Cultural humility
“Culture is the whole complex of distinctive spiritual, material, intellectual and emotional features that characterizes a society or a group. It includes creative expressions, community practices and material or built forms” – Our Creative Diversity: The UN World Commission on Culture and Development Report
Humility
Cultural Humility is “a reflective process of understanding one’s biases and privileges, managing power imbalances, and maintaining a stance that is open to others in relation to aspects of their cultural identity that are most important to them.”
While Tribal members are US citizens, Tribes are also sovereign nations. Looking to recommendations on how public health professionals should interact with other Nations can provide guidance when working with Tribes.
Global Health Equity Recommendations
The CDC’s Global Health Equity provides recommendations on working with people from other cultures. Cultural humility is an active and ongoing process. Engaging in cultural humility means:
1.Examine
Examining one’s personal history, background, and social position related to gender, ethnicity, socio-economic status, profession, education, assumptions, values, beliefs, biases, and culture, and how these factors impact interpersonal interactions.
- This examination can be done at the personal and organizational level.
- When working with Tribes, understanding the history of the Tribes in your jurisdiction and the historical relationship between those Tribes and local, state, and federal governments can provide insight into continuing bias that Tribes may be experiencing.
2.Reflect
Reflecting on how interpersonal interactions and relationships are impacted by the history, biases, norms, perceptions, and relative positions of power of one’s professional organization.
- Much of the public health system was designed without the inclusion of Tribal health departments. Tribes and TECs have to fight against the systemic bias in the public health system.
- Tribes and TECs have not received funding, access to public health data, or control over their members data on an equitable level with states. Work with Tribes must not only acknowledge these inequities, but directly address them to create a more equitable system.
3.Gain
Gaining deeper realization, understanding, and respect of cultural differences through active inquiry, reflection, reflexivity, openness to establishing power-balanced relationships, and appreciation of another person’s/community’s/population’s expertise on the social and cultural context of their own lives (lived experience) and contributions to public health and wellbeing.
- Tribal health departments may have different values and goals for public health surveillance or programs than local, state, or federal public health entities because of cultural differences. Tribes have the right to develop and implement public health programs as they feel is best for their communities in alignment with their values.
4.Recognize
Recognizing areas in which you do not have all the relevant experience and expertise and demonstrating a nonjudgmental willingness to learn from a person/community/population about their experiences and practices.
- Tribes know their communities best and how to best serve them. Their knowledge of their people should be respected and incorporated into your public health practices when working with Tribal communities.
5.Avoid
Avoid the posture, framing, and language of hierarchy, patriarchy, supremacy, saviorism, and colonialism.
- Work with Tribes should be a partnership between Tribal public health entities and non-Tribal public health entities. This relationship should be collaborative and built on a foundation of equality.
- Tribes know their communities best and local, state, and federal public health officials should learn from Tribes about what they need and how to address public health challenges.
- Tribes are sovereign nations and should be treated as such. They are not dependent on nor subservient to states. Working with Tribes is a government-to-government partnership.
6.Engage
The first step of community engagement when working with Tribes is engaging the Tribal government. AI/AN people have a special political status in the United States as Tribal members and Tribal governments should be involved in the relationship with AI/AN communities. .
- Reach out to the Tribe directly. Many Tribes have health divisions and a Health Director. The Health Director can discuss how best to engage with the Tribe.
- Many states with large AI/AN populations have Tribal liaisons in the state government. Even if these people are not in the public health department, they can be a resource to help engage with Tribes.
- Every state is served by a TEC. TECs are not Tribes, but their work is for Tribes and they have close relationships with the Tribes they serve. TECs can help build relationships with Tribes in your jurisdiction. To find the TEC that works in your jurisdiction, visit tribalepicenters.org.
7.Build
Active community engagement builds trust.
- Local, state, and federal public health entities may need to build trust with Tribes in their jurisdictions. Tribes have often been, at a minimum, excluded from public health activities in their communities. It is the responsibility of the non-Tribal public health entities to work to build trust with Tribes and include them in the decision-making process.
- Inclusion of Tribes in public health activities will help improve the health of AI/AN people.
8.Diversify
It can be tempting to use a relationship with a single Tribe to dictate policy or action for all Tribes. However, all tribes are not the same: don’t make decisions for all Tribes based on the loudest voice or from talking with a single Tribe. Different agreements and procedures with different Tribes may be needed.
Continue The Toolkit
Data Is Essential
Tribal Background
Cultural Humility
Sovereignty & Health
Data Collection & Access
Tools & Resources
