Better Health Through Better Understanding for American Indians and Alaska Natives: Health Literacy, Language Preservation, and Culturally Appropriate Care 2023 Reading List
This brief bibliography contains resources focused on American Indian and Alaska Native (AI/AN) health and healthcare. It aims both to provide a snapshot of health disparities facing AI/AN people and to highlight how focusing on health literacy and access to culturally and linguistically appropriate care can mitigate these disparities and improve the health status of this population. The list contains four (4) sections:
- Health, wellness, and community resources in Native languages.
- Fact sheets and health materials for consumers.
- Reports and documents for health care providers and other professionals.
- Journal articles.
The resources in this list are available to read and download for free. For more resources on the health of racial and ethnic minority populations, please visit the OMH Knowledge Center online catalog.
Population Characteristics and Health Status
The AI/AN population includes people with origins in the indigenous peoples of North, South, and Central America, who maintain tribal affiliation or community attachment. In the 2020 Census, an estimated 3.7 million people identified as American Indian or Alaska Native alone, making up 1.1% of the U.S. population. An additional 5.9 million people identified as American Indian or Alaska Native and another race, bringing the AI/AN alone or in combination population to 9.7 million people, or 2.9% of the U.S. population in 2020.
As of 2023, there are 574 federally recognized tribes in the U.S. and approximately 326 federally recognized Indian land areas. According to the 2020 Census, 87% of the American Indian and Alaska Native population (alone or in combination) live outside of tribal lands. States that have more than 100,000 American Indians and Alaska Natives include California, Oklahoma, Arizona, Texas, New Mexico, Washington, New York, North Carolina, Florida, Alaska, Michigan, Oregon, Colorado and Minnesota.
The AI/AN population faces substantial health disparities and concerns. In 2020, the age-adjusted death rate for the AI/AN non-Hispanic population was 1.2 times greater than the White non-Hispanic population. Life expectancy decreased by 4.7 years from the previous year. The leading causes of death in 2021 for the AI/AN population were COVID-19, cardiovascular disease, cancer, unintentional injuries, chronic liver disease, and diabetes. AI/AN populations experience a higher burden of obesity, mental illnesses, substance use disorders, sudden infant death syndrome (SIDS), liver disease, and hepatitis than the U.S. population at large. The non-Hispanic AI/AN population suicide rate increased 20% from 2015 to 2020 and is the highest among all racial and ethnic groups.
A combination of cultural and structural barriers can limit access to medical care for AI/AN populations. Addressing these health disparities and improving healthcare access for AI/ANs remains a priority, with government agencies like the Indian Health Service (IHS) working to provide comprehensive health services to tribal communities. Additionally, initiatives to fund off-reservation health-related activities aim to make healthcare services more accessible to urban AI/AN populations, who make up approximately 70% of the AI/AN population. Recognizing and addressing the unique challenges faced by AI/AN.
Language Access and Revitalization
The 2006-2010 American Community Survey (ACS) showed that an estimated 372,095 people in the U.S. and Puerto Rico speak Native North American languages, and 15% of the AI/AN population speaks a language other than English at home. The most widely spoken Native North American language is Navajo, with 169,471 speakers, followed by Yupik (18,950 speakers), Dakota (18,616 speakers), Apache (13,063 speakers), and Keres (12,495 speakers).
Over the course of American history, colonization and federal policies have resulted in the endangerment and extinction of many of the AI/AN languages spoken over the last 500 years. However, efforts to revitalize Native languages have gained momentum in recent decades. Recognizing the U.S. government’s role in the decline of Native language use, Congress passed the Esther Martinez Native American Languages Preservation Act (PL-109-394) in 2006, providing funding for immersion and restoration programs involving Native languages. The Administration for Native Americans (ANA), a part of the Department of Health and Human Services’ Office of the Administration for Children and Families, provides funding opportunities through the Native Language Preservation and Maintenance and the Esther Martinez Immersion grant programs to support Native language assessments, Native language curriculum and education projects, and community-driven initiatives that support the continuing vitality of Native languages and AI/AN culture.
The reading list below contains links to some of the health, wellness, and community resource materials freely available online that incorporate Native languages. They highlight efforts across North America to revitalize the use of Native languages and make healthcare linguistically accessible to AI/AN populations.
These resources are intended for AI/AN people, health care providers, and other professionals to learn more about issues that affect the AI/AN community. Please click on the title to learn more about each topic.
Advance Directive Brochure (Lakota). South Dakota Department of Health, sd.gov, 2016.
COVID-19 Vaccine Materials in Alaska Native Languages. Alaska Native Tribal Health Consortium, anthc.org, 2021.
