Background: Navajo Nation Community Health Representatives (CHR) are trained community health workers (CHWs) who provide crucial services for patients and families. The success of the CHRs’ interventions depends on the interactions between the CHRs and their clients. This research investigates the culturally specific factors that build and sustain the CHR-client interaction.

Methods: In-depth interviews were conducted with 16 CHRs on Navajo Nation. Interviews were transcribed and coded according to relevant themes. Code summaries were organized into a narrative using grounded theory techniques.

Results: The analysis revealed four findings critical to the development of a CHR-client relationship. Trust is essential to this relationship and provides a basis for providing quality services to the client. The ability to build and maintain trust is defined by tradition and culture. CHRs must be respectful of the diverse traditional and social practices. Lastly, the passing of clients brings together the CHR, the client’s family, and the community.

Conclusion: Understanding the cultural elements of the CHR-client relationship will inform the work of community partners, clinical providers, and other indigenous communities working to strengthen CHR programs and obtain positive health outcomes among marginalized communities.

Gampa et al.

Year: 2017

BMC Health Services Research

https://docs.wixstatic.com/ugd/0dcff4_e4f44afca6184fa0912fa09e14f0f2f9.pdf

Unprecedented in its focus and scope, this collection addresses nearly every aspect of indigenous food sovereignty, from revitalizing ancestral gardens and traditional ways of hunting, gathering, and seed saving to the difficult realities of racism, treaty abrogation, tribal sociopolitical factionalism, and the entrenched beliefs that processed foods are superior to traditional tribal fare. The contributors include scholar-activists in the fields of ethnobotany, history, anthropology, nutrition, insect ecology, biology, marine environmentalism, and federal Indian law, as well as indigenous seed savers and keepers, cooks, farmers, spearfishers, and community activists. After identifying the challenges involved in revitalizing and maintaining traditional food systems, these writers offer advice and encouragement to those concerned about tribal health, environmental destruction, loss of species habitat, and governmental food control.

Devon A. Mihesuah, Elizabeth Hoover, Winona LaDuk

2019

University of Oklahoma Press

https://www.amazon.com/Indigenous-Food-Sovereignty-United-States/dp/0806163216

Innovations in Local Food Enterprise: Fresh Ideas for a Just and Profitable Food System addresses one of the most complex issues facing food access and regional food system development allies today: how can consumer price and producer cost meet in ways that transition healthy, local food from a privilege to a right? Innovations in Local Food Enterprise analyses and aggregates a collection of innovative solutions to overcoming difficult food access and food equity issues with a focus on market-based consumer-driven solutions for low-income underserved communities.

The report is based on learning from our Healthy Urban Food Enterprise Development (HUFED) Center and from the work of others who are creating and implementing market-based and non-market-based food access solutions in a very hands-on, practical way. Our hope is that this report will inform, inspire, and prepare readers to innovate in their own communities and for those in decision making roles, to have this knowledge in mind as they envision and develop programs.

Wallace Center at Winrock International

Year: 2013

https://www.wallacecenter.org/resourcelibrary/hufedinnovationsreport

For far too long, tribal communities have been disconnected from their lands and resources. This has separated many from their traditional foods, putting tribal culture and health in peril. The result has been an increase in chronic illness, such as obesity, diabetes and heart disease. Food scan was completed on behalf of the W. K. Kellogg Foundation, which has a long standing commitment to improving health equity and supporting food systems change. This scan is only a snapshot of the good work happening in tribal communities across the country, and could never be complete. Every day things are changing, people are building upon what we know and bettering their local food systems.

Indigenous Food and Agriculture initiative at the University of Arkansas School of Law and the funder, the W.K. Kellogg Foundation.

Year: 2015

http://communityfood.wkkf.org/pix/WKKF_food-scan_IFAI_r304.pdf

This research project aims to better understand these issues by examining the social determinants of health of childhood obesity and type 2 diabetes among Native American people from a Native/Indigenous perspective.

Using this perspective, this paper considers the unique indigenous factors (i.e. historical trauma, self determination, cultural activities, etc.) in better understanding the role and impact of the social determinants of health among Native people. The goal of this research project is to: 1) provide a research framework to guide the NB3 Foundation’s approach to addressing childhood obesity in Native communities, 2) begin to analyze the current infrastructure for collecting available public data and 3) investigate the gaps and issues with data collection, access and dissemination.

Notah Begay III Foundation

2015

http://www.nb3foundation.org/assets/docs/2015-10-20-SDOH%20Full%20Summary%20FINAL.pdf

Objectives: To evaluate the role of primary care healthcare delivery on survival for American Indian patients with diabetes in the southwest United States.

Methods: Data from patients with diabetes admitted to Gallup Indian Medical Center between 2009 and 2016 were analyzed using a log-rank test and Cox Proportional Hazards analyses.

Results: Of the 2661 patients included in analysis, 286 patients died during the study period. Having visited a primary care provider in the year prior to first admission of the study period was protective against all-cause mortality in unadjusted analysis (HR (95% CI) = 0.47 (0.31, 0.73)), and after adjustment. The log-rank test indicated there is a significant difference in overall survival by primary care engagement history prior to admission (p < 0.001). The median survival time for patients who had seen a primary care provider was 2322 days versus 2158 days for those who had not seen a primary care provider.

Conclusions: Compared with those who did not see a primary care provider in the year prior to admission, having seen a primary care provider was associated with improved survival after admission King et al.

2017

Elsevier Ltd. on behalf of Primary Care Diabetes Europe

https://docs.wixstatic.com/ugd/0dcff4_666c70d67c944e24b6810104459b8bb5.pdf

Reclaiming Indigenous Food Relationships was created and organized for Native American organizations, tribal communities and individuals. By exploring the traditional teachings that connect all parts of life to food and health, it is designed to support Indigenous people in achieving their best health. The framework is based on the traditional medicine wheel with food at the center, surrounded by the stages of life, the changing seasons and the various aspects of individual and community health.

American Indian Cancer Foundation and University of Minnesota

2018

https://www.americanindiancancer.org/wp-content/uploads/2017/12/RIFR-9.7.18-PRINT-1.pdf

The Seeds of Native Health Campaign has chosen a deliberate strategy of reaching out to the agriculture, food, nutrition and public health disciplines to join in the work of solving the dietary health crisis in Indian Country. Healthful measures of deliberation and care are needed. Deliberation is needed because while significant cultural differences between Western/Eurocentric and Indigenous conceptions of the world have always existed, most academic disciplines have not developed strategies or methodologies that might effectively interface and bridge these cultural differences. Care is needed because these intercultural dynamics are further complicated by a difficult history of colonization. A major problem here is that most of us as academic professionals were trained to see and represent our disciplines as holding universal truths. We seldom recognize the truths and knowledge held by Indigenous Peoples. We seldom, if ever, represent our disciplines or position our expertise as cultural constructions. Unlike many academic approaches, my own experience in community and crosscultural engagement represents the starting point for my scholarship and teaching, as well as for this publication. Consistent with my own experience, agriculture, food, nutrition and public health disciplines still lack strategies, methodologies and pedagogies to develop capacity for engaging, interfacing and bridging Indigenous Peoples systems of thought. Openness to what Indigenous Peoples might have to offer is still largely missing from professional training.

Craig A. Hassel

2018

University of Minnesota Extension

https://seedsofnativehealth.org/wp-content/uploads/2019/03/Reconnecting-the-Wisdom-Within-web.pdf

“Much like the 2014 Farm Bill, which was projected to spend $956 billion over a 10-year period, the 2018 Farm Bill will be one of the largest non-defense funding authorizations to be considered in the history of this country. Since the Intertribal Agriculture Council’s inception, we have struggled to rally the support of tribes to effectively advocate for greater Native inclusion in previous Farm Bills. This document will serve as a new foundation for our ongoing efforts, working in partnership with the Indigenous Food and Agriculture Initiative, the SMSC’s Seeds of Native Health campaign, the National Congress of American Indians, and the Intertribal Timber Council to ensure well-crafted, effective, and thoughtful agriculture and nutrition policy; and a soapbox from which tribal voices can be heard in creating of that policy.” – Ross Racine,  Executive Director Intertribal Agriculture Council

Prepared by Janie Simms Hipp and Colby D. Duren: Indigenous Food and Agriculture Initiative;.. Commissioned by Seeds of Native Health – A campaign of the Shakopee Mdewakanton Sioux Community

Year: 2017

https://seedsofnativehealth.org/regaining-our-future-report/

These findings suggest that CHRs have experienced positive benefits from COPE through training. COPE may provide a useful programmatic model on how best to support other Community Health Workers through strengthening clinic-community linkages, standardizing competencies and training support, and structuring home-based interventions for high-risk individuals King et al.

2017

BMC Health Services Research

https://docs.wixstatic.com/ugd/0dcff4_296d4ed14d0647bb815223f0b41751a8.pdf

Sean Sherman with Beth Dooley

After introducing key health factors, this report highlights relevant research on the health of Native American children in New Mexico. The overall purpose of the report is just not to raise awareness. It is intended to help guide discussions and support policy developments that improve future wellbeing of the Native American children of New Mexico. It concludes with a look at indigenous indicators and future opportunities.

Notah Begay III Foundation

http://www.nb3foundation.org/wordpress/wp-content/uploads/2017/12/NB3_NM_FactSheet_v121217WEB.pdf

The 1994 Land-Grants receive four main types of grants. Tribal College Equity supports formal education at these schools. Tribal College Extension supports informal, community-based learning such as farmer education, youth development and rural entrepreneurship. Tribal College Research helps the 1994 Land-Grants build scientific capacity and provide a strong foundation in research knowledge for students. The Federally Recognized Tribes Extension Program (FRTEP) allows 1890 and 1862 Land-Grants to provide informal learning to support youth development and agricultural productivity. They complement the Extension efforts of the 1994 Land-Grants, often serving in states that do not have a 1994 Land-Grant.

https://nifa.usda.gov/resource/tribal-program-data-and-outcomes