Barriers and unmet needs related to healthcare for American Indian and Alaska Native communities: improving access to specialty care and clinical trials

Donald K Warne · Michael Burson · Allison Kelliher · Melissa Buffalo · Jonathan Baines · Michelle Archambault +3 more

20 citations0/0 files storedFrontiers in Health Services

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Indigenous Health, Education, and Rights Indigenous Cultures and History Indigenous Health and Education

Abstract

Substantial healthcare barriers, especially to specialty and cancer care, exist for American Indian and Alaska Native (AI/AN) individuals and communities at all levels. The unique history of AI/AN Tribal Nations and resulting policies, treaties, and relationships with the US government and federal agencies have created specific barriers to healthcare and clinical trial access for AI/AN peoples. Commonly, AI/AN peoples harbor a long-standing mistrust of the healthcare system based on lived and historical experiences. The intersection of various barriers to care for AI/AN communities results in health inequities, lack of representation in clinical research, and other disparities faced by historically marginalized and underrepresented peoples. AI/AN patients face unique barriers in their healthcare journey due to a disproportionate burden of life-threatening and chronic diseases, including many cancers. Identifying barriers specific to AI/AN peoples and improving access to high-quality care, with a focus on building on the strengths and capacities in each AI/AN community are vital to improving health equity. In this review, we describe patient, provider, and institutional barriers to healthcare, particularly specialty care and clinical research, for AI/AN peoples, with a focus on the Northern Plains AI communities. Examples and best practices to improve AI/AN patient access to health services, including screening and specialty care, as well as to clinical research, are provided. We emphasize the importance of longitudinal community-based partnerships and strength- and trust-based approaches as essential components of promoting equitable access to high-quality specialty care and recruitment and participation of AI/AN individuals and communities in clinical research.

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2017Structural racism and health inequities in the USA: evidence and interventions 2017Implicit bias in healthcare professionals: a systematic review 2017Communities in Action 2000The Indian Health Service and the Sterilization of Native American Women 2014American Indian Health Policy: Historical Trends and Contemporary Issues 2004Health Service Access, Use, and Insurance Coverage Among American Indians/Alaska Natives and Whites: What Role Does the Indian Health Service Play?2021Effects of land dispossession and forced migration on Indigenous peoples in North America 2013Moving Forward: Breaking the Cycle of Mistrust Between American Indians and Researchers

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