Knowledge | American Heart Association issues first guidance to improve heart health among pregnant Indigenous women and confront historical trauma and systemic inequity
Knowledge | American Heart Association issues first guidance calling for better heart health among pregnant Native American women and action on historical trauma and systemic inequity
Heart disease is the leading cause of death among U.S. adults, and American Indian/Alaska Native (AI/AN) women face particularly high risks during pregnancy, affecting both current and future generations. To reduce this risk, the American Heart Association (AHA) recently issued its first cardiovascular health guidance specifically for AI/AN women of reproductive age, incorporating intergenerational trauma, poor nutrition, and distrust of healthcare into its framework.
High-risk context and new guidance
Dr. Jason Deen, a pediatric cardiologist, director of the Indian Health Pathway at the University of Washington School of Medicine, and one of the experts who wrote the guidance, said: “My mother is of Blackfeet descent. From a young age, she told me about the healthcare inequities she experienced growing up in Montana. That set me on the path to medicine and Native health research.”
During his medical training in Minnesota, Deen recalled frequently seeing “young Native children with adult heart disease risk factors such as obesity, high cholesterol, and high blood pressure,” conditions that were almost “routine” among them. During night shifts, he also found that cardiovascular emergencies occurred in Native adults “a full decade earlier than in other ethnic groups,” which he believes reflects the continuation of health risks across generations.
Cardiovascular disease is the leading cause of maternal death; Native American women have the second-highest rate
According to a study published in JAMA in July 2023, cardiovascular disease is the leading cause of maternal death in the United States, and AI/AN women have the second-highest maternal mortality rate of all racial and ethnic groups. Although research on this population remains limited, the AHA guidance identifies a set of modifiable core goals known as Life’s Essential 8:
Eat a healthy diet
Exercise regularly
Quit smoking
Get adequate sleep
Manage weight
Control cholesterol
Manage blood sugar
Control blood pressure
These lifestyle-based health goals apply to all racial and ethnic groups. However, Dr. Deen emphasized that AI/AN communities also require attention to intergenerational trauma, deep distrust of government and healthcare systems, and the loss of culture and traditional foods.
Roots of health inequity: colonial history and structural racism
“We cannot ignore that health disparities among American Indian/Alaska Native women are rooted in systemic racism,” Deen said. These systemic factors include economic stability, educational opportunities, neighborhood conditions, and cultural marginalization, collectively known as the social determinants of health.
For example, after many Native communities were forcibly removed from their traditional lands, they had to rely on poor-quality food supplied by colonial governments. These diets were often high in sugar and fat and low in nutrients, contributing over time to high rates of obesity and heart disease.
Native women also experience violence at “staggering” rates, and 60% of AI/AN women already have “suboptimal” heart health during pregnancy. Adverse childhood experiences (ACEs), including domestic violence, mental illness, alcohol misuse, and neglect, can also accumulate and have lasting effects on heart health.
Intergenerational trauma in the shadow of boarding schools
Deen described a common scenario: a Native grandmother may have grown up in a federally funded U.S. boarding school, where she was punished for speaking her language or preserving her culture and may have endured abuse and forced labor. These experiences may have prevented her from learning healthy parenting practices, leading to psychological and physical trauma in her children and raising later generations’ risk of obesity, high blood pressure, and other conditions.
According to a 2022 U.S. Department of the Interior report, at least 408 federally funded boarding schools operated across 38 states from 1819 to 1969 to “assimilate” Native children. Thousands of AI/AN children were forcibly removed from their families and separated from their culture and traditions, and many suffered severe mistreatment. This history continues to shape health across generations in less visible ways.
Changing the approach: from “fighting disease” to prevention and respect
Deen argues that a “decolonized” model of healthcare is better suited to Native communities. “Western medicine finds a disease and attacks it,” he explained. “We should move toward a public-health model—understanding what benefits these communities and preventing disease at its source.”
He also stressed that research involving Native people should not center outside experts, but should build relationships and respect community decision-making. “We should enter communities, listen to them, and ask, ‘What are your actual health needs? What problems do you most want to address?’ rather than arriving with a research agenda and giving orders.”
In many Native cultures, he noted, female elders often serve as guardians of family health, so their guidance should be heard first.
Rebuilding the environment and developing talent are essential to breaking the cycle
Truly improving heart health among AI/AN women requires more than clinical intervention; it also requires systematic workforce development and community-level action. “We need more Native doctors, nurses, and researchers,” Deen said. “Individual health will improve only when communities themselves become healthier.”
“I think Native women have always understood this. They want to break this cycle,” he said. “Yes, we need professional guidance on blood pressure and cholesterol, but more importantly, we must fundamentally change the entire ‘unhealthy environment’ around them. That is the solution.”
