Addressing health inequities with American Indian and Alaska Native kids and teens

Recent research has indicated that many non-White children experience poorer outcomes than their White peers and the pandemic, with its increased toll on non-White Americans, has further illustrated the need to address health inequities. A policy statement from the American Academy of Pediatrics addresses how pediatricians are in a key position to improve health outcomes of American Indian and Alaska Native (AI/AN) children and teenagers.¹

The statement first examines important areas where AI/AN children and teenagers are at increased risk of negative outcomes. Children who were AI/AN are more likely to experience multiple adverse childhood experiences than non-Hispanic White children. Obesity is more prevalent in AI/AN children than other children and the prevalence has been increasing in AI/AN children, even as it decreased in other groups. Poor oral health is another major public health concern for AI/AN children and many of them have limited access to dentists because of lack of recruitment to the Indian Health Services.

The statement has several recommendations for how pediatricians can provide improved care to AI/AN pediatric patients:

• Work with local tribes and communities to set health priorities and understand the historical experiences and context
• Promote using home visiting, high-quality children care, and using early childhood programs
• Use the Reach Out and Read program to promote literacy
• Completely assess the AI/AN child for adverse childhood experiences and social determinants of health
• Train staff in cultural sensitivity
• Discuss the positive effects of breastfeeding and provide support to breastfeeding mothers
• Include oral health programs in the practice
• Make the practice a medical home that is aware of potential discrimination and is sensitive to the multigenerational trauma and racism that AI/AN children experience
• Screen for substance use

The statement also included recommendations for public policy advocacy:

• Advocate for and engage in research and clinical pathways that lead to culturally relevant screenings and interventions for adverse childhood experiences
• Support an improved budget for the Indian Health Service and increased Medicaid coverage
• Work with local tribes and communities to address missing and murdered Indigenous women and girls

Reference

1. Bell S, Deen J, Fuentes M, Moore K, Committee on Native American Child Health. Caring for american indian and alaska native children and adolescents. Pediatrics. March 22, 2021. Epub ahead of print. doi:10.1542/peds.2021-050498