Chapter 5

Native Americans originally came to North America across the Bering Strait. They were significantly impacted by European colonization through the introduction of diseases, firearms, and relocation to reservations in the 19th century. Today, Native Americans live throughout the US but are concentrated in certain states. They have higher rates of poverty and health issues like diabetes compared to the general population, due in part to historical trauma and current lack of access to healthy foods and healthcare. Traditional Native diets emphasized fresh local foods but have shifted to include more refined carbohydrates and fats.

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Chapter 5

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Native Americans

Chapter 5
Native Americans
Largest number of ethnic groups
American Indian
Alaska Natives
American Indians
Inuits (Eskimos)
Aleuts (Alaska Natives)
Most live west of the Mississippi River
History of Native Americans
Came to North America across the
Bering Strait
No written records
Europeans introduced horses, firearms,
metal knives, diseases, massacres of
whole nations
By late 19th century most lived on
reservations
Bureau of India Affairs (BIA) took over
reservations in late 20th century
Have not fully assimilated
Current Demographics
States with largest numbers
California
Oklahoma
Arizona
Largest ethnic groups in Alaska,
Montana, North Dakota, Oklahoma,
and South Dakota
Alaska Natives
NativeAmericans/American Indians
Native American Nations in
the United States.
Socioeconomic Status
Declined with forced migrations of the 19th
century
Indian Self-Determination / Education Act of
1975
Promote Native American participation in
government and education
Unemployment lower than for total population
Median earnings 25% less than average
Overall poverty rate double the general
population
24% have not finished high school or
equivalent
Native American Organizations
Have done much to maintain Indian
identity
Clubs
Service Organizations
Organizations to promote ethnic identity
Athletic clubs
Dance groups
Numerous traditional celebrations
across the nation each year
Worldview
Harmony
Strive to maintain balance
Spiritual
Social
Physical
Earth cared for and respected
Generosity valued, competitiveness
discouraged
Individual right highly regarded
Time without beginning or end
Present-oriented
Native American Religion
Permeates all aspects of life
Holistic worldview
Physical and emotional well-being
Religion varies
Traditional
Catholic
Mixed
Protestantism
Russian Eastern Orthodox in Alaska
Family
Extended family
Children highly valued
Great respect for
elders
Blood kin of all
generation are equal
Men are providers
Women in charge of
domestic matters
Men and women are
equal
Children assist parents
Traditional Health Beliefs and
Practices
Reflects relationship to nature
Imbalance with supernatural, spiritual,
or social
Treatment is holistic in approach
Focuses on restoring harmony
Concerned with physical, mental, and
spiritual renewal
Health maintenance
Prevention of illness
Restoration of health
Traditional Health Beliefs and
Practices
Causes of illness Causes of illness
Witchcraft Possession
Through agents such Soul loss
as Alcoholism
Animals Violation of a taboo
Lightning
Unfulfilled dreams or
Whirlwinds
desires
Improperly performed
ceremonies Domination by white
Evil spirits society
Intrusive objects
Traditional Health Beliefs and
Practices
May reject modern concepts
Virus, bacteria, infection, etc.
Will have their own thoughts as to why
someone is not well
Utilize herbals, medicine bundles,
fetishes, feathers, or symbols for
protection
Will seek home remedy first
May seek traditional healers
Often utilize concurrent with
Westernized care
Causes of Illness
Utilize healers, medicine men & women
Prevention through sweat baths
Diagnose through
Stargazing or listening
Hand trembling
Painting
Singers
Chanters
Dreamers
May diagnose or treat
Traditional Food Habits
Influenced by geography/climate
Maximized indigenous resources
Agriculture or hunter/gatherer/fishing
Staples for almost all
The 3 Sisters
Corn
Squash
Beans
Food introduced from Europe
Apples Turnips
Apricots Livestock
Carrots Alcohol
Lentils Rye
Peaches Wheat
Purslane
Regional Variations
Northeastern
Maple-sweetened baked beans, clambakes,
succotash
Southern
Brunswick Stew, hominy
Plains (hunters )
Jerky, Bison, Pemmican
Southwestern
Piki, Nopales, Tortillas
Northwestern Coast/Alaska Native
Salmon, Berries, Muktuk
Regional Variations
Others
Digger Indians
Roots, supplemented by small game and
insects
Central California
Acorn based diet
Must remove tannic acid
Rugged northern mountains and plains
Game
Wild plants
Meal Composition and Cycle
Daily patterns
Varied patterns
1 2 meals per day
Snacks
Men served first
Monotonous
Silent
Simply prepared
Sweets limited to fruits, honey, maple
syrup
Special Occasions
Religious ceremonies
Planting
Harvest
Hunt
Green Corn Festival
In the South
Thorough cleaning of homes and persons
Amnesty granted for all but murder
Beginning of a new year for marriages,
divorces, periods of mourning
Role of Food in Native American
Culture and Etiquette
Food is sacred
Gift of the natural realm
Ceremonies accompany cultivation of crops
Prayers offered for a successful hunt
Men responsible for hunting /care of livestock
Women gather, prepare and store food
Men and women cultivate crops
Sharing food important
Meals usually prepared and eaten
communally
Idea of selling food not popular
Therapeutic Uses of Food
Important in spiritual and physical
health
Corn derivatives used for a variety of
ailments
Indigenous plants used for medicinal
purposes
Agave, yucca, pumpkin paste, chile
peppers
Bitter purges and emetics
Distasteful and repugnant to evil spirits
Therapeutic Uses of Food, Cont..
Food restrictions common
May eliminate cabbage, eggs, fish, meat,
milk, onions, or organ meats
May eat certain foods to maintain strength
Meat among the Seminole
Meat and blue cornmeal in the Navajo
Pregnancy/childbirth restrictions common
May avoid sweets cod, halibut, huckleberries,
and spring salmon
Psychotherapeutic use of plants
Contemporary Food Habits
Transitional adaptation of the Chippewa may
serve as a
Model for other Native Americans
Traditional: parents and grandparents speak
Chippewa at home, practice Midewiwin religion,
participate in feasts and powwows
More acculturated: English is primary language,
Catholic, involved in primary culture activates
Pan-traditional: Speak either English or Ojibwa
exclusively, practices a combined religion such
as the Native American Church, and is involved
in both traditional and white societies
Adaptation of Food Habits
Diet today includes
few traditional foods
Gardening, hunting,
fishing, gathering
Dependent on foods
provided by the
reservations
Limited access to
supermarkets
Traditional foods have
been lost and
substitutions made
Beef
Fry bread
Adaptation of Food Habits