Glossary for Basic Cancer Terminology in the Navajo Language. Diné College and Mayo Clinic, Nativeamericanprograms.org, 2010.
A Manual for Integrating Salish Language and Culture in Early Head Start 0-3. Confederated Salish & Kootenai Tribes of the Flathead Reservation, csktribes.org, 2018.
Native Language PSA Archive. Centers for Medicare & Medicaid Services, cms.gov, 2023.
Ojibwe Medical Dictionary: A Handbook for Health Care Providers. Sioux Lookout Meno Ya Win Health Centre, slmhc.on.ca, 2011.
Science- and Health-Themed Posters in Cherokee Syllabary. Cherokee Nation, cherokee.org, 2019.
2022 Heart Disease & Stroke Statistical Update Fact Sheet: American Indian/Alaska Native Race & Cardiovascular Diseases. American Heart Association, heart.org, 2022.
American Indian Cancer Burden: Cancer Facts for American Indians and Alaska Natives. American Indian Cancer Foundation, americanindiancancer.org, 2019.
COVID-19 Native Youth Vaccination Toolkit. National Congress of American Indians, ncai.org, 2021.
Diabetes Care and Health Coverage for American Indians and Alaska Natives. Centers for Medicare & Medicaid Services, cms.gov, 2017.
Domestic Violence Against American Indian and Alaska Native Women. National Coalition Against Domestic Violence (NCADV), ncadv.org, 2016.
Healthy Native Foods for American Indian Communities. American Indian Cancer Foundation, americanindiancancer.org, 2014.
HIV in Indian Country. Indian Health Service, ihs.gov, 2019.
The Opioid Crisis Impact on Native American Communities. Albuquerque Area Southwest Tribal Epidemiology Center (AASTEC), tribalepicenters.org, 2018.
Prenatal Care & American Indians. Albuquerque Area Southwest Tribal Epidemiology Center (AASTEC), aastec.net, 2016.
Reclaiming Indigenous Food Relationships: Improving Health with Culture. American Indian Cancer Foundation, americanindiancancer.org, 2018.
Alaska Native Health Status Report. Alaska Native Tribal Health Consortium Epidemiology Center, anthctoday.org, 2021.
American Indians’ Growing Presence in the Health Professions. Health Affairs, healthaffairs.org, 2021.
Behavioral Health Services for American Indians and Alaska Natives. Substance Abuse and Mental Health Services Administration (SAMHSA), samhsa.gov, 2018.
Cultural Competence in Caring for American Indians and Alaska Natives. StatPearls Publishing, ncbi.nlm.nih.gov, 2023.
Culture Forward: A Strengths and Culture Based Tool to Protect Our Native Youth from Suicide. Johns Hopkins Center for American Indian Health, caih.jhu.edu, 2020.
Health Systems Improvement Toolkit: A Guide to Cancer Screenings in Indian Country. National Indian Health Board, nihb.org, 2022.
Hunger Health Equity: Spotlight on Native Americans. Feeding America, feedingamerica.org, 2021.
Indian Health Disparities. Indian Health Service, ihs.gov, 2019.
Lifelong Disparities Among Older American Indians and Alaska Natives. AARP Public Policy Institute, aarp.org, 2015.
LTSS Research: Diabetes in Indian Country - Annotated Literature Review. Centers for Medicare & Medicaid Services, cms.gov, 2018.
Mental Health Disparities: American Indians and Alaska Natives. American Psychiatric Association, psychiatry.org, 2017.
Mortality Profile of the Non-Hispanic American Indian or Alaska Native Population, 2019. National Center for Health Statistics, Centers for Disease Control and Prevention, cdc.gov, 2021.
Status of Tribal Air Report, 2022. National Tribal Air Association, ntaatribalair.org, 2022.
A Toolkit for Advancing the Uptake and Use of PrEP in Indian Country. National Indian Health Board, nihb.org, 2019.
Adaptation of a Brief Smoke-Free Homes Intervention for American Indian and Alaska Native Families. BMC Public Health, v. 19 (May): Art. 981, 2019.
Adapting a Cancer Literacy Measure for Use Among Navajo Women. Journal of Transcultural Nursing, v. 28, #3 (May), p. 278-285, 2017.
Adverse Childhood Experiences and Health-Related Quality of Life in Adulthood in American Indians and Alaska Natives. American Indian and Alaska Native Mental Health Research, v. 30, #1, p. 1-13, 2023.
Cancer Statistics for American Indian and Alaska Native Individuals, 2022: Including Increasing Disparities in Early Onset Colorectal Cancer. CA: A Cancer Journal for Clinicians, v. 73, #2 (March/April), p. 120-146, 2023.
