Social and Structural Determinants of Urban American Indian and Alaska Native Health: A Case Study in Los Angeles

MedEdPORTAL. 2019 May 15;15:10825. doi: 10.15766/mep_2374-8265.10825.


Introduction: American Indians and Alaska Natives (AIAN) experience significant health inequities, yet there are very few curricula dedicated to training a culturally sensitive workforce to care for this population. There is a further dearth of curricula that center on Indigenous values and ways of knowing.

Methods: We developed a 90-minute interactive workshop aimed at increasing faculty and trainee understanding of the social and structural determinants of urban AIAN health. The workshop consisted of a PowerPoint presentation, two videos, an interactive storytelling exercise, and reflection exercises. Participants also completed pre-/postworkshop questionnaires. The workshop was implemented three times at two medical schools.

Results: There were a total of 35 diverse participants. Regarding the effect of the workshop on participants' knowledge base, a comparison of pre- and postworkshop questionnaire responses showed a statistically significant (p < .05) increase in the correct answer being chosen for each question. All participants agreed or strongly agreed that each of the three learning objectives had been met. Participants particularly valued the workshop's interactive nature, as well as its use of storytelling and multimedia to reinforce policy impact.

Discussion: This workshop provided an interactive and effective method to increase participant knowledge of the importance of a land acknowledgment, of connecting federal Indian policy to health outcomes, and of how AIAN identity may impact access to health care.

Keywords: Alaska Natives; American Indian and Alaska Native; Community-Based Medicine; Cultural Competence; Diversity and Inclusion; Editor's Chioce; Health Equity; Health Policy; Historical Trauma; Intergenerational Trauma; Population Health; Social Determinants of Health; Structural Determinants; Urban.

Publication types

  • Case Reports

MeSH terms

  • Alaskan Natives*
  • Cultural Competency*
  • Delivery of Health Care
  • Health Equity*
  • Humans
  • Indians, North American*
  • Los Angeles
  • Social Determinants of Health*
  • Surveys and Questionnaires