A new scientific statement from the American Heart Association highlights the serious health disparities experienced by Indigenous peoples in the US. The statement says racism, historical trauma, and other complex factors known as the “social determinants of health” are at the root of these disparities.
KNAU’s Melissa Sevigny spoke with one of the authors, Dr. Jason Deen of the University of Washington, about why pregnant Native women are especially at risk.
What are ‘the social determinants of health’?
Social determinants of health are political and economic influences, basically, that can affect health. For instance, it’s your ability to have insurance, it’s if you experience racism, it’s your neighborhood you live in, if you have access to health care, it’s your education level, those sorts of things. All those determinants are really stacked against Native people, and the underlying reason that those social determinants are stacked against Native people is because of structural racism.
This particular paper is about cardiovascular health. Can you tell me why that’s particularly a concern for pregnant Native women?
The time around pregnancies is a particularly vulnerable time for a woman. Particularly women who have underlying heart issues, underlying heart risk factors. Because there are a lot of changes that happen during pregnancy that make the heart work more.
Another one of the statistics in the paper is that American Indian and Alaskan Native people are 50 percent more likely to be diagnosed premature cardiovascular disease than white people are. This is an incredibly widespread problem.
Correct. Those statistics are stark, I would say. It’s something we struggle when we are caring for our own communities. Because not only is cardiovascular disease more deadly, but again, it’s premature in Native populations. All of ours screening tools that would employ to the general population, probably catches Indigenous populations a bit too late.
Okay, so the idea is an intervention at the right time with a pregnant mother could help not only her, but the next generation as well.
And that brings into the conversation the notion of generational trauma, or transmission of health risk across generations. Say for example a Native woman is pregnant. Her mother was in boarding schools… so was under quite a bit of toxic stress…. Her daughter grew up with her own stress, her own issues, with unhealthy social determinants of health. So that pregnant mother now has cardiovascular risk factors, diabetes, hypertension.…. During pregnancy that risk was relayed to the offspring. It’s this transmission of poor health. This is something that is tragic, I would say. And definitely hard to interrupt.
As a doctor, this seems like it would be such a difficult thing to grapple with; when you have a Native woman come in to see you, you’re not just treating her, you’re grappling with generations of violence and trauma that have been experienced by Native women.
It calls for systemic solutions, to be honest with you…Getting more doctors trained that look like the communities they serve, for example…. Really, we have to expand opportunities for education for these folks. We have to combat poverty. These are, again, larger more structural issues that unfortunately physicians are not well equipped to deal with, but… Since the problem is structural, we need to come up with structural solutions.
The statement from the American Heart Association is online on their website, and there’s a link to it on our website as well. Dr. Jason Deen, thank you so much for speaking with me.
Thank you.
Read the statement: https://www.ahajournals.org/doi/10.1161/HCQ.0000000000000117
