This dissertation from a geographical perspective analyzes the need and potential of self-‐ determined Indigenous health care structures amongst Indigenous nations of Washington State, USA for the improvement of Indigenous mental health status. Dramatic inequalities dominate Indigenous health. Mental health problems, chronic stress, substance use as well as suicide are over proportionately high within Indigenous communities who have a significantly lower life expectancy the world over. At the same time Indigenous nations are exposed to lack of health care, culturally appropriate services and oftentimes discrimination and institutional racism. Through endeavors of self-‐determination since the 1960s Indigenous nations have started to establish Indigenous health care systems to improve health care provision and lay the basis for an upward trend in their (mental) health status. At the institutional level self-‐governed clinics offer culturally sensitive services based on Indigenous models of integrative care. At the community level public health movements have been initiated that are based on traditional knowledge and on revitalization of Indigenous cultural practices to improve health status.
There has been little research done in any discipline pertaining to the specific regional needs and types of as well as distribution of Indigenous healing services. Very few geographers have explored how cultural values and cosmovisions shape Indigenous health – not to mention the connection between place, identity and health and the importance of cultural and therapeutic landscapes in Indigenous peoples’ everyday lives. In this regard geographers possess valuable knowledge and interdisciplinary skills that can be harnessed for the analysis of comprehensive systems of health and care as a means of ensuring wider coverage of service provision particularly to minority groups such as Indigenous peoples. Incorporating local Indigenous peoples’ perspectives of (mental) health and place the dissertation wants to contribute to the emerging field of Indigenous mental health geographies. Using mainly qualitative methods the thesis tries to ‘map’ an Indigenous cultural approach to understanding the underlying factors behind Indigenous consistent poor health and methods to eliminate health disparities.
The study comes to the conclusion that self-‐governed health care institutions can improve service provision at the institutional level. The analysis of community based health interventions attest use of traditional medicinal knowledge to be an adequate instrument to improve psychological well-‐being among Indigenous nations in the research area.
Die vorliegende Doktorarbeit erforscht aus kulturgeographischer Perspektive Bedarf und Potential selbstbestimmter Gesundheitsversorgung im Bereich psychischer Gesundheit für indigene Gemeinschaften im Bundesstaat Washington, USA.
Weltweit bestehen große gesundheitliche Disparitäten in indigenen Gemeinschaften, die zu den Gruppen mit dem schlechtesten Gesundheitsstatus zählen. Im Bereich psychischer Gesundheit haben Substanzmissbrauch und Suizid teils ein epidemisches Ausmaß erreicht.
Seit den 1960er Jahren findet das Konzept indigener Selbstbestimmung vermehrt Anwendung im Bereich indigener Gesundheitsversorgung. Eine wachsende Zahl von indigen verwalteten Gesundheitseinrichtungen bietet kultursensible Dienste an, die der effizienteren Versorgungsleistung dienen sollen. Gleichzeitig ist im nicht-institutionellen Kontext das Phänomen einer wachsenden kulturellen Bewegung für bessere Lebensqualität und Gesundheit indigener Nationen zu beobachten. Diese basiert auf der Anwendung traditionellen Wissens von ganzheitlichen Heilkonzepten.
Diese rezenten Bestrebungen werden in der Arbeit im Untersuchungsraum aus geographischer Sicht analysiert.
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