussed the many political, socio-economic, genetic, cultural, and institutional factors that ultimately compound to maintain and proliferate the Pima diabetes epidemic. Left unaddressed, the public health problem will continue. Additionally, in a public health initiative, if the initiative does not address all of the factors that are contributing to Pima diabetes, then failure will be written directly into the plan. This same logic runs true for initiatives addressing a myriad of problems on the reservation. An outside agent cannot ride in as a white savior on a white horse and hand the Pima Indians a plan. The plan must be community-based and harness high participation from the beginning. It must be culturally specific and easily sustainable. How can anything make a change in a community--especially in such an ancient cultural community like a Native Nation--if the community is not fully invested in the change nor participating in the implementation and sustainability of said change? Who understands a community and its values better than a community member? It is no wonder that public health initiatives implemented by federal action in Indian Country have failed in the past.