Wicasa Was'aka: Restoring the Traditional Strength of American Indian Boys and Men

摘要

We examined health disparities among American Indian men and boys within the framework of historical trauma, which incorporates the historical context of collective massive group trauma across generations. We reviewed the impact of collective traumatic experiences among Lakota men, who have faced cross-generational challenges to enacting traditional tribal roles. We describe historical trauma–informed interventions used with two tribal groups: Lakota men and Southwestern American Indian boys. These two interventions represent novel approaches to addressing historical trauma and the health disparities that American Indians face. We offer public health implications and recommendations for strategies to use in the planning and implementation of policy, research, and program development with American Indian boys and men. ALTHOUGH AMERICAN INDIANS make up the smallest US ethnic group, they have ranked highest among ethnic and racial groups in health disparities. 1 Addressing the lack of consensus on a definition of health disparities , 2,3 Braveman defined them as potentially avoidable differences in health (or in health risks that policy can influence) between groups of people who are more or less advantaged socially; these differences systematically place socially disadvantaged groups at further disadvantage on health. 3 (p180) According to the Indian Health Service, American Indians in the 12 Indian Health Service areas have higher rates of death from tuberculosis (500% higher), alcohol (514%), diabetes (177%), unintentional injuries (140%), homicide (92%), and suicide (82%) than all other US ethnic and racial groups. 4 These health disparities among adult populations have extended to youths as well. 5,6 Using the Youth Risk Behavior Surveillance Survey to examine disparities between American Indian youths and other racial and ethnic groups, Pavkov et al. 6 found that American Indian youths had higher rates of suicidal ideation and attempts, substance use, and smoking than did youths of other racial and ethnic groups. In addition to these health disparities, a recent nationwide study 7 found that urban American Indians living in Indian Health Service areas were approximately twice as likely as the general population in these areas to be poor, unemployed, and without a college degree. Similar disparities have been found among American Indians living in rural reservation communities. 8 Death rates of male American Indians have exceeded those for their female counterparts for every age group up to age 75 years and for six of the eight leading causes of death. 9 These disparities in men's health disorders (i.e., cardiovascular disease, cancer, diabetes) have been compounded by high rates of suicide, 9,10 substance use, 11,12 and psychiatric disorders, which have had a disproportionate impact on American Indian boys and men. Although research examining the health of American Indian boys and men is scarce, 9,13,14 researchers have found that five of the top 10 leading causes of death have been related to voluntary risky behaviors that might be preventable with appropriate public health interventions. 13 From 2001 to 2005, 11.7% of all American Indian deaths were attributed to alcohol, more than twice the rate of the general US population. 11 Accidents, suicide, and homicide have reached epidemic levels among American Indian boys and men, 9 and their rates of violent victimization were higher than those of all other races. 15 The prevalence of lifetime posttraumatic stress disorder among two large reservation-based American Indian samples exceeded that of Whites in the general US population. 16 Primm et al. 17 called attention to the role of public health in addressing disparities among racial and ethnic minorities in mental health disorder prevalence rates, access to care, and sources of care, and proposed that interventions address social determinants as well as outcomes. We examined health disparities among American Indian men and boys within the framework of historical trauma, which addresses historical context and collective massive group trauma among this population. We considered the impact of American Indian men and boys’ collective traumatic experiences and used the framework of historical trauma to inform interventions aimed at ameliorating the suffering of American Indian men and boys and improving their behavioral and overall health. We posited that incorporating conceptualizations of traditional American Indian male roles in tribal cultures, and the impairment of those roles to varying degrees across generations, would assist in understanding the complex challenges American Indian men and boys continue to face. Restoring American Indian men to strength again—to be wicasa was'aka (“strong men” in Lakota) and to once more be the warriors and protectors of Native nations—may facilitate improved health for American Indian communities.