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Rarely are AIAN people able to read contributions from AIAN authors or have the opportunity for an immediate, familiar frame of reference in the academic literature. Although these concepts support the idea of using local knowledge and local power to resolve community health disparities 1, 9 – 11 and identify increased capacity, strategies for building capacity, and scales for measuring capacity change, 7 none has been specifically developed by or with indigenous communities.įor the most part, these discussions are taking place in environments where the voices of Native America are seldom heard. 1, 3, 4 Other parallel constructs have informed the literature on community capacity, such as empowerment, 5, 6 the readiness of a community to work to improve existing conditions, 7 and the social capital 8 necessary for communities to move forward and collaborate. The current literature identifies various dimensions of capacity, such as participation, leadership, social supports, sense of community, access to resources, and skills, and their importance in developing and empowering local coalitions. Frameworks for developing community capacity, designed by tribal people for tribal people, would be a positive next step in indigenous health policy. Tribes must be able to advocate for indigenous health in ways appropriate to the needs and realities of indigenous communities. Indigenous people need to define and develop not only health care services but also the underlying theoretical frameworks and strategies for positive change. In addition, a change in thinking about the basic foundation upon which tribal health programs are built is needed. Different approaches to the design of tribal health programs and services are required. With this shift in the locus of power, many tribal public health professionals have looked to community mobilization, empowerment, and capacity-building models as a means of developing locally responsive programming. Anecdotal evidence from tribal leaders suggests that many tribes will benefit from this arrangement. Compacts and contracts with the Indian Health Service for tribal health care are becoming the new status quo. Tribal communities are taking control of their own health services and health promotion efforts. However, as federal funds for AIAN health diminish and health care concerns for AIAN people become increasingly complex, there has been a shift toward increasing tribal self-determination. Since the 1950s, the Indian Health Service has been the primary provider of federally defined health care services for American Indian/Alaska Native (AIAN) people. However, for many tribal communities, the conceptualization and implementation of capacity-building strategies are themselves disparate in that they are based on imported Western frameworks rather than on indigenous epistemologies and indigenous “ways of knowing.” 2
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Various expressions of community capacity have been integrated into indigenous (American Indian and Alaska Native) program designs, many of which have helped involve the community in responding to health disparities. Along with this focus is a growing interest in the continuum of strategies for community capacity building (defined as a community’s potential for responding to health issues 1) and community empowerment as a means of mitigating both disparities and other local health concerns.
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THE CHANGING LANDSCAPE OF AMERICAN INDIAN AND ALASKA NATIVE HEALTHĬurrent health policies are changing perspectives on health and increasingly focusing research and program dollars on effective ways to eliminate health disparities.