(StatePoint)

Heart disease is the number one killer of new moms in the United States, and American Indian and Alaska Native (AI/AN) women have even more risk factors for poor heart health than the general population, such as high rates of Type 2 diabetes, obesity and smoking, as well as increased exposure to trauma and violence. In fact, recent research reports that more than 60% of AI/AN women have suboptimal heart health when they enter pregnancy, which is strongly related to the development of heart disease later in life.

According to the American Heart Association and the National Collaborative for Infants and Toddlers, addressing heart disease risks in AI/AN women requires not only attention to traditional cardiovascular disease risk factors, but also an understanding of how the legacy of colonization, exploitation, racism and discrimination shape the health of members of these communities. That’s why a new policy agenda identifies the most impactful ways to protect Tribal women during the vulnerable period of pregnancy, while honoring Tribal sovereignty.

The Tribal Prenatal-to-Three Policy Agenda, from the National Indian Health Board (NIHB), focuses on the earliest years of life, and highlights both the opportunities and complexities that arise within Tribal communities. It is a culmination of a three-year project supported by the Pritzker Children’s Initiative involving a thorough review of existing literature, as well as engagement with subject matter experts and Tribes. These are its five recommendations for charting a path forward to health equity and improved outcomes for AI/AN families:

  1. Protect tribal sovereignty and self-determination: Tribal sovereignty–the inherent right of Tribal nations to self-govern–is the foundation of advancing health equity for American Indians and Alaska Natives. Many of the current issues Tribal communities face are rooted in colonization and a history of paternalistic federal policy. Tribal sovereignty and self-determination are essential for healing from this harmful legacy and setting a more equitable, effective path forward.
  2. Invest Equitable Resources and Funding: Tribes have been starved for funding and resources for centuries as federal policy created conditions of scarcity in Tribal communities. For any chance of widespread improvement in outcomes for children prenatal to 3, large-scale investment into Tribes must be prioritized.
  3. Address Trauma and Strengthen Connection to Culture: Trauma is a root cause of many issues facing Tribal families. At the same time, connection to culture has been found to be a powerful component in building resilience and healing from trauma. Protecting Native kids will require preventing trauma caused or worsened by many systems in place, while supporting healing from previous historical, intergenerational and individual trauma by strengthening culture.
  4. Support Family-Centered Systems: The services and systems Native families must navigate can be complex, stressful and even traumatic. These barriers often prevent young families from accessing the essential care and services they need. More Tribal control over programs can make these systems easier and friendlier to navigate. In short, prioritizing the needs of families and young children, rather than funders, will improve health and wellness outcomes.
  5. Empower Tribal Voices in State and Federal Governance: Tribes must have a voice in the federal and state programs and policies that impact them. Improved state-Tribe and federal-Tribe relations can go a long way toward supporting the policies and infrastructure needed to improve the health and wellbeing of Native families.

For more information about policies that support families, visit https://www.ncit.org.

“We have a responsibility to support AI/AN children, families, and communities in the foundational years of life,” says William “Chief Bill” Smith, NIHB chairman. “By centering Tribal values and perspectives, the Tribal Prenatal-to-Three Policy Agenda represents an essential framework for meaningful policy development and implementation.”