Typical Commodity Foods

Poultry Fruit juices
Peanut Butter

Canned and Peas and string Evaporated

chopped meats beans and powdered
milk

Dried beans Instant potatoes Eggs

May very well be discarded due to dislike or

beliefs
Meal Composition and Cycle
Little reported on meal patterns
3 meals per day, at least 1 or 2 main meals
Meat and starch
Lots of fried food
Little variety
Few fruits & vegetables
Impacted by availability of commodities
Traditional foods consumed at
celebrations, birthdays
Nutritional Status
Research is limited
Low socioeconomic status, lack of
transportation, fuel, refrigeration,
running water contribute to inadequate
diet
Lactose intolerance is common
Diseases today associated with
overconsumption
Obesity, Type 2 diabetes, cardiovascular
disease
Alaska Native
Diet high in refined carbohydrates and
fat
Low in fruits and vegetables
Calorie and protein intake declined
Traditional diet replaced by
processed, canned and packaged
food low in nutrients
Low intake of numerous nutrients
including calcium, iron and Vit C
Diet of other American Indians
Refined carbohydrates prominent
White breads, tortillas, potato chips, French
fries and candy are top contributors of energy
High consumption of soda and fruit-flavored
drinks
Low in fruits and vegetables
Cost, availability, quality
Similar when compared to general
population
Except Alaska Natives
Nutritional Status
Life expectancy has improved
2.4 years less than the average American
Die at higher rates from
TB
Alcoholism
Motor vehicle accidents
Diabetes
Unintentional injuries
Homicide
Suicide
Nutritional Status
Native American mothers more likely to
be younger and not married
No prenatal care for most during first
trimester
Pregnancy considered a healthy state
Postnatal mortality rates 60% higher
SIDS a major concern
Breastfeeding is traditional
Baby Bottle Tooth Decay a major
concern
Nutritional Status: Obesity
Overweight and obesity prevalent
20% above national average
Heavier body weight preferred
May be metabolic differences
Report very low leisure-time physical activity
Some studies indicate:
Sweetened and alcoholic beverages may contribute
to obesity in women
Dieting behaviors among adult women include
healthy approaches
Some do skip meals, fast, induce vomiting, binge-
eat
Nutritional Status: Diabetes
Pima Indians have highest incidence in
of diabetes in the world
2 4 times higher than general
population
Alaska Natives
Plains
Southwest
Rates among children increasing
Death rate 3x as high
Deaths from diabetes 50 years ago were
rare
Cultural Controversy: Type 2 Diabetes,
Thrifty Genes, and Changing Theories

Why the increase in diabetes?

Genetic predisposition?
Increased insulin resistance?
Less indigenous foods?
Less protein?
Change in type of carbs?
Increased fats?
Nutritional Status
Heart disease now leading cause of
death
Often more fatal
High rates of smoking, high cholesterol
and hypertension
Chronic kidney disease associated
with Type 2 Diabetes
Tuberculosis
Nutritional Status: Alcoholism
Numbers have decreased
Rate for alcohol-related deaths 8x higher
than general population
Still a significant medical and social
problem
Reasons for substance abuse
High unemployment rates
Loss of tribal integrity
Loss of ethnic identity
Loss of self-esteem
Counseling
Open-minded
Avoid ethnocentrism
Use intercultural communication skills
Listen carefully
Respect silence
Learn about Native American worldview
Traditional health beliefs
Differences between nations
History of each group
Recognize diversity
Understand local culture
Counseling: Access to care
Biomedical health care may be limited
Low income or limited transportation
May be limited to care through IHS
Often limited technology and other resources
Beliefs may cause them to avoid
treatment
Pregnancy is a healthy state
Fear
Impersonal care
Dislike knowing of risks
Anger and blame
Counseling
Belief in inevitable consequences to
diabetes
Renal failure
Amputations
Blindness
Traditional attitudes about time may
cause delay in seeking care
Do not question family members
Use open ended questions
Counseling
Verbal is best
Watch terminology, even basic words
Ex: vegetables = weeds
Ex: germ word does not exist
Allow silence, avoid yes or no questions
May state I dont know if they dont want to
discuss topic
May use stories or metaphors to make a point
Direct questioning not best
Allow trust to be developed
Emphasize how personal health promotes the
welfare of the clients family and community
Counseling: Nonverbal
Communication
Very sophisticated
May expect practitioner to use intuition
rather than a direct interview
Smile and handshake are customary
Not vigorous
Often sit at distance
Averted eyes are common
Quiet, unhurried, talking with not
to
Counseling
May have misconceptions about biomedicine
Navajo health system classifies illness by
cause rather than symptoms
Believe medication or an injection can cure
anything
Weight loss associated with disease or
witchcraft
Often will combine biomedical with traditional
Most effective for compliance
Identify degree of acculturation through in-
depth interview
Native American

SEE PRACTITIONER
PERSPECTIVE