Environmental Changes, Indigenous Experiences, and Health Outcomes

Background and Purpose: Indigenous coastal communities, given their attachment to and dependence on the land, are especially vulnerable to environmental changes (Ford, 2012). In addition, indigenous peoples worldwide have poorer health compared to their majority groups (Anderson et al., 2006; Castor et al., 2006; Gracey & King, 2009; King, Smith, & Gracey, 2009; Lama, 2012). The aim of this study is to understand the health outcomes of environmental changes and shared cultural experiences among indigenous peoples in south Louisiana. A community advisory council was developed to guide culturally relevant research procedures.

Methods: This community- engaged study uses a concurrent mixed methods design that involves collecting interviewer-administered surveys (n=160) and in-depth qualitative interviews (n=19) simultaneously, analyzing both sets of data, and then merging those results with the purpose of comparing the results with each other using non-probability sampling strategies. Participants were over 30 years of age, enrolled tribal members, and earned income from subsistence activities. Independent sociodemographic variables including age, gender, first language, “Indian” school attendance, education, relationship status and poverty were examined in relation to health outcomes of healthy days, meeting criteria for DSM-IV diagnosis, and felt health impact. Independent indigenous-specific factors including social support, ethnic identity, discrimination, and historical loss were also examined to test the extent to which observed variation in health outcomes were driven by the variation in indigenous-specific factors and environmental change exposure. Qualitative interviews were coded using thematic analysis.

Results: Logistic regression models suggested that, when controlling for sociodemographic variables, indigenous-specific variables, and exposure to environmental changes, those who experience discrimination were 5.34 times as likely as those who do not experience discrimination (OR = 5.34, CI = 1.56 – 18.92) of meeting criteria for a mental health diagnosis and were 3 times as likely as those who do not experience discrimination of having poor health days (OR = 3.07, CI=1.36 – 6.9). Those who were exposed to environmental changes were 17% more likely as participants not exposed to environmental changes (OR = 1.17, CI = 1.01-1.35) of meeting criteria for a mental health diagnosis. Multiple regression results suggest that, when controlling for sociodemographic variables and indigenous-specific factors, as the environmental change exposure score increases by one unit, participants’ felt health impact scale score increases by .13 points (b=.13, t=6.10, p<.0001). Participants reported institutional barriers to education and economic resources based on their race. Participants also reported how they observed and experienced changes to their environment. Mixed methods results converged. The qualitative results expanded knowledge from survey data to highlight the interconnectedness between environmental changes, indigenous experiences, and health. 

Conclusion and Implications: Indigenous peoples’ relationship with land is spiritual, cultural, and place-specific (Pierotti & Wildcat, 2000; Rosier, 2003; Schultz, et al., 2016; Settee, 2008). Interruption of Indigenous Peoples’ ability to interact with land and discrimination are contemporary forms of trauma. Interventions aimed to address poor mental health with indigenous peoples should include considerations of cultural interactions with the environment, access to care, cultural adaptations of effective treatments, and systems approaches.