Decolonizing Evidence to Better Support Native Communities
Every November, Americans celebrate National Native American Heritage Month. During this time, we are encouraged to appreciate native cultures through self-education on indigenous history (which does not include watching Disney’s “Pocahontas”), making donations to organizations serving native populations, visiting reservations, and even “decolonizing” Thanksgiving. What Americans are not encouraged to do is to upend the fundamentally colonial, racist systems that result in perpetually poor health outcomes, including high suicide and substance abuse rates, and underinvestment in native communities.
A 2019 report by Native Americans in Philanthropy and Candid found that “from 2002 to 2016, large U.S. foundations gave, on average, 0.4 percent of total annual funding to Native American communities and causes.” The problem of philanthropic underinvestment in indigenous communities is exacerbated by the fact that billions in available federal funding are made unattainable due to many culturally-appropriate interventions targeting native communities not being considered evidence-based.
During the years I worked in philanthropy, I continually witnessed grantees struggle to obtain funding for critical programs and interventions in native communities. Those that sought to incorporate indigenous healing practices into their approach were overlooked by funders and federal agencies due to a preference to fund evidence-based practices, defined by the Substance Abuse and Mental Health Services Administration as “practices that integrate the best research evidence with clinical expertise and patient values.” Unfortunately, indigenous cultural practices are often undermined as being “alternative” or “quackery” in comparison to narrow Western standards of evidence that hold clinical and randomized controlled trials as the gold standards. Therefore, the criteria that determine evidence-based practice intrinsically excludes native traditions and culture.
We need new, inclusive standards for evidence-based practice and a better approach to supporting native communities.
In order to be considered evidence-based, a program must be regarded as “universally effective.” While this requirement may seem like a positive so that evidence-based programs can be replicated in a variety of communities to reach the largest possible population, this distinction makes it inherently impossible for interventions grounded in native healing practices to be considered evidence-based since they are not generalizable to the greater population. This criterion—along with others such as a lengthy, expensive evaluation process that requires often elusive funding given the underinvestment in native communities—gives preference to Western, mainstream community norms and creates a vicious cycle that fosters continued underinvestment and perpetuated disparities in native communities.
Organizations that have attempted to develop evidence-based programs that address the unique challenges facing indigenous communities, including historical trauma, continue to struggle. The National Indian Child Welfare Association’s (NICWA) Positive Indian Parenting program (PIP) is a culturally-appropriate version of the mainstream evidence-based Positive Parenting Program, which uses the parenting and family support system to prevent and treat behavioral and emotional problems in children and teenagers. Despite PIP being deemed effective by the First Nations Behavioral Health Association and showing positive results among participants, NICWA has been unable to secure funding for, or been able to find a large enough population in which to conduct, the required randomized control trial for PIP’s evidence-based program evaluation, given the small percentage of the U.S. population that identifies as Native American.
This reality pokes a large hole in the argument made by those in scientific and practice communities who treat randomized control trials as the gold standard for robust research evidence, as their argument completely ignores that this standard isn’t attainable for certain populations. Despite guidelines on how to adapt existing evidence-based programs to be culturally appropriate to overcome the inevitable “intervention-consumer mismatch” in native communities, these guidelines require native communities to adapt Western practices and settle for programs deemed merely “effective,” instead of having native practices be considered evidence-based in the first place. This unsatisfactory solution only further otherizes native communities’ cultures, identities, and traditions. As a result, there exist very few evidence-based programs that integrate indigenous cultural practices and target native communities.
We need new, inclusive standards for evidence-based practice and a better approach to supporting native communities. Federal agencies must decolonize the process for determining and evaluating evidence-based programs by collaborating with native peoples and organizations to address the specific needs, practices, and traditions of native communities in the evaluation criteria. Evaluation protocols must be amended to account for small native population size and must value native knowledge as equal to other forms of expertise. Funders must be willing to support interventions that may be outside their usual wheelhouse of grantees. To atone for a historical dearth of support, funders must commit to investing a certain percentage of their endowment in native communities.
We can, and must, do better. We can, and must, hold ourselves accountable by taking steps to genuinely appreciate and support indigenous cultures and communities, not just one month a year, but year-round. Only then will we begin to see improved outcomes in native communities that have historically been ignored, underserved, and underappreciated.
McKenzie Bennett is a 2021 MPH degree candidate in the Department of Population and Family Health. She previously worked at the Doris Duke Charitable Foundation in the Child Well-being Program, which focuses on supporting American Indian/Alaska Native communities.
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