The American Indian/Native American (AI/NA) health controversies have changed greatly over the years, decades, centuries.
One of the primary changes in my lifetime (the last half century) pertains to the modernization of certain AI/NA lifestyles, namely the reduction in early 20th century forms of poverty in exchange for a more modern form of poverty found is certain indigenous living settings accompanied by a revival in sensitivity to AI/NA issues in general, and the initiation of both a newer lifestyle by certain AI/NA people parallel to the development of the casino and now the development of important more culturally-defined tourism settings and attractions.
Accompanying this transition in how to live as an AI/NA, are the epidemiological transitions that occur due to these lifestyle changes. For the most part, the study of epidemiological transition began due to observations made of traditional and non-traditional or acculturated/assimilated former indigenous, lower income living situations. The bulk of these involved other places, formerly called third world countries, and later underdeveloped countries, and still later developing countries. However, within the boundaries of the United States, this United Nations-WHO view of the global health system has had minimal impact on the AI/NA programs and traditions out there. Most of these have been either self-financed changes, a result of specific npos designed to provide these financial resources so desperately needed in the years prior to the building of casinos, and those few research institutional programs that existed, which to some appeared to be taking advantage of indigenous health issues in order to secure very high grants for this area of public health research.
Today, it is fairly easy to search the medical journals and find topics pertaining to AI/NA health matters that are still in need of extensive research. From the 1980s to the 2000s, we see evidence for epidemiological transition work first surfacing as studies of New World Syndrome and the higher susceptibility of AI/NA people to certain infectious and metabolic diseases, followed by urban Indian health problems like asthma and much newer infectious diseases.
Some of these topics I reviewed for my course, and my own responsibilities when I was a student. The Rights of the Shaman I wrote, along with its similar, are examples of my experiences as a student.
The following term paper was a project I managed to complete in record time, and was pretty much theoretical in nature, since at the time, inadequate funding sources still existed for me to submit a related research proposal on this topic for my final MPH thesis work.
A respiratory disease program for Native Americans
The above project served as an example of the preliminary study, sponsored by a teaching hospital affiliated with a university.
The following is a PIP study I designed that never came about. It was based on the standards for design Medicare/Medicaid Performance Improvement Projects or PIPs. Its purpose was to propose a new form of culturally-defined PIPs to be designed for specific parts of the US where certain cultural groups are found in large numbers.
Asthma care management Example of A Cultural PIP MCD Study 2007
Similar projects were in the process of development for entire populations and/or subgroups for each of the following:
- Asian,
- African,
- Hispanic-Middle American,
- South American.
.
Diabetes
One of the greater topics of concern with Native American health is the link between indigenous cultures and obesity, diabetes and a variety of diseases and diagnoses once categorized as a culturally-specific condition called “New World Syndrome”. (See my other paper(s) on this.)
Specific culturally-focused studies on Diabetes in Native Americans has long been warranted by the health profession in general. Yet minimal effort has been made to include this type of study in any Managed Care program.
One of the more important changes needed in the current system is the inclusion of culturally specific, culturally focused disease studies in the form of PIPs. These studies should be applied as a substitute for other standard PIPs in place, and should be considered applicable as a standard PIP review to which addition credits are regarded for the culturally-related programs.
For example, in a standard PIP where 3 clinical studies are required, this special study can be implemented as part of the standard diabetes program already in place, to which the Native American population study is produced as an identical or slight modified study. Similarly the same may be done for African American groups, although the outcomes for such a cultural-ethnic review may not be as easy to argue the significance of any results for due to sampling and race-ethnicity definition problems.
One additional outcome of this study is the reduction in race-ethnicity labeling or documentation problems commonly found with the records for large health care populations (>20,000, the larger the more the problem exists).
An additional effort also has to be made to ensure appropriate race-ethnicity issues normally reviewed by Human Subjects Review groups contained within a standard university or teaching hospital program. These issues alone make it worthy of awarding full program credit to such a PIP, even though it duplicated most of the standard PIPs in place.
Brian Altonen, MPH, MS 
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