The Native Americans of Minnesota: Culture, Healthcare Beliefs, and Oral Health Disparities

Abstract

The Native Americans of Minnesota are a diverse and culturally rich group of people.  Through generations of European colonization, the population has dwindled and many were sent to live in reservations across the state.  Today there are around 61,000 Native Americans across the state, which is only 1.1% of the population.  These people have a historical connection to the land, and their customs and practices reveal this in how they approach healthcare.  Many Native Americans still consult medicine men and women, who use a variety of naturopathic remedies, prayers, and songs to treat sickness.  Native Americans experience some of the worst oral health disparities in the nation because of lack of access to care. A majority of the counties in MN are Dental Health Professional Shortage Areas (HPSAs).  The lack of federal funding for the Indian Health Services causes shortages in dental care providers and diminished care for Native Americans in the state.

The Native Americans of Minnesota: Culture, Healthcare Beliefs,

and Oral Health Disparities

Minnesota, though predominately occupied by white people of Scandinavian and German descent, contains a unique blend of people groups from varying cultures.  One of the oldest groups to have inhabited the state are the Native Americans.  In order to adequately provide oral health care to this population of people, it’s important to understand the history, culture, and hardships they face.  The Native Americans in Minnesota, having experienced a history of mistreatment and neglect, still have a rich cultural heritage displayed across the state, yet experience some of the worst oral health disparities in the country as a result of limited access to healthcare resources, as well as poor social and economic conditions.

Native American Population and Culture

The indigenous populations of Native Americans were settled in the Minnesota area thousands of years before European explorers and settlers began staking claim in the area.  The name “Minnesota” is actually a Dakota Indian term that means “Whitish or Sky-tinted water”. (History of Minnesota, 2018) Early Minnesota natives took advantage of the land’s rich natural resources through hunting, fishing, cultivating and harvesting crops, and gathering wild rice along riverbeds. (Minnesota Historical Society, 2008) Starting as early as the late 1500s, Europeans began to discover and do business with the Native Americans, respecting their sovereignty and establishing a rich fur trade industry along the Mississippi river. (Minnesota Historical Society, 2008) Unfortunately, over the course of several hundred years, European colonization forced the tribes of Native Americans in Minnesota to surrender their natural way of life, as well as a majority of the land they had occupied for centuries.  Starting around 1805, the US government began making treaties with the Native Americans, purchasing and trading for large amounts of their land, many times by dishonest means. Finally, when Minnesota became a state, and after the U.S.-Dakota War in 1863, the Native Americans were forced to surrender all of their remaining land in Minnesota and relocate to reservations across the state. (Minnesota Historical Society, 2008) “A reservation is land which was retained by American Indians after having ceded large portions of it to the United States government via treaty agreements. Most reservations were created by treaties, but some were created through executive order or by other agreements.” (11 nations and flags of Minnesota Native Americans, 2016)

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Today, Minnesota is home to around 61,000 Native Americans, which is about 1.1% of the population. (American Indians in Minnesota, 2019) This population represents 11 sovereign American Indian nations comprised of seven Ojibwe federally recognized reservations, and four Sioux communities. (11 nations and flags of Minnesota Native Americans, 2016) A larger number of individuals, over 100,000 people, in Minnesota identify as “American Indian and Alaska Native persons” in part or in combination with another race.  Of this number, only 20% live on a reservation, and the rest reside in counties adjacent to reservations or elsewhere throughout the state. (Mullen, 2017)

After centuries of European influence and culture assimilation, Minnesota Native Americans are now promoting a resurgence of cultural awareness.  John Poupart stated, “It is important to note that Indians have adapted in varying ways to mainstream social values.  Still most retain the traditional beliefs of their ancestors.  They have become masters of a bi-cultural and pluralistic society and have learned to survive in two worlds.” (as cited in Graves, 2006, p. 3) There is a strong desire among the leaders of the Native American community to educate and carry on the values and traditions once held by their ancestors.  Programs to help facilitate the teaching of the Native American language have been incorporated into the education system, tribes have annual powwows to commemorate Native American pride, and numerous arts and cultural awareness events are held across the state of Minnesota to celebrate and educate the public in Native culture. (Graves, 2006) Even though their population may be small across the state, the rich heritage of the Native American people will continue to grow and flourish throughout the cities, counties, and reservations across Minnesota.

Native American Beliefs About Healthcare

Native American culture not only affects the daily life and artistic expression of the people, but it also plays a part in the way they view healthcare.  Any attempt to bring quality healthcare to this group of people will require at least a baseline knowledge and understanding of Native beliefs and practices.  As Beatty states: “Health is culture bound.  This means that culture influences the conceptions, perceptions, expressions, and approaches to health…at both the individual and community levels.” (2017, p. 246) Native American beliefs about healthcare center around a few guiding principles:  A deep connection to the earth and others through the Great Spirit, a calling to live in balance with the universe, and the use of medicine men and women.

