Culturally Aligned Public Health Strategies

Research over the past decade has improved our understanding of the interconnectedness between culture, tradition, and health at the individual and population level. At the population level, historical separation from cultural traditions generates stressors that are passed down through generations, as traditional coping mechanisms are lost. Within individuals, this long-term exposure to stress over the lifetime has specific physiological consequences which lead to higher risk of physical and psychological poor health. Working to reconnect people with the traditional and cultural coping mechanisms of their people can help to heal unresolved grief, which in turn can produce better health outcomes.

Providing programs, activities, and community events that are designed to address specific public health objectives while concurrently developing and strengthening a sense of cultural connection can help provide Tribal community members – and Tribal youths in particular – with information and tools that are rooted in both evidence-based practice and tradition. This approach leads to an improved reduction in risk and increased population health. In this way we seek to deepen the impact of our public health programs by implementing them in a way that provides participants with a stronger sense of connection to, and opportunities to practice traditional culture and tradition.

Theoretical Basis for Cultural Connectedness and Improved Health Outcomes

There are several theoretical frameworks or models that can help explain links between cultural connection and improved health-related outcomes. These models draw from different bodies of research to help explain the process through which increased connection to culture and traditional practices translates to measurable reductions in specific health-related risk. Three examples are the social development model, historical trauma theory, and psychoneuroimmunology. In general, the research literature demonstrates that increased sense of connection to culture is associated with increases in sense of hope, self-efficacy, community connectedness, and reduced stress.[i],[ii]

• The Social Development Model focuses on the process through which social bonds are developed between youths and members of their communities. These bonds may “pro-social” or “anti-social” depending on the behaviors demonstrated by the community members a youth bonds with. Positive, pro-social bonding is associated reductions in risk and improved health outcomes related to that.

• Historical Trauma Theory examines the ways in which emotional and physiological symptoms associated with past traumas experienced at the population level (war, forced migration, cultural suppression, etc.) can be transmitted through generations. The impact of this process on health at the individual and population level is multi-layered. It leads to increased experience of stress, anxiety, and related symptoms, while at the same time undermining the traditional and cultural strategies which had previously existed for coping with those issues. Efforts to address unresolved grief associated with past trauma by reconnecting people with their culture and traditions can help reduce health disparities.

• Psychoneuroimmunology deals with the physiological impact that stress and related psychological risk factors has on the body, and how that in turn translates into greater health disparities within marginalized communities. It has been said that, “Tribal culture, when allowed to flower, provides an informal, flexible, strength-based, prevention-oriented system with long-standing traditions.” (Pavkov, 2010) Connecting people to these cultural systems that provide positive, traditional frameworks for coping with and managing stress can in turn lead to reduced risk and improved health outcomes.

[i] Haegerich, Tamara M., and Patrick H. Tolan. "Core competencies and the prevention of adolescent substance use." New directions for child and adolescent development 2008.122 (2008): 47-60.

[ii] Groenman, Annabeth P., Tieme WP Janssen, and Jaap Oosterlaan. "Childhood psychiatric disorders as risk factor for subsequent substance abuse: A meta-analysis." Journal of the American Academy of Child & Adolescent Psychiatry 56.7 (2017): 556-569.

PHRI’s Approach to Culturally Aligned Program Planning, Implementation, and Evaluation

PHRI has been working on new ways of assessing implementation processes that seek to integrate standard and traditional approaches to achieve population health outcomes. Including culturally aligned and traditionally rooted strategies into public health programs can help improve the reach, adoption, and effectiveness of those programs. Evaluating a program’s impact on strengthening a sense of connection to culture and tradition involves working closely with partner organizations to develop mixed methods evaluation plans that draw from a combination of validated assessment tools and narrative-based data collection strategies.

PHRI provides operational support to organizations seeking to align population health goals with cultural and traditional concepts, and integrate those concepts into program activities. These services encompass a broad range of services, including board development, organizational policy development, programmatic operational review and operational support.  PHRI helps organizations address critical programmatic areas that will help increase their organizational accountability, efficiency and effectiveness. PHRI provides public health planning support for organizations working to address public health needs within their community. PHRI consultant assist with strategic planning to determine the needs for the organization, determine the best mix of programs to be implemented, and help to build a system for success within their communities.  In all of this work, PHRI uses a community based participatory approach meant to identify, incorporate, develop, and share local knowledge and wisdom in the process of program planning, implementation, and evaluation.