THE IMPACT OF SOCIAL DETERMINANTS OF HEALTH ON AMERICAN INDIAN AND ALASKA NATIVE HEALTH OUTCOMES
The relationship between social determinants of health (SDOH) and health disparities is complex and multilayered. SDOH are the conditions in which people are born, grow, learn, work, play, live, and age, and the wider set of structural factors shaping the conditions of daily life. Health disparities are the preventable differences in the burden of disease, injury, violence, and opportunities to achieve optimal health experienced by socially disadvantaged communities. Health disparities are often the result of or exacerbated by intersecting SDOH factors.
SDOH can be grouped into five domains:
- Economic Stability
- Education Access and Quality
- Health Care Access and Quality
- Neighborhood and Built Environment
- Social and Community Context
American Indian and Alaska Native (AI/AN) populations can experience many environmental and social circumstances that impact their health. For example, AI/AN communities often experience challenges accessing health care services, which is a negative SDOH factor that can contribute to poor health outcomes. Other negative SDOH factors experienced by AI/AN populations that can lead to adverse health outcomes and contribute to growing health disparities within the population include:
Click on the headings below to learn more about the five SDOH domains and the role they play in health outcomes for AI/AN populations. You will also find suggested reading curated by the OMH Knowledge Center librarians. The resources in this list are available to read and download for free. For more resources on the health of AI/AN populations in the United States, please visit the OMH Knowledge Center online catalog.
ECONOMIC STABILITY
Economic stability refers to having a steady income and enough resources to meet basic needs such as food, housing, health care, and transportation. People with economic stability are more likely to have better health outcomes than those struggling financially who are more likely to experience health challenges.
- Advocating for the Federally-Recognized Tribes Extension Program. Holden, L. Native American Agriculture Fund, nativeamericanagriculturefund.org, 2020.
- Food Insecurity in Urban American Indian and Alaska Native Populations During the COVID-19 Pandemic. Nelson, K., Jackson, A. M., Nguyen, C. J., Noonan, C., Muller, C., et al. BMC Public Health, v. 24, #1 (March 27): Art. 903, 2024.
- Measuring Food Security Among American Indian and Alaska Native Adults: Validity Evidence Supports the Use of the US Department of Agriculture Module. Nguyen, C. J., French, B. F., Maudrie, T. L., Ferguson, G. L., 2nd, Blue Bird Jernigan, V., et al. Journal of the Academy of Nutrition and Dietetics, v. 123, #10 Supplement (October), pp. S76-S88, 2023.
- Reimagining Native Food Economies: A Vision for Native Food and Agriculture Infrastructure Rebuilding and Recovery. Native American Agriculture Fund, nativeamericanagriculturefund.org, 2018.
- Social Determinants of Health Among Rural American Indian and Alaska Native Populations. Probst, J. C., and Ajmal, F. Rural and Minority Health Research Center, sc.edu, 2019.
EDUCATION ACCESS AND QUALITY
Access to educational resources and quality education plays a significant role in health. Education gives individuals the knowledge and skills to understand health information and make informed decisions about their health and the healthcare system.
- A Community-Based Evaluation of a Culturally Grounded, American Indian After-School Prevention Program: The Value of Practitioner-Researcher Collaboration. de Heer, B., Heffern, J. K., Cheney, J. S., Secakuku, A., and Baldwin, J. American Indian and Alaska Native Mental Health Research, v. 27, #1 (September 28), pp. 1-20, 2020.
- Conceptualizing School Belongingness in Native Youth: Factor Analysis of the Psychological Sense of School Membership Scale. Hussain, S. F., Domingue, B. W., LaFromboise, T., and Ruedas-Gracia, N. American Indian and Alaska Native Mental Health Research, v. 25, #3, pp. 26-51, 2018.
- Psychometric Evaluation of Protective Measures in Native STAND: A Multi-Site Cross-Sectional Study of American Indian Alaska Native High School Students. Kelley, A., McCoy, T., Skye, M., Singer, M., Craig Rushing, S., et al. PLoS One, v. 17, #5 (May 17): Art. e0268510, 2022.
- Representation of American Indian and Alaska Native Individuals in Academic Medical Training. Forrest, L. L., Leitner, B. P., Vasquez Guzman, C. E., Brodt, E., and Odonkor, C. A. JAMA Network Open, v. 5, #1 (January): Art. e2143398, 2022.
- Understanding Risk and Protective Factors Influencing Urban American Indian /Alaska Native Youth Graduation Expectations. Locklear, S., Harris, C., Yang, A., Liu, K., Ramsey, E., et al. American Indian and Alaska Native Mental Health Research, v. 27, #1, pp. 42-63, 2020.
HEALTH CARE ACCESS AND QUALITY
Health care access and quality of care is a fundamental social determinant of health. Availability, affordability and geographic proximity to healthcare providers influence how easily people can get the care they need. Approximately 10% of the U.S. population does not have health insurance, which can prevent individuals from seeking out healthcare services. Difficulty navigating the healthcare system and lack of culturally and linguistically appropriate care providers can also affect access to quality care.
- American Indian and Alaskan Native Access to Obstetrics and Gynecology Subspecialists: Findings from a National Mystery Caller Study in the United States. Akapo, A. O., Schultz, C., Coelho, D., and Muffly, T. M. Cureus, v. 15, #12 (December 31): Art. e51403, 2023.
- Deployment of Point-of-Care Echocardiography to Improve Cardiac Diagnostic Access Among American Indians. de Loizaga, S., Benashley, L., Hoekzema, J., Ahmed, N., Alexander, C., et al. Journal of the American Heart Association, v. 13, #2 (January 16): Art. e031231, 2024.
- Health Insurance Coverage and Access to Care for American Indians and Alaska Natives: Current Trends and Key Challenges. U.S. Department of Health and Human Services (HHS), Office of the Assistant Secretary for Planning and Evaluation (ASPE), aspe.hhs.gov, 2021.
- Native American Community Perspectives on Oral Health Access: Understanding the Impact of Rurality. Llaneza, A. J., Holt, A., Stephens, L., and Seward, J. Healthcare, v. 11, #20 (October 21): Art. 2788, 2023.
- Patterns of Health Care Access and Use in an Urban American Indian and Alaska Native Population. Garcia, A. N., Venegas-Murrillo, A., Martinez-Hollingsworth, A., Smith, L. V., Wells, K., et al. Journal of Racial and Ethnic Health Disparities, v. 11, #3 (May 18), pp. 1-11, 2023.
NEIGHBORHOOD AND BUILT ENVIRONMENT
Where you live can significantly impact your health and well-being. Creating neighborhoods and built environments that promote health and safety can help improve health outcomes and quality of life.
- Air Pollution in American Indian Versus Non–American Indian Communities, 2000–2018. Li, M., Hilpert, M., Goldsmith, J., Brooks, J. L., Shearston, J. A., et al. American Journal of Public Health, v. 112, #4 (April), pp. 615-623, 2022.
- Health of American Indian and Alaska Native Adults, by Urbanization Level: United States, 2014-2018. Villarroel, M. A., Clarke, T. C., and Norris, T. Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), cdc.gov, 2020.
- Healthcare Professionals' Perspectives of Barriers to Cancer Care Delivery for American Indian, Rural, and Frontier Populations. Varilek, B. M., and Mollman, S. PEC Innovation, v. 4 (December): Art. 100247, 2024.
- Nurturing Resilience in American Indian/Alaska Native Preschool Children: The Role of Cultural Socialization, Executive Function, and Neighborhood Risk. Merculief, A., Lipscomb, S., McClelland, M. M., Geldhof, G. J., and Tsethlikai, M. Frontiers in Psychology, v. 14 (November 30): Art. 1279336, 2023.
- Storekeeper Perspectives on Improving Dietary Intake in 12 Rural Remote Western Alaska Communities: The “Got Neqpiaq?” Project. Koller, K. R., Flanagan, C. A., Nu, J., Lee, F. R., Desnoyers, C., et al. International Journal of Circumpolar Health, v. 80, #1 (January-December): Art. 1961393, 2021.
SOCIAL AND COMMUNITY CONTEXT
Social connections matter. Relationships with family, friends, and community members can provide support, reduce stress, and influence healthy behaviors. Strong social connections and a sense of belonging within a community foster well-being.
- Cultural Factors and Alcohol Use in American Indian Adults: Results From a Culturally Tailored Contingency Management Intervention. Herron, J., Hirchak, K. A., Venner, K., Tofighi, D., McDonell, M. G., et al. Journal of Studies on Alcohol and Drugs, v. 84, #2 (March), pp. 273-280, 2023.
- The Culture Is Prevention Project: Measuring Cultural Connectedness and Providing Evidence That Culture Is a Social Determinant of Health for Native Americans. Masotti, P., Dennem, J., Bañuelos, K., Seneca, C., Valerio-Leonce, G., et al. BMC Public Health, v. 23 (April 21): Art. 741, 2023.
- Family Listening/Circle Program: The Experience of Community Action Projects to Promote Family and Community Wellness in Three Tribal Communities in New Mexico. Rae, R., Belone, L., Tafoya, E., Yepa, M., Cohoe-Belone, B., et al. Frontiers in Public Health, v. 11 (March 30): Art. 1091751, 2023.
- Perceived Racial/Ethnic Discrimination and Depressive Symptoms Among Adolescents Living in the Cherokee Nation. Barry, C. M., Garrett, B. A., Livingston, M. D., Kominsky, T. K., Livingston, B. J., et al. American Indian and Alaska Native Mental Health Research, v. 29, #1, pp. 22-36, 2022.
- Protective Factors Against Depressive Symptoms in Female American Indian Cancer Survivors: The Role of Physical and Spiritual Well-Being and Social Support. Roh, S., Lee, Y. S., Hsieh, Y. P., and Easton, S. D. Asian Pacific Journal of Cancer Prevention, v. 22, #8 (August), pp. 2515–2520, 2021.
Last Edited: 10/31/2024