Improving Health Equity for Native Populations: A Conversation with Researcher John Lowe

With the creation of the Center for Indigenous Nursing Research for Health Equity at Florida State University (FSU), the first research center of its kind in the world — which will officially open in May — native populations will soon gain an ally on the path to greater health.

Leading the development of the center is John Lowe, PhD, a Cherokee Native American tribal member, the endowed McKenzie Professor in Health Disparities Research in FSU’s College of Nursing, and one of only 20 Native American nurses with a doctoral degree in the U.S. INSIGHT Into Diversity recently spoke with Lowe about the creation of the center, his research on health disparities, and his efforts to prevent substance use among native youth.

Q: As a health disparities researcher and professor, how are you working to address and educate people on health inequities, particularly those experienced by Native American and indigenous communities?

A: The current focus of my research has been addressing certain health disparities by conducting prevention-intervention research that is culturally appropriate … and promotes the health and well-being of Native Americans and indigenous peoples. The issues [my colleagues and I] are currently researching include substance abuse, HIV/AIDS, and obesity.

I co-authored the first “Conceptual Framework of Nursing in Native American Culture,” which is being used to guide academic nursing curricula and explains how nursing and healthcare should be delivered to native and indigenous peoples. We also conduct health fairs and educational [workshops] for tribal and indigenous youth, with sessions about nursing and other health career opportunities. We currently have projects with tribes in Oklahoma, North Carolina, and Minnesota, as well as with urban indigenous youth in Florida, Australia, and Canada. And we have been invited to expand our work in Alaska and Hawaii and in countries such as Brazil and Panama.

Also, the College of Nursing at FSU is planning to develop a new PhD in nursing focused on health disparity research. This will provide indigenous nurses with opportunities to pursue a doctoral degree that will enhance their ability to address the health disparities affecting their communities.

Presently, I serve as a voice to represent Native American and indigenous peoples within many international, national, state, and local entities with stakeholders, sociopolitical leaders, and healthcare decision-makers.

Q: Tell me about the development of the Center for Indigenous Nursing Research for Health Equity at FSU. What health-related issues will you and your colleagues study, and what effect do you hope this research will have on indigenous populations?

A: [According to the World Health Organization], there are an estimated 370 million indigenous peoples living in more than 70 countries worldwide. However, their health status varies greatly from that of non-indigenous people. Indigenous peoples tend to die at a younger age, are much more likely to commit suicide, and are generally in worse health than the rest of the population, according to a report from the International Working Group on Indigenous Affairs. In addition, gaps between indigenous and non-indigenous peoples’ life expectancy in the United Nations Human Development Index are unacceptably large in the United States, Canada, Australia, New Zealand, and in Central and South American countries.

The large disparities in the health status of these groups have not diminished and have arguably increased. To attain health equity, indigenous peoples and communities must partner with academic and research stakeholders.

The overall objective of the Center for Indigenous Nursing Research for Health Equity (INRHE) is to partner with indigenous peoples, communities, and organizations — nationally and internationally — to attain health equity. Specific goals of the center are to develop relationships between indigenous nurses, other health professionals, and trans-disciplinary researchers and scholars; develop innovative conceptual methodological approaches to engage indigenous peoples and communities; and design and evaluate contextually tailored and culturally relevant health-equity interventions.

The INRHE center will be the first indigenous nurse-led research center in the world, and Florida provides a unique setting for this. It will serve as the core for connecting indigenous peoples, communities, and organizations at the local, tribal, state, national, and international level, with academic and research partners to guide and lead research, translation, dissemination, and capacity-building efforts.

The center’s research will focus on promoting the health equity and well-being of indigenous people in the U.S. and around the world — [which] is the right of these people. … Our ancestors sacrificed and suffered many atrocities and traumatic events so that we, as their descendants, could have optimal health and well-being.

Q: Why do you believe nurses are key to addressing health disparities and ensuring health equity for native populations?

A: Nurses have been at the forefront of providing healthcare to native and indigenous communities. They know the health issues that need to be studied [among these populations] and are trusted by these communities. Nurses are open to culturally appropriate healthcare delivery as they understand that culture influences health outcomes.

In addition, nurse researchers bring a holistic perspective to studying indigenous communities, taking a bio-behavioral, interdisciplinary, and translational approach to science. This agenda is in alignment with the nursing profession’s mandate to society to optimize the health and well-being of all populations.

Q: From 2009 to 2012, American Indian students’ annual heroin and Oxycontin use was nearly two to three times higher than the national average, according to National Institutes of Health data. Considering these statistics, how are you working to prevent substance use among Native American youth? What is the Intertribal Talking Circle project, and how does it tie into this effort? 

A: We must begin addressing substance-use prevention at an early age. Native American and indigenous youth usually [begin using] alcohol, marijuana, and cigarettes around age 11, which is earlier than other populations. We are testing our Intertribal Talking Circle intervention among youth beginning at age 9, and we have [found] that interest in substance use decreases after completing [the program]. Our method is similar to standard alcohol and drug education programs typically provided in schools; however, it is culturally based, delivered in the format of the “talking circle.”

I have found the Intertribal Talking Circle to be an acceptable and effective approach for working with Native American and indigenous youth. In Native American tradition, a talking circle is coming together [in] a place where stories are shared in a respectful manner and in … complete acceptance by participants. It is used to celebrate the sacred interrelationship that is shared with one another and with their world. Native American and indigenous people usually consider the whole greater than the sum of its parts and have always believed that healing and transformation should take place in the presence of the group since they are all related to one another in very basic ways.

Through the use of the talking circle, [they receive] the support and insight to move away from something such as substance use and toward something else. The traditional sense of belonging and comfort provides healing for all, and the circle reminds Native American and indigenous people of life and their place in it.

These studies are guided by the Native Reliance theoretical model. Native Reliance is described as helping keep a person in balance and describes the holistic worldview, values, and behaviors within Native American and indigenous cultures. The three qualities of Native Reliance include being responsible, disciplined, and confident. The cultural themes of “seeking truth” and “making connections” cut across all three qualities. Seeking truth refers to acknowledging one’s native or indigenous heritage and living by that worldview, which is … considered to be circular and holistic, where all things are believed to come together to form a whole. Making connections refers to identifying and utilizing resources. According to the Native American and indigenous worldview, each person is a resource, and the gifts and talents of each person not only benefit [him or her], but also that person’s family, community, and tribe.●

Alexandra Vollman is the editor of INSIGHT Into Diversity.