Seasons of Change in Indian Country

Fresh winds of transformation are rolling across the expanse of this nation. In American Indian traditional stories, wind is a power larger than life itself throughout the history of the First Americans. During this Native American Heritage Month, we look to the winds of change that are transforming adversity into hope and empowering American Indians and Alaska Natives to live longer, healthier lives.

Elk Sage, a mental health advocate for the Northern Arapaho Suicide Prevention Program in Wind River Reservation, Wyoming, is doing his part to create a more hopeful future for Indian Country. Using American Indian horse culture, he is helping the youth of the Northern Arapaho Tribe fight the epidemics of suicide and substance use that threaten the well-being and future of their community. Elk’s story as a health equity change maker illustrates how Native youth are taking control of their health through traditional American Indian culture and learning how to be resilient in the face of challenges.

Like Elk, we are playing our part to create change and improve health in Native communities. The HHS Office of Minority Health (OMH) is working to ensure that American Indians and Alaska Natives have access to affordable, quality health care through the Health Insurance Marketplace (Marketplace) and the IHS. While members of federally recognized tribes and Alaska Native Claims Settlement Act shareholders can enroll in Marketplace coverage any time of year, we encourage consumers in these communities to visit HealthCare.gov to sign up for coverage during the current open enrollment period, which runs through January 31, 2017. Anyone who signs up for coverage by December 15, 2016 can have coverage starting January 1.

This is especially important because the Affordable Care Act helps address health disparities by investing in prevention and wellness. This includes new and expanded programs for mental and behavioral health treatment and prevention to address the higher rates of behavioral health disorders in Native communities.¹

HHS is also continuing efforts to combat the opioid crisis in American Indian and Alaska Native communities, which are experiencing increased opioid-related poisoning deaths from prescription opioids and heroin.² In June, IHS implemented a groundbreaking policy requiring practitioners in IHS federal-government-operated facilities to check state Prescription Drug Monitoring Program databases prior to prescribing and dispensing opioids for pain treatment longer than seven days and periodically throughout chronic pain treatment. In August, the U.S. Surgeon General Dr. Vivek Murthy took historic action to combat the prescription opioid crisis by urging more than 2.3 million health care practitioners and public health leaders to help end the epidemic through TurnTheTideRx. And this month, the Surgeon General published Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health a landmark report on the science of substance use, misuse, and disorders.

Technology is also driving change. Health care professionals now have a new tool to provide better opioid use disorder treatment services to all communities. The Substance Abuse and Mental Health Services Administration developed MATx, a free mobile app that provides health care practitioners with immediate access to vital information about medication-assisted treatment for opioid use disorder.

Providing greater access to mental and behavioral health services is an important step in achieving health equity as is recognizing the issues underlying the opioid crisis for Native communities. Historical trauma, which is the cumulative emotional and psychological wounding of a community that crosses generations, can lead to long-term mental and physical health consequences.³ This type of trauma is often associated with racial and ethnic population groups in the United States who have suffered major intergenerational losses and assaults on their culture and well-being, such as Native Americans.⁴ And, living under constant, burdensome circumstances can produce stress, which is a risk factor for a host of health conditions that disproportionately affect minority populations compared to whites, including behavioral health conditions.

The HHS OMH supports the development of programs that provide Native youth with opportunities to enhance their capacity to make healthier lifestyle choices. The Menominee Youth Empowerment Program (MYEP), one of OMH’s Youth Empowerment Program grantees, serves middle school students on the Menominee Reservation in Wisconsin. This program helps address certain health risks for Menominee youth, such as diabetes, substance misuse and teen dating and violence.

But, steps like these are just the beginning. In this new season of health equity, powerful winds of change can breathe new life into our commitment to the healthiest future possible for Native communities and all Americans.

J. Nadine Gracia, MD, MSCE, is the Former Deputy Assistant Secretary for Minority Health and the Director of the Office of Minority Health at the U.S. Department of Health and Human Services (HHS)