Background: Indigenous populations across the world are more likely to suffer from poor health outcomes when compared to other racial and ethnic groups. Although these disparities have many sources, one protective factor that has become increasingly apparent is the continued use and/or revitalization of traditional Indigenous lifeways: Indigenous language in particular. This realist review is aimed at bringing together the literature that addresses effects of language use and revitalization on mental and physical health.Methods: Purposive bibliographic searches on Scopus were conducted to identify relevant publications, further augmented by forward citation chaining. Included publications (qualitative and quantitative) described health outcomes for groups of Indigenous people who either did or did not learn and/or use their ancestral language. The geographical area studied was restricted to the Americas, Australia or New Zealand. Publications that were not written in English, Spanish, French, Portuguese or German were excluded. A realist approach was followed to identify positive, neutral or negative effects of language use and/or acquisition on health, with both qualitative and quantitative measures considered.Results: The bibliographic search yielded a total of 3508 possible publications of which 130 publications were included in the realist analysis. The largest proportion of the outcomes addressed in the studies (62.1%) reported positive effects. Neutral outcomes accounted for 16.6% of the reported effects. Negative effects (21.4%) were often qualified by such issues as possible cultural use of tobacco, testing educational outcomes in a student’s second language, and correlation with socioeconomic status (SES), health access, or social determinants of health; it is of note that the positive correlations with language use just as frequently occurred with these issues as the negative correlations did.Conclusions: Language use and revitalization emerge as protective factors in the health of Indigenous populations. Benefits of language programs in tribal and other settings should be considered a cost-effective way of improving outcomes in multiple domains.

Background: Indigenous people experience the greatest cardiometabolic disease disparity in the Unites States, yet high cardiometabolic disease risk factors do not fully explain the extent of the cardiometabolic disease disparity for Indigenous people. Stress, trauma, and racism occur at high rates within Indigenous communities and have not been well explored as significant contributors to cardiometabolic disease disparities despite emerging literature, and therefore will be described here. Methods: This descriptive study explores the relationship between cardiometabolic disease risks and Indigenous-specific stressors (e.g., early childhood stress and trauma, adulthood stress and trauma, and historical and intergenerational trauma) using current literature. Indigenous-specific protective factors against cardiometabolic disease are also reviewed. Results. Increasing research indicates that there is a relationship between Indigenous-specific stressful and traumatic life experiences and increased cardiometabolic disease risk. Mental health and psychophysiology play an important role in this relationship. Effective interventions to reduce cardiometabolic disease risk in Indigenous communities focus on ameliorating the negative effects of these stressors through the use of culturally specific health behaviors and activities. Conclusions: There is increasing evidence that cultural connection and enculturation are protective factors for cardiometabolic disease, and may be galvanized through Indigenous-led training, research, and policy change.

Indigenous populations experience dramatic health disparities; yet, few medical schools equip students with the skills to address these inequities. At the University of Minnesota Medical School, Duluth campus, a project to develop an Indigenous health curriculum began in September 2013. This project used collaborative and decolonizing methods to gather ideas and opinions from multiple stakeholders, including students, community members, faculty, and administration, to guide the process of adding Indigenous health content to the curriculum to prepare students to work effectively with Indigenous populations. A mixed-methods needs assessment was implemented to inform the instructional design of the curriculum. In June 2014, stakeholders were invited to attend a retreat and complete a survey to understand their opinions of what should be included in the curriculum and in what way. Retreat feedback and survey responses indicated that the most important topics to include were cultural humility, Indigenous culture, social/political/economic determinants of health, and successful tribal health interventions. Stakeholders also emphasized that this content should be taught by tribal members, medical school faculty, and faculty in complementary departments (e.g., American Indian Studies, Education, Social Work) in a way that incorporates experiential learning. Preliminary outcomes include the addition of a seven-hour block of Indigenous content for first-year students taught primarily by Indigenous faculty from several departments. To address the systemic barriers to health and well-being and provider bias that Indigenous patients experience, this project sought to gather data and opinions regarding the training of medical students through a process of Indigenizing research and education.

Introduction. There is increased evidence for the effectiveness of integrated behavioral health care, however, it is unknown if integrated care is effective or culturally appropriate for Indigenous populations—the population with the largest health disparities in the nation. Methods. We conducted a literature review to analyze the state of Indigenous health care focusing specifically on the appropriateness of integrated care in this population. Results. Integrated care could improve access to comprehensive care, quality of care, and may be a promising model to reduce health disparities for Indigenous people. Discussion. Indigenous people experience significant barriers to effective health care services that require strategic, systemic, and collaborative interventions to close these gaps. Integrated care appears to be an appropriate solution but additional research is needed to determine this. Further, any health intervention must be carried out in collaboration with tribal communities and nations to ensure success.

Introduction: Indigenous youth and young adults endure some of the highest rates of physical and mental health problems in the United States compared to their non-Indigenous counterparts. Colonization, oppression, and discrimination play a substantial role in these inequitable disease rates. However, culture (e.g., identity, participation, and connection) relates to the prevention of and recovery from illness in Indigenous populations. The Remember the Removal program aims to teach Indigenous youth and young adults tribally specific culture, history, and language to put them on a trajectory to become informed and culturally connected community leaders. We examined the program’s effects on health. Method: Thirty Remember the Removal program participants, mainly young adults, completed surveys four times: before the program’s start, at the end of the training period, at the program’s end, and at a six-month follow-up. Various indicators of physical, mental, spiritual, and cultural health and well-being were measured at each time period. Paired t-tests were completed to compare baseline scores to each subsequent time interval. Results: At program completion, and as indicated with an asterisk at the six month follow-up, participants had statistically significantly improved diet and exercise measures (e.g., reduced sugary, salty, and fatty foods, reduced soda consumption, increased fruit consumption, and improved self-efficacy for exercise), improved mental health indicators (e.g., reduced stress, anxiety, depression*, anger*, post-traumatic stress disorder, and microaggressions*, and improved positive mental health) and improved social and cultural connection (e.g., social support, Cherokee identity*, Cherokee values). Discussion: This is one of the first quantitative studies to demonstrate the profound effects that cultural learning and connection have on the health and well-being of Indigenous people and practices. It also demonstrates the specificity and effectiveness of a program created by and for tribal citizens. Future programs with Indigenous populations should work to center cultural connection and ensure that programs are created and directed by tribal community members.

Purpose: Indigenous patients experience a variety of healthcare challenges including accessing and receiving needed healthcare services, as well as experiencing disproportionate amounts of bias and discrimination within the healthcare system. In an effort to improve patient-provider interactions and reduce bias towards Indigenous patients, a curriculum was developed to improve first-year medical students’ Indigenous health knowledge. Method: Two cohorts of students were assessed for their Indigenous health knowledge, cultural intelligence, ethnocultural empathy, and social justice beliefs before the lecture series, directly after, and 6 months later. Results: Results of paired t test analysis revealed that Indigenous health knowledge significantly improved after the training and 6 months later. Some improvements were noted in the areas of cultural intelligence and ethnocultural empathy in the second cohort. Conclusions: It is feasible to teach and improve Indigenous-specific health knowledge of medical students using a brief intervention of lectures. However, other critical components of culturally appropriate care including social justice beliefs and actions, ethnocultural empathy, and cultural humility may require increased and immersed cultural training.