Connection to the Great Spirit

Native Americans across the nation have different names for what is considered the Great Spirit, or the Great Mystery.  The Sioux use the name “Wakan Tanka” (Wakan Tanka, 2019) and the Ojibwe use the name “Gihze-manidoo” (Ojibwe People’s Dictionary, 2015) to describe the Spirit that is alive and imbedded in all of creation.  “The Great Spirit informs all of life and the traditions and rituals are meant to connect humans with that power.” (Metropolitan Chicago Healthcare Council, 2004, p.1) This belief system is evident in the way the Native American people show a distinct reverence and appreciation for nature and the connection they have with the universe.

 Walking in Beauty

Another aspect of Native American culture related to healthcare is the principle of walking in beauty.  “Walking in the sacred way”, or “walking in beauty” simply means to live in balance and harmony with the universe and with the spirit world. (Metropolitan Chicago Healthcare Council, 2004, p.2) They accomplish this by hearing and passing on the sacred teachings of the past, by prayer and fasting, and through participating in various cultural bonding activities and events.  Native Americans commonly integrate singing, dancing, drumming, worship, and purification rites as ways to connect with each other and to “walk in beauty”.

Medicine men and women

Finally, Native Americans will often consult the help of medicine men and women when in need of health care or healing.  They believe that the Great Spirit blessed these men and women with the ability to cure diseases and promote health.  “For thousands of years, traditional indigenous medicine have been used to promote health and wellbeing for millions of Native people who once inhabited this continent. Native diets…and the use of native plants for healing purposes have been used to live to promote health by living in harmony with the earth.” (Koithan & Farrell, 2010) Many Native American healthcare facilities across the state will integrate these individuals alongside traditional modern medicine.

Native American Oral Health Issues

Despite a rich cultural heritage and a belief system that integrates a holistic connection to nature, Minnesota Native Americans suffer some of the worst oral health issues among the people of the state.  The 2015 Indian Health Service Data Brief reported some astonishing statistics regarding the oral health of American Indian and Alaska Native (AI/AN) children nationwide:  More than half of AI/AN children (54%) between 1-5 years of age have experienced tooth decay.  Preschool AI/AN children have the highest level of tooth decay of any population group in the US, which is more than 4 times higher than white non-Hispanic children.  On average, AI/AN children have 4 teeth with decay experience while white non-Hispanic children have about 1 tooth with decay. (Phipps & Ricks, 2015)  “More astonishing is the 87% of American Indian and Alaska Native children aged 6–14 years and 91% of the 15- to 19-year-olds who have a history of tooth decay.” (Benjamin, 2010)

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Similar stats have been reported concerning AI/AN adults:  Regardless of age, AI/AN adult dental patients have a substantially higher prevalence of untreated caries than the general U.S. population.  About 83% of AI/AN adult dental patients aged 40-64 years have lost at least one permanent tooth compared to 66% of the general U.S. population of the same age.  AI/AN adults are more likely to have periodontal disease.  About 10% of U.S. adults (30+ years of age) have severe periodontal disease compared to about 17% of AI/AN dental patients aged 35+ years.  (Phipps & Ricks, 2016)

Factors Contributing to Poor Oral Health

Numerous factors contribute to the unfortunate oral health conditions in the Native American population.  One of the main contributors is poverty.  According to data from NHANES, children living at or below the US federal poverty level have substantially higher rates of caries than those not living in poverty. (Warren, 2016)  A recent 5-year estimate indicates that 36% of American Indian or Alaska Natives living in Minnesota are in poverty, the second highest prevalence compared to the other racial/ethnic groups. (Minnesota Department of Health, 2014)

Poverty in Native American families contributes to dental caries and other health related factors by severely reducing the quality of food families are able to purchase.  “Financial constraints often mean that American Indians in Minnesota consume a diet based on inexpensive fast food restaurant offerings and processed foods that are high in carbohydrates, sweeteners, and salt.” (Stratis Health, 2019) Historically, Native American diets and the use of plants for healing purposes have been used to promote health by living in harmony with the earth. But more recently, younger generations of Native people are abandoning these customs and succumbing to an “American diet” that is high in carbs, sugars, and saturated fats. (Koithan & Farrell, 2010)

Along with poverty and a poor diet, smoking is another factor that contributes to poor health among Minnesota Native Americans.  Tobacco has played a large role in Native cultural traditions throughout history.  Today, 59 percent of American Indians smoke, which is four times the rate of the general population. (Stratis Health, 2019) Not only is smoking a risk factor for cardiovascular disease, but it is also a risk factor for periodontal disease.  According to the Indian Health Service, prevalence of severe periodontal disease is higher among AI/AN adults who smoke than among non-smokers (28% vs. 15% respectively).  (Phipps & Ricks, 2016) All of these factors contribute to the poor oral health statistics seen in the Native population.

