Association of American Indian Physicians Disenrollment Background Paper
Submitted By Dale Walker, MD, AAIP Member and Past President
The Association of American Indian Physicians, formed in 1971, is the largest Native
health care organization in North America representing over 400 physicians and their
patients nationwide. Our primary goal is to improve the health of American Indian and
Alaska Natives. Our mission is “to pursue excellence in Native American health care by
promoting education in the medical disciplines, honoring traditional healing principles
and restoring the balance of mind, body, and spirit”.
We are reaching out regarding a matter of great health concern to Indian Tribes and
Nations nationwide. That issue is Tribal Disenrollment. We approach you with great
respect for tribal sovereignty, but also to inform you of the negative health
consequences this will have on both the disenfranchised members and those tribal
members who remain. We ask that you reconsider your disenrollment decision and
consider reinstating these members. A motion for this request was made and, after
debate, it passed unanimously at our recent Annual Meeting in early August 2015.
The critical issues concerning tribal disenrollment are the psychiatric implications and
other medical issues that affect the morbidity and mortality of all members. It is
important to note that not just current families are affected but families of future
generations as well. Those issues are presented below.
IDENTITY: For hundreds of years, the challenge to one’s Native identity was external to
the tribe. Now the focus has shifted to internal forces that challenge who we are. Such
decisions are traumatic to both the ones who lose their identity and other tribal
members who are reminded that disenrollment has been happening over several
generations to all tribal members. Therefore, the intergenerational trauma is continued
and oftentimes made worse. Individual identity and one’s tribal identity are the driving
forces to empowerment and realization, but cultural identity loss leads to grief,
depression, anxiety and more serious mental health problems. It is well known that
these problems lead to longer term health care issues and increases morbidity and
mortality. Tribal disenrollment does not make these problems go away; it makes them
worse. Further, it does not just nullify a person’s tribal affiliation; it strips them entirely of
their cultural identity.
Who determines identity? The fact that it is determined externally to the individual or
family has tremendous impact on the entire family and future generations. It also affects
members inside the tribe who are reminded of their own historical challenges of being
“Indian.”
BELONGING: Having a sense of belonging is a common experience. Belonging means
acceptance as a member or part. A sense of belonging is a human need, just like the
need for food and shelter. Feeling that you belong is most important in seeing value in
life and in coping with intensely painful emotions. A single instance of being excluded
can undermine self-control and well-being and often creates pain and conflict. A sense
of belonging to a greater community improves your motivation, health, and happiness.
When you see your connection to others, you know that all people struggle and have
difficult times. You are not alone. There is comfort in that knowledge. Disenrollment
leaves Natives ‘culturally homeless’. The ability to belong centers an individual’s growth
and development. It provides the safety and security to bond with others in the
community and promote tribal growth and expansion.
MEDICALHEALTH: How long one lives (mortalty) and the quality of health (morbidity)
are directly affected by tribal disenrollment. Access to health care, education
opportunity, job opportunities, and housing are all tied in to social determinants of
health. These will affect not only the disenrolled but other tribal members as well. While
there may seem to be short term gains, the tribe will continue to struggle with these
issues and continue to be divided by political infighting.
SOCIAL, ECONOMIC AND SPIRITUAL WELLBEING: The ramifications of
disenrollment affects the social, economic and spiritual well-being of those who are
facing disenrollment and those who have been disenrolled. It threatens the relationship
between tribal leadership and tribal members because it calls into question the fairness
and legality of their motives. It threatens the continued economic growth and stability of
tribal and Native owned business ventures because the negative press surrounding
tribes involved in disenrollment battles may cause investors to second guess or pull
their funding. It threatens federal funding as well as recognition as tribal entities, since
funding and federal/state tribal recognition is often determined by the number of tribal
members. It opens to door to Federal Government interference with Tribal sovereignty
with added definitions of “Indian”. What’s worse is that it CAN happen to anyone, at any
time and in any tribe regardless of their blood quantum, ancestral lineage, traditional
participation or community standing.
CONCLUSION: Historically, our Native nations were inclusive communities with clear
cultural and spiritual identities. We incorporated other individuals and families into our
community in order to gain in numbers and function. This openness is evidence of our
cultural confidence and generosity that is the hallmark of all Native people. That history
is now challenged by decisions to remove longstanding members with kinship bonds
tied deeply into other tribal families. This inconsistency cannot be overlooked. Please
reconsider your vote of disenrollment and bring your families together. We are
convinced it is for the better mental health of your Indian Tribes and Nations and
will serve as a distinct and hopeful model for all Indian Nations.