Association of American Indian Physicians Background Paper on Disenrollment
Submitted By Katya Adachi, AAIP Board Member
The Association of American Indian Physicians, formed in 1971, is the largest Native health care
organization in North America, representing over 400 physician members and their patients
nationwide. Our primary goal is to improve the health of American Indian and Alaska Natives.
AAIP’s 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”.
Strong community engagement provides American Indian/Alaska Natives (AI/AN) with a sense
of belonging and cultural identity that is crucial for the physical, mental, and spiritual health
and wellness of our people. Maintaining strong community engagement is an important
protective factor for the health of AI/AN people. Specifically, strong cultural identity has been
shown to be a preventative factor against suicide.1 Community engagement and positive
cultural identity is also important to healing historical trauma. As Braveheart and DeBryun
describe, “communal support, strength, identity, and the maintenance or replacement of
extended family networks as well as communal responses facilitate healing from unresolved
grief.” 2 In the Indigenist model of mental health, described by Walters, Simoni, EvansCampbell, “poverty has been described as being without relatives” and “reconnecting the ‘sick’
person with family and community is central to the healing process.”3 Disenrollment thus
perpetuates historical trauma by creating a loss of community and culture that further worsens
the individual’s “implicit, unresolved, fixated, or anticipatory grief about perceived
abandonment as well as affiliated cultural disruption”2 that is associated with historical loss.
Historical loss has been found strongly associated with depression4, PTSD, and poly-drug use in
Native youth5. Exposure to historical loss, the symptom manifestation of historical trauma, is
now understood as a “relevant ACE (adverse childhood events) factors for Native American
populations.”5 The resultant health risks are significant. These health risks include “high rates of
suicide, homicide, accidental deaths, domestic violence, child abuse, and alcoholism, as well as
other social problems. Suicide rates are high among our American Indian/Alaska Native nations
and, in particular, suicide rates are highest among our youth.”2 Historical trauma poses
significant health risks due to the “accompanying self-destructive behaviors that have been
passed from generation to generation.”2 Thus the cultural and historical loss impact of
disenrollment thus affects both current and future generations.
Disenrollment further worsens the impact of these health risks through its impact on the social
environment, including access to health care, housing and opportunities in education and
employment, which are known social determinants of health that contribute to health
disparities. 6
Thus, it is clear that the health of Indian Tribes and Nations are only as healthy as their
community members. The Association of American Indian Physicians respects the sovereignty
of all Indian Tribes and Nations to determine their membership. In the interest of the health of
American Indian/Alaska Native people, the Association of American Indian Physicians urges
Indian Tribes and Nations to reconsider decisions to dis-enroll and to consider re-enrollment of
former tribal members in order to improve the health of Native American individuals,
communities, Tribes and Nations.
1. BigFoot, DS. Cultural Issues in Historical Trauma and Implications for Youth at Risk. 2007.
2. Brave Heart, MYH, DeBruyn, LM. The American Indian holocaust: Healing historical
unresolved grief. Amer Indian and Alaska Native Mental Health Research, 1998; 8(2): 6082.
3. Walters, KL, Simoni, JM, Evans-Campbell, T. Substance Use Among American Indians and
Alaska Natives: Incorporating Culture in an "Indigenist" Stress-Coping Paradigm. Pub
Health Reports, 2002; 117(S1):S104-S117.
4. Whitbeck, L., Walls, M., Johnson, K., Morrisseau, A., & McDougall, C. (2009). Depressed
affect and historical loss among North American indigenous adolescents. American
Indian Alaska Native Mental Health Research, 16(3), 16–41.
5. Brockie, NT, Dana-Sacco, G, Wallen, GR, Wilcox, HC, Campbell, JC. The Relationship of
Adverse Childhood Experiences to PTSD, Depression, Poly-Drug Use and Suicide Attempt
in Reservation-Based Native American Adolescents and Young Adults. Am J Community
Psychol, 2015. 1-11.
6. US Dept. of Health & Human Services. Healthy People 2020: An Opportunity to
Address Societal Determinants of Health in the United States: Secretary’s Advisory
Committee on National Health Promotion and Disease Prevention Objectives for 2020,
2010.