Knowledge | American Heart Association issues first guidance to improve heart health among pregnant Indigenous women and confront historical trauma and systemic inequity
Knowledge | American Heart Association issues first guidance calling for better heart health among pregnant Native American women and action on historical trauma and systemic inequity
Heart disease is the leading cause of death among U.S. adults, and American Indian/Alaska Native (AI/AN) women face particularly high risks during pregnancy, affecting both current and future generations. To reduce this risk, the American Heart Association (AHA) recently issued its first cardiovascular health guidance specifically for AI/AN women of reproductive age, incorporating intergenerational trauma, poor nutrition, and distrust of healthcare into its framework.
High-risk context and new guidance
Dr. Jason Deen, a pediatric cardiologist, director of the Indian Health Pathway at the University of Washington School of Medicine, and one of the experts who wrote the guidance, said: “My mother is of Blackfeet descent. From a young age, she told me about the healthcare inequities she experienced growing up in Montana. That set me on the path to medicine and Native health research.”
During his medical training in Minnesota, Deen recalled frequently seeing “young Native children with adult heart disease risk factors such as obesity, high cholesterol, and high blood pressure,” conditions that were almost “routine” among them. During night shifts, he also found that cardiovascular emergencies occurred in Native adults “a full decade earlier than in other ethnic groups,” which he believes reflects the continuation of health risks across generations.
Cardiovascular disease is the leading cause of maternal death; Native American women have the second-highest rate
According to a study published in JAMA in July 2023, cardiovascular disease is the leading cause of maternal death in the United States, and AI/AN women have the second-highest maternal mortality rate of all racial and ethnic groups. Although research on this population remains limited, the AHA guidance identifies a set of modifiable core goals known as Life’s Essential 8:
Eat a healthy diet
Exercise regularly
Quit smoking
Get adequate sleep
Manage weight
Control cholesterol
Manage blood sugar
Control blood pressure
These lifestyle-based health goals apply to all racial and ethnic groups. However, Dr. Deen emphasized that AI/AN communities also require attention to intergenerational trauma, deep distrust of government and healthcare systems, and the loss of culture and traditional foods.
Roots of health inequity: colonial history and structural racism
“We cannot ignore that health disparities among American Indian/Alaska Native women are rooted in systemic racism,” Deen said. These systemic factors include economic stability, educational opportunities, neighborhood conditions, and cultural marginalization, collectively known as the social determinants of health.
For example, after many Native communities were forcibly removed from their traditional lands, they had to rely on poor-quality food supplied by colonial governments. These diets were often high in sugar and fat and low in nutrients, contributing over time to high rates of obesity and heart disease.
Native women also experience violence at “staggering” rates, and 60% of AI/AN women already have “suboptimal” heart health during pregnancy. Adverse childhood experiences (ACEs), including domestic violence, mental illness, alcohol misuse, and neglect, can also accumulate and have lasting effects on heart health.
Intergenerational trauma in the shadow of boarding schools
Deen described a common scenario: a Native grandmother may have grown up in a federally funded U.S. boarding school, where she was punished for speaking her language or preserving her culture and may have endured abuse and forced labor. These experiences may have prevented her from learning healthy parenting practices, leading to psychological and physical trauma in her children and raising later generations’ risk of obesity, high blood pressure, and other conditions.
According to a 2022 U.S. Department of the Interior report, at least 408 federally funded boarding schools operated across 38 states from 1819 to 1969 to “assimilate” Native children. Thousands of AI/AN children were forcibly removed from their families and separated from their culture and traditions, and many suffered severe mistreatment. This history continues to shape health across generations in less visible ways.
Changing the approach: from “fighting disease” to prevention and respect
Deen argues that a “decolonized” model of healthcare is better suited to Native communities. “Western medicine finds a disease and attacks it,” he explained. “We should move toward a public-health model—understanding what benefits these communities and preventing disease at its source.”
He also stressed that research involving Native people should not center outside experts, but should build relationships and respect community decision-making. “We should enter communities, listen to them, and ask, ‘What are your actual health needs? What problems do you most want to address?’ rather than arriving with a research agenda and giving orders.”
In many Native cultures, he noted, female elders often serve as guardians of family health, so their guidance should be heard first.
Rebuilding the environment and developing talent are essential to breaking the cycle
Truly improving heart health among AI/AN women requires more than clinical intervention; it also requires systematic workforce development and community-level action. “We need more Native doctors, nurses, and researchers,” Deen said. “Individual health will improve only when communities themselves become healthier.”
“I think Native women have always understood this. They want to break this cycle,” he said. “Yes, we need professional guidance on blood pressure and cholesterol, but more importantly, we must fundamentally change the entire ‘unhealthy environment’ around them. That is the solution.”
Story source:
Collected online