The Seven Sacred Directions serve as an indigenous framework for presenting the strategic directions for the public health agenda. This framework honors the cyclical nature of life from seed to harvest, and the birth of new and innovative ideas for taking Tribal public health to a new level of service. These seven strategic directions encompass the areas for growth and the relationships needed to move towards a more integrated public health system that is grounded in Native cultures and centered on family and community.
Integration – Holistic Wellness:
Make Important Connections to Integrate our Public Health and Health Care Systems
Respect for Sovereignty:
Expand Advocacy and Influence on Federal Policy to Protect AI/AN Health
Families & Communities:
Support Native Family and Community Well-Being by Creating Healthy Environments
Access and Use Data and Information in a Meaningful Way
“Grow Our Own” Public Health Workforce and Capacity
Culture & Identity
Reclaim, Revitalize, and Reaffirm Indigenous Knowledge and Traditional Practices
Strengthen Public Health Authority as a Function of Sovereignty
Native American concepts of health and well-being not only include an individual’s physical and mental health, but the person’s emotional and spiritual health. This holistic understanding also situates the individual within the context of relationships to family, community, and the environment. However, as currently practiced, most health services delivery only address a specific symptom of illness, leaving out other important, sometimes causative, factors that are absolutely necessary for good health outcomes.
Incorporating the various Native American understandings of health and well-being would mean that tribal health departments integrate the often separate strands of health services delivery: Health care, treatment centers, behavioral health, and public health.
How Integration and Holistic Wellness work in concert with other values:
Ways of life that have sustained Indigenous communities for thousands of years have been assaulted through colonization, genocide, assimilation, and discrimination. Despite this history of loss, many longstanding cultural practices and traditions remain and serve as the basis for cultural renewal and revitalization. These practices and traditions are important for affirming Native Americans’ unique identities, connecting people with the environment, and supporting intergenerational sharing, all of which contribute to good health and well-being.
Reclamation and utilization of these practices can take many forms: the incorporation of tribal healing practices into a treatment regimen; addressing intergenerational trauma through community-based cultural activities; growing & harvesting, or hunting & fishing for traditional, healthy foods; and developing asset-based approaches to research and intervention.
How Culture and Identity work in concert with other values:
The health and well-being of families and communities is at the crux of the public health agenda. Our ability to create healthy environments that support family and community well-being depends on our ability to govern for health, integrate physical and mental health services in a holistic manner, incorporate cultural understandings of what it means to be healthy, and develop and foster positive relationships with local, state, and federal agencies and other important partners.
Because government funding for tribes and urban Indian communities flow through different agencies with different missions, the result is often service delivery in “silos” that are not necessarily coherent with other services. Recently however, the “Health in All Policies” movement recognizes the value of working across sectors to address socioeconomic, cultural, and environmental factors that contribute to health at the individual and community levels. This approach aligns with Indigenous approaches to health.
How Families and Communities work in concert with other values:
The 573 federally recognized nations are legally sovereign according to treaties in which Native tribes ceded land and resources to the U.S. government in exchange for the federal government’s provisioning of health care, education, housing, and other services. All of these programs are severely underfunded.
Instead of competing with other tribes for resources, tribal nations need to work together in inter-tribal groups and national organizations to advocate for rights promised by treaties, including adequate funding for the Indian Health Service, the largest provider of health services for tribal members, as well as for tribal health departments. These organizations can also inform state and federal legislators on the health status of tribal nations, provide relevant tribal data, research the health impact of federal policies, and propose policy recommendations and solutions.
How Respect for Sovereignty works in concert with other values:
Having tribal community members as health services providers brings greater assurances of culturally competent treatment, and with that a greater chance of better health outcomes. Encouraging careers in medicine, nursing, health research, and public health from within the community will go a long way in addressing the chronic shortage of skilled health service providers in rural areas.
Even if there are adequate educational opportunities, however, there still is a lack of funding and workforce investment to place qualified or in-training community people in tribal health departments, and once there, to retain them and provide opportunities for further professional development. Marshalling support for funding additional health care personnel is critical for ensuring that workforce capacity and growth benefit the community.
One way to sustain and maintain personnel would be to create connections laterally across similar tribal departments nationally in a “community of practice,” where professionals would share their expertise and experience, and ask for assistance and opinions from peers.
How Service works in concert with other values:
Data is power: What we collect, how we collect, and how we use data in a health care context affects the quality of care in tribal communities and families. Indigenous peoples have collected and used data for thousands of years to make decisions that affect community survival and community well-being. Data collection must take into account Indigenous perspectives to truly address community needs, reflect community values, and ensure that the community’s ethical principles are met. Data becomes valuable knowledge when it is used in a meaningful way to tell a story about health, develop programs, inform policy, measure impact, and evaluate services.
A major challenge is the lack of funding for developing data infrastructure at all levels—from community clinics, tribal health departments, and even at local and regional levels. Furthermore, when data is collected, it is often stored in isolation: There is a lack of integrated systems to share data that is necessary to place a community’s health story within a larger context, and to source problem-solving solutions employed by other tribal communities.
Tribal Epidemiology Centers (TECs) provide valuable information systems management and surveillance for Tribes and Urban Indian Health Organizations at a regional level. A coordinated effort to build an integrated data infrastructure at a national level can improve quality, increase access, reduce redundancy, and build local capacity. With quality information, we can better understand community health, advocate for policy and systems change, and take measurable action toward improving Native health.
How Indigenous Knowledge works in concert with other values:
A fully functional tribal public health agency has the legitimacy to exercise authority through public health laws, codes, ordinances, and policies. Public health laws and policies support safe environments, for example motor vehicle safety, emergency preparedness, commercial tobacco control, and environmental quality.
One major issue, however, is that the federal and state governments do not recognize tribal public health authority in all realms of public health, often deferring funding to state health departments in the form of block grants; it is therefore the states that often determine how much is granted to tribal health departments.
Another issue is that not all tribes have the infrastructure, capacity, or funding to conduct surveillance or respond to public health emergencies such as outbreaks of disease or natural disasters.
In addition to marshalling resources to fund a robust public health agency, tribes must develop formal relationships with county, state, and federal officials to ensure tribal health issues are addressed with the best possible coordination of personnel and resources
How Tribal Governance works in concert with other values: