Remembering the “Who” and the “How” When Working with Tribal Communities​

Traditionally, public health training focused on the “what” and “when” of understanding the disease or health condition and learning when it is best to intervene was emphasized (Koh, 2014). In other words, traditional public health training was not centered on how to effectively bring about necessary behavior change while considering the identity of tribal communities along with their rich histories, diverse beliefs, and intersecting identities. As public health programs evolve, training should include teaching students about the “who” and “how.” Providing applied experiences where students can work with communities teaches students these concepts. Often non-community members with training may consider themselves the health experts, though we must acknowledge that community members’ expertise on their own context is important for much of our work. Often, we do not belong to the tribal communities we work with, so we must recognize and seek out expert knowledge of tribal members.

Learning about the communities we want to work with (the “who”) requires prioritizing reciprocity and trust building. A common theme in understanding the “who” is building trust via a thorough understanding of community perspectives and establishing relationships through acknowledgement of personal and institutional histories. Without this context, and without trust, it becomes difficult to understand the broader context of a health concern (Israel et al., 2012). This trust is essential given the negative experiences many tribal communities have had with academic institutions, which have a long history of taking advantage of these communities for their own research agendas. In 2010, Arizona State University used blood collected from the Havasupai Tribe across for multiple studies, despite only receiving their consent for one of these studies (Mello & Wolf, 2010). The resulting and well-known legal battle resulted in many tribal communities to be hesitant to work with academic institutions. Given this history and our experiences, building trust in these relationships takes time and patience from both the tribal communities and researcher.

Participatory approaches (e.g., community based participatory research (CBPR), community engaged research) include the people who are directly related to the problem of interest and allow us to understand “how” to incorporate best practices for public health so that they maximize benefit to communities. Participatory principles also include building on the strengths of the community, empowering community members, and facilitating collaborative partnerships in all phases of the work (Israel et al., 2012). One tenant of CBPR emphasizes fostering co-learning. When tribal communities and public health researchers work together, tribal communities can learn about research (e.g., research design, data collection, data interpretation) while public health researchers can learn skills related to working with the community (e.g., how to translate the research findings into action strategies that will benefit the community). This exchange educates public health researchers and allows tribal community members to feel empowered to navigate their communities in solving public health concerns. In learning participatory approaches, we can work with communities in meaningful ways as we seek to mend power imbalances and acknowledge the importance of involving the community. By seeking out opportunities to work with communities, we aim for a greater understanding of contexts, concepts, designs, and approaches that ensure public health solutions are appropriate and applicable to communities.

Given the severity of COVID-19, public health messaging around best practices needed to be created quickly to respond to the urgent need. However, the messages that were created were not practical for many tribal communities, despite our awareness and training in understanding the many factors that impact an individual’s ability to act upon public health messages. It could be speculated that public health officials neglected to recognize the “who” and the “how,” and many already vulnerable communities suffered as a result. As future public health professionals, we have a responsibility to consider the complexity of adhering to public health recommendations such as community contexts and infrastructure. We must learn from this experience and work together with tribal community members to create appropriate public health responses for tribal communities. We are hopeful that students studying public health, including this group of authors, will rise as leaders in their communities to lead this type of work.