Health Disparities Minnesota Native Americans

Native Americans experience some of the worst health disparities of any minority group in the state.  Regina Benjamin, who served as Surgeon General, stated: “The silent epidemic of oral diseases disproportionately affects disadvantaged communities, especially children, the elderly, and racial/ethnic minority groups.” (2010) A large reason for these disparities is lack of access to dental care.

Lack of Access

There are a number of factors that affect the lack of access to dental care experienced by the Native Americans.  The first is the large number of individuals who are in areas considered Dental Health Professional Shortage Areas (HPSAs).  These areas of the country are designated as having shortages of primary care, dental care, or mental health providers and may be geographic (a county or service area), population (e.g., low income or Medicaid eligible) or facilities. (Health Resources & Services Administration, 2019) In 2014, an astonishing 2.4 million Native Americans lived in counties with dental care shortage areas, and half of all Native American children lived in a shortage area. (Mendes, 2015) In January 2018 it was reported that over half of Minnesota counties were designated as full county Dental HPSAs and 7 percent were designated as partial county Dental HPSAs. (Minnesota Department of Health, 2018)

Many shortages occur throughout the state and country because of a lack of dental staff.  Most private practice dentists choose to work in areas of the state that can support them financially.  And the Indian Health Service, responsible for providing care to millions of Native Americans across the country, lacks the Federal funding to attract any dental health professionals to these much-needed areas of the state.  For example, there is 1 dentist for every 2800 individuals in the IHS and tribal health clinics, compared with 1 dentist for every 1500 individuals in the general population. (Nash, 2005) These financial disparities are also revealed in the fact that the U.S. Indian Health Service spent an average of only $99 per person on dental care in 2009, compared with average per capita spending of $272 nationwide. (Mendes, 2015) With limited funding and a severe lack of dental professionals willing to work in areas of need, it’s no wonder why Native Americans have so many oral health issues.

Conclusion

The Native American people of Minnesota have suffered many hardships throughout the past several hundred years at the hands of those who would take advantage of their kindness and peaceful spirit.  Disparities in all areas of health are still rampant today as a result of those historical adversities.  Limited access to healthcare and poor economic conditions have been large factors in the inequalities they face.  But the Native people of Minnesota still look forward to passing on their customs and traditions to the next generation.

References

• “11 nations and flags of Minnesota Native Americans”, (2016, October 6).  Retrieved from https://www.metrostate.edu/metrocatalyst/11-nations-and-flags-of-minnesota-native-americans
• Beatty, C. F. (2017). Community oral health practice for the dental hygienist. St. Louis, MO: Saunders.
• Benjamin, R.M. (2010). “Oral health: The silent epidemic”. Public Health Reports. 125(2). 158-159. doi: 10.1177/003335491012500202
• Graves, K. D., & Ebbott, E. (2006). Indians in Minnesota (5th ed.). Minneapolis: University of Minnesota Press.
• Health Resources & Services Administration. (2019). “HPSA Find”. Retrieved from https://data.hrsa.gov/tools/shortage-area/hpsa-find
• “History of Minnesota”. (2018, January 16). Retrieved from https://www.warpaths2peacepipes.com/history-of-native-americans/history-of-minnesota-indians.htm
• Koithan, M., & Farrell, C. (2010). “Indigenous Native American healing traditions”. JNP, 6(6), 477-478. doi:https://doi.org/10.1016/j.nurpra.2010.03.016
• Mendes, M. (2015, July 23). “The Oral Health Crisis Among Native Americans”. Retrieved from https://www.pewtrusts.org/en/research-and-analysis/fact-sheets/2015/06/the-oral-health-crisis-among-native-americans
• Metropolitan Chicago Healthcare Council. (2004). Guidelines for healthcare providers interacting with American Indian (Native American; First Nation) patients and their families. Retrieved from https://www.advocatehealth.com/assets/documents/faith/cg-native_american.pdf
• Minnesota Department of Health. (2018). “Dental workforce shortage areas”.  Retrieved June 20, 2019, from https://data.web.health.state.mn.us/web/mndata/hpsa-access
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• Mullen, Mary.  (2017, January).  American Indians, Indian Tribes, and State Government (6^th ed.).  Retrieved from https://www.house.leg.state.mn.us/hrd/pubs/indiangb.pdf
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• Phipps, K. R., & Ricks, T.L. “The oral health of American Indian and Alaska Native children aged 1-5 years:  Results of the 2014 IHS oral health survey”.  Indian Health Service data brief. Rockville, MD:  Indian Health Service. 2015.  Retrieved from https://www.ihs.gov/doh/documents/IHS_Data_Brief_1-5_Year-Old.pdf
• Stratis Health. (2019)  “Native Americans of Minnesota: Common health equity issues for American Indian populations”.  Retrieved from http://www.culturecareconnection.org/matters/diversity/americanindian.html
• “Wakan Tanka”. (2019, March 29). Retrieved from https://en.wikipedia.org/wiki/Wakan_Tanka
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