Complementary AlterNative Medicine: A Culturally Centered Approach to Managing Chronic Pain from One American Indian Community. American Indian and Alaska Native Mental Health Research, v. 30, #2, p. 1-15, 2023.
Culturally Adapted Mobile Technology Improves Environmental Health Literacy in Laurentian, Great Lakes Native Americans (Anishinaabeg). Journal of Great Lakes Research, v. 45, #5 (October), p. 969-975, 2019.
Diné (Navajo) Healer Perspectives on Commercial Tobacco Use in Ceremonial Settings: an Oral Story Project to Promote Smoke-Free Life. American Indian and Alaskan Native Mental Health Research, v. 26, #1, p. 63-79, 2019.
Discovering Frugal Innovations Through Delivering Early Childhood Home-Visiting Interventions in Low-Resource Tribal Communities. Infant Mental Health Journal, v. 39, #3 (May), p. 276-286, 2018.
Formative Research and Cultural Tailoring of a Substance Abuse Prevention Program for American Indian Youth: Findings from the Intertribal Talking Circle Intervention. Health Promotion Practice, v. 22, #6 (November), p. 778-785, 2021.
Getting to Know: American Indian Elder Health Seeking in an Under-Funded Healthcare System. SSM – Qualitative Research in Health, v. 1 (December), p. 1-9, 2021.
Health Care Access and Utilization for American Indian Elders: A Concept-Mapping Study. The Journals of Gerontology, v. 76, #1 (January), p. 141-151, 2021.
Health Literacy, Health Numeracy, and Cancer Screening Patterns in the Zuni Pueblo: Insights from and Limitations of “Standard” Questions. Journal of Cancer Education, v. 38, #3 (June), p. 1023-1033, 2023.
Health Literacy and Parental Oral Health Knowledge, Beliefs, Behavior, and Status among Parents of American Indian Newborns. Journal of Racial and Ethnic Health Disparities, v. 7, #4 (August), p. 598-608, 2020.
A Home-Based Educational Intervention Improves Patient Activation Measures and Diabetes Health Indicators Among Zuni Indians. PLoS One, v. 10, #5 (May): Art. e0125820, 2015.
Implementing a Community-Led Arsenic Mitigation Intervention for Private Well Users in American Indian Communities: A Qualitative Evaluation of the Strong Heart Water Study Program. International Journal of Environmental Research and Public Health, v. 20, #3 (February): Art. 2681, 2023.
Innovations in U.S. Health Care Delivery to Reduce Disparities in Maternal Mortality Among African American and American Indian/Alaskan Native Women. Journal of Patient-Centered Research and Reviews, v. 8, #2 (Spring), p. 140-145, 2021.
Long-Term Outcomes of Lifestyle Intervention to Prevent Diabetes in American Indian and Alaska Native Communities: The Special Diabetes Program for Indians Diabetes Prevention Program. Diabetes Care, v. 41, #7 (July), p. 1462-1470, 2018.
My Journey: Development and Practice-Based Evidence of a Culturally Attuned Teen Pregnancy Prevention Program for Native Youth. International Journal of Environmental Research and Public Health, v. 16, #3 (February): Art. 470, 2019.
Native American Caregiver–Child Shared Book Reading Interactions: A Descriptive Study and Integrative Review. Language, Speech, and Hearing Services in Schools, v. 54, #2 (April), p. 409-424, 2023.
Native American Weight Loss Movement: Pilot Test of a Culturally Tailored Weight Loss Program for American Indians. Journal of Health Disparities Research and Practice, v. 12, #1: Art. 1, 2018.
Opioid Misuse Among American Indian Adolescents. American Journal of Public Health, v. 3 (March), p. 471-474, 2021.
Parental Psychosocial Factors and Childhood Caries Prevention: Data from an American Indian Population. Community Dentistry and Oral Epidemiology, v. 46, #4 (August), p. 360-368, 2018.
Prevalence of Mental Health Disorders and Treatment Utilization Among Urban Lesbian, Gay, Bisexual, and Transgender American Indians and Alaska Natives. American Indian and Alaska Native Mental Health Research, v. 30, #1, p. 1-18, 2023.
Reconsidering Culturally Competent Approaches to American Indian Healing and Well-Being. Qualitative Health Research, v. 25, #4, p. 486-499, 2015.
Satisfaction with Cancer Care Among American Indian and Alaska Natives in Oregon and Washington State: A Qualitative Study of Survivor and Caregiver Perspectives. Support Care Cancer, v. 24, #6 (June), p. 2437-2444, 2016.
“When You Hear the Noise, You Know It's Love": Family Support in American Indian Communities. American Indian and Alaska Native Mental Health Research, v. 30, #1, p. 1-23, 2023.